486 ■ III: ROLE FUNCTIONS OF DOCTORAL ADVANCED NURSING PRACTICE
in preparation for practicing independently in the master’s degree programs (Roush,
2014). APRN MSN education has been revamped and is described subsequently.
During the last decade, concurrent with developing the academic practice doctor-
ate degree, debates ensued among nursing leadership about restructuring APRN edu-
cational curriculum, certification, and licensure related to APRN practice. With much
confusion and uncertainty that led to rumors, concerns, and dissension, the leaders
of key nursing organizations, who were stakeholders in current and future roles for
APRNs, formed a task force to reach a consensus (APRN Consensus Work Group, 2008).
Although during the period from mid- 1990s to 2003, the organizations made individual
and collaborative efforts to address the myriad of regulatory APRN issues, it was not
until 2003 that they all came together. After a 6- year period, they reached an agree-
ment on a consensus model for APRN regulation and education. The model established
guidelines for titling, education, certification, accreditation, and licensing for the four
clinical APRN roles— (a) certified registered nurse anesthetists (CRNAs), (b) certified
nurse- midwives (CNMs), (c) clinical nurse specialists (CNSs), and (d) certified nurse
practitioners (CNPs). This model, endorsed by 44 national nursing organizations, was
a great feat for nursing; for in addition to developing nationally recognized standards
for APRN regulation, the consensus model clarified the role and scope of APRNs, which
assists policy makers and the lay public with the understanding of the key roles of
APRNs (Stanley, Werner, & Apple, 2009).
The consensus model, referred to by the acronym LACE (licensure, accreditation,
certification, and education) was released years after the AACN announced their posi-
tion that the DNP degree should be the academic degree for entry into APRN practice.
It is imperative to understand that the LACE model does not repute the value of MSN
as entry into APRN clinical practice. Though AACN and other organizations recom-
mend the practice doctorate for clinical APRN roles, there is currently no movement
to actually restrict APRN licensure and certification only to DNP graduates. Dr. Anne
O’Sullivan, a member of the consensus group and former president of the National
Organization of Nurse Practitioner Faculties (NONPF), in her report on April 18, 2010
at NONPF’s annual conference held in Washington, DC, clarified, on behalf of the con-
sensus group, that there is no current plan to dissolve the MSN degree requirement as
the entry degree for APRN practice. She emphasized that there is absolutely no evi-
dence that the public would be better served by changing the MSN- required degree to
a DNP degree as entry into clinical APRN practice. On the contrary, it was emphasized
that there is a plethora of evidence documenting the positive impact that the master’s-
prepared APRNs have had on improving health outcomes among diverse populations
with various health conditions throughout the United States (Joel, 2004; Stanley, 2005).
So, why should entry into APRN practice be changed from requiring an MSN degree
to a DNP degree?
The two officially recognized accreditation agencies for nursing by the U.S.
Secretary of Education, The National League for Nursing Accrediting Commission
(NLNAC) and Commission on Collegiate Nursing Education (CCNE), have clari-
fied that they will continue to accredit master’s- level educational programs, and
their standards have not changed to require doctoral preparation for NP programs.
Although the AACN’s (2006) document, The Essentials of Doctoral Education for
Advanced Nursing Practice , recommended 2015 as a date for transition from master’s
to DNP degree programs for APRN education; they have clarified that this date
was only a recommendation (NONPF, 2010). Furthermore, the recent RAND Report
commissioned by the AACN confirms that, as of 2015, there is insufficient evidence
of any added value in terms of outcomes of direct patient care provided by DNP-
prepared APRNs over MSN- prepared APRNs (Auerbach et al., 2015). However, the