Should the nurse become a ‘doctor’?
Graduate studies playing increased role in health care

By Ginger Burggraf DNS RN FAAN
Radford University

With health care processing and using new information daily, the nursing profession has had to keep up with the pace. This has led nursing to expand curriculum and to assess the needs of the market/health-care system.

That same thinking prevailed when I graduated with my BSN. It led to the development of MSN programs. In the '60s, many received their M.Ed. degrees. There were few MSN programs available in the U.S. at that time, but times changed and continue to change - and they challenge us.

A 2005 report, "Advancing the Nation's Health Needs: NIH Research Training Programs," called for the development of a nursing practice doctorate to prepare the expert practitioners needed in the future. The American Association of Colleges of Nursing (AACN) endorsed the Position Statement on the Practice Doctorate and also recommended that the Doctorate in Nursing Practice (DNP) be the terminal degree for advanced nursing practice.

After a consensus-building process, AACN member institutions endorsed the "Essentials of Doctoral Education for Advanced Nursing Practice" in 2006. This document, together with many other supporting documents, provides the basis for the five DNP programs in Virginia: at Radford University, University of Virginia, Shenandoah University, Marymount University and Old Dominion University. Implementation of the DNP for Advanced Practice Nurses (APNs) is expected to be fully implemented by 2015.

Impact of the DNP
Karen Butler, RN, MSN, from the University of Kentucky, recently discussed the impact of a DNP education. Major points in her presentation included:

. constant critique of and search for evidence in classroom and clinical settings;
. improved ability to analyze and grade existing evidence and identify gaps;
. develop creative and effective interventions in academia and practice;
. envision the future and project plans for programming and management;
. lead nursing into the future;
. translate research into practice;
. develop and expand expertise in a specialty area with a unique population.

The American Association of Colleges of Nursing's fact sheet on the DNP indicates that the changing demands of this nation's complex health-care environment require the highest level of scientific knowledge and practice expertise to assure quality patient outcomes. The Institute of Medicine, Joint Commission, Robert Wood Johnson Foundation, and other authorities have called for reconceptualizing educational programs that prepare today's health professionals.

Some of the many factors building momentum for change in nursing education at the graduate level include:

* the rapid expansion of knowledge underlying practice;
* increased complexity of patient care;
* national concerns about the quality of care and patient safety;
* shortages of nursing personnel which demands a higher level of preparation for leaders who can design and assess care;
* shortages for doctorally prepared nursing faculty; and
* increasing educational expectations for the preparation of other members of the health-care team.

In a 2005 report titled "Advancing the Nation's Health Needs: NIH Research Training Programs," the National Academy of Sciences called for nursing to develop a nonresearch clinical doctorate to prepare expert practitioners who can also serve as clinical faculty. AACN's work to advance the DNP is consistent with the call to action.

Nursing is moving in the direction of other health professions in the transition to the DNP. Medicine (MD), Dentistry (DDS), Pharmacy (PharmD), Psychology (PsyD), Physical Therapy (DPT), and Audiology (AudD) all offer practice doctorates.

Do you need such a degree? Yes, particularly if you are planning your career as an Advanced Practice Nurse. There are five Doctor of Nursing Practice (DNP) programs in Virginia. The target for the transition to the DNP is the year 2015. (For information, dnp.radford.edu.)

Editor's Note: Dr. Ginger, RN DNS FAAN, as she is called, has been on the faculty at Radford University School of Nursing for 10 years. She is the coordinator of the graduate program. Dr. Ginger is well known in her specialty area of gerontological nursing, having served previously as a health policy analyst and grant writer with the American Nurses Association. Prior to that time she also served on the faculty at Marymount University and the Louisiana State University School of Nursing in New Orleans.