Mary Blegen has eloquently and convincingly identified the extraordinary benefits of three decades of nursing research, guided and proliferated by the National Institute for Nursing Research (NINR). She is so right. As a member of the charter study section of what was then the National Center for Nursing Research, I have been privileged to witness our expanded nursing knowledge buttress and hone nursing practice. Doctoral programs in nursing have proliferated, research journals have matured, and despite concerns about the future of the nursing professoriate, we have faculties with credentials that are consistent with the tradition of the academy.
The potent role of evidence in practice is plain, but evidence, alone, does not yield better clinical outcomes. The translation of evidence into practice requires highly qualified and well-credentialed clinicians, in leadership roles, to introduce and institutionalize practice innovations. An irony of the current debate is that the Doctor of Nursing Practice (DNP) is truly the logical and inevitable product of our researchers, who have expanded our knowledge base so bountifully that it cannot be encompassed in the conventional time and credit allotment for master's preparation. The tenor of the DNP controversy also suggests an intraprofessional dissonance between the practitioners and researchers, despite the experience of other professions in which the advancement of the discipline is related to having both qualified practitioners and scientists, working in an interdependent and mutually respectful way.
Many of the arguments in opposition to the DNP assume a zero sum game in which the practice doctorate will usurp the limited pool of research doctorate aspirants, but where is the evidence? This is not unlike the argument, 25 years ago, that NINR would appropriate resources desperately needed by the Division of Nursing. Indeed, another irony of the debate is that the protestors' commitment to evidence for guiding practice has not been applied to education. A competing assumption to the "limited good" concept might be that the leadership opportunities that accompany the title of Doctor, enjoyed by practitioners in all health professions except nursing, will attract and retain quality, science-oriented individuals who would otherwise have chosen medicine, dentistry, pharmacy, physical therapy, etc., and further, that many of these may pursue a research doctorate.
As the repository of brilliant women with limited career choices, nursing has been able, with persistence and intelligence, to meet professional and intellectual challenges, despite enormous odds. But we can no longer rely on sex discrimination to assure the intellectual capital needed for nursing excellence. To attract the best and brightest to be our future scientists we must engage them. Rather than trying to preserve the scientific integrity of the profession by limiting options for clinicians, we must resolve to creatively expand our pool of potential scientists with direct-entry PhD programs, undergraduate research opportunities, funding students' participation in research meetings, coauthoring papers, mentoring, etc. If the PhD is so fragile that it is threatened by the long overdue appropriate credentialing of qualified practitioners, we have more to worry about in nursing than a new title.
Melanie C. Dreher
Kelting Dean and Professor, The University of Iowa College of Nursing, E-mail: [email protected]