146 ■ II: ROLES FOR DOCTORAL ADVANCED NURSING PRACTICE
institutions and populations of patients by providing NPs with advanced levels of edu-
cation built on their core NP education, or to educate the NP of the future—it is not to
disenfranchise the NPs of today. The future role of the DNP-prepared NP will likely be
oriented toward adding additional areas of expertise to current practice roles and aimed
at improving patient outcomes across practice settings. DNPs will also likely lead many
organizational-level performance improvement initiatives, take on leadership roles
in ensuring best practices based on current evidence, and assume leadership roles in
health care legislation and policy at the national level. Given the remaining timelines
before the DNP-entry requirement changes indicated by AANA and NACNS however,
as well as the silence on the issue from NONPF and the AANM, it may be decades yet
before the role and scope of practice for DNP-prepared APRNs becomes any clearer.
The intended scope of practice for DNP-prepared NPs is an issue that needs to be
settled, although it is unlikely to be resolved in the near future. A hotly debated topic
currently in nursing academic circles is whether the DNP degree will broaden the cur-
rent scope of practice for NPs, allowing “advanced” NP competencies traditionally held
as the purview of physicians, especially in light of calls for “doctoral-level clinical prac-
tice.” This idea has incited much disagreement and debate among nursing scholars as
well as among physicians. In order to lend clarity regarding what is and is not intended
regarding scope of practice issues pertaining to the DNP-prepared NP, perhaps the con-
fluence and level of agreement of several documents published by key leading nursing
organizations need to be raised for discussion.
First, there is no evidence put forth by the AACN in any of their documents that
the intent of the DNP is to “expand scope of practice” for NPs (AACN, 2004, 2006). In
fact, the question is raised and answered unequivocally for all via the AACN website
(AACN, 2009). Aligned with and supported by AACN, neither the APRN Consensus
Work Group nor the National Council of State Boards of Nursing (NCSBN) APRN
Advisory Committee put forth any language supporting expanded scope of practice
for NPs in their licensure, accreditation, certification, and education (LACE) document
(APRN Joint Dialogue Report, 2008). Finally, there is also no mention of expanding the
scope of practice for NPs based on doctoral-level competencies as articulated by the
NONPF (2006). In contrast, all documents speak to doctoral-level education for APRNs
as focusing on the concepts articulated in the Essentials documents and aligned with the
IOM papers (IOM, 1999, 2001, 2003). These documents seem to identify the need for an
APRN provider with a new, unique skill set designed to fill a current need within the
health care arena, not necessarily to produce more providers with the skill sets tradi-
tionally held by physicians.
Opportunity exists at this time for nursing to say “yes, expand the scope of tradi-
tional NP practice,” but perhaps not in the manner in which academicians traditionally
envision. The notion that “advanced clinical skills” beyond those currently encom-
passed in NP practice, in light of the content of various relevant publications, although
intriguing, seems rather contrary to the intent of the degree and the skill set collectively
described by AACN, the NCSBN APRN Advisory Committee, and NONPF. For the
purposes of clarity, perhaps nursing academics should broaden their application of the
word “clinical” to include “things relevant to the practice setting” rather than the single,
more traditional use of the term denoting “hands on, individual-level patient manage-
ment.” If the confusion relating to “expanding scope of practice” were to be disavowed,
perhaps the lingering resentment of physicians and their opposition to DNP education
may also abate. In any case, the domain of DNPs will likely become clearer and less
controversial in the decades to come as more DNP-educated practitioners begin to dem-
onstrate their skill set in the health care arena, presenting themselves as credible leaders
and collaborative partners with a unique knowledge base rather than as competitors.