26 ■ I: HISTORICAL AND THEORETICAL FOUNDATIONS FOR ROLE DELINEATION
■ THE AACN’S EARLY DEVELOPMENTAL WORK ON THE DNP DEGREE
While Columbia started down one track toward what it called a new clinical doctorate
(DrNP), which would ultimately become a practice doctorate, and with Kentucky boldly
introducing a practice doctorate (DNP) that did not actually emphasize clinical practice,
we should trace the third track by the AACN that in the end had the most influence. In
March 2002, the AACN Board of Directors charged a task force to examine the current
status of clinical or practice doctoral programs and other related charges (AACN, 2004b).
What is interesting about this 2004 document is that the task force reported that it had es-
tablished a collaborative relationship with the NONPF, and therefore there was a strong
faculty– NP connection in these early deliberations. Yet, there was also no liaison to the
major practicing APRN organizations including the ACNM, the American Association
of Nurse Anesthetists (AANA), the National Association of Clinical Nurse Specialists
(NACNS), the American Academy of Nurse Practitioners (AANP), or the American
College of Nurse Practitioners (ACNP). Further, none of the 10 external reaction panel
members invited by the AACN to comment on deliberations represented these organiza-
tions, and the formal exclusion of the ANA is noteworthy (AACN, 2004c). This lack of
diversity of decision makers and formal consultants to the exclusion of organizations
representing members (and future members) who would be the most impacted by any
proposed change in educational requirements led to early criticism of the AACN for not
fully vetting its proposal with audiences not inclined to agree with them. As Fulton and
Lyon wrote back in 2005, “In proposing the practice doctorate AACN has engaged only
a limited number of stakeholders in meaningful dialogue” (Fulton & Lyon, 2005, p. 3).
As of the writing of the chapter in 2016, only national groups representing nurse
anesthesia and CNSs (two of the four traditional APRN specialties) have endorsed man-
datory doctoral entry. The Council on Accreditation’s (2007; which accredits nurse anes-
thesia programs) requirement that doctoral entry be required by 2015 (the DNP was not
specified as the only option) was actually announced in 2007. In 2015, the NACNS called
for the DNP requirement for entry- level practice by 2030. The NACNS had remained
neutral on the DNP degree, neither endorsing it nor discouraging it for future CNSs
(NACNS, 2009). Part of the NACNS argument was a study presented at the 2007 DNP
Conference in Annapolis, Maryland, indicating significant duplication of curriculum
outcomes between MSN and DNP degrees, and thus the need for another degree was
questioned (Jacobson et al., 2007). Furthermore, because many CNS positions have a
strong research role component (and many have a PhD), a degree that de- emphasizes
the conduct of research was seen as problematic (Fulton, 2010; McNett, 2006). Even
today, this author questions why master’s preparation for the CNS with additional edu-
cation at the PhD level in nursing is not offered as an option.
The ACNM Accreditation Commission for Midwifery Education has gone on
record of endorsing the DNP but not to the exclusion of its other educational entry- level
degree options for nurse- midwives (ACNM, 2009). In 2012b, they updated their 2009
statement with:
There is inadequate evidence to support the DNP as the entry- level require-
ment for midwifery education. While it is true that additional time spent
in an educational environment would likely benefit graduates, no data are
available addressing the need for additional education to practice safely as a
midwife. (p. 1)Finally, with regard to the preparation of NPs, in 2016, the NONPF called for the
preparation of future NPs at the DNP level without a first exit point for the awarding of