1: THE HISTORICAL AND POLITICAL PATH OF DOCTORAL NURSING EDUCATION ■ 23
DSN, and DNS degrees were the first generation), in that its graduates did complete an
ND thesis and were generating evidence for the discipline.^11 In other words, this post-
master’s model emphasized practice and practice- based research. And in the transition
from the ND to the DNP, it is perplexing why the practice mission of the degree was
retained but the practice– evidence- generating mission eliminated (at least until the cur-
rent DNP white paper; AACN, 2015b).
■ THE CONTEMPORARY PRACTICE DOCTORATE MOVEMENT:
DNP (MOSTLY) AND DRNP
The contemporary practice doctorate movement can be largely attributed to the innova-
tors at Columbia University School of Nursing and its dean, Mary Mundinger (who re-
tired in 2010). In the late 1990s, a team of investigators conducted a randomized clinical
trial to determine whether, under comparable primary care protocols, MSN- prepared
NPs and doctorally prepared physicians would have similar or different patient out-
comes? In 2000, Mundinger et al. published their findings in the prestigious Journal of
the American Medical Association ( JAMA ) and indeed reported that the outcomes were
equivalent. This was certainly a landmark study for the nursing profession and caused
quite a controversy in medicine. This author, if possible, would give a special courage
award to the physician investigators and participants who even agreed to participate in
the study (at seemingly some risk to the prestige of their discipline and the superiority
of physician practice). The first outcome of this study set the stage for an innovative
comprehensive care practice by Columbia University faculty NPs (Rubenstein, 2009).
With this evidence, they gained admitting privileges (albeit with great passionate, polit-
ical maneuvering by Dean Mundinger) to hospitals, and participated in the first model
of comprehensive care where the NP sees and follows patients throughout their hospital
stays, and not just seen by the APRN in the confines of a primary care clinic (Mundinger,
2005).
The second outcome of this study was the initiation of the Doctor of Nursing
Practice (DrNP) degree model. Although the inventors first described this as a “clinical
doctorate” and a “Doctor of Nursing Practice in Primary Care,” they later dropped the
primary care emphasis, largely out of the realization that many of their APRNs were
not practicing just primary care and they embraced their comprehensive care model
more explicitly (Dreher et al., 2005; Mundinger, 2005). They have since retained the idea
that their degree is a clinical doctorate, as the overwhelming emphasis in their cur-
riculum is on direct clinical practice and focuses on Essential VII: Advanced Practice
from the AACN’s Essentials of Doctoral Education for Advanced Nursing Practice (2006;
Dr. Janice Smolowitz, personal communication, June 25, 2010). This author is in a quan-
dary whether this iteration is really a clinical doctorate. It does not have the thesis or
dissertation knowledge generation model that the earlier clinical doctorates all had.
Instead, they have implemented a DNP portfolio that is innovative, but does not have
an emphasis on generating new practice knowledge; rather, it emphasizes translation of
evidence to practice (which is technically more in line with the AACN conception of the
DNP degree as a nonresearch degree; Honig & Smolowitz, 2009). Nonetheless, there is
no DNP program in the United States that has more emphasis on clinical practice, and it
even includes a 1- year full- time practicum in the second year of study. For whatever rea-
son, the Columbia DrNP degree model has never been replicated. Indeed they changed
their initials to “DNP” in 2009, probably in order to be accredited by the CCNE, which
elected to only accredit DNP programs that subscribe to the “DNP” initials (AACN,