Is the burden worth the benefit of the doctorate of nursing for NPs? Implications of doctorate in nursing practice—still many unresolved issues for nurse practitioners

Nephrology Nursing Journal, Nov-Dec, 2006 by Sara Otterness

The Doctorate in Nursing Practice (DNP) is a suggested practice degree to prepare nurse practitioners (NP) to assume full leadership roles in clinical practice, clinical teaching, and research applications, with the ability to deliver exceptional, high quality care and leadership in increasingly complex health care delivery systems. The DNP implies NPs will be provided parity with medical doctors, pharmacists, and dentists (Steefel, 2005). However, there is no indication from these professionals that this theory will materialize in everyday clinical practice.

Practice-focused doctoral degree programs in nursing were first offered in 1979. Since then, many programs have been developed to offer an alternative to the Doctor of Philosophy (PhD), which has historically been a research- focused degree. There currently exists programs for Doctor of Nursing (DN), Doctor of Nursing Science (DNS, DSN, or DNSc), and now a Doctor of Nursing Practice (DNP, DrNP). In October 2004, the American Association of Colleges of Nursing (AACN) voted to establish the DNP degree as the terminal degree for NPs by 2015 (Glazer, 2005). This shift has created many controversies and implications to the practice of advanced practice nursing. The most significant issues to NPs that the practice doctorate creates are the need for standardized education, which includes addressing the present status of NPs with masters degrees, standardized nomenclature and titling for NPs, definitive identification of practice guidelines, changes in billing and coding procedures, and the necessary education of the public and the healthcare industry.

Dr. Ann O'Sullivan, president of the National Organization of Nurse Practitioner Faculty (NONPF), maintains that the move to the practice doctorate is no longer in question for NPs of the future. The question is how to bring about the transition and the needed change in the educational system to facilitate this move (Glazer, 2005). The current curriculum for NPs is being changed and expanded on an ongoing basis. Many NP programs currently exceed the usual and required credit load and duration for a typical master's degree, raising additional concerns that professional nurse graduates are not receiving the appropriate degree for a very complex and demanding academic experience (The Essentials of Doctoral Education for Advanced Nursing Practice, 2006). Formulating curricula to standardize the education provided to basic entry level nurses, entry level consideration of students who are not nurses, and graduate nurses with varying degrees and varying levels of experience and expertise is an enormous challenge to the individuals establishing curricula and to the nurse educators. An additional challenge is the fact that the nursing faculty shortage is limiting college enrollment. NPs who practice in specialty care areas and may decide to return for doctorate preparation also have the issue of finding appropriate preceptors for residency programs and preceptorships.

It has been recommended by AACN to standardize terminology and titling to include research doctorate (PhD) and practice doctorate (DNP) for doctorate prepared nurses (AACN, 2004). There is no recommendation for practitioners who carry prior licensure as NPs which will lead to significant confusion with the presence of multiple titles and levels of education.

The contribution to health care systems of educationally prepared individuals with DNPs is not established. Regulations in many states require collaboration with a physician to practice as an NR The expectation of DNP-prepared nurses is that they practice as autonomous health care providers, therefore current restrictions will lead to licensing and practice conflicts with the DNR To better support the graduates of DNP programs, there should have been a survey of the clinical needs, clinical agencies, consumers, employers and current NPs to clarify the desired outcomes and competencies needed of these graduates.

The DNP is a degree that is suggested to have a high level of functionality in the health care systems. The path to establishing this degree in the current nursing environment has many implications and concerns to current NPs. There has been significant exploration into position statements, standardization of education, practice implications and uniformity in credentialing and titling in the recent past. There is continued need for further standardization of basic nursing entry level education requirements, uniformity of practice and billing standards, research on the effectiveness of doctorate prepared clinical providers, and evaluation of acceptance by the health care environment and the consumers. More data should have been gathered prior to nursing recommending a change in the status quo. The idea of the DNP may be popular with some nurses, but it may foster and promote yet another controversial issue for nurses to debate and other health care providers to criticize.

References

American Association of Colleges of Nursing (AACN). (2004). AACN position statement on the practice doctorate in nursing. Washington, DC: Author.