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In October 2004, the members of the American Association of Colleges of
Nursing (AACN) endorsed the Position Statement
on the Practice Doctorate in Nursing which called for moving the
level of preparation necessary for advanced nursing practice roles from
the master's degree to the doctorate level by the year 2015. The AACN
position statement calls for educating advanced practice registered nurses (APRNs)
and other nurses seeking top clinical positions in Doctor of Nursing Practice
(DNP) programs. The following talking points were developed to help explain
this evolutionary step forward for nursing education.
The Need for Change in Graduate Nursing
Education
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The changing demands of the nation's complex health
care environment require that nurses serving in specialty positions
have the highest level of scientific knowledge and practice expertise
possible. Research from Drs. Linda Aiken, Carole Estabrooks, Christopher Friese, and others
have established a clear link between higher levels of nursing education
and better patient outcomes.
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Some of the many factors which are emerging to build
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
of doctorally prepared nursing faculty, and increasing educational
expectations for the preparation of other health professionals.
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The Institute of Medicine, Joint Commission, and other authorities have
called for reconceptualizing health professions education to meet
the needs of the health care delivery system. Nursing is answering
that call by moving to prepare APRNs for evolving practice.
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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 non-research clinical
doctorate to prepare expert practitioners who can also serve as clinical
faculty. AACN's work to advance the DNP is consistent with this call
to action.
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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.
Impact on Nursing Education and Practice
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Currently, advanced practice nurses, including Nurse
Practitioners, Clinical Nurse Specialists, Nurse Mid-Wives, and Nurse
Anesthetists, are typically prepared in master's degree programs, some of which carry a credit load equivalent
to doctoral degrees in the other health professions.
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DNP curricula build on current master's programs
by providing education in evidence-based practice, quality improvement,
and systems thinking among other key areas.
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Transitioning to the DNP will not alter the current
scope of practice for APRNs. State Nurse Practice Acts describe the
scope of practice allowed, and these differ from state to state. (These
requirements would likely remain unchanged.) The transition to the
DNP will better prepare APRNs for their current roles given the calls
for new models of education and the growing complexity of health care.
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The DNP is designed for nurses seeking a terminal
degree in nursing practice and offers an alternative to research-focused
doctoral programs. DNP-prepared nurses will be well-equipped to fully
implement the science developed by nurse researchers prepared in PhD,
DNSc and other research-focused nursing doctorates.
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The title of Doctor is common to many disciplines
and is not the domain of any one health profession. Many APRNs currently
hold doctoral degrees and are addressed as doctors, which is similar
to how clinical psychologists, dentists, podiatrists, and other experts
are addressed. Like other providers, DNPs would be expected to display
their credentials to insure that patients understand their preparation
as a nursing provider.
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Nursing and medicine are distinct health disciplines
that prepare clinicians to assume different roles and meet different
practice expectations. DNP programs will prepare nurses for the highest
level of nursing practice.
DNP Transition in Progress
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The movement to the DNP has raised many questions about the future of nursing education, certification, regulation and practice. AACN created two task forces, the DNP Essentials and the DNP Roadmap task forces, to define the essential curricular elements of nursing practice doctorates and to address key operational and transition concerns. The results of these two task forces are posted on the Web at http://www.aacn.nche.edu/DNP/pdf/Essentials.pdf and http://www.aacn.nche.edu/DNP/pdf/DNProadmapreport.pdf.
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The Commission on Collegiate Nursing Education (CCNE),
the leading accrediting agency for baccalaureate and higher degree
nursing programs in the U.S., has initiated a process for
accrediting DNP programs as recommended in AACN's 2004 position statement.
Last Update: October 5, 2009
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