16 ■ I: HISTORICAL AND THEORETICAL FOUNDATIONS FOR ROLE DELINEATION
the most progressive state, a decade ago, some 70% of all RNs had an ADN degree; 2014
data indicate that 61.5% now have a BSN degree, a remarkable shift (California Board of
Registered Nursing, 2014; Dreher, 2008a).
Because data from Aiken, Cheung, and Olds in 2009 indicated that only 6% of
nurses who first get an ADN go on to advanced practice (the master’s degree or higher),
this trend away from an initial community college nursing education may have an
important impact on the profession. Moreover, even as we enter a period of uncertain
supply and demand of RNs with the Great Recession blunting the retirement of many
older nurses, a continuing shortage of nursing faculty (with doctorates), and a shortage
of nurse scientists (with the projected retirements of so many senior faculty), the pros-
pects for an adequate supply of nurses in different sectors remains predictably uneven.
Furthermore, the movement to end advanced practice at the master’s degree, or at least
the transition away from the MSN to the DNP, has caused some to warn that this move
may cause a drop in the number of new NPs each year (Bloch, 2007; Dreher & Gardner,
2009; Ford, 2008). As the expense and time commitment to skip the MSN can be burden-
some and can take longer than obtaining the MSN, the Great Recession that began in the
Bush administration and ended during the Obama administration, negatively impacted
the employer- based tuition reimbursement system that so many RNs who seek higher
education have always relied on (Azam, 2010; Babcock, 2009; Krugman, 2009). Bloch
warns that NPs, particularly those who work with vulnerable professions, may see
declining numbers, and this would be tragic, especially now that about 30 million or
more individuals are transitioning into the health care system and all need primary
care (National Association of Community Health Centers, 2009). No data have been
reported whether the move to the entry- level DNP has specifically curtailed the NP sup-
ply, but 2012 data report a slowing of growth of individuals who identify themselves as
a “nurse practitioner” (Auerbach, 2012). According to the Society for Human Resource
Management (2013), some 61% of employers offer undergraduate tuition assistance in
greatly varying amounts. But while graduate tuition assistance is slightly less prevalent
(59%), this author has had doctoral students whose employers specifically did not sup-
port doctoral tuition reimbursement. We mention this in particular because the 2004
AACN vote must be placed in this context— the vote occurred before this substantial
economic downturn and this author wonders whether it would still pass today?
Likely, and partly due to economic factors that have impacted the United States
since the 2004 AACN vote (2004a), we are seeing that while more schools are offer-
ing the post- master’s DNP degree, they are increasingly reticent about closing their
MSN advanced practice tracks out of fear of potential declining enrollments and loss of
tuition revenue. We now hear of schools indicating that they plan to offer both options
(MSN and DNP entry) permanently. The slow rate of actual conversions of master’s
advanced practice programs to the DNP actually caused the AACN to commission the
RAND Corporation to study this problem (Auerbach et al., 2015). We discern the four
most important conclusions from this report as:
- The DNP continues to expand steadily.
- The MSN remains the dominant pathway for APRN entry- into- practice educa-
tion, though there is some limited movement toward replacement with the
BSN to DNP. - There will likely be two tracks toward the DNP for the near future (defined by
schools’ planning horizons): a single- step process (BSN to DNP) and a two-
step process (BSN to MSN followed by an MSN to DNP at a later date). - The value of the added content of the DNP education is almost universally
agreed upon (p. x).