34 ■ I: HISTORICAL AND THEORETICAL FOUNDATIONS FOR ROLE DELINEATION
However, even the NAS recognized that “the concept of a nonresearch clinical doctorate
in nursing is controversial” (NAS, 2005, p. 7). Today, in 2016, we are still wrangling with
this question and we now ask instead: What kind of research (or scholarship) should the
DNP graduate produce?
The first of the chief positive outcomes of the DNP degree is the realization that with
the complexity of health care today, there is indeed curricular content and specialized knowl-
edge beyond the MSN to give DNP graduates additional, enhanced skills. This has been
detailed earlier both by the AACN (2004a) and the National Panel for Nurse Practitioner
Practice Doctorate Competencies (2006). And even with the NONPF (2012) now abandoning
specific DNP only competencies, this text implores the profession to seek the next domain
of doctoral ANP. How can there not be skills, competencies, and expectations of doctorally
educated clinicians over master’s- prepared clinicians? Obviously, there will be continuous
resistance, however, to claiming that there is a domain of practice and a skill set above and
beyond basic advanced practice. Whether the DNP degree ultimately changes the scope and
practice of the advanced practice nurse is another question. Although the AACN (2009b)
says, “No, transitioning to the DNP will not alter the current scope of practice for APRNs”
(p. 1), it is somewhat illogical to require additional skills and competencies for more ANP
and then assume that the scope of practice will not change. Maybe that is actually what the
American Medical Association (AMA) fears the most: not nurses using the title “Dr.” but
real fears about the possibility that the scope and boundaries of their practice will expand
(AMA, 2009). Nevertheless, if there was ever an argument against the DNP, it would be a
situation in which MSN programs simply added a few credits and called the degree a “doc-
torate” without any forthright attention to educating a more highly prepared practitioner.
A second positive outcome is that there is now a widely established nursing doc-
torate that gives nurses an alternative to the PhD (Buchholz, Yingling, Jones, & Tenfelde,
2015; Sperhac & Clinton, 2008). For decades, nurses only had a research- intensive degree,
clinical doctorates that were de facto research- intensive degrees, and four NDs and one
lone EdD— degree models that never gained a foothold within the profession. Whether
it really is in the interest of nursing for there to be only one alternative to the PhD, the
DNP, with the CCNE’s refusal to recognize any form of the practice doctorate except the
initials “DNP,” is still debatable (AACN, 2005b). However, because of the power and
influence of the AACN and CCNE, they are not likely to endorse a third doctorate at this
time. The National League for Nursing Accrediting Commission (NLNAC, 2005) indi-
cated a more progressive stance on titling, however, stating in their NLNAC Statement
on Clinical Practice Doctorates :
Other health care professionals such as dentists (DDS and DMD), psycholo-
gists (PhD and PsyD), and physicians (MD and DO) are able to define their
roles, qualifications, and expertise to their patients and the public with more
than one type of degree. We have confidence that doctorally prepared ad-
vanced practice nurses will be able to do so as well. (p. 1)
Nevertheless, in graduate nursing education circles, the AACN and CCNE seem
to be more influential in some ways, but we must recognize that the former NLNAC,
now ACEN since 2013, and now the NLN CNEA began accrediting nursing programs
in Spring 2016. It should be noted that both ACEN and CNEA will accredit DNP pro-
grams with a focus on nursing education, whereas the CCNE will not (CNEA, 2016). In
the end, often the determining factor of influence is whether it is the CCNE, ACEN, or
CNEA that is accrediting the individual nursing school and sometimes different pro-
grams can be accredited by different agencies as nurse anesthesia, for example, must be
accredited by the Council on Accreditation and sometime additionally by the CCNE or
the newer options.