Continued Evolution of the DNP Degree

The Evolution of the Doctor of Nursing Practice Degree

by Grace Buttriss

In 2004, the American Association of Colleges of Nursing (AACN) endorsed the “Position Statement on the Practice Doctorate in Nursing”. This decision was initially made based on research from a task force formed to assess the need for a clinical practice doctorate with specific stakeholders. These stakeholders included education, practice and research.

Related organizations then voted to change the educational level required for Advanced Nursing Practice from the Master’s degree to the Doctor of Nursing Practice (DNP) degree by the year 2015. This motion recommended that the DNP become the terminal degree in nursing practice for all Advanced Practice Registered Nurses (APRNs) which include: Nurse Practitioners, Certified Nurse Midwives, Certified Registered Nurse Anesthetists, and Clinical Nurse Specialists. Based on a positive response to the initial DNP proposal, AACN reaffirmed support for the DNP in 2010.

According to the AACN, the rationale for advancing educational preparation is based on the shifting needs of our existing healthcare environment. The proposed change will require providers to achieve the highest level of scientific knowledge and practice expertise to promote optimal patient outcomes, provide care for complex patients and increase the quality and safety of patient care.

Although the AACN has endorsed the DNP as the entry level for Advanced Practice Nursing, the individual state Nurse Practice Acts are the official guide for an APRN’s practice. Each state Nurse Practice Act provides the initial and subsequent approval to practice defines the scope of advanced practice and supports prescriptive authority. The NP Act additionally supports financial reimbursement for Advanced Practice Nursing care. To date, no Nurse Practice Act has altered the current requirements for any Advanced Practice educational preparation.

Many Advanced Practice Nursing programs are electively transitioning from Master’s to Doctoral degrees with specified end-dates for their Master’s programs. As of April 2013 there were 217 DNP Programs enrolling students with an additional 97 in the curriculum development and approval stages. A number of educational programs are also continuing to award Master’s degrees for APRN graduates, as this is currently the required degree for Advanced Practice Certification.

The 2015 transition from Master’s to Doctoral level preparation for Advanced Practice Nursing remains in the discussion phase among Advanced Practice Groups. Consumer demand, reimbursement, legislation and state regulatory agencies must all agree this is the appropriate direction before final decisions are made. Nursing education institutions and accreditation agencies must also be involved and be prepared to support this decision.

It is probable that Advanced Practice Nurses who elect not to return to school for an advanced degree will be “grandfathered” in their APRN roles and continue to be eligible for recertification within the United States.

There are a significant number of DNP programs currently opening and accepting students. The national Nurse Practitioner and Nurse Anesthetists groups endorse the transition but not the 2015 target date. They are currently proposing a later transition goal date. The National Association of Clinical Nurse Specialists holds a neutral position, and the American College of Nurse Midwives views the DNP as an option but not a requirement.

The National Council of State Boards of Nursing, which is accountable for licensure requirements and the certifying organizations, will likely reconcile the DNP proposal. This most likely will be based on future healthcare reform and the role APRNs will play in the resulting healthcare delivery plan.

Many RN’s, who have a desire to become APRNs, are pursuing their DNP degrees to get out in front of this growing momentum for higher levels of education for Advanced Practice Nursing within the healthcare systems.

The role of nurses within the healthcare systems is rapidly changing. As education levels increase, we will see nurses playing an increasing role in the delivery of high quality and efficient healthcare services across the country.