Literature Review
Content
Pierre 1
Briana Pierre
Prof. Leslie Wolcott
ENC 1102
08 April 2015
The broad-range of nursing is a continuously evolving profession in which innovations
are constantly brought into play in order to accommodate the increasingly complex healthcare
system. In this dynamic field, it is prevalent for nurse educators to analyze and modify education
curriculum, proposals, and programs that is vital to new and current practicing nurses. With
regard to advanced practicing nurses (APN), nurses who are nurses who have at least have
obtained a master’s degree in nursing, recent studies have put an emphasizes on a new
innovation related to the credentials of advanced nursing practice. This innovation has sparked a
decade-long conversation brought to attention by the American Association of Colleges of
Nursing (AACN) when it adopted a proposal to move the education and required credentials of
APN’s from the master’s degree to the doctoral level by the year 2015. Outside of the normality
of delivering high-quality patient care and disease prevention, this new innovation seeks to focus
on the leadership, research, and problem-solving skills of an advanced practice nurse.
To further understand the driving force behind the AACN’s position on the potential
implementation on a required doctoral degree for current and future APN’s, this literature review
attempts to address both negative and positive viewpoints, addresses the educational curriculum
on this controversial debate, and lastly, compares/contrasts the difference between a DNP and
PhD program degree and its relation to the nursing field. This review also analyzes a gap, and
considers a proposal that seeks to address this research gap and is formulated from
scholarly/academic journals. This issue sparks an interest to future nurses, current advanced
Pierre 2
practicing nurses, nursing education programs, and the overall doctoral education program in
general because this debatable subject has direct effects, whether positive or negative on those
who are most involved and do not pertain to those who do not wish to purse or have an interest in
the nursing profession. The professions of the contributing authors to the academic journals in
this field ranges from nurses who have gained credentials beyond the post-graduate level in
nursing to researchers who are experts in nursing informatics.
In this literature review, researchers, current and future advanced practice nursing
students, nurse education programs, and nurse educators will be made knowledgeable of the new
innovations that has the nursing community buzzing and the effects it has on the growing health
care industry.
When deciding to possibility implement a Doctors in Nurse Practice degree credential
requirement, what would be the educational preparation/curriculum behind it must be taken into
careful consideration (Fain, Asselin, & McCurry, 2008; Lenz, 2005; O'Sullivan et al. 2005; Wall,
Novak, & Wilkerson, 2005). In order to prepare advanced practice nurses for the DNP program,
the requirement for academic institutions to increase clinical and didactic hours is needed to
accommodate the growing need for scientific knowledge by including practice management,
leadership skills, evaluation of evidence, risk management, and a health policy decision into the
educational curriculum (2008). By introducing these new practices, Fain, Asselin, & McCurry
(2008) has found that this will better prepare APN’s for the challenges of care in an evolving
healthcare system. Lenz (2005) seeks to provide recommendations about content areas for the
doctoral program which include: scientific underpinnings for practice, organizational and
systems contexts for care and management; research and analytic methodologies needed to
evaluate, apply, and generate evidence; informatics and the use of information technology; health
Pierre 3
policy analysis and evaluation; and interdisciplinary collaboration. These recommendations were
derived from an analysis of the existing DNP programs, the growing needs of the healthcare
system, and also from the needs of the nursing profession. In recent years, nurse practitioner’s
primary objective focused on prevention of diseases and delivering quality healthcare to a widerange of people, but on the other hand, O’Sullivan et.al (2005) and Wall et.al (2005) are trying to
slightly change this aspect to include informatics, more knowledge, leadership, and a business
outlook on the demanding healthcare system.
With regard to the impact this can have on the nursing community, some researchers
believe that this potential implementation of the DNP degree requirement may be a step in a
positive direction (Apold, S., 2008; Fain, J., Asselin, M., & McCurry, M., 2008; Mundinger, M.
