Potential Crisis in Nurse Practitioner Preparation in the United States

[Doctors of Nursing Practice, Inc.]

This article was shared by Dr. Michael Carter, one of the authors of this study that is sobering and challenging for all involved in advanced practice. Please review and share your thoughts on how we, as DNP prepared leaders, can influence this dynamic.
Click HERE to view this article.

[Abigale Schucker]

Hello,
Thank you for posting this article. I think Dr. Mundinger and Dr. Carter bring up a valid point about DNP preparation. If I understand this correctly, their claim through their research is that more DNP programs are geared to administration or leadership positions versus practice programs preparing primary care DNPs. Given the climate of our healthcare and the need for primary care providers to serve communities, not having enough is a fear. As someone going into AGPC, I am worried about having an increased patient load, if there is not an adequate amount of providers. As a side note, I worry about how my current training; Will I be able to perform as a PCP adequately? (That is another topic for another time). However, the limitation of this article gives me pause. Because the type of educational program was tracked over the admission or graduation rate, it is hard to say with accuracy if there will be a fair number of “practice” DNPs produced based on the research presented. I would want to know about the number of admissions into practice (clinical) DNP programs, and the success rate with both graduation and boards.

[Linh Tran]

Thank you for brining up about this topic. DNP preparation and readiness for future roles has been greatly discussed over the expansion of more graduates and complexity in healthcare within recent years. Dr. Mundinger and Dr. Carter mentioned the expanded roles of leadership and scholarship has left practicing curriculum to be shortened. Indeed, DNP roles has expanded beyond advanced practice roles into administrative leadership, research, and faculty roles. Being in a DNP program right now, I do see many introductory courses of management and research which is doctorate core essentials. It does leave me wonder given the compacted program of DNP curriculum, how can we look for a better position forward. I do believe the current curriculum depending on each school will provide requires practicing hours and these hours are adequate to provide clinicians. However, for future clinicians who would like to specialize in their field, perhaps, new jobs should have a nurse fellowship program just as how medical school does have fellowship options in complexity fields. This will help nurses who are more geared towards practicing essentials while ensuring every DNP graduates can be a potential strong leader and researcher.

[Wichanee Borisuthirattana]

Thank you, David, for sharing this article. The potential concerns about the number of nurse practitioners in the near future, and the perspectives toward nurse practitioners and relating clinicians may become critical reasons for potential NP candidates to decide against the profession. As reported in Mundinger & Carter (2019), since the American Association of Colleges of Nursing allowed DNP programs to include nonclinical DNP curriculum, the number of graduate students pursuing clinical DNP degree, such as NP and CNS, are decreased. There are also other concerns regarding the nonclinical DNP programs such as the fast-growing nonclinical DNP programs that is exceeding the number of clinical DNP programs. A more flexible schedule and curriculum between part-time and full-time study may also post some doubt regarding the credibility and the competency of the graduates. I understand the future issues that Dr. Mundinger and Dr. Carter may feel uneasy about. However, I think there are still some hope that there will be a rising number of clinical DNP graduates in the near future. More and more clinical nurses view NP as a great opportunity for professional growth. And as NPs are allowed to practice independently in more states, I believe the option of pursuing clinical DNP degree will be a more favorable one. Although the data from the article may be recent, I believe that NP is becoming a more and more popular profession among clinical nurses. I also think that the flexibility of the schedule and the curriculum would promote the growth of the NP candidates. As nurses are working full-time trying to earn income for their family, it is the flexibility of the school that they needed in order to complete their degree. Some may need longer time than the others, but eventually the profession would welcome another competent clinical DNP graduate.

[Prerna Wilson-Pauliah]

Thank you for sharing this article, David. It is known that there is a huge shortage of healthcare providers in the United States – so Drs. Mundinger and Carter are right to be concerned about the growing movement of DNPs into the non-clinical settings. However, like Wichanee pointed out, DNPs are seeking employment opportunities that will provide them a better work-life balance, compensation, and job satisfaction. On the other hand, I see this as a great opportunity for DNPs to bring their perspective to the table and affect change from other angles in healthcare. However, I think it is important to evaluate why nurses might be choosing nonclinical settings – I would go on a limb to maybe suggest that this could be related to lack of support and compensation in the workplace.

[Susan]

Great discussion~ The crisis that Mundinger and Carter identify is with the preparation of nurse practitioners within DNP programs themselves. The authors discuss the convoluted and fragmented timeline of the development of early DNP programs and the diverging curriculum and outcome competencies for NPs. This approach is unfortunate and all too common in nursing’s history. Originally conceived as a clinical practice doctorate for NPs to meet growing demands for greater clinical expertise, the DNP degree quickly grew in appeal for those who needed advanced knowledge and skills in other roles (CNS, Executive Leadership) to meet the growing complexities of health care. This growth was likely facilitated by the AACN policy change and broadened definition of ‘practice’. “Nursing practice is any form of nursing intervention that influences health care outcomes for individuals or populations,including the direct care of individual patients, management of care for individuals and populations, administration of nursing and health care organizations, and the development and implementation of health care policy. (p. 3).

The fact that 85% of DNP programs are non-clinical is a different issue and one that bears examining. Why are there fewer clinical DNP pathways? Does it reflect less interest among those who want to become APRNs? What does that say about the appeal and value of the degree to those who are already APRNs or who might want to become an APRN but can do so with a master’s degree? What does it say about the value of a DNP in the workplace? Do employers see more value in DNP prepared APRNs?

The authors also point out that approximately 30% of nonclinical DNP programs do not require clinical skills beyond what the nurse had upon entry to the program (Mundinger & Carter, 2019). This seems to be an irrelevant point because if a nurse is pursuing a DNP in an excutive leadership pathway why would they need advanced clinical skills? Instead they need advanced preparation and skills in other content areas. If you agree with the expanded definition of AACN for ‘practice’ then this role pathway within the DNP degree should not be problematic. However, it is interesting that in other disciplines (pharmacy, physical therapy) the practice doctorate is strictly reserved for those in clinical practice. But what options does that leave for those who desire a terminal degree in nursing but do not want to pursue a PhD? Should they seek terminal degrees outside of nursing?

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