1. Marecki, Marsha EdD, WHNP-C

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Although there are reasons to support the DNP degree, I believe that we should not mandate the DNP for APNs by the year 2015, as proposed by the American Association of Colleges of Nursing (AACN). One of the major criticisms is the notion that the DNP will place nursing more on par with the education of MDs and PharmDs (AACN, 2004, 2006). Most disciplines that prepare licensed independent practitioners (e.g., podiatrists, psychologists, optometrists, PharmDs, osteopaths, medical doctors, and dentists) have the doctorate as the entry into practice degree. Nursing does not. Nursing has, as we all know, multiple educational routes into the profession and has relied on the master's degree for advanced practice. One problem with the DNP, therefore, is the concern that a transition to clinical doctoral preparation for nurse practitioners will disenfranchise master's prepared practitioners; we must guard against this happening (American Academy of Nurse Practitioners, 2006).


The suggestion by supporters of the DNP that more education will lead to equality with other healthcare professions may not be a reality for nursing, because we continue to have debates about entry into professional nursing practice. The professions that offer professional doctorates (such as medicine) also have control over their practice and are not required to have collaboration agreements in order to practice. Currently, nurse practitioners must have a collaborative agreement with a physician in most states. Because collaborative agreements control the APN practice arena, the DNP could interfere with the scope of the APN's role. If the DNP becomes the degree for ANPs, then autonomy will have to be a key concept in the practice of ANPs in the future. This could involve immobilizing our profession in legal battles for years, however. Do we want to change our nurse practitioner acts in each state to include the DNP? This is a tenuous situation that may affect practice in an unfortunate way.


Another point to consider in arguing against the DNP is the length of time needed to complete its educational requirements. This educational rigor can only impede professional practice in underserved areas. Fewer APNs will mean a professional shortage of healthcare providers in areas that already face a healthcare delivery crisis. What about the argument that a DNP will increase a nurse's financial remuneration? Pursuing a DNP will not necessarily do this and could even prove economically disastrous. Nurses may out-price their practice and make themselves no longer cost effective to the already financially overburdened healthcare system. Insurers will still reimburse only at a certain percentage.


Another argument against a DNP is the preparation of educators in these DNP programs. Already there is a shortage of nursing faculty nationwide. Suggesting that we now must create a DNP faculty to educate these new practitioners is a premature endeavor. Challenges of credentialing, faculty practice, and funded clinical evidenced-based research may be out of reach for certain academic programs, yet these fundamental requirements are necessary to stay competitive with other professional doctorates. An additional concern is the regulation of the DNP, which could create chaos in each state and nationally, because regulation of nursing has always varied from state to state. It could also worsen the difficulties between APNs and physicians, just as most past efforts by nursing to gain more control and power in the healthcare delivery system have been met with confrontation by organized physician groups.


In my opinion, the DNP for nurses will require a great deal of thought and planning to allow for transition into a nursing future that is unpredictable.




AACN. (2004). AACN position statement on the Practice Doctorate in Nursing. Washington, DC: Author. [Context Link]


AACN. (2006). Draft: DNP essential revised, February 16, 2006. Retrieved October 2006, from[Context Link]


American Academy of Nurse Practitioners. (2006). Discussion paper: Doctor of Nursing Practice. Washington, DC: Author. [Context Link]