2005). With the advent of the DNP credential, Apold (2008) argues that doctoral prepared nurses
will no longer be expected to be all things to all people. Nurses who want to advance their
education with a practice focus will now have a venue to seek the education they desire. Other
researchers such as Mundinger (2005) claims that “a formal and standardized educational
process leading to a doctoral degree is essential for quality assurance, to clarify and validate
authority/responsibility, and to recognize and identify these practitioners.” More APN-prepared
clinical faculty are needed to ensure patient safety and to help prepare nurses of the future
according to Fain et.al (2008) in which they also proclaim that the development of a DNP
credential for advanced practice nurses provides nursing with myriad opportunities, excellent
preparation for an increasingly complex health care system, an option to obtain a terminal
clinical degree, enhancement of nursing’s image as a rigorous and learned discipline, and an
increase in the numbers of qualified nurse educators.
Pierre 4
Although some researchers express positive viewpoints on the possible DNP required
credential, other researchers believe that this innovation could greatly have a negative effect on
the nursing profession (Apold, 2008; Chase & Pruitt, 2006; Dracup et al. 2005; Hathaway et. al
2009; Webber, 2008). One of the negative effects expressed by Susan Apold (2008) has argued
that nurses who hold a DNP may find it difficult to find faculty positions with a tenure track or to
obtain tenure. Without tenure, it will enable faculty members from participating in policy issues,
decision-making on the college/university level, budget distributions, and other inquires that
focuses on the overall growth, development, and actually sustainability of nursing as a discipline
in higher education. Described as a “disruptive innovation,” Chase & Pruitt (2006) has set their
own recommendations and opinions in which they have proposed that the AACN entirely
eliminate the 2015 deadline for the innovation of a doctoral prepared nursing practice. The cost
of the DNP to health care delivery is another critical issue in which Chase & Pruitt (2006) in
which they argue with increasing preparation costs, the number of NPs will decrease, yielding
fewer primary care providers. A resultant demand for increased salary from graduates of longer,
more expensive programs will contribute to the upward spiral of health care costs. They also
claim that by increasing the cost and complexity of APRN preparation, it does not, by itself,
improve the health care system. The potential consequences of adopting a practice doctorate
within the nursing profession in which Dracup et.al (2005) argue might be negative for the
nursing profession, for healthcare, and for society as a whole. The practice doctorate, in their
professional opinions threatens the number of nurses who are prepared at the PhD level and
changes the nature of university-based faculties of nursing. Hathaway et.al (2009) also describes
the potential DNP credential requirement as being a “disruptive innovation” that will alter the
landscape of nursing and health care and creating a great deal of controversy within and beyond
Pierre 5
the profession of nursing. Dr. Webber (2008) has argued that nurse practitioners run the risk of
adopting practice values of medicine rather than those unique to this specialty and that despite
this risk, several national organizations have recommended that DNP programs not prepare
graduates to be principle investigators. This decision in which she oppose, poses several levels of
concern, including failure to analyze the adequacy of our current approach to research, and the
effects of the downhill doctoral faculty shortage.
In this debate, researchers attempt to sum up the confusion and distinguish between the
DNP degree and the PhD and also the effects they pose on each other in relation to the nursing
field (Brar et.al, 2010; Chism, 2009; Dracup et al., 2005; Webber, 2008). The establishment that
the driving need for the DNP program correlates to the shortage of nurses educated at the
doctoral level and argues that the program can bridge gap in knowledge between the master’s
degree level and the PhD program is argued by Brar et al (2010), and Chiasm (2009). Brar et. al
(2010) compares and contrast between the DNP and the PhD in nursing. The PhD in nursing
focuses on the research and education aspect of nursing whereas the DNP concentrate more on
the clinical practices or clinical teachings. A major similarity between the two, the authors
argues, are that both programs both utilize content from research methods. The practice
doctorate, in the professional opinions of Dracup et al (2005) threatens the number of nurses
prepared at the PhD level and changes the nature of university-based faculties of nursing. By
discussing the literature behind the innovation of required DNP degree, Webber (2008) seeks to
determine if the Doctor of Nursing Practice (DNP) curricula should prepare students to be
principle investigators of research or whether this skill should be left to other doctoral prepared
nurses such as a PhD.
