468 ■ III: ROLE FUNCTIONS OF DOCTORAL ADVANCED NURSING PRACTICE
also invited to sit for the examination if they believed they have mastered the exami-
nation’s content. To help clearly understand who falls under the category of APRN,
the American Nurses Association (ANA) and American Nurse Credentialing Center
(ANCC) categorize APRN under four domains: certified nurse- midwife (CNM), certi-
fied registered nurse anesthetist (CRNA), clinical nurse specialist (CNS), and certified
nurse practitioners (CNP).
The actual 2- day examination is based in part on Step 3 of the United States
Medical Licensing Examination (USMLE). It consists of two 5- hour tests administered
in 60- minute blocks allowing 90 seconds per question (ABCC, 2009). The examination is
comprised of two dimensions including: (a) 336 multiple- choice questions that require
action- oriented clinical decisions and judgment for normal development and disease,
and (b) a series of dynamic interactive patient vignettes that evaluate the diplomate can-
didate’s ability to apply knowledge and to manage a variety of patient problems across
various health care settings along a simulated- time format. Acting as primary health
care providers, diplomate candidates manipulate simulated time in a variety of acute
or chronic patient cases by advancing the computer clock to find out results of diagnos-
tic tests, procedures, and patient conditions so that additional assessments, treatment
orders, consultations, and interventions can be formulated. Diplomate candidates are
allotted 25 minutes to complete each patient vignette, and scoring is based on algo-
rithms derived from codified policies of experienced health care providers.
Diplomate candidates are expected to possess advanced- level knowledge in nor-
mal development, mechanisms of disease, and general principles of patient- care man-
agement (ABCC, 2009). In addition, they are expected to provide evidence of an in- depth
understanding of disorders of the blood and of the central nervous, mental, skin, mus-
culoskeletal, respiratory, cardiovascular, gastrointestinal, renal and urinary, male and
female reproductive, endocrine, and immunologic systems. The diplomate candidate
is also expected to demonstrate expertise across a variety of clinical tasks including the
ability to perform history and physical assessments, order appropriate diagnostic tests,
formulate diagnoses and prognoses, order appropriate medications, perform health
maintenance, understand disease prevention, provide clinical interventions, communi-
cate with multidisciplinary health care team members, demonstrate an understanding
of legal and ethical issues, and demonstrate an understanding of patient- care manage-
ment across a variety of health care settings.
Three eligibility criteria are required to sit for the examination: national certifi-
cation as an APRN, graduation from an accredited DNP program, and recognition or
licensure by a state board of nursing as an APRN (ABCC, 2010). Although the DNP
examination was not designed to replace national certification or guide curriculum
development, the NBME and CACC consider it an additional assurance to the public
of a high level of clinical competency and safety of the DNP graduate. A controversial
issue that has not been fully addressed is whether future non- DNP- educated doctoral
APRNs with a different doctorate degree (e.g., PhD) may be eligible to sit for the exami-
nation, because at present they are not eligible.
■ ARGUMENTS FOR THE DNP EXAMINATION
Proponents of the DNP certification examination argue that it was never designed to
evaluate clinical expertise among nonclinical DNP graduates (administrative and edu-
cation tracks; NBME, 2009). According to the NBME and CACC, the DNP examina-
tion was designed to assure the public that clinical DNP graduates function within
the boundaries of their practice as well as meet the standards of their profession. They