Professional Nursing Practice: Concepts and Perspectives

There has been continuous development in the nursing profession over the past few years attributed to the societal changes and systems of delivering healthcare. In addition, the advancement of technology has called for the need to upgrade professionalism in all sectors especially the healthcare sector (Blais and Hayes, 2010).

It is therefore in the quest for better health care delivery that the American Association of Colleges of Nursing (AACN) recommended educational migration from a graduate level through masters and then to the doctorate level. It is viewed that the quality of care delivered to patients is directly proportional to the level of education a nurse/doctor holds. Moreover, it is of utmost importance for every medical practitioner to invent, critically examine, and improve the way care is delivered, thus spearheading patient satisfaction as well as the individual clinician.

The advanced practice nursing is developed from the registered nurses whose scope of operation cover nurse practitioner (NP), clinical nurse specialist (CNS), certified registered nurse anesthetist (CRNA), and nurse midwife (CNM). In the recent years, there has been a shift from of education program emphasizing on role preparation like educator and more specialized clinical expertise, which is now termed as advanced practice nursing (Blais and Hayes, 2010). In addition, there is increased demand for better ways of delivering health care to patients. This is because there has been a continued change in disease patterns, which calls for smarter and more innovative medical professionals to overcome the challenges created by the advancing technological expertise (Blais and Hayes, 2010).

The Clinical Nursing Leader (CNL) versus the Doctor of Nursing Practice (DNP)

The Clinical Nursing Leader

The Clinical Nursing Leader (CNL) project resulted from discussions by various medical personnel over a span of three months driven at coming up with a more definite description of the role of a Clinical Nursing Leader. There was need to assess the effect on the outcome of patients, thus the VHA Office of Nursing Services organized a group of leaders who would examine and monitor the effectiveness of the project. This was carried out in the Department of Veteran Affairs (VA) health care system. Concurrently, the American Association of Colleges of Nursing AACN welcomed the active involvement of VHA in the formation of a CNL Evaluation Task Force. As a result, a Kaplan and Norton Scorecard were adapted to align the CNL activities with the performance of the organization.

The scorecard has four domains whose coverage is the CNL role and functions. The first domain, termed as ‘financial’, evaluates the cost benefits and measures that have direct impact on the financial statement. The second domain covers measurable aspects of management and delivery of patient care and is called ‘quality processes’. The third and the fourth domains encompass the staff and patients’ satisfaction, and the learning and development in line with the advancing technologies and innovation respectively (Fitzpatrick and Wallace, 2008). A CNL’s main obligation is to examine an entire group of patients from a systems level and recommend the necessary alterations required to improve patient outcomes.

The role of the Clinical Nurse Leader (CNL)

The CNL provides a general evidence-based service, which employs result-oriented strategies. He ensures disciplinary care (or a manager of care) between the parties involved, and practices the most recently discovered mode of treatment to yield better results. In addition, a CNL is charged with the responsibility of addressing such issues as nursing shortage, patient outcomes, as well as the challenges facing the health care system (Fitzpatrick and Wallace, 2008).

The Doctor of Nursing Practice (DNP)

A Doctor of Nursing Practice (DNP) is a practicing nurse who has acquired the highest level of education. The idea of introducing the Doctor of Nursing Practice (DNP) degree as the terminal degree for advanced nursing practice was supported by the American Association College of Nursing (AACN) in October 2004 (Glazer, 2005). Basically, there are two doctorate programs in nursing, with the first focusing on research while the other one focusing on practice. The practice-focused program takes into account any form of nursing intervention that affect the final health care result for all populations e.g. the Doctor of Medicine (MD). According to the American Association of College of Nursing, the following definition for advanced nursing practice is given:

“The term practice, specifically nursing practice, as conceptualized in this document refers to any form of nursing intervention that influences health care outcomes for individuals or populations, including the direct care of individual patients, management of care for individuals and populations, administration of nursing and health care organizations, and the development and implementation of health policy” (Chism, 2009).

This practical program focuses on integrative practice experiences, and only puts into application what has been researched and has credibly been approved. Currently, the University of Colorado and Case Western Reserve University offers this practical oriented doctorate program as an entry-level degree. The research-focused program majorly yields the academic doctorate, the Doctor of Philosophy (PhD) while to a lesser extent, it can lead to the Doctor of Nursing Science degree (DNS, DSN, or DNSc). Moreover, this program lays emphasis on theory, meta-theory, research methodology, and statistics.