Pierre 6
While the researchers above have expressed the possible positive and negative effects of
the potential innovation to make the DNP a required credential to practice advanced nursing or
how it MAY affect the nursing profession as whole, no one has really taken the time to study/talk
about what nurses who are involved in this profession ACTUALLY think about this innovation
and the ways it may affect them personally if it is implemented. How current and future
practicing advance practice nurses feel about this potential innovation is important because there
are many factors that may have a direct impact on their career.
Proposal
To consider the thoughts and concerns of APN’s involved in this profession, an online
survey should be implemented that will allow for nurses (current and future) to formally express
their viewpoints on this controversial debate. The questions in this online survey will touch base
on their status/rank in the nursing profession, the pay grade that correlates to their rank, and also
the independency in healthcare facilitates will also be addressed. By copying and pasting the
weblink below into a search engine, an online survey has been created in hopes to obtain the
viewpoints of current and future APN’s on the controversial debate of a potential required DNP
degree. I plan on sharing the online survey results with the American Association of Colleges of
Nursing (AACN) who was the first to propose the DNP credential requirement. The AACN
should take into consideration of how this innovation may affect those who are directly involved
or those who wish to become involved in the APN profession before finalizing this decision.
Copy and Paste the link below:
Pierre 7
https://freeonlinesurveys.com/app/dumbsurvey.asp?lastPage=1
Works Cited
Apold, S. (2008). The doctor of nursing practice: looking back, moving forward. Journal For
Nurse Practitioners, 4(2), 101-108.
Brar, K., Boschma, G., & McCuaig, F. (2010). The development of nurse practitioner preparation
beyond the master's level: what is the debate about?. International Journal Of Nursing
Education Scholarship, 7(1), 15P.
Chase, S., & Pruitt, R. (2006). The practice doctorate: innovation or disruption?. Journal Of
Nursing Education, 45(5), 155-161.
Chism, L. (2009). Toward clarification of the doctor of nursing practice degree. Advanced
Emergency Nursing Journal, 31(4), 287-297.
Dracup, K., Cronenwett, L., Meleis, A., & Benner, P. (2005). Reflections on the doctorate of
nursing practice. Nursing Outlook, 53(4), 177-182.
Draye, M., Acker, M., & Zimmer, P. (2006). The practice doctorate in nursing: approaches to
transform nurse practitioner education and practice. Nursing Outlook, 54(3), 123-129.
Pierre 8
Fain, J., Asselin, M., & McCurry, M. (2008). The DNP... why now?. Nursing Management,
39(7), 34-37.
Hathaway, D., Jacob, S., Stegbauer, C., Thompson, C., & Graff, C. (2006). The practice
doctorate: perspectives of early adopters. Journal Of Nursing Education, 45(12), 487Lenz, E. (2005). The Practice Doctorate in Nursing: an idea whose time has come.
Online Journal Of Issues In Nursing, 10(3).
Mundinger, M. (2005). Who's who in nursing: bringing clarity to the doctor of nursing practice.
Nursing Outlook, 53(4), 173-176.
Mundinger, M., Cook, S., Lenz, E., Piacentini, K., Auerhahn, C., & Smith, J. (2000). Assuring
quality and access in advanced practice nursing: a challenge to nurse educators. Journal
Of Professional Nursing, 16(6), 322-329.
O'Sullivan, A., Carter, M., Marion, L., Pohl, J., & Werner, K. (2005). Moving forward together:
the practice doctorate in nursing. Online Journal Of Issues In Nursing, 10(3).
Webber, P. (2008). The Doctor of Nursing Practice degree and research: are we making an
epistemological mistake?. Journal Of Nursing Education, 47(10), 466-472.
