12 ■ I: HISTORICAL AND THEORETICAL FOUNDATIONS FOR ROLE DELINEATION
discipline in the way the EdD was first created to advance nursing education practice.
Some would applaud this return to our disciplinary roots, whereas others would see
this as a diversion.
As there was very sluggish growth of doctoral programs in nursing after the Teachers
College experiment in 1933, it is noteworthy that three of the next four doctoral nursing
programs were aimed at clinical specialization in the discipline rather than a doctorate
awarded in the general discipline of nursing itself. The first doctor of philosophy (PhD)
program in nursing was started at New York University in 1934. There is not a lot written
about this very early PhD and this author has wondered “Who taught in this program?”
Furthermore, because nursing was often not allowed to offer a PhD degree by many uni-
versity faculties beginning in the 1960s and into the 21st century,^4 with other disciplines
arguing “is nursing a real science?” it is remarkable that the New York University fac-
ulty was progressive enough to position itself at the literal forefront of nursing as a rec-
ognized academic discipline (Meleis & Dracup, 2005). It would take until the mid- 1980s,
at least 50 years, before nursing science would clearly evolve into a scientific discipline
(Dreher, 2010a); and as stated in an issue of The Academic Nurse (2010),
In late 1985... In nursing schools where faculty were active in moving the
profession forward, research was now becoming a significant part of the aca-
demic role, while at the same time faculty clinical practice was falling out of
favor. (p. 21)
The third and fourth doctorates in nursing were developed with a clinical focus
too. The PhD in nursing at the University of Pittsburgh was started in 1954 with a
clinical nursing and clinical research emphasis and the DNSc at Boston University in
1960 with a psychiatric– mental health focus (Grace, 1989; Nichols & Chitty, 2005). Two
important distinctions should be made about these two programs, as they both created
two distinctive pathways to nursing science knowledge development and shaped doc-
toral nursing education differently.
First, it is the historic inability of the profession to truly develop a widely viewed
“clinical doctorate” for the profession as an alternative to the research- intensive PhD
that has led to the surge of the DNP degree. Fitzpatrick (2003) made a very strong case
for the clinical doctorate in nursing in 2003 (prior to the 2004 AACN vote), even advo-
cating a clinical doctorate for teachers of nursing. Over the years, much has been written
about the DNSc, DSN, and DNS degrees. Although all three were initially designed to
be clinically oriented doctorates, the profession has come to view them all as de facto
PhD degrees (AACN, 2006; Carlson, 2003). To that measure, in 2016, almost all of them
have now converted to a PhD mostly in the last decade (except for one DNSc degree at
the University of Tennessee Health Sciences Center, which oddly converted to a DNP
program perhaps because they already had a PhD degree). Table 1.1 lists most of the
schools that attempted the clinical doctorate and also traces one school’s history from
its earliest nursing education, to the conversion of its clinical doctorate (DNS) to a PhD,
and finally to the approval of the DNP degree (Exhibit 1.1).
The unanswered question is: Why did the profession ultimately abandon the idea of
a clinical doctorate? The discipline of psychology faced this very issue in the 1960s when
many felt the PhD in psychology had become too research oriented, too experimental, and
not client focused. As a result, the doctor of psychology degree (PsyD) was first started in
1968 as a clinical doctorate (Murray, 2000). The PsyD degree, however, did not eliminate
the research enterprise in the new degree, only de- emphasized it, and its founders devel-
oped a clinical dissertation model in lieu of the traditional PhD dissertation, which is still
integral to the degree (Sayette, Mayne, & Norcross, 2010). Peterson (1997), in referring to
the PsyD degree versus the PhD, succinctly said that it is not that science and practice do