4: HOW DOCTORAL-LEVEL ADVANCED PRACTICE ROLES DIFFER ■ 115Columbia University had proposed an older DNP degree model first, a DrNP, but there
were concerns that multiple practice degrees might take the degree model down the
path of the DNSc, DSN, DNS alphabet soup path again (AACN, 2004). As the first DNP
degree founded at the University of Kentucky in 2001 did not prepare practitioners but
only clinical executives, it is unclear why the Columbia degree model, which prepared
advanced practitioners and clinicians, was not the preferred degree model.
Presently, CCNE continues to accredit master’s in nursing programs lead-
ing to advanced practice (CCNE, 2010). In 2006, the National Organization of Nurse
Practitioner Faculties (NONPF) also issued a position statement supporting the prac-
tice doctorate in nursing. The NONPF (2006) statement highlighted core competencies
expected of entry- level nurse practitioners (NPs) with DNP preparation. This work,
along with The Essentials of Doctoral Education for Advanced Nursing Practice (AACN,
2006), identified the competencies and outcomes necessary for quality DNP educational
programs (Exhibit 4.1).
The DNP Roadmap Task Force stipulated steps to be taken to achieve the 2015 goal
relative to educational programs. Having now identified that the DNP will be the ter-
minal clinical practice doctorate supported by the previously mentioned organizations,
the two major questions still remain: How will the DNP- educated APRN differ from the
traditional master’s- educated APRN? Can the health care system afford a workforce of
exclusively doctoral- prepared APRNs, particularly in this economic climate?
■ THE MSN ADVANCED PRACTICE NURSE
The MSN- prepared APRN role as first outlined by the American Nurses Association
(ANA) in 2004 has been historically restrictive and prescriptive. More recently, the ANA
(2010) stated that an APRN is the regulatory title for one of the four advanced prac-
tice nursing direct care roles (e.g., certified nurse anesthetists, certified nurse- midwives,
certified NPs, clinical nurse specialists).The requirements for licensure, accreditation,
certification, and education for APRNs are outlined in the Consensus Model for APRN
Regulation: Licensure, Accreditation, Certification, and Education (2008). The authors of this
chapter acknowledge that well- educated master’s- level APRNs provide safe, efficient,
comprehensive, high- quality care to the population they serve. Mundinger and col-
leagues’ (2000) classic article in the Journal of the American Medical Association reported
equivalent master’s APRN outcomes compared with physician primary care outcomes;
these study findings were replicated 2 years later by Horrocks, Anderson, and Salisbury
(2002) in the United Kingdom. These studies indicate the DNP degree was certainly
not created because MSN APRN care was inferior. Unfortunately, the professional rec-
ognition of MSN- prepared APRNs outside of the nursing profession has been stunted
because of numerous factors including “cookie cutter” educational training programs
(e.g., overly restrictive, lacking innovation, or “designed for the past, not the future”)
and inaccurate and derogatory perceptions of these providers as being simply physician
extenders or mid- level providers. These are terms that the nursing profession has fiercely
tried to negate. As NPs, what we do is not midlevel anything: We certainly do not pro-
vide just mid- level care, and we certainly do not practice at a midlevel, nor is it medio-
cral! We suspect you, as well the authors of this chapter, provide high- quality care to
the best of your ability all of the time. To us, that is not midlevel. We would prefer to be
called by our title or be identified by the role that we hold within the health care domain
with an emphasis on maintaining our nursing identity as APRNs, advanced practice
nurses, doctoral APRNs, board certified nurses, or the designation provided by respec-
tive State Boards of Nursing.