- Email: [email protected]
Should Advance Practice Nurses Be Grandfathered, Rather Than Required to Obtain a Doctor of Nursing Practice?
POINT
counter-point
Linda Sullivan
Linda Sullivan, RN, BC, DSN, FNP, PNP, is a certified family and pediatric nurse practitioner who currently teaches in the family practioner program. She received her doctorate at the University of Alabama in Birmingham and her master’s degree at Mississippi University for Women in Columbus, Miss. She is an associate professor and coordinator of the nurse practitioner programs at Florida State University in the College of Nursing, where she teaches a variety of clinical and theoretical courses. Currently practicing at the North Florida Pediatric Group in Tallahassee, Sullivan has a long history of advanced practice since 1986 at both a rural health family clinic and a large pediatric clinic in Columbus, Miss.
Susan P. Porterfield
Susan P. Porterfield, PhD, ARNP-C, is a family nurse practitioner who received her PhD from the University of Florida and her MSN in the family nurse practitioner program at Florida State University. She is an assistant professor at Florida State University’s College of Nursing, where she teaches a variety of graduate and undergraduate courses. She maintains her FNP skills by working in an NP-owned and operated rural family practice office in Quincy, Fla. Additionally, she works at the walk-in Thagard Student Health Center at Florida State University.
Should Advance Practice Nurses Be Grandfathered, Rather Than Required to Obtain a Doctor of Nursing Practice? Proposed changes to the level of entry for the advanced practice nurse (APN) will be enacted in 2015. The current document that supports this change, issued by the American Association of Colleges of Nursing, states that all nurses who perform at the advanced practice level (clinical nurse specialist [CNS], clinical nurse leader [CNL], advanced registered nurse practitioner [ARNP], etc) will be required to have a doctor of nursing practice (DNP) degree to practice. Although the practice doctorate is not a new idea, the notion that this will be entry level for advanced practice is a concept that many nurses are continuing to struggle with. Given the fact that entry to practice arguments have been going on for more than 25 years, this new entry-level challenge continues to cause concern among nurses. Currently, no clear mechanism addresses what will happen to those already practicing. The work done to establish the DNP does not clearly present the specific process that will be available for NPs that currently hold master’s degrees. We believe that NPs need to examine how they feel toward adoption of a grandfather clause for those without the DNP degree. Should practicing NPs be grandfathered in without a DNP? What do you think? To comment on this matter, e-mail section editor Jacqueline Rhoads at [email protected].
Online Poll: What is your view on this topic? Go to www.npjournal.org to register your preference. 246
The Journal for Nurse Practitioners - JNP
April 2007
Support
for
a Grandfather Clause
Rationale
a Grandfather Clause
Linda Sullivan
Susan P. Porterfield
any disciplines have required the terminal degree for practice within the past several years. Physical therapy and pharmacy come to mind immediately. This standardization of the entry level to practice provides consistency in the expectation of performance level for these professions. The question that nurses need to ask ourselves is why do we find it so unnerving to require a certain level for practice? If indeed we say that advanced practice nurses deliver a higher level of care, why would we not insist that the level of preparation also be at the highest level? Several reasons must be carefully examined about the question of grandfathering. Currently, with approximately 115,000 ARNPs, the job of bringing them to the higher educational level would certainly be oppressive. Although an educational course with options that could be accomplished online might serve the purpose well, is it not enough to have experience as evidence of excellence in caring and simply grandfather those already in practice? Although it is important to standardize entry into practice for nurses, it is also important that we be cognizant of the limitations both of the system and the individual nurses. Currently, there is a shortage of educators, and if we suddenly place 115,000 more students into the system, who will teach them? If we suddenly remove 115,000 practicing APNs from their practices so that they can attend school, who will care for our clients? Although the ideal would be that each nurse receives a DNP degree, we need to consider that there is precedent for grandfathering currently qualified practicing nurses, and we need to do just that. Recognizing the expertise that these 115,000 APNs possess and the amount of care they provide is critical when we sanction the grandfathering of this group.
N
M
Against
ursing has a long and proud history, but entry-level inconsistencies have hampered growth in our profession. The roots of advance practice nursing began during the American Civil War, and, over the years, nurse education has moved from battlefield training to collegiate schools of nursing. Initially, NP education was a non-degree certification program, which met the physician shortages and was developed in response to public need and interest. Currently, nursing needs to establish a consistent entry level for practice to assure the public that indeed the profession of nursing holds its members to the highest standards of practice. In order for our profession to move forward, these standards of practice must include consistent educational requirements for all levels and specialties. In addition to having a standard entry level, it is important to look at the need for an increase in the knowledge base of APNs, considering the complexity in the current health care system. This degree, the doctor of nursing practice, would ensure that, as well. In general the population is aging, and, as people live longer, they tend to have one or more chronic illnesses. The health care provider must be current in science, evidence-based practice, and standard treatments and be willing to incorporate alternative therapies as they emerge to meet the needs of the population. This lends itself nicely to promoting the advancement of APN preparation by requiring all clinical health care providers to obtain a DNP by completing additional coursework that will standardize our professional requirement and bring us parity with other professions. Having parity with other professionals, such as doctor of medicine, doctor of dental surgery, doctor of pharmacology, and others will bring our profession to a level that should have occurred years ago. Fulfilling the academic requirements for the DNP will not only enhance knowledge base and clinical expertise but also award a degree title commiserate with clinical experience. 1555-4155/07/$ see front matter © 2007 American College of Nurse Practitioners doi:10.1016/j.nurpra.2007.02.015
www.npjournal.org
The Journal for Nurse Practitioners - JNP
247
counter-point
Linda Sullivan
Linda Sullivan, RN, BC, DSN, FNP, PNP, is a certified family and pediatric nurse practitioner who currently teaches in the family practioner program. She received her doctorate at the University of Alabama in Birmingham and her master’s degree at Mississippi University for Women in Columbus, Miss. She is an associate professor and coordinator of the nurse practitioner programs at Florida State University in the College of Nursing, where she teaches a variety of clinical and theoretical courses. Currently practicing at the North Florida Pediatric Group in Tallahassee, Sullivan has a long history of advanced practice since 1986 at both a rural health family clinic and a large pediatric clinic in Columbus, Miss.
