4 ■ I: HISTORICAL AND THEORETICAL FOUNDATIONS FOR ROLE DELINEATIONin a time of health care upheaval and an economy with limited resources still recovering
from the Great Recession, that DNP degree outcome research be conducted and data
disseminated (Krugman, 2009; Rhodes, 2011).
This text explores the intricately complex historical trajectory of the discipline
toward the nursing “practice doctorate” with an emphasis on the evolution of doc-
toral nursing practice roles. This new quest to prepare nurse clinicians (the four tra-
ditional APRN roles) and the nurse executives at the doctoral level is progressive, to
some exhilarating, and still to others, regressive and not necessarily welcome. Mainly,
the real opposition to the DNP degree has waned, and the discussion now is, “what is
the future of the doctor of nursing practice degree?” and “how does the degree need
to be refined?” The nature of the final scholarly project, initially recommended to be
called a capstone project by the AACN (2006) and now a scholarly project (2015b)
by the AACN in a new white paper The Doctor of Nursing Practice: Current Issues and
Clarifying Recommendations , remains a central issue with the degree. These authors
hope that a more meaningful discussion about knowledge development occurs as
the DNP degree evolves, especially because many senior nurse scientists are retir-
ing and PhD enrollments are remaining flat. In the first edition of this text, it was
worrisome that the profession was missing an opportunity to embrace DNP- gener-
ated “practice knowledge development.” But again the new white paper (AACN,
2015b) has made advances in this area recognizing “that practice- focused graduates
are prepared to generate new knowledge” (p. 2) and recognizing that “new knowl-
edge generated through practice innovation, for example, could be of value to other
practice settings” (pp. 2– 3). However, we must continue to be diligent in promoting
the different aspects of knowledge development that are critical to the evidence base
of the scientific basis of our discipline. More than ever, clinicians need to practice
safely and expertly and for a degree in its seminal stages of maturation, the doctoral
nursing community needs to continue to debate and discuss the vision and essential
competencies of this degree.
The first doctoral degree in nursing was a professional doctorate (EdD) in nursing
education at Teachers College, Columbia University, in 1933 (Roy, 2007). Remarkably,
despite its innovation, this degree model was never replicated in the profession until
recently with the emergence of programs at Southern Connecticut State University, the
University of West Georgia, University of Alabama, Capstone College of Nursing, and
Western Connecticut State University (EdD programs housed in Schools of Education
with some form of concentration in nursing education were excluded from this
review). The first PhD in nursing was founded at New York University in 1934, and
yet it was 20 years before the next PhD at the University of Pittsburgh was founded in
1954 (AACN, 2009). This text actually may be the first to declare that the first doctorate
in nursing, the EdD, was actually a practice doctorate. Because the EdD degree is classi-
fied globally as a professional doctorate (Maxwell, 2003; Townsend, 2002) and the term
“professional doctorate” has become mostly synonymous with “practice doctorate”^1
(the influential Carnegie Project on the Education Doctorate [n.d.] calls the EdD a “pro-
fessional practice doctorate”), the DNP may actually be a doctoral degree that returns
us to the practice roots of our profession and discipline. Thus, some may even consider
the DNP degree “an awakening” and a welcome departure from our recent emphasis
on the science of nursing at the expense of its art of practice. Alas, even the often used
term the practice of medicine is still defined and described as both “art” and “science”
(Tucker, 1999). The DNP degree will certainly undergo further metamorphosis and we
have no idea what it will ultimately look like in 20 years. The anticipated transforma-
tion of the DNP degree is actually what makes graduate and doctoral nursing educa-
tion so fascinating today.Dreher_71733_PTR_01_int_p1-8.indd 4Dreher_71733_PTR_01_int_p1-8.indd 4 12/7/2016 6:04:22 PM12/7/2016 6:04:22 PM