The meeting was an opportunity for parents to discuss special services needs for school-age children. In addition to the parents, who had prepared brief statements outlining concerns and possible solutions, the attendees included members of the local school board, the state department of education, and several state legislators. As the parents spoke, the need for more speech therapy services became a common thread. On this subject, the representative from the state department of education responded that universities are not graduating many speech therapists, and that one local university program had to close because of faculty retirements and the inability to replace them with new faculty. Putting pressure on universities to increase enrollment was not effective because therapists in private practice earn higher salaries and have more benefits, thus it is difficult to recruit new faculty. "I don't understand," the education department representative said more than once, "why someone with a college degree-a bachelor's degree in a speech and hearing-is not qualified to independently deliver some level of speech therapy service." In response, a legislator asked if the regulatory changes specifying higher educational requirements for speech therapists, recently implemented by the state board of health professions, had contributed to the problem. No one was sure; no data were available. However, the parents eagerly suggested increasing the number of speech therapy aids because, from their perspective, some level of service was better than no service. A parent noted that the special education rules were changed to allow for services by nonlicensed aids, to which a speech therapist responded that her practice has moved from direct care to supervision of therapy aids.

Perhaps this meeting is a foreshadowing of the future of healthcare services with clinical practice doctorates for advanced practice nurses. One argument for creating a clinical doctorate in nursing has been the movement toward clinical doctorates by other health professions. Audiology was among the first to move to a clinical doctorate. Retiring faculty, closing programs, and higher education may all add up to decreased advanced practice nursing services for the public. Many advanced practice master's programs exist in schools and colleges that do not offer and are not permitted to offer doctoral degrees or clinical doctorates. If master's programs close, the number of advanced practice nurses available to provide specialty-focused nursing care would decrease. Adding a requirement for a clinical doctorate to licensure eligibility will create a costly roadblock for many current advanced practice nurses, thus reducing the overall number of practicing advanced practice nurses. It is difficult to believe that patient care will be improved by fewer advanced practice nurses.

The assumption underpinning the notion of a clinical doctorate for advanced practice nurses is that with increased education comes increased clinical ability and better patient outcomes, thus increasing educational requirements will benefit the public. Maybe we should reconsider the assumption. Have we-the greater nursing community and, collectively, the healthcare professions-explored the consequences of clinical doctorates for the public at large? Whose interest is being protected, the public or the professions? At what point does increasing the educational requirements for advanced practice nurses actually hurt the public. By setting the educational standards too high without data to suggest that the current educational standards are lacking, we may well create a small cadre of advanced practice nurses who are so exclusive that they are incapable of addressing the public's need for advanced nursing services. Many parents at the meeting seemed willing to accept a marginally qualified therapy aid delivering some level of services over no services at all because the job for a therapist with a clinical doctorate remains unfilled. The same may occur in nursing and the public will be deprived of quality of care provided by advanced practice nurses.

In this age of technology, the recorded meeting is playing on public access television. How many other such meetings are playing on television? How long will the public be willing to wait for healthcare professions to provide the services they need before the public takes charge? As advanced practice nurses, clinical nurse specialists have a responsibility to address nursing's social mandate and, along with our professional organizations, educational institutions and regulatory agencies, we must advocate for the public's interest. This does not necessarily mean mandating additional education through regulation. Our future is tied to the public interest.