Abstract and Introduction
Although the current masters and PhD programs in nursing are critical to the future of the profession and are evolving to keep pace with new demands, they do not fill the growing need for expert clinical teachers and clinicians. Informational shifts, demographic changes, growing disparities in healthcare delivery and access, and stakeholder expectations are all creating new demands on the nursing profession. The practice (also called clinical and professional) doctorate, with a focus on direct practice and healthcare leadership, offers nursing an exciting opportunity to meet these demands. Programs are already underway or being developed at several institutions, although problems and challenges such as standardization, regulation, and potential "devaluing" of existing programs have yet to be adequately resolved. The National Organization of Nurse Practitioner Faculties (NONPF), along with professional organization and educational institutional partners, supports the development of the practice doctorate and is committed to providing leadership to ensure quality educational outcomes. Nursing must develop a shared strategic vision to shape the rapidly moving practice doctorate initiative.
At one university, a student graduates with a baccalaureate degree in nursing. After 6 years of practice in an adult intensive care unit, she completes a graduate program to become a women's health nurse practitioner (NP). Later, because she wants to broaden her scope of practice to include comprehensive, multisite primary care of families with complex health problems, she completes a post-master's certificate program to become a family NP. She has completed 4 years of post-baccalaureate rigorous clinical study, and her highest credential is a master's degree. Furthermore, her education increased the breadth of her practice without advancement beyond the traditional NP role.
At a nearby health science center, an acute care NP specializing in care of patients with pulmonary disorders has sought every possible learning experience, including continuing education and on the job training for the newest technical skills and has participated in a year-long institute for leadership development. He collaborates with an interdisciplinary team on advanced pulmonary diagnostic and treatment procedures. He communicates with patients and families, providing and coordinating information and services across multiple settings. However, he finds he must prove himself again and again to clinicians and students. His master's credential lacks parity with those of colleagues from other disciplines, such as pharmacy, psychology, and medicine.
A nurse manager is also a clinical nurse specialist in an emergency department of an academic health center (AHC). She not only manages the healthcare unit but also ensures staff competence and occasionally serves as a staff nurse, as is required at this institution. As an exemplary nurse leader, she has been asked to join the corporate management. While she has the skills for operations management in her department, she does not yet have skills for strategic planning and implementation for the next level. She has some competence for systems thinking from a unit perspective, but she is not ready to collaborate with chief executive, operations, and information officers for corporate leadership. As an advanced practice nurse (APN), she needs additional training in evaluation of process and outcomes to ensure the highest healthcare quality. She also needs more education related to AHC human resource management and health policy.
These examples are just the tip of the iceberg. Schools of nursing faculty struggle within the current educational structure to prepare their students for cutting-edge roles in a changing healthcare system, knowing that the system will demand ever-higher levels of clinical skills and clinical knowledge. Similarly, prospective graduate students from other fields shy away from nursing because it does not offer a comparable credential after 4 years of professional preparation as pharmacy or medicine.
The practice doctorates in nursing are designed for people in these scenarios and others. There is a growing interest in these programs as they reflect the continually increasing complexity of healthcare and clinical leadership within the existing systems. Nurses with practice doctorates are needed to do the following:
Evaluate the evidence base for care;
Deliver that care;
Set healthcare policy;
Lead and manage clinical care units and health systems;
Develop interdisciplinary standards;
Solve healthcare dilemmas; and
Reduce disparities in healthcare delivery.
It is our belief that the graduates will ultimately affect the entire healthcare delivery system.
Topics in Advanced Practice Nursing eJournal. 2003;3(2) © 2003 Medscape
Cite this: The Practice Doctorate in Nursing: Future or Fringe? - Medscape - May 12, 2003.