By Debra Wood, RN, contributor
In a bold move, the American Association of Colleges of Nursing plans to reshape advanced practice nursing by advocating a doctorate as an educational entry requirement for nurse practitioners, clinical nurse specialists, nurse midwives and nurse anesthetists.
“This position statement is a major step towards fulfilling a future vision for nursing education with a goal of enhancing the capacity for professional nurses to provide high-quality, patient-centered care,” said Geraldine Bednash, RN, FAAN, Ph.D., executive director of the American Association of Colleges of Nursing (AACN). “This is all about patient care and the complexities of today’s and the future’s health care system.”
AACN will lead in the development of a road map to achieve its goal to increase the educational requirement from a master’s degree to a doctor of nursing practice degree by 2015.
“What their thinking of is, it creates a better playing field for nurse practitioners to be doctors, just like physicians, pharmacists, podiatrists and optometrists,” said Jan Towers, NP-C, CRNP, FAANP, Ph.D.,a family nurse practitioner and director of health policy for the American Academy of Nurse Practitioners (AANP), which has not adopted a formal academy position on the plan.
Towers thinks the proposed practice doctorate requirement has merit, because many nurses seeking master’s degrees are completing doctoral-level work, yet not graduating with the terminal degree. AACN research found that many NP programs now exceed 60 credits and take more than three years to complete.
“They’re packing so much into these programs, they might as well be doctoral programs,” Towers said. “What is expected of our master’s students is essentially the same as a lot of doctoral programs.”
Karen Peddicord, RN-C, Ph.D., director of research, education and publications for the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), agreed.
“The knowledge base required for these positions continues to expand, so the credit allocation continues to expand beyond what you would typically see in a master’s program,” Peddicord said. “I think that was one of the primary reasons they moved to propose this practice doctorate.”
AWHONN has not established a formal position on the plan. Peddicord said one of the factors AWHONN will grapple with is the additional expense associated with a doctoral degree.
“I think it could deter some people on the basis of cost,” Peddicord said. “On the other hand, there may be others more motivated, because it’s a better allocation of credits and workload.”
Patricia Starck, DSN, RN, FAAN, dean of the University of Texas School of Nursing at Houston, has noted much early interest in practice-doctorate programs from potential students and physicians ready to add graduates to their practices. She thinks the practice doctorate is a good idea, with health care becoming more complex and a pending physician shortage.
“We are going to need more advanced practice nurses to do various things in this health care system that will require higher level skills and require them to go from one setting to another setting,” said Starck, who envisions doctorally prepared nurses will follow patients across the continuum of care.
The practice doctorate would differ from a research-focused doctor of philosophy degree in that it would emphasize clinical practice, leadership and health policy. It would likely include a residency requirement.
A few universities currently offer practice-focused doctorates, and several more have expressed interest. The Commission on Collegiate Nursing Education has agreed to initiate a process for accrediting practice doctorate programs.
Gwen Sherwood, Ph.D., RN, FAAN, professor and executive associate dean at the University of Texas School of Nursing at Houston, added that the international community has become quite excited about the plan.
“I think it will catch on around the world, particularly in countries like England and Australia,” Sherwood said. “Traditional nurse practitioner preparation, which is only now catching on globally, will quickly transition to the doctorate of nursing practice model. I do expect to see a lot of movement globally.”
Many advanced practice nursing organizations in the United States have not adopted formal positions about the practice doctorate, including the National Association of Pediatric Nurse Practitioners (NAPNAP), which will fully evaluate the proposal’s affect on its members and children’s health.
“NAPNAP continues to monitor developments regarding the practice doctorate and is working to inform and engage our membership about these developments,” said Ric Ricciardi, MSN, RN, CPNP, president of NAPNAP.
Susan Wysocki, RNC, NP, president and chief executive officer of the National Association of Nurse Practitioners in Women's Health (NPWH), has some reservations about the plan and questions what problems switching to a practice doctorate will remedy.
“I don’t see in the document anything that suggests the current expertise among nurse practitioners if somehow deficient,” Wysocki said.
Wysocki said another issue AACN will need to address is employability and whether employers truly want doctorate-prepared nurses. The AACN position statement said a market analysis by the University of Kentucky College of Nursing showed that acute-care, long-term care and public-health employers in that state were interested in hiring nurses with a doctoral preparation.
NPWH also will formally ask AACN if it foresees a doctorate leading to greater practice independence and increased reimbursement rates. Wysocki wonders if the additional investment, in time and money, will offer an appropriate payback.
AACN created two task forces with members from large and small nursing schools to assist with the transition and consider such concerns. It charged one task force with developing an outline of basic competencies essential for practice doctorate programs.
The second task force will address issues related to implementing the switch from master’s to doctorate preparation. It will consider how to provide bridge programs for nurses with master’s degrees to continue their education and obtain a practice doctorate. It also will examine licensure, certification and reimbursement issues.
“One thing we will have to do is protect all of the people who have master’s degrees,” Towers said.
Wysocki also expressed concern about master’s prepared nurses already in practice. Nurse practitioner education began as a certificate program. Wysocki said certificate-prepared nurse practitioners who did not upgrade their education experienced reimbursement difficulties that led to their losing their jobs or an inability to practice in the same positions.
AACN President Jean E. Bartels acknowledges that transiting to the new educational level will require careful planning and a collaborative effort, something the association is prepared to facilitate.
“Nursing education has a unique opportunity here to rally around a shared vision for the future and work together to move the profession forward,” Bartels concluded in a written statement.
Bednash.jpg: Geraldine Bednash, PhD, RN, FAAN, executive director of the American Association of Colleges of Nursing, believes a educating advanced practice nurses with a practice doctorate will enhance patient care.
Jan tower's Picture.bmp: Jan Towers, PhD, NP-C, CRNP, FAANP, a family nurse practitioner and director of health policy for the American Academy of Nurse Practitioners, believes the practice-doctorate plan has merits, especially with the increasing educational requirements in master’s programs.
peddicord.jpg: Karen Peddicord, RN-C, PhD, director of research, education and publications for the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), expressed some cost concerns but felt that a practice doctorate would provide a better allocation of credits and workload.
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