Pierre 9
Briana Pierre
Prof. Leslie Wolcott
ENC 1102
08 April 2015
The broad-range of nursing is a continuously evolving profession in which innovations
are constantly brought into play in order to accommodate the increasingly complex healthcare
system. In this dynamic field, it is prevalent for nurse educators to analyze and modify education
curriculum, proposals, and programs that is vital to new and current practicing nurses. With
regard to advanced practicing nurses (APN), nurses who are nurses who have at least have
obtained a master’s degree in nursing, recent studies have put an emphasizes on a new
innovation related to the credentials of advanced nursing practice. This innovation has sparked a
decade-long conversation brought to attention by the American Association of Colleges of
Nursing (AACN) when it adopted a proposal to move the education and required credentials of
APN’s from the master’s degree to the doctoral level by the year 2015. Outside of the normality
of delivering high-quality patient care and disease prevention, this new innovation seeks to focus
on the leadership, research, and problem-solving skills of an advanced practice nurse.
To further understand the driving force behind the AACN’s position on the potential
implementation on a required doctoral degree for current and future APN’s, this literature review
attempts to address both negative and positive viewpoints, addresses the educational curriculum
on this controversial debate, and lastly, compares/contrasts the difference between a DNP and
PhD program degree and its relation to the nursing field. This review also analyzes a gap, and
considers a proposal that seeks to address this research gap and is formulated from
scholarly/academic journals. This issue sparks an interest to future nurses, current advanced
Pierre 2
practicing nurses, nursing education programs, and the overall doctoral education program in
general because this debatable subject has direct effects, whether positive or negative on those
who are most involved and do not pertain to those who do not wish to purse or have an interest in
the nursing profession. The professions of the contributing authors to the academic journals in
this field ranges from nurses who have gained credentials beyond the post-graduate level in
nursing to researchers who are experts in nursing informatics.
In this literature review, researchers, current and future advanced practice nursing
students, nurse education programs, and nurse educators will be made knowledgeable of the new
innovations that has the nursing community buzzing and the effects it has on the growing health
care industry.
When deciding to possibility implement a Doctors in Nurse Practice degree credential
requirement, what would be the educational preparation/curriculum behind it must be taken into
careful consideration (Fain, Asselin, & McCurry, 2008; Lenz, 2005; O'Sullivan et al. 2005; Wall,
Novak, & Wilkerson, 2005). In order to prepare advanced practice nurses for the DNP program,
the requirement for academic institutions to increase clinical and didactic hours is needed to
accommodate the growing need for scientific knowledge by including practice management,
leadership skills, evaluation of evidence, risk management, and a health policy decision into the
educational curriculum (2008). By introducing these new practices, Fain, Asselin, & McCurry
(2008) has found that this will better prepare APN’s for the challenges of care in an evolving
healthcare system. Lenz (2005) seeks to provide recommendations about content areas for the
doctoral program which include: scientific underpinnings for practice, organizational and
systems contexts for care and management; research and analytic methodologies needed to
evaluate, apply, and generate evidence; informatics and the use of information technology; health
Pierre 3
policy analysis and evaluation; and interdisciplinary collaboration. These recommendations were
derived from an analysis of the existing DNP programs, the growing needs of the healthcare
system, and also from the needs of the nursing profession. In recent years, nurse practitioner’s
primary objective focused on prevention of diseases and delivering quality healthcare to a widerange of people, but on the other hand, O’Sullivan et.al (2005) and Wall et.al (2005) are trying to
slightly change this aspect to include informatics, more knowledge, leadership, and a business
outlook on the demanding healthcare system.
With regard to the impact this can have on the nursing community, some researchers
believe that this potential implementation of the DNP degree requirement may be a step in a
positive direction (Apold, S., 2008; Fain, J., Asselin, M., & McCurry, M., 2008; Mundinger, M.
