114 ■ I: HISTORICAL AND THEORETICAL FOUNDATIONS FOR ROLE DELINEATION
the development of the Doctor of Nursing Practice (DNP)?^1 The authors of this chapter
hopefully present a thought- provoking discussion regarding the roles of the long- stand-
ing and historically master of science in nursing (MSN)- prepared APRN, and contrast
it with the newly heralded DNP- prepared APRN, as a new method of achieving a ter-
minal degree that supports superior professional excellence.
■ THE EMERGENCE OF THE DNP DEGREE
The timeline leading up to the DNP degree for APRNs began with the call of the IOM
(2001) for sweeping redesign of the entire health care system. The IOM outlined basic
skills that all health care professionals should have and suggested that new educational
options be developed to ensure the safety of patients and close the gap that impedes
quality care. The IOM (2001) stated:
Forced with rapid changes in the healthcare system, the nation’s healthcare
delivery system has fallen far short in its ability to translate knowledge into
practice and to apply new technology safely and appropriately. And if the
system cannot consistently deliver today’s science and technology, it is less
prepared to respond to the extraordinary advances that surely will emerge
during the coming decades. There is a dearth of clinical programs with the
multidisciplinary infrastructure required to provide the full complement of
services needed by people with common chronic conditions. The healthcare
system is poorly organized to meet the challenges at hand. (IOM, 2001, p. 1)
IOM’s challenge ignited a series of responses by a myriad of organizations that
called for better- prepared APRNs who could address the complexity of patient care
requirements, improve the efficiency of health care environments, and provide for an
increased knowledge base for practice and excellence in nursing leadership. Three years
later in 2004, the American Association of Colleges of Nursing (AACN) adopted a posi-
tion to move the level of preparation necessary for advanced practice roles from a mas-
ter’s degree to a doctoral degree. Initially, the AACN (2004) anticipated that the DNP
would become the requisite credential for entry into advanced practice nursing by 2015.
Although there has been significant movement toward this goal over the past decade, the
lack of clarity regarding the definition of “nursing practice,” the variety of curriculum
existing among DNP programs, and the barriers inhibiting a school’s implementation of
a DNP program have prompted further reconsideration when to initiate this requirement
(AACN, 2015a). Through a national survey of nursing schools offering APRN programs
by the RAND Corporation, the AACN found great support and rising demand for DNP
programs from nursing schools and nursing academic leaders (AACN, 2015a). The RAND
study also identified obstacles inhibiting DNP programs such as lack of faculty, financial
concerns, lack of clinical sites, resource issues regarding DNP scholarly projects, and con-
fusion of potential employers surrounding the difference between master’s- prepared and
DNP- prepared APRNs. The Council on Accreditation of Nurse Anesthesia Educational
Programs (American Association of Nurse Anesthetists [AANA], 2007) has mandated that
all nurse anesthetists have doctoral education in order to practice by 2025. Could this pos-
sibly be the impetus for all APRN specialties to mandate the IOM’s recommendation for
nursing’s seamless academic achievement (IOM, 2010)?
Similarly, the Commission on Collegiate Nursing Education (CCNE, 2005), the
accrediting body of the AACN, decided that only practice doctorate degrees with the
credential DNP would be considered for accreditation by the CCNE. At the time, this
was a controversial stance since the initial 2004 vote was not unanimous (AACN, 2004).