The Current National Status on the DNP
In the years that have elapsed since the AACN 2004 position statement, the number of DNP Programs nationwide has increased dramatically, suggesting acceptance by many in the academic setting, if not on a broader scale. As of the most recent data available on the AACN Web site (updated July 2011), there are 138 DNP Programs listed as "currently accepting students" with a note that "More than 100 additional nursing schools are considering starting DNP programs nationwide." For AACN, this rapid proliferation in number of DNP Programs is undoubtedly reassuring. Despite the increase in programs, the intended groups of advanced practice nurses to be impacted most directly by this entry into practice have not quite committed.
According to the most recent position statements available, not a single advanced practice specialty organization at the national level has adopted the 2015 implementation date advocated by AACN. Of the four advanced practice roles articulated by AACN and identified in the Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation—Nurse Practitioners (NP), Certified Nurse Midwives, Certified Registered Nurse Anesthetists, and Clinical Nurse Specialists (CNS)—some have endorsed the move to the DNP, whereas others have not.
Those most closely aligned with the AACN position are the organizations representing NPs, several of whom have issued a "unified statement" on the matter. Although they collectively endorse the move to the DNP for entry into advanced practice, they do not endorse the 2015 goal date. The American Association of Nurse Anesthetists currently holds a similar position, endorsing the move to the DNP, but advocating a goal date of 2025.
On the other hand, the National Association of Clinical Nurse Specialists holds a "degree neutral" position stating that the DNP is an option for CNSs, although the CNS role may be more closely aligned with the traditional PhD. Similarly, the American College of Nurse Midwives also does not endorse the DNP as the requirement for entry into midwifery practice. Like the CNS organizations, the American College of Nurse Midwives holds the position that future practice doctorates, other than the current DNP, might be options for those pursuing careers as midwives.
Therefore, can this new requirement for doctoral education for entry into advanced practice succeed if literally half of the intended target audience does not intend to comply? In the end, the National Council of State Boards of Nursing, who is responsible for determining licensure requirements, and the varying certifying bodies will likely settle the matter. At present, the Consensus Model for APRN Regulation attempts to reconcile many of the existing discrepancies in licensure, accreditation, certification, and education requirements across state lines and denotes an implementation date of 2015, as consistent with the AACN goal date. However, it is interesting to note that the language incorporated in this document specifies that the educational requirement for APRNs is a "graduate degree" from an accredited program; it does not specify the DNP as the only graduate degree option.
The AACN's role is setting educational standards and providing accreditation for academic programs via its accreditation arm, the Collegiate Commission on Nursing Education, and is not to determine licensure or certification criteria, or at least not directly. However, given that the Collegiate Commission on Nursing Education is an accrediting body, if the organization decides in the future to only accredit DNP-level APRN programs and does not continue to accredit MS programs, then the requirement for the DNP for licensure will be seemingly accomplished by default. This is not necessarily true, however, if the academic institution decides to seek accreditation through the National League for Nursing Accrediting Commission. In affiliation with the National League for Nursing, whose position is that MS-level APRN education be continued, accreditation for programs offering APRN education at the MS level will still be available as an alternative option.
At first blush, it may seem odd that the AACN would have taken such a bold step in publishing its position statement, especially in light of current societal events and the many professional issues facing nursing today. After all, the goals of the 1965 ANA position statement have yet to be realized. Upon closer examination, however, the AACN action may have been a politically savvy move, designed to best place nursing in the most advantageous position as health care reform legislation evolves.
NAINR. 2012;12(1):12-16. © 2012 Elsevier Science, Inc.