2005). With the advent of the DNP credential, Apold (2008) argues that doctoral prepared nurses
will no longer be expected to be all things to all people. Nurses who want to advance their
education with a practice focus will now have a venue to seek the education they desire. Other
researchers such as Mundinger (2005) claims that “a formal and standardized educational
process leading to a doctoral degree is essential for quality assurance, to clarify and validate
authority/responsibility, and to recognize and identify these practitioners.” More APN-prepared
clinical faculty are needed to ensure patient safety and to help prepare nurses of the future
according to Fain et.al (2008) in which they also proclaim that the development of a DNP
credential for advanced practice nurses provides nursing with myriad opportunities, excellent
preparation for an increasingly complex health care system, an option to obtain a terminal
clinical degree, enhancement of nursing’s image as a rigorous and learned discipline, and an
increase in the numbers of qualified nurse educators.
Pierre 4
Although some researchers express positive viewpoints on the possible DNP required
credential, other researchers believe that this innovation could greatly have a negative effect on
the nursing profession (Apold, 2008; Chase & Pruitt, 2006; Dracup et al. 2005; Hathaway et. al
2009; Webber, 2008). One of the negative effects expressed by Susan Apold (2008) has argued
that nurses who hold a DNP may find it difficult to find faculty positions with a tenure track or to
obtain tenure. Without tenure, it will enable faculty members from participating in policy issues,
decision-making on the college/university level, budget distributions, and other inquires that
focuses on the overall growth, development, and actually sustainability of nursing as a discipline
in higher education. Described as a “disruptive innovation,” Chase & Pruitt (2006) has set their
own recommendations and opinions in which they have proposed that the AACN entirely
eliminate the 2015 deadline for the innovation of a doctoral prepared nursing practice. The cost
of the DNP to health care delivery is another critical issue in which Chase & Pruitt (2006) in
which they argue with increasing preparation costs, the number of NPs will decrease, yielding
fewer primary care providers. A resultant demand for increased salary from graduates of longer,
more expensive programs will contribute to the upward spiral of health care costs. They also
claim that by increasing the cost and complexity of APRN preparation, it does not, by itself,
improve the health care system. The potential consequences of adopting a practice doctorate
within the nursing profession in which Dracup et.al (2005) argue might be negative for the
nursing profession, for healthcare, and for society as a whole. The practice doctorate, in their
professional opinions threatens the number of nurses who are prepared at the PhD level and
changes the nature of university-based faculties of nursing. Hathaway et.al (2009) also describes
the potential DNP credential requirement as being a “disruptive innovation” that will alter the
landscape of nursing and health care and creating a great deal of controversy within and beyond
Pierre 5
the profession of nursing. Dr. Webber (2008) has argued that nurse practitioners run the risk of
adopting practice values of medicine rather than those unique to this specialty and that despite
this risk, several national organizations have recommended that DNP programs not prepare
graduates to be principle investigators. This decision in which she oppose, poses several levels of
concern, including failure to analyze the adequacy of our current approach to research, and the
effects of the downhill doctoral faculty shortage.
In this debate, researchers attempt to sum up the confusion and distinguish between the
DNP degree and the PhD and also the effects they pose on each other in relation to the nursing
field (Brar et.al, 2010; Chism, 2009; Dracup et al., 2005; Webber, 2008). The establishment that
the driving need for the DNP program correlates to the shortage of nurses educated at the
doctoral level and argues that the program can bridge gap in knowledge between the master’s
degree level and the PhD program is argued by Brar et al (2010), and Chiasm (2009). Brar et. al
(2010) compares and contrast between the DNP and the PhD in nursing. The PhD in nursing
focuses on the research and education aspect of nursing whereas the DNP concentrate more on
the clinical practices or clinical teachings. A major similarity between the two, the authors
argues, are that both programs both utilize content from research methods. The practice
doctorate, in the professional opinions of Dracup et al (2005) threatens the number of nurses
prepared at the PhD level and changes the nature of university-based faculties of nursing. By
discussing the literature behind the innovation of required DNP degree, Webber (2008) seeks to
determine if the Doctor of Nursing Practice (DNP) curricula should prepare students to be
principle investigators of research or whether this skill should be left to other doctoral prepared
nurses such as a PhD.
