113chapter FOUR
How Doctoral- Level Advanced Practice
Roles Differ From Master’s-Level
Advanced Practice Nursing Roles
Kym A. Montgomery and Sharon K. Byrne
Since the publication of the first edition of this book, two sentinel events have further
transformed the landscape of nursing practice: the passage of the Patient Protection and
Affordable Care Act (PPACA; U.S. Department of Labor, 2010) and the release of Institute
of Medicine’s (IOM) report The Future of Nursing: Leading Change, Advancing Health (IOM,
2010). The PPACA has challenged the U.S. health care delivery system to provide care
to 30 million previously uninsured Americans, improve the health of our society, and to
reduce the overall health care costs by providing the necessary health care services in a
most efficient way. The IOM (2010) report is a prescription for the future of nursing’s role
in American health care through nursing leadership in decision making in a multidisci-
plinary arena, seamless academic advancement for all nurses, and the ability to achieve
the maximum scope of nursing practice. The Doctor of Nursing Practice (DNP) graduate
exemplifies the vision of the IOM report and is perfectly positioned to achieve the goals
of the PPACA. In essence, the DNP is the answer to the future of nursing practice.
Globally, the ranks of advanced practice registered nurses (APRNs) have exploded
over the past 50 years. Despite the number of APRNs in clinical practice, however, there
has been a lack of consistency in education that is reflected in poor degree parity com-
pared to other health care professions such as physical therapy, nutrition therapy, occu-
pational therapy, and pharmacy that have successfully developed doctoral programs as
entry into their fields of practice. Nursing’s first foray into doctoral nursing education
began in 1932 at Teachers College of Columbia University with the awarding of the first
doctor of education (EdD) degree in nursing education (Nichols & Chitty, 2005). Since
that time, the profession has been persistently and unsuccessfully seeking a true clinical
doctorate degree that showcases the true intellectual triad of the nursing profession. In
the past, the profession’s support of the PhD, doctor of nursing science (DNSc), doctor
of nursing science (DNS), and doctor of science in nursing (DSN), and lukewarm sup-
port of the EdD and doctor of nursing (ND) degrees, did not yield an appropriate path-
way to the “clinical” doctorate. Is it possible that amid this chaos and ongoing scholarly
debate about which is the right terminal degree for clinicians, opportunity knocks with