5: THE ROLE OF THE PRACTITIONER ■ 143These publications also called on the many health care professions to align their visions
and educational processes to produce clinicians with advanced skills and knowledge to
address these issues (IOM, 2003). The AACN heeded this call and set about redesign-
ing the role of the NP. This move to DNP education has evidently resonated with many.
As of March 2015, a total of 264 DNP programs have been established in 48 states and
the District of Columbia, with reports of an additional 60 programs in the planning
stages (AACN, 2015). The Commission on Collegiate Nursing Education (CCNE) began
accrediting DNP programs in 2008, with 158 programs currently accredited and 33 addi-
tional programs seeking accreditation (AACN, 2015). Program growth has been robust
with more than 18,000 enrolled DNP students and more than 3,000 DNP graduates in
2014 (AACN, 2015).
The NP of tomorrow, as articulated by AACN (2006), will need expertise and lead-
ership ability in areas such as quality assessment, outcomes evaluation, evidence-based
practice, health policy, systems leadership, and health information technologies—
topics identified in the IOM papers—in addition to the current required competencies
for NPs. If the goals of health care reform are to be met, the existing research–
practice gap, cited as existing for as long as 17 years in some studies, needs to be closed
(Balas & Boren, 2000). Important research findings generated at the bench need to be
implemented in a far more timely fashion at the bedside. Research findings establish the
evidence on which clinical practice guidelines are founded. By integrating the most
recent research findings into clinical practice and reducing variation in practice, adher-
ence to evidence-based practice guidelines can improve patient outcomes as much as
28% (Heater, Becker, & Olson, 1988; Melnyk, 2015). It can be argued that NPs, as front-
line care providers, are ideally positioned to contribute toward that goal. Therefore,
DNP programs need to have strong emphasis on advancing the evidence base for prac-
tice within their curricula.
When discussion of the DNP degree first emerges in conversation, one of the more
common controversies that can quickly come to light is whether the DNP is a role or a
degree. To be clear, the DNP is a terminal practice degree (AACN, 2006), designated as
the educational level for several advanced nursing practice–registered nurse (APRN)
roles, including certified nurse-midwife, certified registered nurse anesthetist, clini-
cal nurse specialist, and NP (APRN Joint Dialogue Group Report, 2008). That said, the
AACN endorses the notion that although all APRNs must be DNPs, not all DNPs will
be APRNs. Although the DNP will be required for APRN practice, MS-prepared aca-
demic nurse educators as well as nurse administrators from practice settings also seek
the degree.
What do nurses think about the role of the DNP-prepared nurse? A recent study
by Udlis and Mancuso (2015) was designed to examine nurses’ perception ( N = 340) of
the roles that DNP-prepared nurses engage in (Udlis & Mancuso, 2015). They found that
nurses’ understanding of the DNP degree as a terminal degree was clear, but that there
was ambiguity regarding potential overlap between PhD and DNP roles and the DNP’s
ability to unite the nursing profession, even though DNPs would be able to describe
how nurses contribute to health care. Respondents felt that DNPs were prepared as
leaders in clinical practice who could influence changes in health care delivery systems,
policy, and interprofessional collaboration. They were less sure of the DNP’s role as
leaders in academia. They did appreciate that DNPs could help ameliorate the faculty
shortage, but were not certain that DNPs were prepared as educators. They thought that
DNP preparation provided equivalence to other entry-level doctorally prepared clini-
cians and that the DNP degree would enhance outcomes, as well as lead to improved
position, salaries, and professional regard. They did not think that employers would