152 ■ II: ROLES FOR DOCTORAL ADVANCED NURSING PRACTICE
Care” (Mundinger, 2008) via an exam prepared and administered by the American
Board of Comprehensive Care. The CACC has made the argument that the intent
of having DNPs sit for and successfully pass an exam very similar in content to the
exam taken to license MDs is to “assure the public of quality and reliable standards
for these new clinical nurse experts” (Mundinger, 2008, p. 4), or the DNP-prepared
NP. This position has raised the ire of the American Medical Association, as well as
many within nursing. If the underlying assumption for this certification exam is that
without it, the “assurance of quality to the public” (Mundinger, 2008, p. 4) would be
in question, the idea seems inconsistent with previous research findings (Horrocks et
al., 2002; Mundinger et al., 2000), which have shown that NPs (most with MS prep-
aration) and MDs provide equivalent care. Although still popular in some circles,
the idea that DNP-prepared NPs would be designated by this additional certifica-
tion has been “debunked” in a 2008 statement from the American Academy of Nurse
Practitioners as unnecessary and potentially disenfranchising to the large numbers of
MS-prepared NPs in the workforce (Stanik-Hutt, 2008a, 2008b). At the time of writing
of this second edition text, the CACC certification endorsed in 2007 appears to have
stalled. The website for the CACC ( abcc.dnpcert.org/# ), while active and containing
information about the CACC exam option for DNP graduates from “across the life
span” programs only, simply lists application status as “coming soon.” Given the
lack of momentum on this front since 2007, it is unlikely that CACC will be required,
or even available, in the near future.
■ THE ESSENTIALS: STILL RELEVANT?
The AACN Essentials were published following tremendous effort on the part of the
DNP Essentials Task Force in 2006. They have served as the foundation on which
all DNP programs have been developed and by whose criteria today’s programs
are accredited. The AACN reaffirmed in April 2013 at the DNP Summit that the
2006 DNP Essentials should guide the DNP curriculum. Outcomes expectations are
outlined in the Essentials and should serve as the basis for evaluation of DNP grad-
uate competencies, however the extent to which these outcomes are aligned with
the Standards for Accreditation of Baccalaureate and Graduate Nursing Programs from
the Collegiate Commission on Nursing Education (CCNE, 2013) is somewhat open
to interpretation. Student learning objectives should be clearly tied to expected
outcomes per the White Paper (AACN, 2015), but specifically, whose outcomes? The
space between the DNP Essentials (2006) and the AACN White Paper (2015b) and the
Standards for Accreditation of Baccalaureate and Graduate Nursing Programs (CCNE,
2013) leaves plenty of latitude for academic freedom in both curriculum design
and outcomes measures; not nearly as prescriptively defined as those from AACN
(2015).
But are they still current? Are they fluid enough to be adapted in the ever-changing
climates of health care and higher education? What about the decision by the AACN
not to recognize ethics as an essential unto itself (it was previously Essential #3 in the
last 1996 AACN’s Essentials of Master's Education for Advanced Nursing Practice , which
is also currently in revision)? If, in fact, DNP programs include ethical issues at the
advanced practice level that are threaded throughout the curriculum and include top-
ics considered nontraditional for clinicians, then this may be a solid decision on their
part. Although it is imperative to include traditional ethics content for clinicians, such
as ethical treatment of patients, it would also be pertinent to include ethics related to