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In a 2005 white paper, the National Association of Clinical Nurse Specialists (NACNS) outlined concerns and questions surrounding the then-proposed doctor of nursing practice (DNP) degree. In the end, NACNS decided to take a neutral position regarding the DNP degree.1 Recently, NACNS board of directors reaffirmed the position of neutrality-neither endorsing nor opposing the DNP degree as an option for clinical nurse specialist (CNS) education.2 The board also affirmed the organization's long-held position of supporting graduate education for the CNS at either the master's or the doctoral level, provided the program follows curricular recommendations for preparing graduates to meet entry-level CNS practice competencies.3,4


This affirmation of graduate education at either master's or doctoral level is important in the face of the nursing or, more specifically, the current CNS shortage. Preserving existing master's-level CNS programs helps continue a flow of new graduates to meet expanding need. Although some schools may choose to move to DNP education, not all schools have the option or capacity to make the change. Given the current economic downturn, the added tuition of a DNP degree may not be warranted for everyone, and salaries offered by healthcare systems for additional DNP education may not materialize. It may be some time before the benefits of a DNP emerge.


Also important to note is the board's reaffirmation that CNSs graduate from programs specifically designed to prepare students with CNS practice competencies. Practice competencies are developed by professions to communicate performance expectations to the public and other providers. Practice competencies also guide curricula. Graduates should be prepared to meet performance expectations identified by entry-level practice competencies. Clinical nurse specialist master's-level competencies have been in place since 1998.3 An NACNS task force has been developing doctoral-level practice competencies with release planned for summer 2009. These new doctoral-level CNS competencies are particularly important for programs offering bachelor to doctorate options. In addition, NACNS board reports that curricular standards for both master's- and doctoral-level CNS programs will be released late summer 2009. The new curricular standards will replace the original master's-level curriculum recommendations.3,4


These developments are all good news. Clinical nurse specialist programs, although less diverse since the first curricular recommendations were released, have never been guided by national CNS curriculum standards. Over the years, differing CNS preparation has led to varied role expectations and practice competencies, a situation that underlies some of the current exchanges about the DNP on the CNS listserv. On the listserv, CNSs ask questions about the practice doctorate and exchange information about programs. Among the responses are testimonials to increased knowledge and skill gained from earning a DNP degree, often with specific clinical examples cited. Responders contest the examples, citing knowledge and abilities to perform at the same level with a master's degree. As an observer of these conversations, I believe such exchanges are evidence of years of variability among CNS curricula. Where master's programs underprepared graduates for the CNS role, are those graduates finding the doctoral degree fills in the gaps? Do graduates of master's programs that required courses in statistics, research design, research utilization, and original research (thesis), as was common among programs in the 1970s and 1980s, find a practice doctorate's emphasis on evidence-based practice to be redundant-old ideas in a new package? Do the newer DNP programs focus on current topics in health and nursing care and are thus more applicable? Are some new practice doctorate programs less rigorous than some older master's programs? These and other explanations are plausible. No minimum level of performance with corresponding curricular recommendations existed for CNSs until recently. Or could it be that experience does bring knowledge and wisdom, and some CNSs are excellent examples of lifelong learning regardless of the academic degree?


The current work of NACNS is important because it is creating a much needed minimum practice expectation for graduates and leveling the expectations by degree awarded. Through these initiatives, NACNS is moving CNS practice forward and safeguarding the public's access to CNS services by shaping contemporary CNS practice and education. The journal continues to invite articles and letters addressing CNS education and practice competencies at both the master's and doctoral level-although listserv conversations can be more expeditious!




1. National Association of Clinical Nurse Specialists. 2005 White paper on the nursing practice doctorate. Accessed June 2, 2009. [Context Link]


2. National Association of Clinical Nurse Specialists. Position statement on the nursing practice doctorate. Accessed June 2, 2009. [Context Link]


3. National Association of Clinical Nurse Specialists. Statement on Clinical Nurse Specialist Practice and Education. Harrisburg, PA: NACNS; 1998. [Context Link]


4. National Association of Clinical Nurse Specialists. Statement on Clinical Nurse Specialist Practice and Education. 2nd ed. Harrisburg, PA: NACNS; 1998. [Context Link]