477chapter TWENTY-ONE
Refl ective Response 1
Michael Clark
In my current role, I teach both master of science in nursing (MSN) and Doctor of
Nursing Practice (DNP) nurse practitioner students. The MSN students frequently ask
me if they “need the DNP.” I tell them that “the market will dictate the answer.” The
only argument that makes sense to me about the validity of the American Board of
Comprehensive Care (ABCC) is whether it is predictive of competence and success in
the marketplace. Certification examinations should address both fiduciary and predic-
tive concerns.
External market forces are driving an increase in the number of bachelor of science
in nursing (BSN) graduates. Employers recognize that nurses need more sophisticated
skill sets in order to meet quality standards and add value to their organization. Similar
forces will drive DNP education.
Currently, there is an explosion of new DNP programs. There are quality concerns
about rigor and variance among programs. I do think that more demanding measures
of competence might have a positive impact on the quality of DNP programs. This
has been seen in BSN education where Commission on Collegiate Nursing Education
(CCNE) requires minimum pass rates for the National Council Licensure Examination
(NCLEX). Currently, the only claim that can be substantiated regarding DNP graduates
is that they take more courses.
There are, however, deeper issues. The ABCC primarily targets DNP essential
eight (advanced nursing practice). Measurement of competence for this essential is nec-
essary but not sufficient. We need to grapple with how we measure the other seven
competencies.
DNP programs may make the case that the scholarly project or capstone is
designed to evaluate multiple DNP essentials. However, there is no practical way to
verify the scope and depth of capstone projects across programs. A test or series of tests
that measure competencies across all eight essentials may serve to ensure minimum
competence in all eight essentials.
It would take time and a good deal of money to develop quality psychometrics
for certification examinations that measure DNP competence in multiple domains.
Many of the constructs need to be developed within the paradigm of improvement
science. These constructs must incorporate many sources of expertise including
those of medicine, business and policy. Having a PhD in nursing does not ensure