The Doctor of Nursing Practice for Entry Into Advanced Practice

The Controversy Continues as 2015 Looms

Sandra Bellini, DNP, APRN, NNP-BC, CNE; Regina M. Cusson, PhD, APRN, NNP-BC, FAAN

Disclosures

NAINR. 2012;12(1):12-16. 

In This Article

Professional Controversies

Seven years have passed since the historic publication of the AACN Position Statement on the Practice Doctorate in Nursing.[2] Although many former opponents of the degree have since become late adopters, many within the discipline remain firm in their opposition. Controversial issues remain unresolved at present, some valid and credible and others without clear supporting evidence to one side or the other. A brief summary presentation on the current state of the discourse follows.

There are many enthusiasts toward the DNP.[2,5,6,12,13,16,19–21] Seen by some as a symbol of social progressivism,[12] the endorsement of doctoral education for advanced practice nursing has many potentially positive outcomes. Among them, better parity with other practice disciplines such as medicine, audiology, physical therapy, and pharmacy, which all require a doctoral degree for entry into practice. In relation to the goals for health care reform, the need for advanced practice nurses with an additional skill set encompassing policy making, quality improvement, and evidence-based practice is clear. In addition, the preparation of more nurses holding doctoral degrees will expand the pool of educators qualified to teach at the University level, so important to replace the large number of nurse educators expected to retire in the next few years.[22]

Despite these arguments, not everyone is in agreement that elevating the degree requirements for entry into APRN practice to the DNP is right for the discipline, society, or practicing APRNs. Discourse on the issue continues to be lively. To be sure, both sides deserve careful deliberation and consideration if consensus, or even majority, is to be reached. Arguments against the move to the DNP are both intelligible and worthy of debate.

As all nurses are aware, the first attempt to raise the educational requirement for entry into nursing practice has yet to be realized.[1,17] It should be remembered that although the impetus for the 1965 Position Statement was to advance nursing education to the baccalaureate degree for entry into professional practice, most practicing nurses today still do not hold baccalaureate degrees.[17] Does it really make sense for the profession to delve into a second entry into practice battle when the first was not successful?

Workforce issues surrounding APRNs is another strong opposing argument against the move to the DNP.[23] In a recent publication, Cronenwett and colleagues strongly argue for the retention of MS-level preparation for APRNs based on economic and workforce issues, although critics of this publication argue that the authors turn the paper "into an indictment of the DNP itself." Essentially, Cronenwett and colleagues argue that the elevation of APRN education to the DNP would be detrimental to society, as the projected number of APRNs needed is expected to rise in the years to come, The authors argue that this is unlikely to occur if the DNP-mandate deters potential APRN students from pursuing graduate study.

The need for more doctorally prepared faculty in nursing is another argument for the DNP from AACN, yet this notion is often opposed on two grounds: the DNP degree is not intended to prepare educators in the pedagogy of teaching;[2] and DNP-prepared faculty will not be successful academicians at some universities, where a more traditional view of discovery scholarship alone is the accepted norm.[24]

The last, yet probably most compelling, argument against the move to the DNP is based on lack of evidence supporting the need for this change. This opposition appears valid, especially in light of evidence to the contrary, supporting the excellent care outcomes by today's largely MS-prepared APRN workforce.[27,28] was conducted among International Council of Nurses advanced practice network members representing 32 countries. The members reported that advanced practice programs existed in only 23 of those countries (71%). There was wide variability in educational preparation for advanced practice, with approximately 50% reporting that the master's degree was the most common educational credential. The master's degree has been required for all advanced practice in the United States for more than 10 years. The move toward the practice doctorate puts the United States in the forefront of all educational requirements because no other country requires, or even strongly recommends, a doctorate for entry into advanced nursing practice.

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