Nursing is currently undergoing an educational paradigm shift - and great controversy - with the doctor of nursing practice degree (DNP). While many argue that nursing does not need another tier of educational preparation, others contend that the DNP degree has been a long-anticipated innovation.^1-5 As enrollment in DNP programs increases, debate about the issues surrounding the degree will be heated. Understanding the facts will help to ensure that the debate is based on accurate information and not misconstrued perceptions.

The DNP Defined
The DNP is a terminal doctorate degree for nursing practice. It is a practice-focused degree, rather than a research-focused degree (PhD).

Advanced practice nursing includes several specialty roles in which nurses function at an advanced level of practice.^6,10 These roles include, but are not limited to, nurse practitioner, clinical nurse specialist, nurse midwife and nurse anesthetist.⁸ Advanced practice nurses use their advanced knowledge and skills within their specialty roles to provide care to individuals, families and communities.

The DNP is considered to be the highest level of preparation for nursing practice for any nurse who functions in various nursing practice roles. These roles may include leadership, research, clinical practice, policy and advocacy, education or, ideally, an integration of these roles.

The DNP is not intended to increase level of clinical expertise. Current master's degrees have more than adequately prepared nurses to function in advanced practice roles. Instead, the DNP offers additional preparation to enable nurses to improve health care delivery. The current health care environment is complex and ever changing. Advanced preparation, which gives nurses the additional tools to improve health care delivery, will only empower nursing to meet the needs of health care now and in the future.

Evolution of Doctoral Education in Nursing
The notion of a practice-focused doctorate in nursing is not new. Early doctorates earned by nurses were actually offered outside of nursing. These included the EdD (Doctor of Education) degree and the PhD degree in basic science fields, such as anatomy and physiology.^11,12

The first nursing-related doctoral program originated in 1924 at Teacher's College at Columbia University in New York and consisted of an EdD designed to prepare nurses to teach at the college level.¹¹ The EdD continued to be the mainstay of doctoral education for nursing well into the 1960s.¹²

The first PhD in nursing was offered in 1934 at New York University. The PhD degrees for nurses earned elsewhere continued to be in nursing-related fields, such as psychology, sociology and anthropology. This trend continued until actual nursing PhD degrees became more popular in the 1970s.¹³

The first practice-focused doctorate, the Doctor of Nursing Science (DNS) degree, originated at Boston University and "focused on the development of nursing theory for a practice discipline."¹² Although the DNS was initially proposed as a practice or professional doctorate, over time, the curriculum requirements became very similar to a PhD.^12,14,15

Another attempt to develop a practice-focused doctorate was made in 1979 when the Nursing Doctorate (ND) was introduced at Case Western Reserve followed by the University of Colorado, Rush University and South Carolina University. Unfortunately, enrollment in these programs did not flourish.

In 2002, the American Association of Colleges of Nursing (AACN) Board of Directors formed a taskforce to examine the current progress of practice doctorates in nursing. In 2004, AACN published a position statement on the practice doctorate and recommended that the Doctor of Nursing Practice (DNP) degree become the terminal degree for nursing practice by the 2015.

Eventually, AACN also developed Essentials of Doctoral Education for Advanced Nursing Practice, which serves as a guide for curriculum development and to promote uniformity for the degree. (See table.) The development of DNP programs has been astonishing. Currently, there are approximately 80 DNP programs across the country and more than 50 in development.¹⁶