This is what a DNP does: Change Practice
Work calls attended to. Check. Three-and-a-half-year-old down for his nap. Check. Casserole in the oven for dinner. Check. Let's see... oh yes, time for blogging.
I'm new to blogging, but not quite as new at being a DNP. Back in 2003 when I investigated universities with an interest in pursuing my practice doctorate, there were very few in the nation, and most of them went under the ND (nursing doctorate) nomenclature, now long since forgotten. (The ND now clearly understood by most as the naturopathic degree.) I didn't want to be a researcher, although I've since realized what an exciting option that is for nursing, and if I had another lifetime would unquestionably add that to my educational plan. But I did want to make a difference.
I was in our university's first graduating class of DNPs in 2005. So what does a DNP do? I think the answer is as varied as the degree's essentials, encompassing practice, systems, populations, policy, etc. Among our graduating class, there is a chief wellness officer of a university (the first of its kind), a nurse anesthetist program director (also published author, and in a prior life a VA director), a psychiatric nurse practitioner who helps direct her state's NP organization, a Mayo nursing director, at least two professors, and a college health nurse practitioner. Most of us have published or been part of the sea of change in nursing. We are not an idle bunch. We are about changing things up.
I'm the entrepreneur among us. Prior to my DNP, I had visions of starting a practice that somehow met the needs of the underserved in the community (at a reasonable cost), while also being financially stable and not dependent upon grants. I had seen too many good-hearted nonprofits spend all their time fundraising and grant-writing (I LOVE grant writers, I'm just not one), only to be open for a mere 4 to 8 hours a week, which in my mind made it impossible to provide the kind of continuity of care patients need. I had seen too many for-profit NPs with the heart of a nonprofit find themselves in a distressing state of dissolution after a few years, as Medicaid payments or lack thereof kept them from keeping their doors open long term. Yet I continued to see so many uninsured or underinsured patients fail to get the care they needed, and end up in the ER with a much worse prognosis than if they'd had routine primary care.
I had a lot of ideas about how a hybrid clinic (which would meet the needs of the uninsured, low-income patient AND see insured patients or possibly cash services to stay stable) might work. But it wasn't until I took the time to pursue a DNP that I was able to: 1) evaluate the factors that caused local NP clinics to fail; 2) evaluate the financials and payer mix; 3) look at new models of care; 4) look at consumer perspectives on NP practices; and 5) be a change agent. Gradually it all came together: a unique model of care to meet a local population's need. About 3 years later, as the economy tanked, I went out and opened a little clinic.
And it was the best thing that ever happened to me. I hope it was also a boon to our community. A clinic where people get the kind of care they want and need (you know what I'm talking about if you're an APN: relationship-centered care, use of new technologies, time for evaluating each concern thoroughly, and time for education). And you know what? Even in 2014, ACA or not, there are people (insured or not) looking for a new-fangled, old-fashioned practice like mine.
My professional life consists of clinical practice, managing a business, involvement in professional groups, involvement in political action, publications, education, mentoring ... and yet I still have the control to be able to carve out plenty of play time during the week with the little guy. Now that's a benefit I didn't think of when completing my DNP.