In an effort to raise the standards for advanced-practice nurses — a select group who work as practitioners, midwives, specialists and anesthetists — the American Association of Colleges of Nursing has approved a policy that recommends nursing schools offer a doctorate in clinical nursing.
The recommendation comes amid concerns that advanced-practice nurses need training above and beyond the required master’s degree.
Many nursing institutions are already hard at work making sure that doctoral programs in clinical nursing are available by 2015. But several schools whose current doctoral programs focus more on research say they have no plans to follow AACN’s recommendation.
Advanced-practice nurses typically work with individuals who require long-term health care, such as heart or kidney transplant patients. Experts say the doctorate of nursing practice, or DNP, will eventually be a requirement for nurses who work within an advanced specialty field.
“There seems to be no end in sight for the need for highly educated nurses to take care of patients,” says AACN President Jeanette Lancaster. “Many people have enormously complex health conditions, and you need people who are highly prepared in the specialty they are working in.”
The new recommendation, however, has sparked controversy, particularly among those who argue that it will prevent low-income or first-generation minority professionals, who may not have the means to finance a doctoral education, from advancing in the field.
“I do think that there are class and ethnic issues, especially given the curtailment of funding for graduate education and the salary levels of nurses, whether in practice or on teaching faculties,” says Dr. Nona Y. Glazer, emeritus professor of sociology at Portland State University.
Kimberly Maciorowski, a senior at the University of Pennsylvania’s School of Nursing, says the recommendation may be discouraging to students who have plans of pursuing an advanced degree.
“We come from very different backgrounds and degrees,” she says. “We really struggle to find a shared identity, and I don’t know that this will be the best move for the profession to have one more rung on the ladder.”
Meanwhile, some officials are concerned that AACN’s recommendation will encourage nursing institutions to replace their existing master’s programs with doctoral offerings.
“There is a significant and measurable difference between the two currently existing degrees,” says Dr. Mary Mundinger, dean of Columbia University’s School of Nursing. “Public safety and quality require that we increase and standardize the level of competency from master’s-prepared nurses when awarding the DNP degree.”
The master’s degree offered at Columbia is typically a two-year program based in a specialty such as primary care, midwifery or anesthesia. Graduates of the program are trained in site-specific care, such as in an office or intensive care unit, Mundinger says. The DNP requires an additional two years of study.
Columbia became the nation’s first school of nursing to offer the DNP, making it available in 2004.
“We at Columbia believe there is a valuable role for master’s-prepared advanced practice nurses, and that the DNP is additional knowledge and competency. We don’t think everyone should get the DNP,” Mundinger says.
Although AACN member institutions approved the DNP in October 2004, it will not become effective until 2015. The delay will allow nursing institutions across the country to bring their existing specialty programs up to the doctorate level. To aid institutions in that transition, AACN has formed two task forces that mandate what a doctoral curriculum in nursing should look like.
“The essentials help you understand what needs to go into your curriculum and what needs to be covered, but it does not tell you how to do it,” says Lancaster.
Not all nursing institutions are jumping at the prospect of revamping their current programs. Officials at several schools insist that their existing doctoral programs — which focus on research over clinical practice — work just fine.
“We don’t intend to pursue the DNP degree,” says Dr. Daniel J. Pesut, associate dean for graduate programs at Indiana University’s School of Nursing. “Our faculty believes that the Ph.D. program is the best choice for us at this point.”
Penn’s School of Nursing has also decided to maintain a research-based doctoral program, according to the school’s dean, Dr. Afaf I. Meleis.
“At this time, the faculty decided that they are devoting their efforts to the education of future scientists and faculty members through the Ph.D. and postdoctoral programs,” she says.
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