5: THE ROLE OF THE PRACTITIONER ■ 149Findings from the RAND study (Auerbach et al., 2014) demonstrated that 30% of
nursing schools with APRN programs do offer the BSN–DNP option, with evidence
that the rate will increase to 50% within the near future (RAND Study on the DNP
by 2015). Although most APRN programs continue to offer the MS degree (14% are
DNP exclusively), an additional 27% plan to close their MS programs in the next few
years, indicating an acceleration in the national progression to DNP-only education for
APRNs. Finally, the report concluded that demand remains robust for all types of APRN
preparation programs, with applications exceeding available program slots.
Now that many programs are conferring DNP degrees, what makes them
“doctoral-level” rather than “master’s-plus?” Undoubtedly, there are programs today
that fall into both of these categories. In light of the “credit-creep” rationale mentioned
by AACN as part of the reason for the move to the DNP, some programs may have
simply added several courses to their current MS-level curriculum to address the DNP
essentials and competencies and retitled the degree as a “doctorate,” while philosophi-
cally retaining the notion the DNP programs are really “master’s-plus” (AACN, 2006).
Other programs have embraced the idea that a doctorate degree denotes academic
expectations well beyond those expected at the master’s level and have designed a
truly doctoral-level curriculum. Perhaps this philosophical difference of opinion is more
important than we think, and if resolved, might result in programs with more consistent
levels of expectation.
The case for and against PhD-style educational rigor in DNP programs has been
discussed in the literature (Sheriff & Chaney, 2007), and while both sides of the issue
present strong arguments, we would have to make our decision based on a traditional
risk–benefit ratio. Although the level rigor of DNP programs as perceived by some might
not necessitate a level consistent with what is expected in a PhD program, the outcomes
may offer significant benefits in terms of valuable learning experiences consistent with
clinical scholarship and development of leadership abilities, thereby establishing the
DNP-prepared graduate as a truly learned individual, respected in the academic setting
and valuable in the practice setting. Conversely, the question that must be considered
is: What is the perceived risk of traditional doctoral-level scholarship if offered to DNP
students? It could hardly be argued that DNP students graduating from such rigor-
ous programs would be considered “too scholarly”; therefore, we take the position that
expected level of scholarship should be equitable, but with a distinctly different focus.
Important points to consider in this distinction are competencies to be achieved
at the DNP level as designated by both AACN (2006) in their Essentials document and
NONPF (2006). Competencies articulated by both organizations are distinctly different
for MS-level programs and for DNP-level programs. Simply stated, MS-level competen-
cies address the expectations for patient care management at the traditional APRN level,
while DNP entry-level competencies speak to additional areas of expected expertise
having to do with quality assessment, practice inquiry, policy, and leadership (NONPF,
2006). Perhaps going forward, BS-DNP programs might consider various curriculum
design schemes whereby mastery of APRN competencies might be attained early in
the program, allowing for leadership competencies to be acquired via DNP coursework
later in the program. An example of this curricular structure may offer all “traditional,”
MS-level APRN specialty-focused content within the first 2 years of the program, while
the latter years of study would be devoted to the DNP-level competencies such as sys-
tems perspectives, populations and quality focus, the development of clinical schol-
arship, and leadership skills. True leadership experience may be gained through an
immersion experience at the DNP residency level. It is difficult to imagine that mastery
of skills at the traditional APRN level could be attained at the same time that leadership
expertise within that role is gained. Generally, leadership follows mastery consistent