Pierre 6
While the researchers above have expressed the possible positive and negative effects of
the potential innovation to make the DNP a required credential to practice advanced nursing or
how it MAY affect the nursing profession as whole, no one has really taken the time to study/talk
about what nurses who are involved in this profession ACTUALLY think about this innovation
and the ways it may affect them personally if it is implemented. How current and future
practicing advance practice nurses feel about this potential innovation is important because there
are many factors that may have a direct impact on their career.
Proposal
To consider the thoughts and concerns of APN’s involved in this profession, an online
survey should be implemented that will allow for nurses (current and future) to formally express
their viewpoints on this controversial debate. The questions in this online survey will touch base
on their status/rank in the nursing profession, the pay grade that correlates to their rank, and also
the independency in healthcare facilitates will also be addressed. By copying and pasting the
weblink below into a search engine, an online survey has been created in hopes to obtain the
viewpoints of current and future APN’s on the controversial debate of a potential required DNP
degree. I plan on sharing the online survey results with the American Association of Colleges of
Nursing (AACN) who was the first to propose the DNP credential requirement. The AACN
should take into consideration of how this innovation may affect those who are directly involved
or those who wish to become involved in the APN profession before finalizing this decision.
Copy and Paste the link below:
Pierre 7
https://freeonlinesurveys.com/app/dumbsurvey.asp?lastPage=1
Works Cited
Apold, S. (2008). The doctor of nursing practice: looking back, moving forward. Journal For
Nurse Practitioners, 4(2), 101-108.
Brar, K., Boschma, G., & McCuaig, F. (2010). The development of nurse practitioner preparation
beyond the master's level: what is the debate about?. International Journal Of Nursing
Education Scholarship, 7(1), 15P.
Chase, S., & Pruitt, R. (2006). The practice doctorate: innovation or disruption?. Journal Of
Nursing Education, 45(5), 155-161.
Chism, L. (2009). Toward clarification of the doctor of nursing practice degree. Advanced
Emergency Nursing Journal, 31(4), 287-297.
Dracup, K., Cronenwett, L., Meleis, A., & Benner, P. (2005). Reflections on the doctorate of
nursing practice. Nursing Outlook, 53(4), 177-182.
Draye, M., Acker, M., & Zimmer, P. (2006). The practice doctorate in nursing: approaches to
transform nurse practitioner education and practice. Nursing Outlook, 54(3), 123-129.
Pierre 8
Fain, J., Asselin, M., & McCurry, M. (2008). The DNP... why now?. Nursing Management,
39(7), 34-37.
Hathaway, D., Jacob, S., Stegbauer, C., Thompson, C., & Graff, C. (2006). The practice
doctorate: perspectives of early adopters. Journal Of Nursing Education, 45(12), 487Lenz, E. (2005). The Practice Doctorate in Nursing: an idea whose time has come.
Online Journal Of Issues In Nursing, 10(3).
Mundinger, M. (2005). Who's who in nursing: bringing clarity to the doctor of nursing practice.
Nursing Outlook, 53(4), 173-176.
Mundinger, M., Cook, S., Lenz, E., Piacentini, K., Auerhahn, C., & Smith, J. (2000). Assuring
quality and access in advanced practice nursing: a challenge to nurse educators. Journal
Of Professional Nursing, 16(6), 322-329.
O'Sullivan, A., Carter, M., Marion, L., Pohl, J., & Werner, K. (2005). Moving forward together:
the practice doctorate in nursing. Online Journal Of Issues In Nursing, 10(3).
Webber, P. (2008). The Doctor of Nursing Practice degree and research: are we making an
epistemological mistake?. Journal Of Nursing Education, 47(10), 466-472.
Pierre 9
