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To the Editors:

I want to thank Kathleen Dracup and Chris Bryan-Brown for their insightful (inciteful!) editorial on the doctor of nursing practice (DNP, July 2005: 278–281). In my past work as a critical care clinical nurse specialist (CNS) and as a former member of AACN and the Society of Critical Care Medicine, I was proud of the work that the nurses who called themselves CNSs did.

If we proceed with the DNP, I believe we will affect resource replacement in advanced practice roles in ways that cannot be imagined. One has only to look at the report done by the Health Resources and Services Administration, "The Pharmacy Workforce, A Study of the Supply and Demand for Pharmacists."¹ I quote from this document:

The evidence clearly indicates the emergence of a shortage of pharmacists over the past two years. This shortage is considered a dynamic shortage since it appears to be due to a rapid increase in the demand for pharmacists coupled with a constrained ability to increase the supply of pharmacists. The factors causing the current shortage are of a nature not likely to abate in the near future without fundamental changes in pharmacy practice and education.

I suggest to you that this will be the narrative, long before a study can be conducted by anyone at the federal level in nursing. When the rhetoric of an equitable voice at the table, same number of credit hours, credit creep, and so on is introduced into the dialogue about closing programs that offer a master of science in nursing (MSN) and offering instead the DNP, I wonder what practice doctorate in any profession is equal to what we do in the MSN program. The MSN program is in no way a doctoral program.

The juxtaposition to a higher level of critical and reflective thinking begins to happen only at the master’s level; simply adding a few more courses to the curriculum does not make a doctoral program. When one simply approaches the issue quantitatively and examines the demand for clinical pharmacists in real numbers, it pales in comparison to the need for advanced practice nurses. The educational move to the doctorate in pharmacy has caused an increase in pharmacy vacancies, which cannot be filled. Imagine what limiting educational opportunities to nurses (ie, requiring the DNP) will do to the current shortages. Yikes! These solutions bear only critical problems!

I suggest that those making these decisions venture into the real world of practice, into the real life of the advanced practice nurse, into the real needs for human resources in meeting the healthcare demands of our population. The MSN continues to meet these many challenges. Large state universities and small private colleges can offer the MSN. Move this requirement to the doctoral level, and you have removed access for a large segment of the persons who might otherwise pursue the master’s degree.

I continue to believe that good decision making will survive the current dialogue and the master’s degree will continue to serve a large contingent of very well prepared nurses delivering and meeting the healthcare needs of their patients/clients.

Elizabeth Torrence
Seattle, Wash

REFERENCE

1. The Pharmacy Workforce, A Study of the Supply and Demand for Pharmacists. Rockville, Md: HRSA, US Department of Health and Human Services; 2000.

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