1: THE HISTORICAL AND POLITICAL PATH OF DOCTORAL NURSING EDUCATION ■ 41
agent of the university. Further, I am skeptical that one can prepare a more advanced
practitioner just by gaining more clinical research skills that can be applied in the prac-
tice environment. Nevertheless, especially with the emerging codified language from
the Bologna Third Cycle, it is very unlikely that a nursing doctorate without a research
project would be accepted outside the United States. Therefore, any American DNP nurse
who might seek a teaching position outside the United States should be aware of this ex-
pectation. On the other hand, the proximity of Canada to the United States has already
got Canadian nursing scholars wondering how the DNP might impact the Canadian
nursing educational system (Brar, Boschma, & McCuaig, 2010; Joachim, 2008), but the
DNP degree is still absent outside the United States. I conclude by writing humorously
that I did warn my mostly British colleagues in London once that they should not ignore
what is happening in the United States with the professional doctorate or with the DNP
degree. Our ideas, both good and bad, can easily make a transatlantic voyage or flight.
■ SUMMARY
As the DNP degree continues to evolve, more than 15 years since the first DNP degree and
over 10 years since the first large cohort of programs were first established, it is now time
to take a deep breath and evaluate how far we have come and what direction this degree
should now take. Only recently, in the spring of 2010, did the ANA undertake its first anal-
ysis of the DNP degree and take public comment. As far as this author can tell, the ANA
has never offered a final public document on the DNP degree. In the first edition of this
text, I predicted it would likely be a 2- year process before the ANA House of Delegates
voted on this degree and that it would either: (a) endorse it; (b) offer cautionary approv-
al or suggest a slower period of transition (rather than 2015 which has now passed); or
(c) possibly reject the idea that all advanced practice nurses one day must have an entry-
level doctorate. But more realistically, I suggested the ANA’s ultimate position may not be
determinative and I still agree with that point. This degree has arrived and graduates are
going out into the professional work force and starting to make their mark. New DNPs
are working in roles that the health care system has never seen before. Some PhD nursing
graduates have unfairly, but sometimes fairly, had their relevance to the clinical practice
environment questioned (Wilkes & Mohan, 2008). The clinical practice environment, how-
ever, is fertile ground for the DNP graduate, and it is here where they are educated to excel.
This author has tried to provide a descriptive analysis of the trajectory of this
degree, particularly in the context of doctoral nursing education. Sometimes history
and its analysis and commentary are not pretty, especially as an author may suggest or
affirm views a reader may disagree with. But mostly history and its politics are complex.
In the end, the history of the DNP degree can be summarized as follows: Initially there
was great opposition to the DNP degree, but the opposition was largely quelled quickly.
Now what we have left is the fine tuning of the degree and a need to generate outcome
data that will help enable our graduates to better define and “live” this new role so that
nursing’s mission to improve health and alleviate suffering can advance.
■ CRITICAL THINKING QUESTIONS
- How do you view the state of critical discourse in nursing? Do we debate enough? Do we
need more agreement and more consensus? Or should we embrace difference more and be less
concerned with conformity?