158 ■ II: ROLES FOR DOCTORAL ADVANCED NURSING PRACTICE
Program to DNP within 2 years. With others achieving similar goals, each forward step
has required careful attention to the challenges presented in Chapter 5.
Although the authors described AACN as being largely responsible for the DNP
movement, a much larger group of organizational and individual participants were
active in mainstreaming the DNP rather than to be a “fringe” degree. Societal forces
such as complexity of health care, changing demographics, increase in doctoral degrees
among other health professionals, and the rapidly emerging need for nurse practitio-
ners (NPs) to provide much of the nation’s primary care, set the stage for change in
advance practice nursing education. These forces caused the stampede to create DNP
programs, growing in number from four clinical nursing doctorates (NDs) in 2000 to
20 in 2006, to 120 in 2010, and to 264 in 2015 (AACN, 2015). In spite of the cries of folly
(Dracup, Cronenwett, Melies, & Benner, 2005) concerning the new DNP, many issues
have been resolved: the accreditation process is complete, the number of PhD students
has increased instead of a dreaded decrease, and DNP graduates do get meaningful
jobs and advance within their employing institutions. With almost half of APRN edu-
cational programs offering DNP degrees, we probably have reached the tipping point.
Now DNP faculty are educating their stakeholders on how maximize DNP contribu-
tions to the triple aim of accessibility, affordability, and quality health care.
Of the several important and well-documented DNP issues addressed, I will tar-
get educational rigor, differences in practice capability with MS and DNP programs, the
potential of DNPs as educators, and the closing of MS APRN programs. Not surpris-
ingly, lack of standardization (Marion, 2015) or setting the appropriate methods and
rigor for applying evidence to practice and practice change, standardization, continues
to be a major challenge for DNP education today. Curricula for medicine, dentistry,
pharmacy, and other professions include applied research methodologies as a founda-
tion for evidence-based health care, and many require a scholarly project. Some dis-
ciplines have the option of a dual practice/research (PhD) degree with a dissertation.
Nursing, on the other hand, has had challenges in envisioning the role of the DNP grad-
uate in applied scholarship. Early efforts in creating a Doctorate of Nursing Science
and other such non-PhD nursing degrees resulted in PhD look-alikes (AACN, 2009).
The ND did not flourish. Could this reticence to embrace a nursing practice doctor-
ate reflect perceptions of low prestige and usefulness of such scholarship? Do/will our
DNP programs prepare the learner to conduct selected types of research? And to gener-
ate funding to support those activities? Time will tell, but DNP students and graduates
can further develop their expertise in research through joint and dual degrees, postdoc-
toral research fellowships, and research team membership. In my view, the DNP is the
degree for improving practice and patient outcomes through evidence-based practice
change. Also, the DNP-prepared scholar serves best as clinical expert on research design
teams, research interventionist, and intervention delivery specialist. A DNP dissertation
with PhD-level research methodological rigor can detract from the primary purpose of
the practice doctorate.
The authors addressed the question: Is DNP practice better than/different from MS
practice? In the early years of the previous decade, open forums with advanced practice
nurses and faculty discussed the viability and usefulness of the DNP, and the partici-
pant themes provided guidance for next steps (Fontaine, Stotts, Saxe, & Scott, 2008). We
heard the need for synthesis of content, more evidence-based practice, and more chronic
disease management, genomics, ethics, informatics, cutting-edge pharmacology, sys-
tems leadership, and so on. Strong themes were later incorporated in the AACN’s
Essentials (2006) and NONPF competencies (2016). The ensuing DNP education pro-
vides vision, structure, and additional credits to meet the new demands of a highly
complex system undergoing radical design change. The few available studies indicate