Two certifying organizations have come together to produce a certification exam for Doctor of Nursing Practice (DNP) graduates. The Council for the Advancement of Comprehensive Care (CACC) was established in 2000 for the purpose of developing and promulgating the clinical doctorate role and competencies for nurses in the primary care delivery arena.1 Subsequently, the CACC founded the American Board of Comprehensive Care (ABCC) as its certifying body. The National Board of Medical Examiners (NBME) was founded in 1915 to establish a nationwide medical exam that physician-licensing authorities may use to evaluate candidates for medical licensure. The work of the NBME is physician-focused.2

The ABCC, in conjunction with the NBME, has developed the certification exam for NPs who have completed a DNP degree.3 The exam is comparable with step 3 of the United States Medical Licensing Examination that is administered to physicians prior to licensure. The first ABCC exam will be offered in November of this year. Currently, this certification is voluntary and is not accepted as the basis for licensure in any state.

Varying Reactions

Support in the nursing community for the DNP degree as entry into practice is growing, and articles in the press are picking up on the movement. An article in the Wall Street Journal (WSJ) entitled "Making room for 'Dr. Nurse'" first brought to the public sphere the information about the new ABCC exam.4 However, many leaders in the NP community have strong objections to or concerns about this new certification exam. The American Academy of Nurse Practitioners (AANP) responded in a letter to the editor of the WSJ, stating that "AANP is not supportive of another layer of certification for DNPs at this time, particularly one that would involve the profession of medicine. It is inappropriate for one profession to credential or regulate another[horizontal ellipsis]."5 The National Organization of Nurse Practitioner Faculties (NONPF) also wrote about the WSJ article in its newsletter, stating that "the board identified numerous shortcomings of the article, notably its limited focus in presenting the DNP and the issue of certification."6 Additionally, the NONPF states that "issues of certification do need further clarification within the profession."6

Proponents of the new ABCC certification believe that certification by this organization may lead to improved reimbursement by insurers and greater recognition of the profession. However, many do not make this connection, and there is no clear evidence to support that supposition. As only DNP graduates are eligible to take the exam, this move may prove to be extremely divisive for the NP community. It is important to make certain that MSN graduates should not be disenfranchised in the movement toward the DNP. Further, the nursing profession continues to work diligently to support autonomous NP practice; the NP certifying organizations have produced rigorous, psychometrically sound certification exams; and the nursing regulatory boards have done an excellent job of regulating the profession. In light of this, why resort to the use of a physician certifying body?

A Bad Move?

Evolution toward the DNP degree seems like a natural progression for the NP profession and falls in line with the ever-expanding educational requirements. NPs have fought some hard-won battles to remove the mantle of physician supervision and have demonstrated that they provide excellent healthcare in a safe and cost- effective manner. A certification exam developed by the NBME seems like a step in the wrong direction.

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