The National Association of Pediatric Nurse Practitioners (NAPNAP) has consistently led the way in advancing the role of the Pediatric Nurse Practitioner (PNP) by advocating quality education. Master's prepared PNPs are vitally important to the maintenance of the health and welfare of our nation's children. In looking to the future, and responding to the call by the Institute of Medicine (2003) and the Pew Health Professions Commission (Finocchio, 1995), NAPNAP agrees with the response of nursing in the development of the doctorate in nursing practice (DNP) as the appropriate credential and level of education for advanced practice nursing. Nurse practitioner (NP) education is at a critical juncture as the need for increased content, growing disparities in health care delivery and access, and stakeholder expectations contribute to a challenge in NP education. The American Association of Colleges of Nursing (AACN) (2004) outlined multiple factors contributing to the need for doctoral level education for advanced practice nursing professionals, such as a need for improved patient care outcomes, an expansion of scientific knowledge, and the increasing complexity of health care systems. The DNP movement received further support when the National Research Council of the National Academy of Sciences (2005) issued a report that called for a distinction between “the educational needs and goals of nursing as a practice profession that require practitioners with clinical expertise from nursing as an academic discipline and science that requires independent researchers and scientists to build the body of knowledge…” (National Research Council of the National Academies, 2005). For the DNP graduate, the AACN (2006a) has delineated specific curricular elements and measurable outcome competencies, including scientific underpinnings which translate evidence into practice, organizational and nursing systems leadership, clinical scholarship and evidence-based advanced nursing practice, information technology, health policy development and implementation, and interprofessional collaboration for improving patient and population health outcomes.
Education is the foundation to ensure that PNPs are prepared with the specialized knowledge, skills, and experience to deliver optimal patient care and to be leaders in the health care environment. The complexity of health care systems requires PNPs to be fluent in the language and practice of leadership, management, and health policy in order to successfully collaborate in patient care and advocacy. NAPNAP supports doctoral education that encompasses technological advances, informatics, evidence-based practice, systems approaches to quality improvement, independent practice, and health care business models that provide the essential foundation for practice.
NAPNAP supports the AACN Position Statement on the Practice Doctorate in Nursing (2004), which states that the current level of preparation necessary for advanced nursing practice will move from the master's degree to the doctorate level (DNP). NAPNAP believes that DNP education for PNPs should be based on the AACN's Essentials of Doctoral Education for Advanced Nursing Practice (2006b) and the National Organization of Nurse Practitioner Faculties' (NONPF) Practice Doctorate Nurse Practitioner Entry-Level Competencies (2006). The AACN DNP Essentials (2006b) and the NONPF DNP Competencies (2006) build on the content and competencies in the master's programs for PNPs.
Some of the challenges of implementing the DNP are that the educational program may take longer, there may be additional cost, there is no guarantee of a salary difference, and there may be variability in the transition phase.
NAPNAP believes that:
•The changing demands of the nation's complex health care environment require that PNPs have the highest level of scientific knowledge and practice expertise possible.
•The DNP is a future oriented goal for PNP practice entry.
•The DNP is the terminal degree for professional practice representing the highest level of clinical competence.
•The DNP graduate is prepared to be an expert clinical practitioner and faculty member.
•The DNP will incorporate the scope of practice as outlined in the Pediatric Nursing: Scope & Standards of Practice document (NAPNAP & SPN, in press). •Master's-prepared PNPs will continue to be valued.
•Those who choose to acquire the DNP may do so over time; articulation programs should be provided.
•It is not necessary for all Master's-prepared PNPs to acquire a DNP.
•It is important to monitor the practice doctorate and its impact on practice, education, regulation and certification.
In conclusion, increasingly complex health care systems require PNPs who have the highest level of educational preparation that includes leadership, health policy, evidence-based practice, and clinical content in order to be active participants in improving health care systems. The health system requires PNPs who can be expert clinicians in a variety of settings and leaders in health care. The practice doctorate prepares PNPs to provide leadership in coordination of care and improvement of methods of health care delivery for children and complements the research-focused nursing doctorates (i.e. PhD, DNSc).
The National Association of Pediatric Nurse Practitioners would like to acknowledge the contribution of the following members of the DNP Position Statement Work Group for their contribution to this statement: Arlene Sperhac, PhD, CPNP, FAAN, Certification Chair; Faith Claman, DNP, RN, CPNP, WHNP; Patricia Clinton, PhD, RN, CPNP, FAANP; Kathleen Falkenstein, PhD, CPNP; Judy Honig, EdD, DrNP, CPNP; Carol Savrin, CPNP, FNP-BC; Jo Ann Serota, MSN, RN, CPNP; Renee McLeod, DNSC, APRN, BC, CPNP-PC; and Heather Keesing, MSN, RN, APRN (Staff).
The National Association of Pediatric Nurse Practitioners would also like to acknowledge the contribution of the following DNP Position Statement Reviewers: Michelle A. Beauchesne, DNSc, RN, CPNP; Donna Miles Curry, PhD, RN; Jennifer D'Auria, PhD, CPNP; Andra M. Hanlon, PhD, ARNP, CPNP; Amy J. Howells, RN, CPNP; Jean B. Ivey, DSN, CPNP; Dawn Lee Garzon, PhD, APRN, BC, CPNP; Helen Lerner, RN, EdD CPNP; Dottie Needham, APRN, DNS; and James P. Ronan, PhD, MN, PNP.
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