the move toward the dnp degree title
Ten nursing schools across the US have DNP programs; and 40 more have a curriculum in the works. Is the DNP designation the wave of the future?
By Joan Tupponce

As health care becomes more complex, the level of information required for nursing specialists has expanded. In the past, a master's degree was the degree of choice. But that may be changing with the formation of the Doctor of Nursing Practice or DNP degree.

More than 40 doctor of nursing practice programs are being developed nationwide following the American Association of Colleges of Nursing's (AACN) decision in October 2004 to endorse a position statement which called for moving the current level of preparation necessary for advanced nursing practice roles from the master's degree to the doctorate level by the year 2015. Included in this statement were recommendations that all practice doctorates carry the same degree title, namely the Doctor of Nursing Practice or DNP, and that an accreditation process be developed to assess the quality of these programs.

"This program is designed to be different than a PhD program, which is typically research oriented," explains Jeanette Lancaster, PhD, RN, FAAN, Sadie Health Cabaniss Professor and Dean, PS University of Virginia School of Nursing. "The DNP educational route is for highly skilled clinicians, some nursing educators and nurse administrators."

One focus of the DNP degree is evidenced-based practice, looking at the body of current research and best practices. "[It's about] basing clinical actions on clinical research," explains Lancaster.

Like any change, the move to establish this degree has its proponents and opponents. In looking at the pros, Lancaster talks about the number of credits that many nurses accrue in the master's degree program.

"People are going to school for several years and some master's programs have up to 60 credits and more - [many master's degree programs are 30-40 credits to complete]," says Lancaster . The DNP would then be an "equitable degree for the amount of preparation that nurses are putting in."

Another pro: alignment with other health care degrees. "Most people in the health care discipline when they are at the top of the clinical ladder have a doctor's degree," says Lancaster , noting that the DNP would give nurses at the top of their field the same designation.

Last September, in a move consistent with other health professions, the Commission on Collegiate Nursing Education (CCNE), the autonomous accrediting body of the AACN, decided that only practice doctoral degrees with the Doctor of Nursing Practice (DNP) title will be eligible for CCNE accreditation.

"Consistent degree titling will help to reduce confusion among health care consumers about the qualifications of doctorally prepared nursing clinicians," says Dr. Mary Margaret Mooney, Chair of the CCNE Board. "With dozens of practice doctorates now in the development stage, CCNE deemed it important to articulate a position that may assist programs in adopting a common degree name."

Dr. Mooney represents CCNE on the AACN task force charged with developing the DNP essentials that will outline curricular expectations for practice doctorates in nursing. Represented on the CCNE Board of Commissioners, which is separate and distinct from the AACN Board of Directors, are nursing deans, nursing faculty, practicing nurses, professional consumers (employers of nurses) and public consumers.

CCNE's decision to consider for accreditation only practice doctorates with the DNP title is consistent with good accreditation practice and with similar actions taken by accrediting organizations for the other health professions. The nationally recognized organizations responsible for the accreditation of doctoral degrees in all opathic medicine, osteopathic medicine, optometry, podiatry, pharmacy and chiropractic, as examples, require a specific degree title in order for the doctoral programs to qualify for the accreditation process.

"This requirement helps to assure consistency in degree titling, which, in turn, helps to protect consumers and the general public - a primary goal of CCNE accreditation," explains Dr. Jennifer Butlin, Director of CCNE. "In other health professions where degree names have not been an issue, practice doctorates are consistently titled. For example, all of the accredited practice doctorates in physical therapy and occupational therapy are titled DPT or OTD, respectively."

Not everyone wants to add a new degree program to the curriculum.

"Change can be unsettling," says Lancaster . "This will require creative thinking. Schools will have to move what has typically been at the master's level into a clinical doctoral level. It will take longer to get advanced practice education in the doctoral program than it did in the master's program. Each school of nursing must decide if it wants to offer this degree. A professional organization can't make academic institutions [create this program]. I do think that schools will move toward it."

According to Lancaster there are no current programs in Virginia schools. "I believe there are several in the planning stages," she says. "In Virginia , universities are required to go to the State Council of Higher Education for approval of the new degree."

Each school charts its own course, Lancaster adds. "My projection is that many of our schools in the state will go in this direction. I've seen a lot of excitement from people in the clinical area. This degree will keep them close to clinical practice. We want them to continue to give care to patients. We also want to give them an opportunity to advance in their own educational preparation."

For more information about CCNE, see www.aacn.nche.edu/Accreditation. For details about the movement toward the practice doctorate in nursing, see www.aacn.nche.edu/DNP.