Should Master's NP Programs be Replaced by DNP Programs?

Article Outline

• Support for Replacing Master's NP Programs
• Rationale Against Replacing Master's NP Programs
• Copyright

Melissa Joy Roberts, JD, RN, is the assistant dean for student affairs at the University of Missouri-Kansas City, where she earned a law degree in 2005. She teaches courses in the MSN and DNP programs and coordinates the Saint Joseph outreach site. She teaches courses in health promotion, health assessment, health policy, and family nurse practitioner clinical courses. She has a nurse practitioner practice at Indian Health Services clinics in Lawrence and White Cloud, KS, and practices law part time in Independence, MO.

Kenneth P. Miller, PhD, CFNP, FAAN, is the director of the University of Delaware's School of Nursing. He is a past president of the ACNP and a recipient of the ACNP Leadership Award. He is the former vice dean of internal programs in the College of Nursing at the University of New Mexico Health Sciences Center and held professorial positions at the Uniformed Services University of the Health Sciences in Bethesda, MD. He practices as an FNP at Westside Family Healthcare Services in New Castle County, Delaware.

In October 2004, the American Association of Colleges of Nursing (AACN) endorsed the Position Statement on the Practice Doctorate in Nursing, calling for the preparation level for advanced practice nursing to move from the master's degree to the doctorate level by 2015. Since that time, there has been a proliferation of doctor of nursing practice (DNP) programs; 81 were listed on the AACN website as of September 2008. The proposed move to DNP education for advanced nurses has stimulated many questions among master's-prepared NPs. Will the DNP credential devalue the excellence of the MS credentials that current NPs have earned, causing others to view this education as second class? Will the DNP undermine the hard-fought place that PhD nursing faculty has won to gain credibility in graduate schools as bona fide academics? Is the increased cost of this new program justified in a time of growing financial pressure? The DNP is a terminal degree intended to enable nurses to implement the science developed by nurses with research-focused doctorates. While higher education for nurses has been linked to better patient outcomes, the impact of the DNP remains to be seen.

What do you think? Should master's NP programs be replaced by DNP programs? Go to www.npjournal.org to vote. Contact Editor Janet Selway at janet.selway@gmail.com if you would like to comment on this matter.

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Support for Replacing Master's NP Programs 

Melissa Joy Roberts

If we want to present ourselves as competent, professionally educated health care providers, we must be professionally educated. The Merriam-Webster dictionary defines a doctor as “a person who has earned one of the highest academic degrees…conferred by a university” and “a person skilled or specializing in healing arts; especially: one…who holds an advanced degree and is licensed to practice.” If nurse practitioners (NPs) wish to be recognized as professionals providing high quality health care, they are going to have to start by getting a professional education—a doctoral degree. Only by holding a terminal degree and a license to practice will NPs be able to legitimately claim professional status.

The major forces behind the recommendation for the DNP requirement are the increasingly complex health care needs of an aging nation, a system that is becoming more complex, the explosion of scientific data, quality of care issues, and the undercredentialing of current NPs. NP programs tend to require almost enough credits for a doctoral degree but only confer a master's degree.

If NPs are unable to agree on the required level of education, they will never be more than “mid-level providers” practicing under the auspices of physicians. There are many excellent master's-prepared NPs practicing right now. Changing the educational requirement for future NPs to a DNP will do nothing to diminish the experience and skills of existing NPs. Instead, requiring a doctoral degree will lift NP practice to the professional level, leading to the recognition and autonomy we have long been seeking.

This move is consistent with other health professions who made the change to doctoral education in a single sweeping move, like the PharmD. The DNP will move the profession into the future and should be mandated for all.

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Rationale Against Replacing Master's NP Programs 

Kenneth P. Miller

The issue of maintaining master's programs for NPs is really a moot point. There are data going all the way back to the mid-1970s that clearly show that master's-prepared NPs provide care that is equivalent to, and sometimes, better than that provided by family practice physicians. Given these data, it is hard to argue that the master's programs have seen better days. There are currently some 141,000 NPs with master's degrees or post-master's certificates who have been providing competent, quality care and a full scope of services for the past 40 years. The advent of the DNP degree has not altered that fact. There are no data that show that DNP programs produce better prepared clinicians than do master's programs.

If DNP programs are mandated, then many smaller schools that lack economic and faculty resources will be disadvantaged and may be put out of business. At this point in the history of our nation, when we are facing healthcare and economic crises of monumental proportions, it is not the time to replace our master's programs with DNP programs, especially since there are no data to show that the latter produces a more competent clinician than the former. Clinicians are respected for their competence, not their degrees.