The practice doctorate: Implications for nursing education

This study evaluated factors driving the proposal to create the Doctor of Nursing Practice degree to prepare advanced practice nurses. This new degree was designed to replace the Master of Science in Nursing degree, the current entry point to advanced practice nursing as Clinical Nurse Specialists, Nurse Practitioners, Nurse Anesthetists, and Nurse-Midwives. Several reasons have been identified for this educational change including: increased complexity of health care; increased knowledge required of advanced practice providers; trends toward the creation of practice doctorates in other health fields; increased MSN-level credit requirements; and the severe shortage of nursing faculty. Much debate accompanied this suggested educational paradigm shift as schools and faculty determined their response to the American Association of Colleges of Nursing\u27s call for educational change in the preparation of advanced practice nurses. Three research questions guided a series of interviews conducted at three research-focused schools of nursing. Two schools offered the DNP and one school rejected this option. The research questions were: 1. What factors and issues influenced these institutions\u27 decisions to offer/not offer the Doctor of Nursing Practice degree? 2. How was the decision to implement the degree operationalized in the institutions offering the Doctor of Nursing Practice degree? 3. What were the unresolved and future issues (regulatory, employment, etc.) surrounding the development and implementation of the Doctor of Nursing Practice degree for these institutions? A case study methodology was used to address these research questions. A change perspective was used to evaluate the case study findings and outcome data. Factors used to evaluate the schools\u27 decisions to offer the DNP included: perceived fit with the university\u27s and school\u27s mission and goals; a desire to decrease the time from knowledge development to clinical application; achievement of parity with other health-related professions; the schools\u27 leadership style and influence; faculty beliefs about the importance of the PhD vs. the DNP in the advancement of nursing science; and an effort to respond to the nurse faculty shortage. Additional findings were: cost of the program; faculty workload; and the need for post-BSN vs. post-MSN entry into the DNP program. Unresolved issues identified were: the anticipated effect of health care reform including the Affordable Care Act, especially the reimbursement for DNP practice; the appointment of DNP graduates to faculty positions; and the availability of external, especially federal, research funding to DNP graduates