Reply To: Potential Crisis in Nurse Practitioner Preparation in the United States

[Susan]

Great discussion~ The crisis that Mundinger and Carter identify is with the preparation of nurse practitioners within DNP programs themselves. The authors discuss the convoluted and fragmented timeline of the development of early DNP programs and the diverging curriculum and outcome competencies for NPs. This approach is unfortunate and all too common in nursing’s history. Originally conceived as a clinical practice doctorate for NPs to meet growing demands for greater clinical expertise, the DNP degree quickly grew in appeal for those who needed advanced knowledge and skills in other roles (CNS, Executive Leadership) to meet the growing complexities of health care. This growth was likely facilitated by the AACN policy change and broadened definition of ‘practice’. “Nursing practice is any form of nursing intervention that influences health care outcomes for individuals or populations,including the direct care of individual patients, management of care for individuals and populations, administration of nursing and health care organizations, and the development and implementation of health care policy. (p. 3).

The fact that 85% of DNP programs are non-clinical is a different issue and one that bears examining. Why are there fewer clinical DNP pathways? Does it reflect less interest among those who want to become APRNs? What does that say about the appeal and value of the degree to those who are already APRNs or who might want to become an APRN but can do so with a master’s degree? What does it say about the value of a DNP in the workplace? Do employers see more value in DNP prepared APRNs?

The authors also point out that approximately 30% of nonclinical DNP programs do not require clinical skills beyond what the nurse had upon entry to the program (Mundinger & Carter, 2019). This seems to be an irrelevant point because if a nurse is pursuing a DNP in an excutive leadership pathway why would they need advanced clinical skills? Instead they need advanced preparation and skills in other content areas. If you agree with the expanded definition of AACN for ‘practice’ then this role pathway within the DNP degree should not be problematic. However, it is interesting that in other disciplines (pharmacy, physical therapy) the practice doctorate is strictly reserved for those in clinical practice. But what options does that leave for those who desire a terminal degree in nursing but do not want to pursue a PhD? Should they seek terminal degrees outside of nursing?