172 ■ II: ROLES FOR DOCTORAL ADVANCED NURSING PRACTICE
competencies and are not exhaustive of all areas of expertise for the nurse executive.
They believe that the core competencies establish the standard for executive practice
and can be used as a guideline for educational preparation of nurses seeking knowledge
in executive practice.
The authors agree with the position of AONE in that there needs to be more evi-
dence to support making the DNP a requirement for those nurses functioning in clinical
leadership advanced nursing practice roles. The authors, DNP graduates themselves,
aver that this degree is scholarly, uniquely different from a graduate- level preparation
for leadership, and is an educational process that prepares the nurse executive to think
and function at an advanced level as evidenced by the positions held by these indi-
viduals and their accomplishments in these roles. Having said this, it is necessary to
address some key questions before concluding that the DNP must be a requirement for
any nursing leadership roles. In addition to the questions posed by AONE, other ques-
tions need to be addressed as well. First, one must determine for what level of nurse
leadership should the doctorate be required. It is the belief of the authors that it would
be illogical to require all nurses in leadership to be doctorally prepared. As stated by
Jones (2010), this becomes a scope of practice and a level of accountability issue. It con-
nects back to the level of preparation offered by the DNP that has been highlighted as
producing graduates able to function at a macroscopic level. The nurse executive at the
most senior level in the organization needs to see the big picture that often times tran-
scends traditional organizational boundaries. Second, what impact, if any, would such a
requirement have on MSN programs? This issue is also raised by AONE in their position
statement. Some colleges have or are moving in the direction to eliminate MSN tracks as
they create DNP degree options as part of their academic offerings. Third, what impact
would the potential elimination of MSN programs have on the supply of nurses? AONE
recognizes that nurses may choose other disciplines to acquire a master’s degree, which
may result in outward migration from the nursing profession. Overall, the reduction of
the number of MSN programs or their elimination may result in some unintended con-
sequences that may have long- term effects on the nursing profession and particularly
on providing a steady pool of highly educated clinical nurse executives at a variety of
levels. Does the MSN in nursing administration or health systems leadership benefit a
mid- level manager/ executive? We believe such preparation is highly beneficial for new
directors.
■ FUTURE PERSPECTIVES
Future considerations regarding the DNP degree need to include three key compo-
nents. (a) The nursing profession must find a way to ensure that the degree can with-
stand the test of time through evidence to support its benefits. Since the inception of
the DNP degree, there is growing evidence of its impact as demonstrated by successful
graduates of the program functioning as effective clinical executives. Key indicators,
as highlighted by AONE, that need to be further investigated include the financial
impact of increasing salary expectations of doctorally prepared executives and the
corresponding financial impact on organizations, patient satisfaction with holders of
this degree, and specific degree- related patient outcomes as evidenced by organiza-
tions’ performance with core measures established by the Centers for Medicare and
Medicaid (CMS) and Hospital Consumer Assessment of Health- care Providers and
Systems (HCAHPS) scores. (b) The profession must carefully examine the scope of
practice and the level of accountability of nurses who would benefit most from a DNP