Position Statement of the PA State Nurses Association
on
Doctor of Nursing Practice

Background

Prior to 1979 nurses pursuing doctoral education were either in research-focused programs (Doctor of Philosophy – PhD) or what was initially termed ‘professional nursing doctorates’ - the Doctor of Nursing Science (DNSc, DNS, or DSN) (AACN, 2004) or the lone EdD in Nursing Education at Teacher’s College. In 1979 Case Western Reserve University became the first institution to offer an entry-level nursing degree called a clinical doctorate, the Doctor of Nursing (ND). Over the course of some twenty-five years the ND degree never gained widespread acceptance as an entry level degree for professional nursing, with only four progams ever established. In 2000, Mundinger and Kane published a report in Journal of the American Medical Association detailing a new clinical doctorate degree in development at Columbia University– the doctor of nursing practice (DrNP). In 2001, the University of Kentucky founded the first doctor of nursing practice degree (DNP) – albeit a different model. A year later in March 2002, the American Association of Colleges of Nursing (AACN) Board of Directors charged a task force with examining the status of current clinical or practice nursing doctorate programs in the United States and with making future recommendations. Over a period of two years the AACN, in partial collaboration with the National Association of Nurse Practitioner Faculties (NONPF), worked on this emerging issue. In October 2004 the AACN membership voted by a margin of 160 ‘for’ and 106 ‘against’ (with 53% of eligible schools voting) to approve the DNP (Doctor of Nursing Practice) as the entry level degree for all advanced practice nurses (APN) by 2015. As of November 2005, there are eight DNP programs and two DrNP programs with approval to enroll students in the United States, although the controversy over this degree persists.

Position Statement

PA Nurses supports doctoral preparation in nursing and the American Association of Colleges of Nursing’s (AACN) effort to advance nursing practice and create more parity between nursing and other health care professionals. However, PA Nurses does not support, at this time, the AACN mandate that all entry level APNs have the Doctor of Nursing Practice by 2015. We support open and vigorous dialogue with many more stakeholders, including all major APN organizations and the American Nurses Association. We call for more evidence-based research on the cost effectiveness and benefits to patient care related to any new practice doctorate degree model.

Rationale

While the AACN has moved forward with the 2015 proposal and is now taking the first steps towards accrediting DNP programs (but not DrNP programs), there has still been no national consensus about the doctor of nursing practice from any of the major advanced practice nursing organizations or the American Nurses Association. Below are their most current positions on the doctor of nursing practice:

• The National Association of Clinical Nurse Specialists published a White paper on the Nursing Practice Doctorate in April 2005 and described multiple reasons for their decision to not support the DNP proposal. Their reasons include the threat to the future of MSN programs in colleges where there is no charter to confer a doctoral degree (and thus will these programs be forced to close?) and the lack of outcome data on the need for APNs to be prepared at the doctoral level.
• In June 2005 the American College of Nurse Midwives (ACNM) Division of Accreditation Governing Board affirmed that the Doctor of Nursing Practice may be one option for some nurse-midwifery programs, but that the ACNM “does not support the DNP as a requirement for midwifery education” (p. 1).
• In June 2005 the American Association of Nurse Anesthetists (AANA) convened a summit on doctoral preparation for nurse anesthetists. They indicated in their final report there was no support from the AANA to move nurse anesthesia education to the doctoral entry level by 2015, although the issue of doctoral preparation for nurse anesthetists in general would continue to be examined by the association.
• The three major organizations representing nurse practitioners are speaking independently and perhaps they ought to jointly produce a consensus statement on the practice doctorate (if possible). At present, the American College of Nurse Practitioners does not have an official position on the DNP. National Organization of Nurse Practitioner Faculty has not fully endorsed the AACN proposal, despite their close work with the AACN on the development of the practice doctorate. The American Academy of Nurse Practitioners, representing the largest number of NPs, appears to somewhat support the DNP, although they do raise eight important issues or concerns (2005).
• Finally, in June 2005 the American Nurses Association raised some thirty unanswered questions regarding the DNP that pertain to education, practice, economics, regulation, and credentialing.

PA Nurses agrees that some of the arguments presented by the AACN for an entry level doctorate for APNs are valid: 1) the time spent in master's level nursing education is often not congruent with the degree earned; and 2) there is the need for more parity with other health professions, most of which have a doctorate as the credential required for practice (i.e., DPT or PharmD). Nevertheless, PA Nurses believes there needs to be much more analysis, careful study, publication of outcomes from current programs in operation, and more input from agents within nursing and outside nursing before a more fully informed decision to support the AACN 2015 proposal can be weighed.

References

American Academy of Nurse Practitioners. (2005, October). Discussion paper: Doctor of

Nursing Practice. Retrieved November 28, 2005 from the AANP website:

http://www.aanp.org/NR/rdonlyres/eohypbva5ab2yefiszlbl3nttmi3czv2lojklfe
chu5w3lecyuy6gmnn6ykpzv6xhjmropsmeo2wou3ebo6qhdsafgf/Doctor+of+
Nursing+Practice+_DNP_+Discussion+Paper.pdf.

American Association Colleges of Nursing. (2004, October). AACN Position Statement on the
practice doctorate in nursing. Retrieved October 5, 2005 at http://www.aacn.ncha.edu.

American Association of Nurse Anesthetists. (2005, June). Report of the American Association of
Nurse Anesthetist’s Summit on Doctoral Preparation for Nurse Anesthetists. Retrieved November 4, 2005 at http://www.aana.com/education/pdfs/090205/DNP%20Summit%20Final%20Report.pdf.

American Nurses Association. (2005, June). Questions/Concerns to be Addressed Regarding
Doctor of Nursing Practice. Retrieved November 4, 2005 at http://nursingworld.org/gova/state/
april19call/dnphandout.pdf.

ACNM Division of Accreditation. (2005, June). Statement on Midwifery Education.

Retrieved November 4, 2005 at http://www.acnm.org/siteFiles/DNPstatementedited.doc.

Mundinger, M.O., & Kane, R. L. (2000). Health outcomes among patients treated by

nurse practitioners or physicians. Journal of the American Medical Association, 283, 2521-2524.

National Association of Clinical Nurse Specialists. (2005, April). White paper

on the Nursing Practice Doctorate. Retrieved May 20, 2005 from http://www.nacns.org/papers.shtml.

National Association of Nurse Practitioner Faculties. (2005, November). Practice

Doctorate Resource Center: Frequently asked questions. Retrieved November 4, 2005 at http://www.nonpf.com/NONPF2005/PracticeDoctorateResourceCenter/PDfaqs.htm.

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