Susan P. Porterfield
Susan P. Porterfield, PhD, ARNP-C, is a family nurse practitioner who received her PhD from the University of Florida and her MSN in the family nurse practitioner program at Florida State University. She is an assistant professor at Florida State University’s College of Nursing, where she teaches a variety of graduate and undergraduate courses. She maintains her FNP skills by working in an NP-owned and operated rural family practice office in Quincy, Fla. Additionally, she works at the walk-in Thagard Student Health Center at Florida State University.
Should Advance Practice Nurses Be Grandfathered, Rather Than Required to Obtain a Doctor of Nursing Practice? Proposed changes to the level of entry for the advanced practice nurse (APN) will be enacted in 2015. The current document that supports this change, issued by the American Association of Colleges of Nursing, states that all nurses who perform at the advanced practice level (clinical nurse specialist [CNS], clinical nurse leader [CNL], advanced registered nurse practitioner [ARNP], etc) will be required to have a doctor of nursing practice (DNP) degree to practice. Although the practice doctorate is not a new idea, the notion that this will be entry level for advanced practice is a concept that many nurses are continuing to struggle with. Given the fact that entry to practice arguments have been going on for more than 25 years, this new entry-level challenge continues to cause concern among nurses. Currently, no clear mechanism addresses what will happen to those already practicing. The work done to establish the DNP does not clearly present the specific process that will be available for NPs that currently hold master’s degrees. We believe that NPs need to examine how they feel toward adoption of a grandfather clause for those without the DNP degree. Should practicing NPs be grandfathered in without a DNP? What do you think? To comment on this matter, e-mail section editor Jacqueline Rhoads at [email protected].
Online Poll: What is your view on this topic? Go to www.npjournal.org to register your preference. 246
The Journal for Nurse Practitioners - JNP
April 2007
Support
for
a Grandfather Clause
Rationale
a Grandfather Clause
Linda Sullivan
Susan P. Porterfield
any disciplines have required the terminal degree for practice within the past several years. Physical therapy and pharmacy come to mind immediately. This standardization of the entry level to practice provides consistency in the expectation of performance level for these professions. The question that nurses need to ask ourselves is why do we find it so unnerving to require a certain level for practice? If indeed we say that advanced practice nurses deliver a higher level of care, why would we not insist that the level of preparation also be at the highest level? Several reasons must be carefully examined about the question of grandfathering. Currently, with approximately 115,000 ARNPs, the job of bringing them to the higher educational level would certainly be oppressive. Although an educational course with options that could be accomplished online might serve the purpose well, is it not enough to have experience as evidence of excellence in caring and simply grandfather those already in practice? Although it is important to standardize entry into practice for nurses, it is also important that we be cognizant of the limitations both of the system and the individual nurses. Currently, there is a shortage of educators, and if we suddenly place 115,000 more students into the system, who will teach them? If we suddenly remove 115,000 practicing APNs from their practices so that they can attend school, who will care for our clients? Although the ideal would be that each nurse receives a DNP degree, we need to consider that there is precedent for grandfathering currently qualified practicing nurses, and we need to do just that. Recognizing the expertise that these 115,000 APNs possess and the amount of care they provide is critical when we sanction the grandfathering of this group.
N
M
Against
ursing has a long and proud history, but entry-level inconsistencies have hampered growth in our profession. The roots of advance practice nursing began during the American Civil War, and, over the years, nurse education has moved from battlefield training to collegiate schools of nursing. Initially, NP education was a non-degree certification program, which met the physician shortages and was developed in response to public need and interest. Currently, nursing needs to establish a consistent entry level for practice to assure the public that indeed the profession of nursing holds its members to the highest standards of practice. In order for our profession to move forward, these standards of practice must include consistent educational requirements for all levels and specialties. In addition to having a standard entry level, it is important to look at the need for an increase in the knowledge base of APNs, considering the complexity in the current health care system. This degree, the doctor of nursing practice, would ensure that, as well. In general the population is aging, and, as people live longer, they tend to have one or more chronic illnesses. The health care provider must be current in science, evidence-based practice, and standard treatments and be willing to incorporate alternative therapies as they emerge to meet the needs of the population. This lends itself nicely to promoting the advancement of APN preparation by requiring all clinical health care providers to obtain a DNP by completing additional coursework that will standardize our professional requirement and bring us parity with other professions. Having parity with other professionals, such as doctor of medicine, doctor of dental surgery, doctor of pharmacology, and others will bring our profession to a level that should have occurred years ago. Fulfilling the academic requirements for the DNP will not only enhance knowledge base and clinical expertise but also award a degree title commiserate with clinical experience. 1555-4155/07/$ see front matter © 2007 American College of Nurse Practitioners doi:10.1016/j.nurpra.2007.02.015
www.npjournal.org
The Journal for Nurse Practitioners - JNP
247