24: ESSENTIALS OF DOCTORAL EDUCATION ■ 545so why is this equivalency needed at the DNP level? Is this why NONPF abandoned
their separate educational outcomes for DNP versus master’s- prepared NPs? Was it
too difficult to maneuver, to establish separate educational outcomes especially when
it is not likely that any state Nurse Practice Act in the future is likely to abandon mas-
ter’s degrees in favor of doctoral degrees for entry into practice? Nevertheless, despite
Columbia’s innovation, it has yet to be copied and thus its critical impact on the profes-
sion is historical more than influential. Even the diplomate in comprehensive care (DCC
credential; begun at Columbia), which this author highly supports, is given little atten-
tion today in the doctoral advanced practice arena. The chief critique of this Essential by
this author is that the abandonment of separate competencies for doctoral practice has
limited the expansion of the APRN role at the doctoral level.
Fairman, Rowe, Hassmiller, and Shalala (2011) explore some of the barriers and state
restrictions on the scope of practice for NPs. Hain and Fleck (2014) estimate that only one
third of states permit the full practice of APRNs. There is significant NP migration to states
with expanded practice opportunities, but concurrent movement from general to specialty
practice even among NPs is the result. Fairman et al. further state, “We believe that if we are
to bridge the gap in primary care and establish new approaches (my italics] to care delivery, all
health care providers must be permitted to practice to the fullest extent of their knowledge
and competence” (p. 193). These authors may very well not be referring to DNP practice,
but new approaches to care delivery would mostly be expected from practitioners with
expanded credentials and additional education. It is an inference that is not unfounded.
Finally, many individuals also mistakenly think the Institute of Medicine (Institute of
Medicine, 2011) report on nursing, The Future of Nursing: Leading Change, Advancing Health,
included the DNP in their recommendation to double the number of nurses with a doctor-
ate by 2020. Instead, they were specifically referring to the PhD. As in all IOM reports, there
is an immense emphasis on data, and at the time of the report, there just was not sufficient
evidence on the outcomes of the DNP degree versus the master’s degree for APRNs. What
is needed is not just a directive that future APRNs switch to doctoral rather than traditional
master’s practice, but also ongoing outcome data that analyzes this decision. The early
arguments were made, but doctoral education is not just expensive to the student, but
expensive to the health care consumer as extra education should mean “higher salaries” to
most individuals who make that investment. As an employer, I would ask the DNP “what
additional skills do you have that I could not get with a master’s- prepared advanced prac-
tice nurse?” If I were that DNP- prepared job applicant, I think I would know exactly how
to answer that and I would have practiced my response over, and over, and over! The
wrong answer I suspect is, “well my profession now requires the doctorate.”
■ SUMMARY
After all this analysis, where does the 2006 essentials stand a decade later? I think the
answer is— very well. It was a document that did look to the future and while a decade
later it is certainly time for an update (as most of the initial DNP curricula have changed
and some have changed more than once), the basic curriculum structure is sound. The
new white paper on the DNP (AACN, 2015) has expanded some of the discussion and
while it provided some additional clarity on nomenclature for the final DNP scholarly
outcome, there is more intellectually territory to mine as the profession truly figures out
that the domain of knowledge development for the DNP really is. Restrictions on em-
pirically derived nursing knowledge or restrictions in methodology are a nuisance in the
academy. At the doctoral level, creative, enthusiastic inquiry needs to be supported and
if a student has the zest and interest to pursue an area of clinical problem solving, then