- Email: [email protected]
Squaring Off Over the Practice Doctorate
7/26/05
9:35 AM
counter-point
Jacqueline Rhoads
Page 28
POINT
Point-Counterpoint.qxd
Jacqueline Rhoads, PhD, NP, graduated with a BSN from the University of the Incarnate Word in San Antonio,TX, with a MS from Texas Woman’s University, and a PhD from University of Texas at Austin. She holds certifications as an ANP, ACNP, and has recently completed post masters study as a GNP. She has 18 years experience as a CNS, and 6 years as an NP in acute and primary care. She has taught critical care for 23 years and has 30 years’ experience in the Army Nurse Corp. She is currently on the faculty of Louisiana State University Health Science Center School of Nursing. She can be reached at [email protected].
Jane Houck
Jane Houck, MS, NP, is an ANP and women’s health NP who received a BS degree from Johns Hopkins University and an MS from the University of Maryland at Baltimore. She is employed by Johns Hopkins Hospital First Step Day Program for substance abuse patients who require intensive medical supervision. She worked 6 years in Johns Hopkins University AIDS Service providing a full range of HIV care across Maryland in county health departments. She has taught undergraduate students and precepted NP students for 2 years for the Johns Hopkins University School of Nursing. She can be reached at [email protected].
Squaring Off Over the Practice Doctorate Nurse practitioners have observed for some time that, despite their graduate degrees, once they enter practice, they are not given the same status and privileges as those clinical professionals with a clinical practice doctorate (dentists, psychologists, MDs). In October 2004, the National Organization of Nurse Practitioner Faculties (NONPF) and the American Association of Colleges of Nursing (AACN), along with other academic institutions and key organizations, issued a position statement supporting the practice doctorate in nursing. In addition, AACN member institutions voted to make the level of preparation for the advanced practice nurse (APN) at the doctoral level effective by 2015. This will require academic institutions to review their APN programs and determine if the reorganization of their program of study to include the practice doctorate will meet the needs of the APNs they serve. If this is the case, they will need to refocus their APN education to include essential content that incorporates both the practice doctorate and APN competencies. The announcement of these changes in educational requirements has come as a shock to the thousands of NPs currently practicing in the role. 28
July/August 2005
Point-Counterpoint.qxd
7/26/05
9:35 AM
Page 29
SUPPORT
DISAPPROVAL of a Required
for the Practice
Doctorate
Doctorate
Jacqueline Rhoads
Jane Houck
support the practice doctorate as the level of preparation for APNs for 3 reasons. First, the current level of APN preparation has required academic institutions to increase clinical and didactic clock hours to accommodate increased need for scientific knowledge to include practice management, leadership skills, evaluation of evidence, risk management, and health policy. This has resulted in an increase in program credit hours and a longer time commitment for students to complete their studies. It is not unusual to see programs where APN students are required to complete 50–60 program credits, which can take 3–4 years. This is almost twice as long as other nonpractice master’s degree programs. Second, some academics argue that the consequence of the current education is that APNs have remained in a lower position than other professional disciplines that have moved to clinical doctorates. For example, pharmacists have accepted the PharmD (doctor of pharmacy), psychologists the PsychD (doctor of psychology) degree, the dentist as doctor of dentistry, etc, as clinical doctorates for those engaged in clinical teaching and expert clinical practice. Third, there is a critical need for clinically competent APN faculty. In academia, the standard for teaching is the doctorate, but in 2001 only 49.4% of fulltime faculty in baccalaureate and graduate programs held doctorates, and that year there was an 18.9% decrease in the number of doctoral nursing graduates. In my experience, most APNs elect not to pursue the PhD or DNS because it does not seem to fit into their vision for their practice and teaching. The question is, must all faculty have these same sets of skills? I believe there should be two distinctly different terminal degree paths for APN faculty: a research terminal degree (PhD) and a clinical practice terminal degree (DNP).
find it hard to believe that we are about to shoot ourselves in the foot yet again! Have we forgotten the confusion and frustration that grew out of the 3 levels of education for a registered nurse? University programs battled with diploma schools over who produced a better nurse. Associate degree programs ignored everyone and kept producing more graduates. One fact stood out in this discussion: how unfortunate that nursing did not have a single, entry-level degree! Today most nurse practitioners are master’s level prepared. We are grateful to those pioneers who assertively fought to establish what we take for granted today. We have achieved a growing acceptance by the medical community. There are an increasing number of patients who request NP care. We have a professional identity and a single entry-level degree. How can we think of changing this nearly perfect world? AACN and NONPF must be lost in the stairwells of their ivory towers. Do they have any sense of the energy we have spent convincing our legislators that we are not trying to “practice medicine without a license”? Have they considered how much effort we have put into working with physicians demonstrating that we do have skills and that we are colleagues who can enhance a medical practice. The term nursing doctorate will be a red flag and an easy target for those who have never stopped trying to reduce our scope of practice. Finally a note on “endless nursing education.” Some nurses have worked their way from LPN or diploma programs through master’s level coursework and post-MS certificate. How can you tell them they now need more education? We have not yet opened the Pandora’s Box of the nursing doctorate. Could we please come together as a profession and prevent this potential disaster?
