5: REFLECTIVE RESPONSE ■ 159that DNP practice is different from the MS, as would be expected—albeit mostly in
the systems arena, which can be measured by standard health services research meth-
ods. Specifying comparative effectiveness in direct patient care and determining the
questions and analyses to answer the effectiveness questions will require a complex
design and methods. The answers are likely to emerge from qualitative inquiry, big data
gleaned from CMS and other insurance data, more comprehensive surveys, and per-
haps from APRN relicensure data.
The DNP-prepared faculty workforce has had a major impact on nursing educa-
tion in most parts of the country. According to the RAND study (Auerbach et al., 2015),
approximately half of DNP graduates are in educational settings. Doctorally prepared
nurses are relatively rare (AACN, 2006), and those with practice doctorates are wel-
come in most educational settings. Whether the DNP graduate is qualified to teach is
just one aspect of the question: Can or should any nursing faculty member, including
PhD graduates, be expected to teach without gaining minimal competencies to teach?
The authors describe how DNP programs could add education courses to the curricu-
lum, and some programs have done so with tracks, graduate certificates, and graduate
degrees in education. More often the clinician is employed without preparation in peda-
gogy and curriculum, and the nursing program then is held accountable for extensive
faculty orientation and development to ensure quality teaching. This costly problem is
exacerbated when clinical faculty members decide to return to the clinical setting (due
to lower income and lack of preference after all) following extensive faculty develop-
ment efforts. Most doctorally prepared faculty members do not have a solid foundation
in education and indeed the profession should address this need.
The question of who is qualified to teach DNP students is interesting. Overall,
many nursing programs generally accept that credentialed professionals with requi-
site skills and teaching ability can teach selected components of the curriculum to any
level of nursing students. The issue of PhD APRN faculty as qualified to teach clinical
content to DNP students has not yet been addressed, but the question is being asked.
Interprofessional teaching and learning are targets for many health science centers if
not already in practice. For example, a physician’s assistant who performs a screening
test or treatment proficiently several times each day should be considered qualified to
teach that skill to an NP student. Similarly, a DNP/NP faculty member should be able
to teach health assessment to medical students. The DNP faculty member is not usually
expected to teach all components of the entire DNP curriculum, and the wide range of
topics necessitates different types of faculty. Of course, nursing programs must stay
within the limits of accreditation standards, most of which are not yet evidence based,
but are the product of collective wisdom of educators and will likely change as we
gather more data on competency process and outcomes.
Finally, the authors discussed the closing of MS APRN programs by the AACN
sanctioned year of 2015. This aspiration was not reached for several reasons including
the growing demand for primary care APRNs from health care reform and increasing
demand for complex care outside of acute care settings; different APRN groups’ time
frames for closure; and program leaders’ inability to accommodate this time frame. State
regulatory boards and accreditation and certification bodies are not obligated to follow
the AACN membership vote or NONPF guidance. With budget challenges for many
nursing programs and parent institutions, administrators are fearful that closing tradi-
tional MS APRN programs will reduce tuition generation. However, programs with the
DNP as entry to APRN practice will be able guide others in the transition. Some creative
partnership models have already emerged and more will follow (AACN, 2006). One
negative consequence of program conversion from MS to DNP has been the shortage
of fully qualified, doctorally prepared faculty to teach at the DNP level. A potentially