HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Respond to This Article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Topham, D. Search for Related Content PubMed PubMed Citation Articles by Topham, D.

To the Editors:

Kudos to the American Journal of Critical Care for a thoughtful analysis of the doctor of nursing practice (DNP) proposal and the related history of education and credentialing in nursing (July 2005: 278–281). Two perspectives on the issue:

The first perspective is viewing the DNP proposal in relationship to the clinical nurse leader (CNL) proposal. According to the American Asociation of Colleges of Nursing, "In practice, the CNL oversees the care coordination of a distinct group of patients and actively provides direct patient care in complex situations. This master’s degree–prepared clinician puts evidence-based practice into action to ensure that patients benefit from the latest innovations in care delivery. The CNL evaluates patient outcomes, assesses cohort risk, and has the decision-making authority to change care plans when necessary. The CNL is a leader in the health care delivery system, and the implementation of this role will vary across settings." This description sounds suspiciously like a well-established role known as the clinical nurse specialist (CNS). As deans of schools of nursing are scrambling to get graduate students enrolled and minimize the financial burden of undergraduate education, they have created yet another entry-level role for nurses, as their original ideal was for the CNL to be a non-nurse with a bachelor’s degree who wants to enter into the nursing profession. In response to heavy criticism, most programs require the CNL to have a bachelor of science degree in nursing. Some programs do have an entry-level master’s alternative, which would lead to the CNL in 3 years. There remains great overlap in the CNS and the CNL job descriptions, with the American Asociation of Colleges of Nursing distinguishing the 2 by labeling the CNL as a generalist and the CNS as a specialist.

The second perspective is around the perceived need to elevate nursing by having a DNP. The same esteemed dean, referenced earlier, argued that the DNP was needed to elevate the nursing profession because other disciplines, such as occupational therapy and physical therapy, are moving to the doctorate for entry level. What my learned colleague failed to realize is that those disciplines are moving to that for entry into basic practice; the DNP addresses entry into advanced practice. The deans have created yet another opportunity for nursing to sidestep the entry-into-practice issue.

Nursing will remain a nonprofessional/profession as long as entry level into practice remains an associate’s degree. To truly elevate the profession, we need professionals who have high-level critical thinking skills and tools to provide care at the bedside. This requires a baccalaureate degree. Admittedly it is a tough issue to tackle with many obstacles, but creating more degrees, more roles, and more confusion will not resolve nursing’s entry-into-practice issue.

Debra Topham, PhD, RN, CNS, APRN-BC
Saint Paul, Minn

This Article Full Text (PDF) Respond to This Article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Topham, D. Search for Related Content PubMed PubMed Citation Articles by Topham, D.