21: THE DNP CERTIFICATION EXAMINATION ■ 473DNP certification examination is based on the practice of medicine and does not measure
APRN expertise. Unlike current national certifying examinations for APRNs, opponents
believe that the DNP examination is extraneous and unrelated to advanced practice
nursing. NONPF (2008), which designed a population- based academic curriculum for
the DNP, issued a statement that the individual- based DNP certification examination
from the NBME is too broad to assess competency among DNP graduates with differ-
ing roles and specialties. This statement was also endorsed by six other organizations
representing nurse practitioners including the AANP, ACNP, Association of Faculties
of Pediatric Nurse Practitioners (AFPNP), National Association of Nurse Practitioners
in Women’s Health (NPWH), National Association of Pediatric Nurse Practitioners
(NAPNAP), and National Conference of Gerontological Nurse Practitioners (NCGNP)
(Johnson, 2008).
Several physicians have expressed concern regarding the ability of the DNP to
practice independently (Guadagnino & Mundinger, 2008). In addition, some physi-
cians have raised concerns that unsupervised DNP diplomates will ultimately decrease
patient safety and quality of care. Some opponents also argue that there is no research
to substantiate that DNP certification improves patient care (Michalski, Sagan, Moore,
Bednash, & Rosseter, 2006). Finally, opponents argue that adding another layer of cer-
tification will dissuade nurses from becoming APRNs and further decrease the pool of
available primary care providers (NONPF, 2008).
In summary, opponents argue that the DNP certification examination is irrelevant
to nonclinical DNP graduates and DNP graduates who do not have expertise in family
and adult advanced nursing practice. Furthermore, opponents believe that it:
- Blurs the lines between physician and doctoral advanced nursing practice
(Guadagnino & Mundinger, 2008; Hoyt & Proehl, 2009) - May result in physician regulation of advanced nursing practice (NONPF,
2008) - Is unnecessary as a plethora of psychometrically sound national certifying
examinations already exist (Counts & Dempster, 2008; NONPF, 2008) - Is too broad to assess competency among DNP graduates with differing roles
and specialties (NONPF, 2008) - Could result in decreased safety and quality of care (Guadagnino &
Mundinger, 2008) - May dissuade nurses from becoming APRNs (NONPF, 2008)
- May add an extraneous certification examination that may increase barriers to
practice (NONPF, 2008)
■ WHERE DO WE GO FROM HERE?
We are currently sitting at another crossroads in nursing history where proponents and
opponents of the DNP competency examination are currently unable to find a mid-
dle ground between their two divergent positions. The nursing profession has con-
tinually experienced “growing pains” since the days of Florence Nightingale. While
some innovations have flourished, others have failed, and yet others have undergone
metamorphosis through lively dialogue. For example, when the National League for
Nursing (NLN) refused to give nurse- midwives a special niche during their 1954 con-
vention, a group of nurse- midwives formed the ACNM (Rooks, 1997). Despite the alien-
ation that nurse- midwives felt from the nursing profession in the 1950s, today State
Boards of Nursing, the Advanced Practice Registered Nurse Consensus Group, and the