November 9, 2009
response from Joan Rosen Bloch to the topic The Doctor of Nursing Practice (DNP): Need for More Dialogue (September 30, 2005)
I write in response to the OJIN topic on the Doctor of Nursing Practice Degree (DNP), encouraging all nurses to ‘Continue the Dialogue’ on this important topic.
Now that we have DNP/DrNP graduates throughout the country, what is our vision? What do we see? Are our stakeholders best served with the PhD, DNP, DrNP, and MSN-Prepared Nurse Practitioners, Clinical Nurse Specialists, Nurse Midwives, and Nurse Anesthetists? Our profession’s introduction of the new, innovative terminal degree, ‘the practice doctorate of nursing,’ was designed to fix major problems resulting from our nation's complex healthcare environment that, supposedly, require nurses to have the highest level of scientific knowledge and practice expertise possible. Let us continue our dialogue.
Thirty years ago, those of us who were Nurse Practitioners (NPs) back then, can remember the confusion and bitter battles over what our name should be and what educational pathway was sufficient. The system was broken and needed to be fixed. Despite the controversies within the nursing profession, the role of the NP emerged, and evolved into a credible and well-respected role. Vulnerable, marginalized populations benefited greatly from increased access to care.
Now, again the system appears broken and the new degrees of the DNP/DrNP have evolved to fix it, also amidst much controversy. Looking at the current context and reflecting back to when the new role of the NP emerged, there are fond memories of pride and empowerment, recognizing our ability to think out of the box and create incredible programs of care for individuals and their families. Yet, the current context of various terminal degrees becomes complex for those committed to serving humankind though the profession of nursing.
In recent years, as some of us have obtained PhDs at prestigious universities, we have learned that continuing to contribute to society through our expert practice was difficult, or no longer possible, if we transition to traditional academic roles with our PhDs. In doing so we have been, and continue to be confronted with the tripartite mission of teaching, scholarship, and service that comes with becoming a university faculty member. Little time is left for serving society while trying to build one’s Curriculum Vitae for tenure. Yet tenured nursing faculty must exist at universities to give the discipline visibility and presence among other academic disciplines.
Can we really expect junior faculty to develop programs of research in the context of a faculty shortage and economic downturn? Conducting research is exciting and stimulating, but difficult for new nursing PhDs without real mentorship. Unlike new scholars or junior faculty in other disciplines, the discipline of nursing has not embraced relationships whereby junior investigators are mentored by senior investigators. For many of us junior faculty, finding our way as a novice in the culture of academia is challenging. Besides teaching new courses, there are a plethora of meetings, work task forces – even recruitment and proctoring activities- keeping us away from developing serious scholarship. The prior years of nursing practice expertise may help us land the new academic job, but may not have much relevance after we land the job. For the nurse who loves nursing and is very proud of being a nurse, there is something wrong with the picture when returning for your terminal degree does not enhance your nursing practice expertise, and in fact keeps you away from it. Establishing a program of research that is worthwhile to anyone outside of academia is extremely difficult. Teaching, nonetheless, is both fun and a worthwhile contribution to society as it allows us to help prepare the next generation of nurses.
DNP/DrNP programs have proliferated. Now their graduates have appeared on the scene. Are they really able to apply their ‘higher level of education’ to help fix some of the systems in disarray, such as practice, education, and/or policy? At this time, in an ever-changing world, we need, as a profession, to join together with wisdom to advance the discipline of nursing in both academia and practice. Amidst a nursing faculty shortage, there should be room for all of us. Let’s continue our dialogue, so together we can build strong bridges in which ALL stakeholders benefit. Let us be reminded of Linda Aikens’s words of wisdom: “…What is good for nursing is also good for the American public” (1992, p.11). Thus, let the DNP/DrNP/ PhD dialogue continue.
Joan Rosen Bloch, PhD, CRNP
Assistant Professor in Doctoral Nursing Department & Epidemiology in the School of Public Health
Aiken, L (1992). Charting nursing’s future. In L.H. Aiken and C. M. Fagin (Eds.), Charting nursing’s future: Agenda for the 1990s (p. 11). Philadelphia: J.B. Lippincott Company.