24 ■ I: HISTORICAL AND THEORETICAL FOUNDATIONS FOR ROLE DELINEATION
2005b). Consequently, is this degree model a clinical doctorate as the profession has tra-
ditionally defined this term? As this author is aware that some Columbia graduates are
actually assuming primary investigator roles and obviously going to be at the forefront
of creating new evidence for the profession, the conclusion is yes, the Columbia DNP
model with its intensive emphasis on clinical practice is a new type of third- generation
clinical doctorate (despite the use of the DNP degree initials).
Historically, credit for the first DNP degree in 2001 belongs to the faculty of the
University of Kentucky. However, this DNP focused on the clinical/ executive manage-
ment role and not advanced practice. As Montgomery and Byrne detail in Chapter 4, it
is perplexing why the AACN membership chose to endorse the Kentucky DNP model
that did not emphasize advanced clinical practice, instead of the Columbia DrNP degree
model that did. It is also unfortunate that the inventors of the Kentucky DNP model did
not publish the reasoning behind their new degree in the peer- reviewed literature. Thus,
we are left only with the dean’s deliberations at the AACN membership to ascertain
why the DNP degree model was preferred and why it was altered (from the Kentucky
degree model) to include the traditional advanced practice role in the organization’s
first endorsement of the degree (AACN, 2004a). Interestingly, the addition of the clini-
cal executive role^12 (termed aggregate/ systems/ organizational focus) was only done
after minor language in the AACN draft document was changed from the January 2004
AACN Draft Position Statement on the Practice Doctorate in Nursing (AACN, 2004b). From
the January 2004 draft, it is stated in Recommendation 8 that:
The practice doctorate should eventually be identified as the preferred grad-
uate degree for APN preparation in the four current roles: clinical nurse spe-
cialist, nurse anesthetist, nurse midwife, and nurse practitioner. (2004b, p. 10)
Two months later, in March 2004, AACN Draft Position Statement on the Practice
Doctorate in Nursing in Recommendation 10 (originally Recommendation 8), the lan-
guage changed to:
The practice doctorate should eventually be identified as the preferred grad-
uate degree for advanced nursing practice preparation, but not limited to [italics
my emphasis] the four current roles: clinical nurse specialist, nurse anesthe-
tist, nurse midwife, and nurse practitioner. (AACN, 2004c, p. 12)
The change in language from APN to ANP is important, because the administra-
tive role could never technically be equated with the advanced practice roles of the four
traditional APRN roles. But if it were under the umbrella of ANP, it could. This inclusion
of the clinical executive role, however, was not widely realized or perhaps promoted
(again we reaffirm the clinical executive has been granted an advanced role by this defi-
nition, but not the advanced role of the educator). Even in the October 27, 2004 press
release by the AACN titled AACN Adopts a New Vision for the Future of Nursing Education
and Practice , the AACN states:
In a historic move to help shape the future of nursing education and practice,
the American Association of Colleges of Nursing (AACN) has adopted a new
position which recognizes the Doctor of Nursing Practice degree as the high-
est level of preparation for clinical practice ” [italics my emphasis]. (AACN,
2004d, p. 1)Further in the press release, the AACN states:Currently, advanced practice nurses (APNs), including Nurse Practitioners,
Clinical Nurse Specialists, Nurse Mid- wives, and Nurse Anesthetists, are