Is the burden worth the benefit of the doctorate of nursing for NPs? Doctor of Nursing Practice: the time is now

Nephrology Nursing Journal, Nov-Dec, 2006 by David C. Smith

The American Association of Colleges of Nursing Calls for Requiring the DNP for Entry into Practice for Nurse Practitioners

I recently enrolled in Doctor of Nursing (DNP) program at the University of Arizona. During orientation, I learned that the amount of healthcare information doubles every 5 years. That fact gave me pause as it should anyone. We practice in a scholarly environment that is moving at a mind-numbing speed. The increasing complexity of healthcare demands the best possible preparation for licensed independent providers. Accordingly, the American Association of Colleges of Nursing (AACN) has proposed that the DNP be the terminal clinical degree offered in nursing (for the full report, see http://www.aacn. nche.edu/DNP/pdf/DNP.pdf). It is expected to be the requirement for entry into practice for nurse practitioners by 2015. The DNP is a clinical practice degree; it is neither a replacement nor a substitution for the PhD in nursing, which emphasizes development of nurse researchers. The focus of the DNP is to create expert nurse clinicians.

Doctoral Level Education is the Standard for Independent Healthcare Providers

The AACN is not alone in appreciating the need for doctoral level education for clinical practice. A clinical doctorate has become the standard for many healthcare professions that once required MS-level preparation such as pharmacy (PharmD), physical therapy (DPT), and audiology (AuD). The necessity of a doctorate has long been accepted in medicine, podiatry, and dentistry. There is no debate about the need for doctoral level education for physicians and dentists. Should the bar be any lower for nurse practitioners? The fact is that the call for doctoral level education for nurse practitioners is also arising from outside our profession. In a 2005 report entitled "Advancing the Nation's Health Needs: NIH Research Training Programs," the National Academy of Sciences endorsed the clinical doctorate in nursing stating, "the need for doctorally prepared practitioners and clinical faculty would be met if nursing could develop a new non-research clinical doctorate, similar to the MD and PharmD in medicine and dentistry" (National Research Council, 2005).

The DNP Will Prepare NPs for the Challenges of the 21st Century

As envisioned by the AACN, the DNP curriculum will require a global increase in the amount of scientific education and clinical training of nurse practitioner students. The proposed curriculum will provide advanced instruction in pathophysiology, pharmacology, informatics, statistics and research methodologies, genetics, evidence-based practice, diagnosis and management of illness, and preventive healthcare. There is also content in healthcare systems and health policy. In addition to preparing the NP to be a highly competent independent provider, the DNP will enable the NP to possess the skills necessary to be a thoughtful consumer of healthcare research, a vital skill for healthcare professionals. The ability to comprehend areas such as research, genetics, and informatics is now fundamental in the technology-driven world of 21st century healthcare.

Grandfathering for NPs Currently in Practice

Historically, licensure requirements for NPs have varied greatly from state to state. In many states, an ADN nurse could work as an NP. Over time, a consensus developed among most state boards of nursing requiring masters-level education and national certification. This evolution caused considerable anxiety and anger in many NPs. Boards of nursing grandfathered-in NPs who did not meet the new educational requirements. The move to require the DNP for entry into NP practice will follow this same pattern of grandfathering.

The DNP Has Arrived

The reality is that the DNP is here. Twenty universities are enrolling DNP students. Over 100 schools of nursing are developing DNP programs. This is the natural progression of NP education. This evolution is driven by the complexity of healthcare sciences, the increasing autonomy of NPs, and the move of NPs into more and more specialized roles. To remain relevant in healthcare, NPs must hold doctoral level training. The DNP should be embraced by the nursing community. It is what is best for us as a profession and what is best for those we serve, our patients.

Reference

National Research Council. (2005). Committee for Monitoring the Nation's Changing Needs for Biomedical, Behavioral, and Clinical Personnel, Board of Higher Education and Workforce. Advancing the Nation's Health Needs: NIH Research Training Programs. Washington, DC: The National Academies Press.

David C. Smith, MS, RN, NP

Adult Nurse Practitioner (Nephrology)

Scottsdale Healthcare

Scottsdale, AZ

Member, ANNA's Desert Vista Chapter