554 ■ III: ROLE FUNCTIONS OF DOCTORAL ADVANCED NURSING PRACTICE
with the contemporary work of Harvard Business School professor and innovation
guru Clayton Christensen, who first coined the term disruptive innovation (Christensen,
1997; Christensen, Grossman, & Hwang, 2008). These futuristic works from over sev-
eral decades form the footprints for this degree’s ultimate future. These luminaries
and social critics of society, and our own record of progress and future serve as models
for our own predictions about the roles that are next perhaps for the DNP graduate. It
should be an exciting journey!
■ THE DOCTORAL ADVANCED NURSING PRACTICE “PRACTITIONER”
When U.S. News and World Report featured a doctorally prepared RN on the cover of
its January 2005 issue with the title “Who needs doctors: Your future physician might
not be an MD— and you may be better off!”— indeed a Pandora’s Box was opened, and
the rush to anoint an alternate supply of primary care providers in the United States
was ushered in, but retrospectively in a most controversial way (Fischman, 2005). That
was in 2005, and now more than a decade later, we have grown from less than 10 DNP
programs in 2005 to some 269 as of 2014 (American Association of Colleges of Nursing
[AACN], 2015a). We are certain that the designers of this degree (a dean’s task force at
the AACN) had no idea this would be the projected growth of this degree. Indeed, in
2015a, the number of DNP programs has far surpassed the number of PhD ( N = 134)
programs in nursing, a degree that has been around since 1934 (Dreher, 2009a). With this
large number of DNP programs producing doctorally prepared practitioners (referring
broadly to nurse practitioners [NPs], nurse midwives, nurse anesthetists, and clinical
nurse specialists) for the health care market, two fundamental questions remain. Will
they perform differently than if they were instead master’s- prepared advanced prac-
tice nurses and will doctorally prepared clinicians improve health outcomes beyond
those improvements made by master’s- prepared advanced practice registered nurses
(APRNs)?
In 2009, Dreher and Montgomery proposed the term doctoral advanced practice
registered nursing (the acronym “DAPRN” is used in this text) to better differentiate
the practice of a DNP graduate from the practice of a traditional master’s- prepared
clinician or practitioner. We think this is critical, because if there are no new, real,
identifiable skills that a new doctorally prepared practitioner possesses, then why
should APRNs have pursued the doctorate, and why should the market place pay
these health care professionals more money? So our challenge to the profession and in
particular to the DNP educator and graduate, is to be very clear about what additional
skills beyond the MSN the DNP graduate is going to acquire. It is our view that the
emergence of new roles for the DNP- prepared practitioner will be dependent on a crit-
ical mass of graduates presenting new prospective employers with measurable claims
of what they have acquired during their doctoral education. For this reason, we do
believe there will be both: (a) programs that will produce quality graduates (the pro-
grams that are very adept at producing clinicians ready to practice at the doctorally
advanced practice level); and, unfortunately, also (b) programs that will do a poor job
of this. We are particularly concerned about the impact of programs that poorly differ-
entiate graduates with the master’s versus the doctoral degree, and whether gradu-
ates hired from weak programs will leave their new employers skeptical of graduates
with this new degree.
To combat this, we encourage DNP students, especially new DNP students reading
this text early in their curriculum, to challenge the faculty to make sure you are getting