Disruptive innovations provide solutions with positive or negative consequences to complex problems in a manner that is more cost-effective and efficient (Chase & Pruitt, 2006). Unfortunately, not everybody embraces disruptive innovations. Such innovations challenge the usual way of doing things, resulting in resistance by stakeholders who would prefer to continue doing things as they’ve been done, even when the innovations represent more up-to-date and efficient solutions (Chase & Pruitt, 2006). This raises the question: can one then view the Doctor of Nursing Practice (DNP) as a “disruptive innovation”? My answer is yes! The DNP is a disruptive innovation because it makes the nurse practitioner an equal to and on par with other healthcare professions (medicine, pharmacy, and occupational and physical therapy) which require a practice or professional doctorate for entry level into their professions (Apold, 2007).
As mentioned earlier, there will be some acceptance and resistance to a disruptive innovation. Therefore, it should be no wonder that even among different nursing tracts and their professional organizations there are differing positions regarding the need for the DNP terminal degree as the entry level for advance practice nursing. For instance, the American Association of Nurse Practitioners (AANP) (2013) in their reviewed position statement supports the DNP terminal degree as the future entry level to advance practice. They reason that advance nursing practice is part of a small number of healthcare professions where master’s education not a doctorate remains the educational requirement for practitioners. The organization embraces and supports the DNP terminal degree partway into advance nursing practice. However, they assert that current nurse practitioner master’s education curriculum is equal to coursework completed by “other clinical doctoral programs” (AANP, 2013). AANP (2013) further cautions that master’s educated nurse practitioners should not be marginalized, as the nursing profession incorporates the DNP degree requirement for clinical practice (AANP, 2013).
On the other hand, the American College of Nurse-Midwives (ACNM) (2012), in their reviewed position statement, bluntly states that “ACNM does not support the requirement of the DNP for entry into the clinical midwifery practice.” In support of their stance, the ACNM (2012) explained that:
There are not enough supporting data to validate changing the entry level into midwifery from a master’s to DNP degree.
Data suggesting increased safety in practice midwifery as a result of additional coursework are lacking.
There is no projected future cost to the healthcare system, the individual pursuing the DNP degree, and educational institutions providing the degrees.
There will be a decrease in the number of women’s health and midwife providers in the workforce during this period of shortage if NPs have to spend more years receiving education.
There are decade long data supporting cost-effective and safe healthcare provision by women’s health and maternity nurse practitioners with or without earning a terminal degree.
In other words, the ACNM does not feel that there is sufficient information to justify such a requirement. The ACNM (2012) strengthened their opposition to the DNP as entry level for practice by stating their belief that as there continues to be high educational standard, ‘well-documented’ data as to the safe practice and positive records of quality care provided for both newborns and women by midwives and similar professionals. Furthermore, as long as accreditation/certification of their program remains maintained, monitored as well as regularly updated, there is no need to make the DNP mandatory entry level for practice.
On a personal level, an interview with a women’s health nurse practitioner (Ms. C) revealed that she and her NP colleagues at work conclude that they do not have a desire to become DNPs just because “I do not see myself as a systems changer” (personal communication). She can see how the DNP terminal degree may put nurse practitioners on par with other healthcare providers at the discussion table. Ms. C has worked as an OBGYN NP for 17 years and for most of that time she has worked with the same organization. She said that in all her years at this organization, the NPs were never invited to join in the providers meetings or discussions about the clinic. She also expressed feeling slighted and treated like one of the medical assistants. She said at her annual review, she would get a thank you note with a $5 gift card for all her hard work. She asserted that she would rather get a thank you card without the gift card since that is what the medical assistants get with their annual reviews. Ms. C hopes that the DNP terminal degree will bridge the gap and level the professional playing field for NPs in the healthcare industry.
In conclusion, is the DNP terminal degree a good idea? Yes, because as a disruptive innovation, the DNP has the potential to make a lot of positive contributions to the future of clinical nursing and the healthcare industry. DNP prepared NPs can contribute to lowering healthcare costs in our country as they access and operate more on the macroeconomic level of the healthcare. This is where evidence-based research can be used to implement change in clinical practice.
- American Academy of Nurse Practitioners. (2013). Discussion paper: Doctor of Nursing Practice. Retrieved from http://www.aanp.org/aanpqa2/images/documents/publications/DNPDiscussionPaper.pdf
- American College of Nurse-Midwives. (2012, April). Midwifery education and the Doctor of Nursing Practice (DNP). Retrieved from http://www.midwife.org/
- Apold, S. (2008). The Doctor of Nursing Practice: Looking back, moving forward. The Journal for Nurse Practitioners, 4(2), 101-107. doi:10.1016/j.nurpra.2007.12.003
- Chase, S. K., & Pruitt, R. H. (2006). The practice doctorate: Innovation or disruption? Journal of Nursing Education, 45(5), 155-161.