133chapter FOUR
Refl ective Response 1
Connie L. Zak
The question of how doctoral- level education versus MS education impacts the role of
advanced practice nurses (APNs) is asked by many nursing faculty and APNs nation-
ally. The authors have eloquently presented their own experiences and impetus for pur-
suing the Doctor of Nursing Practice (DNP). The authors started their discourse with
a historical recapitulation of doctoral education in nursing, leading up to the practice
doctorate, and going on to give their personal journeys from seasoned practitioner to
doctoral student and graduate.
It is important to understand that the inception of a practice doctorate in nursing is
not a new concept, but one that has been around for 30 years. Nursing has been debat-
ing the need for a practice doctorate for a very long time. Unfortunately, the early prac-
tice doctorates, such as the doctor of nursing (ND) degree, were not generally accepted.
Schools of nursing offering such degrees for nurse practitioners (NPs) lost students to
MS programs and in the end had to phase out such programs.
Subsequently, with the position statement from American Association of Colleges
of Nursing (AACN) in 2004 came the era of agreement (for the most part) within the
nursing profession of the importance for APNs, and especially NPs, to have doctoral
education as entry into advanced practice, as noted by the authors (AACN, 2004). This
shift in nursing education is timely, given the changes in health care occurring in our
nation today, which started with the Institute of Medicine’s (IOM, 2001) report, outlin-
ing the skills needed for improving health care. It is important to highlight that translat-
ing research into practice, testing new models of care, and working in transdisciplinary
teams, are the essentials of the role of DNP- prepared practitioners. Furthermore, the
IOM emphasized the need for all health professions programs to educate students to be
able to deliver patient- centered care as members of interdisciplinary teams that empha-
size evidence- based practice, quality improvement, and informatics.
It is also important for the reader to understand that the DNP is a degree and not
a role. The practice doctorate is not just role oriented, but it is advanced education that
gives “added value” to the practitioner to better serve their patients and populations.
One must keep in mind the AACN definition of advanced nursing practice as conceptual-
ized in the DNP Essentials document refers to:
any form of nursing intervention that influences health care outcomes for
individuals or populations, including the direct care of individual patients,