Should DNP Students Be Permitted to “STEP-OUT” With a Master’s Degree?

Abstract

The education and training model envisioned for advanced practice registered nurses (APRNs) is a postbaccalaureate doctorate of nursing practice (DNP) without the master’s degree that is held by the vast majority of nurse practitioners (NPs) currently in practice. However, life does not always play out as outlined in academic plans. What if, for example, a student were not able to complete the DNP program? Maybe their money has run out. Family events such as illnesses may occur. Perhaps there is an unexpected move that takes the student away to a new location. Assuming that the student had already completed enough of the DNP program to satisfy what would have been required for a master’s degree, should the student be able to “step-out” of the DNP program and be awarded a master’s degree? –Donald Gardenier Tina EscobedoTina Escobedo, DNP, FNP-BC, is assistant clinical professor at the Sue & Bill Gross School of Nursing at the University of California, Irvine, where she directs the master's entry program and coordinates clinical education for NP programs. Dr. Escobedo has 30 years of experience, ranging from emergency room nurse to NP, researcher, clinical director, and as a nurse educator. Tina Escobedo, DNP, FNP-BC, is assistant clinical professor at the Sue & Bill Gross School of Nursing at the University of California, Irvine, where she directs the master's entry program and coordinates clinical education for NP programs. Dr. Escobedo has 30 years of experience, ranging from emergency room nurse to NP, researcher, clinical director, and as a nurse educator. The AACN failed to fully identify the academic pathway implications that would be encountered by baccalaureate nurses in meeting their recommendation of a postbaccalaureate DNP degree and retiring the master’s degree as entry to APRN practice. Although many have cited the growing complexity of the health care system as supportive of this change, the clear majority of currently practicing APRNs are master’s-prepared and have already demonstrated high-level outcomes. The AACN recommendation would appear to ignore the decades-long success of master’s-level APRN education. Stepping out of DNP programs at the master’s level must remain an option. Higher education requirements add cost and time, and limit a practicing registered nurse’s ability to work. The DNP-level entry will seriously impact the number of nurses choosing an APRN role. Without a viable master’s-level option, the candidate pool of future APRNs greatly diminishes. Any decrease in the supply of APRNs is detrimental to the nation, as APRNs continue to address the shortage of health care providers nationwide. The recommendation’s premise was flawed. An undergraduate student entering a DNP program only finishes the program when everything goes according to plan. Where is the allowance for those who have limited time or money to invest or when unforeseen circumstances occur? With no step-out option available, what happens to the student who has met the certification requirements for advanced nursing practice, yet does not have the DNP? Do they lose all the time and money they invested? Do we lose a provider because of failure to complete a few hundred more hours or nonclinical courses? Are we looking for academic degrees or clinically competent providers? A step-out option continues what has been successfully demonstrated for more than 50 years: master’s-level APRNs are clinically and academically qualified. Advocate for correcting the recommendation: preserve the master’s-prepared APRN. Point/Counterpoint offers thought-provoking topics relevant to nurse practitioners in every issue of JNP. Two authors present thoughtful but opposing viewpoints on current subjects, from scope of practice and regulations to work ethics and care practices. Your opinion on these matters is also important, so go to www.npjournal.org or scan the QR code here to register your vote for either side of each topic. Comments or suggestions for future columns should be sent to Department Editor Donald Gardenier at [email protected] Rod HicksRodney (Rod) Hicks, PhD, RN, FAANP, FAAN, is a professor at the College of Graduate Nursing at Western University of Health Sciences in Pomona, CA, where he teaches in the DNP program. He is the innovator of eLOGS, the world’s first electronic clinical log system for NP students, and is also a researcher with a focus on medication and perioperative safety. He has been a nurse practitioner since 1994. Rodney (Rod) Hicks, PhD, RN, FAANP, FAAN, is a professor at the College of Graduate Nursing at Western University of Health Sciences in Pomona, CA, where he teaches in the DNP program. He is the innovator of eLOGS, the world’s first electronic clinical log system for NP students, and is also a researcher with a focus on medication and perioperative safety. He has been a nurse practitioner since 1994. Consistent doctoral level entry education is bringing parity among health professionals. Practice doctorates facilitate collaboration to improve health care systems at local, national, and global levels. Other health professions have not only envisioned but also achieved practice doctorates for entry to practice, including pharmacists in 1992, physical therapists in 2000, audiologists in 2007, and occupational therapists in 2014. In 2004, the American Association of Colleges of Nursing (AACN) recommended the DNP as the entry-to-practice doctorate for APRNs. Schools and colleges of nursing at universities with doctoral degree granting authority should cease offering master's-level step-out as an entry point to advanced nursing practice. Nursing education has a long history of stair-climbing from one educational level to the next. Having multiple entry points (diploma, associate, baccalaureate, and master's entry programs) is confusing and promotes more expense and time to reach the doctorate. It also leaves many nurses behind. Educational programs must innovate and create seamless paths that allow cost-effective practice doctorates. Registered nurses (RNs) also bear the burden of recognizing the time and commitment that it takes to earn the doctorate. Returning to school for higher education is an investment that offers long-term rewards and benefits. New APRNs face a care system that will continue to grow in complexity. APRNs need the practice doctorate and the skills it confers to manage patients, families, and communities. Not completing the practice doctorate by stepping out at a lower level threatens that investment. Failure to move to a practice doctorate weakens not only nursing and interprofessional collaboration, but it also harms the health care system itself. Registered nurses should make the decision to return to school wisely, and commit to finishing the DNP. Stepping out will not create APRNs with the full set of skills needed for tomorrow's health care system.