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


NAINR. 2012;12(1):12-16. 

In This Article

The International View of the DNP

The United States is the leader in advanced practice education worldwide.[27] A recent survey[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.

Many countries are just beginning to introduce advanced nursing practice. France recently opened its first advanced nursing practice program, housed in the School of Public Health, Ecole des Hautes Etudes en Sante Publique, Paris, offering both doctoral and master's degrees. Other countries, such as Japan and Russia, do not have formal graduate education programs to prepare advanced practice nurses.[29] Even in countries where nurses have practiced as advanced practice nurses, national oversight of the educational programs and of advanced practice licensure is lacking.

There is, however, a robust movement toward professional doctorate education internationally. At the recent second International Conference on Professional Doctorates, representatives from universities throughout Europe, North America, and Asia discussed interdisciplinary issues in professional doctorate education.[30] One important theme emerged during large group discussion: keeping high standards across all programs and fostering scholarship of the highest quality among students. All doctoral students must complete a dissertation. The only difference between the dissertation of a PhD student and a professional doctorate student is that the professional doctorate student must conduct research that is grounded in clinical practice, whereas the PhD student does not need to consider clinical applicability. There was grave concern among the audience with what they perceived as a lack of scholarship with the recent proliferation of clinical doctorate programs in the United States that do not require a dissertation. The lack of standards for the terminal, or end of program project, required from DNP students is cause for concern. Consider the lost potential for contributions to clinical scholarship in the United States, where the advanced practice role is far advanced beyond other countries. Will the United States lose that supremacy if other countries begin to set the bar with the clinical dissertations arising from international professional doctorate programs?


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