1555-4155/05/$ – see front matter © 2005 Elsevier Inc. All rights reserved.
doi: 10.1016/j.nurpra.2005.07.005
I
I
1555-4155/05/$ – see front matter © 2005 Elsevier Inc. All rights reserved.
doi: 10.1016/j.nurpra.2005.07.004
www.npjournal.org
29
9:35 AM
counter-point
Jacqueline Rhoads
Page 28
POINT
Point-Counterpoint.qxd
Jacqueline Rhoads, PhD, NP, graduated with a BSN from the University of the Incarnate Word in San Antonio,TX, with a MS from Texas Woman’s University, and a PhD from University of Texas at Austin. She holds certifications as an ANP, ACNP, and has recently completed post masters study as a GNP. She has 18 years experience as a CNS, and 6 years as an NP in acute and primary care. She has taught critical care for 23 years and has 30 years’ experience in the Army Nurse Corp. She is currently on the faculty of Louisiana State University Health Science Center School of Nursing. She can be reached at [email protected].
Jane Houck
Jane Houck, MS, NP, is an ANP and women’s health NP who received a BS degree from Johns Hopkins University and an MS from the University of Maryland at Baltimore. She is employed by Johns Hopkins Hospital First Step Day Program for substance abuse patients who require intensive medical supervision. She worked 6 years in Johns Hopkins University AIDS Service providing a full range of HIV care across Maryland in county health departments. She has taught undergraduate students and precepted NP students for 2 years for the Johns Hopkins University School of Nursing. She can be reached at [email protected].
Squaring Off Over the Practice Doctorate Nurse practitioners have observed for some time that, despite their graduate degrees, once they enter practice, they are not given the same status and privileges as those clinical professionals with a clinical practice doctorate (dentists, psychologists, MDs). In October 2004, the National Organization of Nurse Practitioner Faculties (NONPF) and the American Association of Colleges of Nursing (AACN), along with other academic institutions and key organizations, issued a position statement supporting the practice doctorate in nursing. In addition, AACN member institutions voted to make the level of preparation for the advanced practice nurse (APN) at the doctoral level effective by 2015. This will require academic institutions to review their APN programs and determine if the reorganization of their program of study to include the practice doctorate will meet the needs of the APNs they serve. If this is the case, they will need to refocus their APN education to include essential content that incorporates both the practice doctorate and APN competencies. The announcement of these changes in educational requirements has come as a shock to the thousands of NPs currently practicing in the role. 28
July/August 2005
Point-Counterpoint.qxd
7/26/05
9:35 AM
Page 29
SUPPORT
DISAPPROVAL of a Required
for the Practice
Doctorate
Doctorate
Jacqueline Rhoads
Jane Houck
support the practice doctorate as the level of preparation for APNs for 3 reasons. First, the current level of APN preparation has required academic institutions to increase clinical and didactic clock hours to accommodate increased need for scientific knowledge to include practice management, leadership skills, evaluation of evidence, risk management, and health policy. This has resulted in an increase in program credit hours and a longer time commitment for students to complete their studies. It is not unusual to see programs where APN students are required to complete 50–60 program credits, which can take 3–4 years. This is almost twice as long as other nonpractice master’s degree programs. Second, some academics argue that the consequence of the current education is that APNs have remained in a lower position than other professional disciplines that have moved to clinical doctorates. For example, pharmacists have accepted the PharmD (doctor of pharmacy), psychologists the PsychD (doctor of psychology) degree, the dentist as doctor of dentistry, etc, as clinical doctorates for those engaged in clinical teaching and expert clinical practice. Third, there is a critical need for clinically competent APN faculty. In academia, the standard for teaching is the doctorate, but in 2001 only 49.4% of fulltime faculty in baccalaureate and graduate programs held doctorates, and that year there was an 18.9% decrease in the number of doctoral nursing graduates. In my experience, most APNs elect not to pursue the PhD or DNS because it does not seem to fit into their vision for their practice and teaching. The question is, must all faculty have these same sets of skills? I believe there should be two distinctly different terminal degree paths for APN faculty: a research terminal degree (PhD) and a clinical practice terminal degree (DNP).
find it hard to believe that we are about to shoot ourselves in the foot yet again! Have we forgotten the confusion and frustration that grew out of the 3 levels of education for a registered nurse? University programs battled with diploma schools over who produced a better nurse. Associate degree programs ignored everyone and kept producing more graduates. One fact stood out in this discussion: how unfortunate that nursing did not have a single, entry-level degree! Today most nurse practitioners are master’s level prepared. We are grateful to those pioneers who assertively fought to establish what we take for granted today. We have achieved a growing acceptance by the medical community. There are an increasing number of patients who request NP care. We have a professional identity and a single entry-level degree. How can we think of changing this nearly perfect world? AACN and NONPF must be lost in the stairwells of their ivory towers. Do they have any sense of the energy we have spent convincing our legislators that we are not trying to “practice medicine without a license”? Have they considered how much effort we have put into working with physicians demonstrating that we do have skills and that we are colleagues who can enhance a medical practice. The term nursing doctorate will be a red flag and an easy target for those who have never stopped trying to reduce our scope of practice. Finally a note on “endless nursing education.” Some nurses have worked their way from LPN or diploma programs through master’s level coursework and post-MS certificate. How can you tell them they now need more education? We have not yet opened the Pandora’s Box of the nursing doctorate. Could we please come together as a profession and prevent this potential disaster?
1555-4155/05/$ – see front matter © 2005 Elsevier Inc. All rights reserved.
doi: 10.1016/j.nurpra.2005.07.005
I
I
1555-4155/05/$ – see front matter © 2005 Elsevier Inc. All rights reserved.
doi: 10.1016/j.nurpra.2005.07.004
www.npjournal.org
29