470 ■ III: ROLE FUNCTIONS OF DOCTORAL ADVANCED NURSING PRACTICE
to provide evidence of high- quality standardized assessment of DNPs who practice
within the boundaries of their profession and provide care that is complementary to
other primary health care professions. The NBME and CACC also view the DNP exami-
nation as complementary to the goals of uniform regulation of APRN practice via LACE
(licensing, accreditation, certification, education), which emphasizes the achievement
of competency- based standards of practice (American Psychiatric Nurses Association
[APNA], 2010).
Proponents of the DNP examination also assert that the DNP examination reflects
more in- depth knowledge, training, and skills than master’s- prepared APRNs, and that
this distinction is necessary to assure the public of safe and high- quality care (Landro,
2008). In contrast to opponents’ negative views regarding the broadness of the examina-
tion, the ABCC asserts that the DNP certification examination was designed to be broad
in scope to reflect the DNP diplomates’ complex advanced practice knowledge, skills,
and decision making (ABCC, 2009). Finally, according to proponents, the DNP exami-
nation, which is based on standards endorsed by medicine, assures the public that the
DNP diplomate is not a second- tier professional (Landro, 2008).
Although some opponents argue that there is no distinct difference between
master’s- prepared and doctorally prepared APRNs, proponents argue that DNPs
invest more time in education beyond the master’s level to prepare them to act as lead-
ers in translating research into practice and to address the faculty shortage (McGrath
& Piques, 2009). According to proponents, each represents a distinct level of prac-
tice reflected in their essential components (Table 21.1). Although master’s- prepared
APRNs are more focused on a specific populations such as pediatric or women’s health
care in limited health care settings, the DNP is more focused on complex diagnosis,
coordination of care, and management of individuals across a variety of health care set-
tings (Landro, 2008). In addition, their extended training in medical practice and man-
agement is more similar to primary care physicians than to master’s- prepared APRNs
(Mundinger, 2009).
Compared to master’s- prepared APRNs, who focus mainly on understanding
theories of practice and health care policies, DNPs are expected to take leadership in
translating theoretical knowledge into clinical practice, changing health care policy,
organizing and facilitating financing of health care to eliminate health care disparities,
and improving the overall quality of care to benefit patients (American Association of
Colleges of Nursing [AACN], 1996, 2006). In contrast to master’s- prepared APRNs who
are expected to utilize evidence- based nursing in practice, DNPs are expected to synthe-
size, translate, disseminate , and integrate new evidence- based knowledge into practice.
Although master’s- prepared APRNs are educated to deliver culturally sensitive care , pro-
mote health , and prevent disease for specific patient populations, DNPs focus on improving
the nation’s health by integrating and institutionalizing evidence- based nursing knowledge
for disease prevention and health promotion for individuals and populations. The DNP
also takes health care management one step further by not only managing complex ill-
nesses and conducting individual and systemic assessments, but by evaluating links
between individuals, populations, and health care financing and policy.
According to ANCC, a majority of nurses have varying opinions and find it dif-
ficult to agree for or against the DNP certification examination (ANCC, 2010). In an
ANCC survey of 4,284 nurses, where 71% were currently practicing as an APRN,
respondents were asked, “What do you envision as the desired future for certification
of nurses holding the DNP degree in the year 2015?” While 60% expressed the desire for
a single endpoint examination, 40% expressed the desire for staged examinations where
testing would occur at one or more midpoints during master’s preparation with a final
endpoint DNP examination.