Reflections on the doctorate of nursing practice.

A debate is currently raging in many academic nursing circles about a new degree, the Doctor of Nursing Practice (DNP). The degree is envisioned as the terminal degree in the discipline that focuses on clinical practice, and it is proposed to supplant the master's degree by 2015. There are a number of driving forces fueling the proposed change, including the hoped-for parity it will create with other health care disciplines and the potential for addressing the complexity of today's health care system. However, we believe that a substantive debate is required prior to a full-scale adoption of this new degree. In this article, we pose the potential unintended consequences of adopting a practice doctorate within our profession-the ones that might be negative for the nursing profession, for health care, and for society as a whole. We discuss these 3 dimensions and suggest that the DNP may erode the major progress nursing as a scientific discipline has made in universities over the past 3 decades. We suggest that the adoption of a DNP will threaten the generation of theory-based science in our discipline, either by decreasing the number of PhD-prepared nurses that will enter the field in the future or by lengthening the course of study to a PhD, thereby significantly shortening productive scientific careers. We question whether the creation of 2 doctoral tracks will further widen the chasm between nurse scientists and clinicians and result in many nurse clinicians feeling disenfranchised. We also pose questions about the impact of the DNP on health care and society. We are concerned that the number of nurses prepared at an advanced practice level will decrease and that the DNP will, thus, have negative impacts on quality, cost, and access to care. Finally, we question whether the DNP will create confusion among colleagues and consumers. We recommend that the adoption of the DNP only occur after thoughtful discussion both within and outside the profession.

Advanced nursing training in health policy: designing and implementing a new program.

Although the nursing profession has a growing role in the health policy arena, the rapidly changing health care environment means that clinicians need a sophisticated understanding of health policy. Nurses are assuming leadership roles in advocacy, research, analysis, and policy development, implementation, and evaluation, contributing to a growing need to educate nurses to specialize in health policy research and analysis. This article provides an overview of a new master's and doctoral educational program specializing in health policy for advanced practice nurses who are culturally diverse and sensitive to issues of diversity. The program, currently in its third year of operation at the University of California San Francisco, School of Nursing, is addressing the gap in nursing education and practice expertise in health policy. The program is supported through funding by the Department of Health and Human Services Health Resources and Services Administration, Advanced Nurse Training program.