9chapter ONE
The Historical and Political Path of
Doctoral Nursing Education to the
Doctor of Nursing Practice Degree
H. Michael Dreher
This opening chapter examines the history of the Doctor of Nursing Practice (DNP) de-
gree in the United States. It is the historical and sociological evolution of the degree and
its reception in our health system labor market that will ultimately shape the role of this
new doctoral advanced practice nurse or the nurse who engages in doctoral advanced
nursing practice (ANP; Dreher & Montgomery, 2009). The chapter draws on contexts,
both historical and political, that illustrate the progress of the degree— from the earli-
est attempts, the failures, and successes in our discipline— to first create a professional
doctorate (EdD), then a research doctorate (PhD), a clinical doctorate (doctor of nursing
science [DNSc]), another professional doctorate (doctor of nursing [ND]), and finally
a DNP, including other various degree iterations splattered along the way— doctor of
science in nursing (DSN), doctor of nursing science (DNS), and DrNP.^1 Some of the
important benefits and unresolved issues with this still relatively new DNP degree are
also summarized. Finally, this chapter concludes with final points on how the American
iteration of the DNP degree interfaces with the prevalent international professional doc-
torate degree model, highlighting how today’s global health issues can impact anyone
anywhere, and the need for the health professions’ education that advances health best
for all.
A new doctorate in any discipline is rarely created without some controversy. The
DNP degree is no different. However, the largely subsided controversy today is more
“Where do we go from here?” Some of the earliest programs are now about 10 years
old, and curriculum evaluation and revision have been completed by many of the early
programs. Different from most historical analyses in nursing education, this chapter
attempts to provide an honest and objective (as much as possible) narrative critique
of both the problems and progress of this new nursing doctorate as it has emerged
over this past decade. This author was not at the table of the American Association of
Colleges of Nursing (AACN) when members (restricted to college, schools of nursing
deans, and/ or the chief nursing administrator in any given AACN- affiliated program)
cast a very narrow vote in 2004 to require the DNP degree instead of the MSN degree for