The research-focused program put emphasis on carrying out scientific projects and applying research methodology to analyze the project. Upon completion and defense of the thesis, the graduate is accredited with a Doctor of Philosophy degree to serve as a nurse scientist and scholar. This program is knowledge imparting since it requires extensive research developed in form of linked research papers or dissertation (Zaccagnini et al., 2010).

However, the introduction of the two doctorate programs attracted some challenges. Firstly, many people’s perception was that, it would lead to marginalization within the faculty. There was fear that knowledge development would be derailed or quality of care delivery would be affected. There was also disagreement about incorporating the roles of a DPN other than the already existing ones (Zaccagnini et al, 2010). Another bone of contention was in the naming of the degree. The introduction of this program was perceived as a threat to other professionals like the physicians.

Some nurses also feared that with the increase in the role of advanced practice nurse, it could lead to abandoning of the most critical role of a nurse. There was also growing concern over inadequacy of the nursing faculty, which led to turning away of many qualified students. Additionally, majority of the task force preferred the DN (Doctor of Nursing) designation, but they were later to discover that it was a title reserved for the Doctor of Naprapathy. However, they adapted the Doctor for Nursing Practice (DNP), which is deemed as the most descriptive title (Zaccagnini et al, 2010).

The role of a Doctor of Nursing Practice (DNP)

The DNP is fully equipped with the ability to design, evaluate, and apply research methodology in evaluating a specific medical problem. They are competent specialists who are able to give systematic recommendations for treatment of a specific illness given their in-depth learning and research.

Preferred alternative

Though the roles of a Clinical Nurse Leader and that of a Doctor of Nursing Practice are both important, one would advocate for the DNP. This is because a DNP graduate is well versed with the in-depth technological knowledge unlike a CNL who only has the general information about the problem in question. The DNP has greater contribution to the improvement of the health care since he is an innovator who seeks to find specialized solutions to an impending problem.

My Nursing Philosophy

According to my view, the nursing profession is not just a profession alone but also an inherent talent. It calls for service delivery in a compassionate, caring manner while employing the technical and academic skills one has acquired. A nurse should be able to take the concerns of the patient at heart to meet both the physical and emotional needs of the patient. Nursing also calls for patience and honest dedication in order to ensure that the patient attain, regain and maintain good health. The passion and drive to offer care should be derived from within such that one does not focus on external forms of motivation.

Conclusion

The future for the nursing profession is promising as there is a clear-cut path already set. The Doctors of Nursing Practice (DNP) graduates have now a good platform for carrying out research geared at resolving some of the existing problems in the healthcare arena. The developments that have so far been achieved have produced a more qualified professionals equipped with the expertise of using very complex systems (Zaccagnini et al, 2010).

The schools offering the Doctors of Nursing Practice (DNP) programs therefore need to be developed, expanded and be well maintained in preparation for extensive exploration by the students. It is therefore of utmost importance to ensure that the necessary infrastructure e.g. well equipped library, clinical laboratories and equipments, etc, is availed to ensure success of the program. The government should provide incentives in case there are no adequate infrastructures.

Additionally, it is vital for nurses planning to advance in nursing to determine their professional goals prior to choosing a study program. This is because it will help the nurse establish and meet specific desired goals that are key to quality health care. The nurse is supposed to evaluate the desired program based on program characteristics like accreditation status, as well as personal and family needs. This would help the nurse to strategically plan for the program and be able to meet all the responsibilities at ease.

References

Blais, K. and Hayes, J. (2010). Professional Nursing Practice: Concepts and Perspectives. NY: Prentice Hall publishers.

Chism, L. (2009). The Doctor of Nursing Practice: A guide book for Role Development and Professional Issues. NY: Jones and Bartlett Learning Press.

Fitzpatrick, J. J. and Wallace, M. (2008). The Doctor of Nursing Practice and Clinical Nurse Leader: Essentials of Program Development and Implementation for Clinical Practice. NY: Springer Publishing Company.

Glazer, L. (2005). Overview and Summary: The Doctor of Nursing Practice (DNP): Need for more dialogue. Online journal of Issues in Nursing, Vol. 10, No 3. Web.

Zaccagnini, M. et al. (2010). The Doctor of Nursing Essentials: A New Model for Advanced Practice Nursing. NY: Jones and Bartlett Learning Press.