Should DNP graduates take the NBME Certification Examination?

Article Outline

• Support for DNPs Taking the NBME Examination
• Rationale Against DNPs Taking the NBME Examination
• Reference
• Copyright

Michael Carter, DNSc, FAAN, has practiced as an NP for over 35 years and is certified as an FNP and GNP. He is currently University Distinguished Professor at the University of Tennessee Health Science Center in Memphis, where he served as dean for 18 years. He is a board member of the American Board of Comprehensive Care, the certifying body of the Council for the Advancement of Comprehensive Care.

Susan Apold, RN, ANP-BC, PhD, has been an advanced practice nurse for more than 20 years. She is currently dean of nursing at Concordia College in Bronxville, New York. A past president of both the ACNP and the Nurse Practitioner Association of New York State, she is in private practice as an ANP. She is the first recipient of the ACNP Leadership Award.

In April 2008, the National Board of Medical Examiners (NBME) entered into a contractual agreement with the Council for the Advancement of Comprehensive Care (CACC) to develop and administer a certification examination for qualified doctor of nursing practice (DNP) graduates using an exam similar in content and format to the Step 3 U.S. Medical Licensing Examination (USMLE). The Step 3 USMLE is the last in a sequence of examinations to provide “a final assessment of physicians assuming independent responsibility for providing general medical care.”¹ The certification model proposed by the CACC is a 3-step process that requires licensure as an advanced practice nurse, graduation from a DNP program, and successful completion of the CACC DNP certification examination. The examination was scheduled to be administered to DNP graduates for the first time in November 2008.

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Support for DNPs Taking the NBME Examination 

Michael Carter

Yes, the appropriate DNP graduate should take the new certification exam by the American Board of Comprehensive Care and administered by the National Board of Medical Examiners (NBME). The DNP is an outgrowth of the tremendous impact that nurse practitioners (NPs) have made on the health of the nation. Early NPs experienced rejection by the nursing profession, as they were seen as a capitulation to medicine. The argument was that NPs performed the medical tasks of diagnoses and treatment of medical problems and were no longer nurses. Certification programs emerged that confirmed that the graduates of master's-level NP programs were competent.

Almost from the beginning, we knew that the master's degree would not be sufficient. Master's degrees are short and are an anomaly in the health care system. Today, we see the rapid movement to the DNP for advanced nursing practice. But there is a problem: all DNPs are not NP programs. Nursing schools are offering DNP preparation in areas that may be important to the profession but are not clinical practice. We now have standards in NP education that specify that DNP graduates will be competent in independent practice. There is no way to determine if the NP who holds the DNP has been prepared in independent practice or one of the other areas offered. Patients and payers need to know this information without reviewing transcripts, and the new certification provides that measure.

The NBME offers 30 different certification examinations to over 50,000 participants each year. Clearly, NBME has the expertise to develop the exam. Passing this exam designates that the DNP-prepared NP is competent in independent practice. For these reasons, I support the new exam.

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Rationale Against DNPs Taking the NBME Examination 

Susan Apold

The DNP is an academic credential designed to provide NPs and other nurses with an option to earn a terminal practice degree. The DNP is not a role. The DNP was not designed, nor do any of the available curricula indicate, that the credential will increase scope of practice or provide its carrier with the ability to practice independently. Barriers to independent practice exist through state legislation and regulation, and only changes in those areas can provide for independent practice. NPs practice without any requirement for physician oversight in 14 states. The states that continue to require physician oversight do so because organized medicine has persuaded legislators that independent NP practice is a quality of care issue. Barriers to independent NP practice persist, despite 40 years of research on NP quality, safety, and efficacy.

Nurses who have obtained research or other practice doctorates have earned their advanced practice credential at the master's level. Nursing does not provide certification of a PhD, an EdD, or a DNS. Even when DNP programs become the entry level for advanced practice, it will be the role, not the academic credential, that should be certified.

Certification is an earned credential that validates a nurse's specialized skills, knowledge, and ability against a published and measurable set of standards. Psychometrically sound certification examinations are developed after thorough role-delineation studies. Given that the first cohorts of DNPs are only now beginning to graduate in substantial numbers, it is not possible that these studies have been conducted. An exam developed for physicians cannot adequately evaluate the skills of an NP. A variety of psychometrically sound board certification exams already exist for NPs.

For these reasons, I do not support the NBME-derived DNP exam as a certifying examination for NPs.

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Reference 

1. National Board of Medical Examiners  . NBME collaboration with the Council for the Advancement of Comprehensive Care . Examiner . 2008;55(1):1–2 Retrieved November 20, 2008 from: http://www.nbme.org/PDF/springsummer2008Examiner.pdf
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