Dear Editor,
Although the National Association of Clinical Nurse Specialists (NACNS) has officially claimed to be neutral on the advent of the doctorate of nursing practice (DNP), I am concerned about what I have perceived as negativity about the DNP over the last several years, especially during the NACNS annual meetings. As a graduate of the first DNP class at the University of Kentucky, I can offer a different view of the DNP. I would like to address some commonly discussed concerns about the DNP.
Many have been concerned that the DNP programs will siphon off candidates for more research-focused doctoral programs, such as doctor of philosophy (PhD) or doctor of nursing science (DNS) programs, when we presently do not have enough nurses interested in pursuing these degrees, and that this diversion of doctoral candidates will eventually reduce our scientific base. I am 25 years post-master's and had never pursued a PhD or a DNS because of their focus on research. Although I did do a master's thesis and I have always been committed to the application of research to practice, I was not interested in being primarily a researcher. Rather than focusing on the generation of new knowledge, the DNP focuses on the application of existing knowledge, trying to shorten the 16- to 20-year gap between the discovery and application of new knowledge. As my classmates and I talked about why we were in the DNP program, a recurring theme could be noted: we would not be in a doctoral program at all if this option did not exist. Most of us were CNSs and nurse practitioners and had been functioning in advanced practice roles for many years without enrolling in a doctoral program. I believe that the DNP will open an entirely new pool of doctoral candidates and that researchers need doctorally prepared clinicians to assist in the translation of research to practice. In my opinion, it is a match made in heaven.
Although all CNSs are teachers of patients and staff, many of us have opted to accept faculty positions in schools of nursing. The faculty shortage is fueling the nursing shortage, and schools of nursing are in desperate need of classroom and clinical faculty. Many have voiced concerns about whether the new DNP graduate will be accepted into tenure track positions. I was offered a tenure track position, but because I knew that I would be evaluated by the tenure track criteria, which is heavily influenced by the acquisition of extramural funding for research projects, I opted to accept a clinical track position. Could I have chosen to focus my attention on translational research or the scholarship of teaching and learning and achieve the requirements for tenure? Yes, but that is not my interest. I am a clinician and a teacher. Would I like to see a restructuring of the promotion and tenure criteria to reward excellence in clinical practice and pedagogy? Absolutely, but I do not see that shift coming any time soon. I have heard that some deans claim that they would not hire a DNP and certainly not offer them a tenure track position. Are there nurses with doctor of education degrees and other nonnursing doctorates in tenure track positions at those institutions, and would those deans not prefer to have nurses doctorally prepared in the discipline of nursing in those positions?
We want faculty to be doctorally prepared. Are faculty members with a research-focused doctorate better teachers than faculty members who are master's or DNP prepared? In undergraduate and advanced practice programs, current clinical expertise is crucial. In addition, all faculty members should be skilled in the effective facilitation of learning. The "sage on the stage" is dead, and undergraduate and advanced practice students expect and deserve faculty members who are knowledgeable clinical experts and skilled in effective teaching-learning strategies, whether PhD, DNS, DNP, or master's prepared. Just being knowledgeable about the content that you are teaching does not make you an effective teacher. These are additional skills that all faculty members must attain.
In conclusion, even if NACNS chooses to oppose the DNP as the entry level for the advanced practice nurse, we should not be opposed to the DNP in principle. This would be eliminating a career option that, in my opinion, is perfect for the advanced practice nurse who desires to bean expert clinician and teacher. We need options because we do not all want to be the primary researchers that the research-focused doctoral programs are designed to develop. Many nurses with PhD and DNS degrees are not researchers. They are clinicians and teachers who opted to take advantage of the one doctoral option that was available. Choice is good. Keep your mind open and do not close this door.
Robin Donohoe Dennison, DNP, RN, CCNS
Assistant Professor of Clinical Nursing
University of Cincinnati
Cincinnati, Ohio
NACNS BOARD RESPONSE
The Board of Directors of the National Association of Clinical Nurse Specialists (NACNS) is pleased to respond to Dr Dennison's letter to the editor of the Clinical Nurse Specialist: Journal for Advanced Nursing Practice. First, the board thanks Dr Dennison for her willingness to share her opinions with the readers of the journal. The journal is a communication venue for clinical nurse specialists (CNS) and supports commentaries on issues of relevance to CNSs. Second, the board wishes to clarify a few points that Dr Dennison raised.
Dr Dennison correctly identified NACNS's position on the doctorate of nursing practice (DNP) as neutral. This neutral position is specified in NACNS's White Paper on the Nursing Practice Doctorate (April 2005) available on the NACNS Web site (http://www.nacns.org). Although more than a year has passed since the White Paper was originally published, the board's position continues to be neutral.
Why neutral? A number of documents were reviewed at the time that the White Paper was developed. Analysis of issues at that time identified both opportunities and areas of concern related to American Association of Colleges of Nursing's (AACN) proposed DNP. Opportunities identified included many of the points that Dr Dennison herself includes as rationale for the affirmation of the DNP. These points include the fact that there is a need to engage in national dialogue about nursing practice competencies, clarify expectations for outcomes of care at all levels of nursing, and discuss leadership roles in today's complex healthcare system. The board's neutral position was the result of many unanswered questions related to the proposed DNP degree. Insufficient data were available to support either a positive or negative position by NACNS.
The NACNS White Paper is framed as a series of thought-provoking questions that should be considered in developing an educational course for our profession. The questions are offered to support continued national dialogue. Many of the questions have not been fully addressed at the time of writing this response.
Dr Dennison suggests that NACNS's neutral position on the DNP discriminates against members who have chosen a DNP degree. On the contrary, NACNS welcomes all CNSs regardless of graduate preparation as NACNS has consistently defined a CNS as a nurse prepared by either master's or doctoral degrees.
Readers may be interested in knowing that Dr Dennison was invited to and participated as a discussant in the 2007 CNS Summit, an annual meeting convened by NACNS to bring together the CNS community around issues impacting CNS practice. The 2007 Summit provided an opportunity for NACNS and specialty nursing organizations to discuss competencies necessary for CNS practice at the doctoral level. This discussion contributed to NACNS's explorations into curricular recommendations for CNS doctoral level education. The NACNS Board of Directors sincerely thanks Dr Dennison for her willingness to serve as a participant in the Summit.
Sincerely,
NACNS Board of Directors