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“We have a proven, quality product educating APNs the way we are currently educating them and have attained some parity across nursing specialties at the master’s level,” says Linda Cronenwett, RN, PhD, FAAN, dean and professor, School of Nursing, University of North Carolina, Chapel Hill. Research shows that APNs improve patient outcomes and reduce cost. In this era of cost containment, Cronenwett asks, will this be so of doctorally prepared APNs who may command a higher salary?

Dracup wonders if a discipline should create a longer graduate program and new sets of initials for the APN role that is already so successful. Rather, for nurses who want to maintain their clinical practice, the PhD program should reflect a more clinical component, housed in the PhD curriculum but with a flexible formula that allows for more time in practice and research, she says.

“Master’s-prepared APNs can gain experience in their specialty areas and then choose whether or not to go on for a higher degree, obtain a PhD, and become specialists in their clinical field,” says Dracup.

A matter of change

There are at least eight nursing practice doctorate programs accepting students nationwide and more than 60 under some phase of development. To reduce confusion, AACN calls for the DNP as the title for the practice-focused doctorate and recommends phasing out the ND degree.

“Though much needs to be done, a stunning amount of activity has occurred,” says Bednash. The Essentials Taskforce, chaired by Donna Hathaway, RN, PhD, FAAN, dean, University of Tennessee Health Sciences Center, Memphis, is developing curriculum and content requirements and identifying the competencies for the DNP. The Roadmap to 2015, chaired by Carolyn Williams, RN, PhD, FAAN, dean and professor, School of Nursing, University of Kentucky, Lexington, is examining program development, master’s to doctoral transition programs, and regulations and licensure. The Commission on Collegiate Nursing Education is initiating a process for accrediting the new programs.

Rather than taking an official position, APN organizations — American Academy of Nurse Practitioners, the National Association of Pediatric Nurse Practitioners, the National Association of Nurse Practitioners in Women’s Health, the American College of Nurse Midwives, and the American Academy of Nurse Anesthetists — are adopting a wait-and-see approach, carefully discussing the pros and cons and exploring the effects the DNP would have on nurses, their profession, and their patients.

The National Association of Clinical Nurse Specialists (NACNS) remains neutral until concerns voiced in their recently disseminated “White Paper on the Nursing Practice Doctorate” are addressed. The document reports the DNP passed by 54 votes (160 for, 106 against) at the October Deans’ Meeting in Washington, D.C. Only those in attendance were able to vote, despite membership of more than 500 schools.

“This is a huge professional paradigm shift for which there should be more extensive dialogue,” says Angela Clark, RN, PhD, CNS, FAAN, FAHA, immediate past president, NACNS. “Opportunity for discussion from national stakeholders to look at some of the complex issues would be a positive outcome.”

Dracup foresees a mixed reaction from APNs. Some will think it’s just what they wanted — an entry-level, terminal degree in practice rather than the PhD. Others will balk at returning to school — the huge commitment of time and money — when they have a viable practice and have already met APN state and professional organization requirements. Will the DNP signify an evolution of practice excellence or stir up more controversy within the nursing community? Time will tell, she says.

Lorraine Steefel, RN, MSN, CTN, is a senior staff writer for Nursing Spectrum.

References

1. McEwen M, Bechtel GA. Characteristics of nursing doctoral programs in the United States. J Prof Nurs. 2000;16:282-292.

2. Fitzpatrick JJ. The case for the clinical doctorate in nursing. Reflect Nurs Leadership Perspect. 2003;1:8-9, 37.