142 ■ II: ROLES FOR DOCTORAL ADVANCED NURSING PRACTICE
two have clearly articulated a plan for implementation of the new practice entry require-
ments. Although it is admirable progress that 50% of APRN roles will be transitioned
to the DNP entry level, these transitions will not happen until 2025 for nurse anesthe-
tists (American Association of Nurse Anesthetists [AANA], 2007) and not until 2030 for
clinical nurse specialists (National Association of Clinical Nurse Specialists [NACNS],
2015). Since 2006, the National Organization of Nurse Practitioner Faculties (NONPF)
has held the position that while they endorse the notion of the DNP, the change would
be gradual and the organization holds no time frame on which to require a DNP for
entry into NP practice (NONPF, 2015). As we begin our chapter, we mention as a note
to the reader that the term “practitioner” is used as a broadly inclusive term throughout
this chapter, pertaining to traditional APRN roles, not exclusively or specifically to the
role of the certified NP.
Among a number of issues to be explored in this chapter, there is one very basic
question: What does the DNP degree itself represent? Is it a degree, or is it to be synon-
ymous with a particular advanced nursing role? Because AACN has made this deter-
mination now more than a decade ago, what precisely is different when comparing the
current practice of an MS-prepared NP to that of a DNP-prepared NP? What are the
potential consequences to our discipline if we move too quickly to close our MS APRN
programs? What about the apparent variability in curriculum and foci in DNP pro-
grams? Should they all be the same? Do they need to be? Another contentious issue at
present is certification. When in the educational process should DNPs become certified,
in what, and by whom? Does the DNP curriculum prepare graduates to assume full-
time academic faculty roles? Finally, this chapter reexamines the document that got us
here: The Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2006) and
the report of the Task Force on the Implementation of the DNP: New White Paper on the
DNP: Current Issues and Clarifying Recommendations (2015b); are they fluid enough?
At the present time in our society, with such uncertainty in the economy, an aging
population with increasingly diverse health care needs, and the health care system at a
breaking point in spite of recent reforms to enhance access to health care, is this really
the moment to undertake such a grand agenda on the part of our profession? Added to
these societal issues are other intraprofessional issues that further complicate the pic-
ture, such as uncertainty about the adequacy of the nursing workforce, the aging work-
force, the nursing faculty shortage, as well as faculty nearing retirement. Or perhaps at
this time in history, with a constellation of such pressing issues, this is exactly the right
time.
■ THE DNP: DEGREE OR ROLE?
Unlike many sweeping changes in education, it is important to remember that the move
to the DNP degree for entry into practice for future NPs did not result from poor patient
outcomes with NP-managed care. On the contrary, research comparing physician-
managed patient outcomes with those of their NP counterparts has consistently demon-
strated comparable outcomes (Horrocks, Anderson, & Salisbury, 2002; Mundinger et al.,
2000). The decision to elevate the educational requirement for NPs came as a result of
a broad consensus among health professions: In order to meet the needs of health care
reform, tomorrow’s clinicians would need additional skill sets from those currently exist-
ing in today’s NP programs. Multiple publications by the Institute of Medicine (IOM,
1999, 2001) and the National Research Council of the National Academies (NRCNA,
2005) highlighted the serious nature of health care quality issues in the United States.