Submitted by Wendy Van Cauwenbergh
Professional Nursing: Is A Doctorate Degree Necessary
Obtaining a higher education has transitioned from being a privilege to a prerequisite for professional success. However, success is not always correlated with the level of education the individual possesses. This is especially true in the field of nursing. According to the American Academy of Nurse Practitioners (2010), AANP, the minimum degree requirements for obtaining a nurse practitioner license certification should be changed to a doctorate degree in nursing. With these changes being suggested to take affect in 2015, the urgency is now to repeal such a notion. Doctorate level degrees in nursing provide little added benefit, but add excessive time and cost to the student nurse when compared with masterÕs level degrees. This added cost and time suggests that making any changes to the educational requirements for the nurse practitioner license will negatively affect those currently practicing and those pursuing their degree in the future. Therefore, the minimum degree necessary to practice as a nurse practitioner should be a masterÕs degree. Not only does the masterÕs degree provide the necessary skills to practice, but it also provides the opportunity for growth if the nurse desires in the future.
Over the years, the world of nursing has shown constant growth and change. The days of Florence NightingaleÕs original vision of what nursing should be and what it has become are prime examples of such versatility. It was Nightingale who brought to light the importance to teach nurses with formal education. She made this vision a reality by starting a school in St. Thomas Hospital (Monteiro, 1985). Prior to her influence, the nurse was merely a housekeeper and doctorÕs helper. Education was developed on the job without any formality. It then grew more structured using on-the-job experience as a textbook and establishing a structured belief system to define the roles of the nurse. This is how the diploma nurse was created. As the development of skills became more defined so did the educational criteria. Now, licensure is obtained across the nation using a universal test of competency. The passing of this test demonstrates that the student has the foundation of knowledge required to begin expanding on their skills in practice. This constant growth continues as a nurse decides to progress from a clinical nurse to a professional.
The nurse practitioner was created in the 1960s. Originally being pediatric nurses residing in rural areas, they provided health promotion care to children and families. Soon this new area of nursing grew into a broad-spectrum practice. Now, nurse practitioners not only treat babies, but children, adults, and elderly individuals as well. Growth continued by establishing specialties within the nurse practitioner practice. Duties also began to range from performing assessments to prescribing medication for treatment. Now, the need for additional healthcare providers adds to the high demand for this field of nursing. After evaluating patient satisfaction scores from care received from nurse practitioners, these additional healthcare providers bring the added benefit of high quality care to patients. Not only was satisfaction for the nurse practitioner higher than that of the physician, but the patients also felt the nurse practitioner provided better educated them about their current health state (Agosta, 2009). This illustrates that the new health provider role has grown and become respected amongst society as a legitimate profession.
In order to identify what it means to be a professional nurse practitioner, the question of what a profession is must be answered. The American Nursing Association (ANA) identifies ten standards for professional performance: Òethics, education, evidence-based practice and research, quality of practice, communication, leadership, collaboration, professional practice evaluation, resource utilization, and environmental healthÓ (2001). Kearney-Nunnery (2012) further expands on this stating, Òprofessional development is provided through continuing education and specialty preparation and continual competency as a professionalÓ. Based on these attributes, education is an important aspect of professionalism. With great focus placed on expanding this foundation of knowledge, it is important to properly identify how much is enough to enter the field of professional nursing. In the area of research and evidence-based practice, it is important to understand that this entails more than actively working in research. As a nurse practitioner, it is important that focus is place on what is the best practice and implementing that into the plan of care for the patient. This is where the true focus regarding evidence-based practice as part of professionalism is placed.
A masterÕs degree in nursing is the appropriate minimum requirement to obtain a nurse practitioner license. The skills developed within the program prepare the nurse to begin providing prudent care to patients. In fact, the care provided by the masterÕs level nurse was comparable to that of the doctorate level after a study was conducted in order to compare the two professionals (Dreger & Glasgow, 2011). The continual growth of knowledge that comes from experience on the job will provide the additional education to fulfill the requirements spelled out within the nursing code of ethics. According to the ANA Òthe nursing profession should engage in scholarly inquiry to identify, evaluate, refine, and expand the body of knowledge that forms the foundation of its discipline and practiceÓ (ANA, 2001). This additional education does not necessarily mean a higher degree. Instead, it means staying attuned to the advancements in healthcare as a way to provide and offer a greater level of care.
With rising educational costs being a growing concern, this only adds to the importance of keeping a masterÕs degree the minimum level of education required to be a nurse practitioner. A masterÕs degree leaves students with the equivalent of a small mortgage. By mandating additional schooling requirements, the cost of a new car is added to that mortgage. This can be perpetuated by the difficulty of job placement following graduation. The need for nurse practitioners is evident, but greater is the need for experienced, professional nurses. Unfortunately, this leaves the recent graduates drowning in student loans and fighting to establish the credentials that will make them one of the needed experienced professionals. The financial strain this can place on the nurse may be a deciding factor regarding whether the advancement of their degree is worth the cost. On the opposite hand, the universities that offer the doctorate degrees in nursing find it financially beneficial and therefore the promotion of such advancements are seen extensively from these institutions.
This experience and previous job evaluation employers take into great consideration when recruiting new employees. Previous experience reduces the training time making the employee more cost effectiveness to hire. Also, the proficiency of the nursing skills implemented by the nurse adds to the integrity and quality of care provided to patients. This suggests that value is not placed on where, when, or how much schooling the nurse possesses. Instead, value and growth is based on years of experience on the job. Therefore, there is no evidence to support withholding the nursesÕ opportunity to establish that growth by practicing with a masterÕs degree, as opposed to extending their education in the field of research offered through the doctorate degree.
When the nurse does graduate, they will work side-by-side with physicians. The belief that a doctorate level of education is necessary in order to perform their duties proves inconsistent with over forty years of the profession. When the nurse practitioner position was established in the mid-sixties, the minimum level of education was a masterÕs degree. The duties included health promotion, treatment of acute/chronic conditions, and health maintenance. Doctorate degrees expand on researching practices to add to the evidence-based practice used in the field of nursing. That is inconsistent with definition of what a nurse practitioner is and duties they perform. It is true that the doctorate nurse will be better prepared in identifying the abilities to expand upon the evidence-based practices but does not prove that this skill will make them a better prepared healthcare provider for doing so.
Since the nurse practitioner works alongside the doctor, the education behind providing care should be comparable. The career path for a doctor starts similar to a nurse practitionerÕs position. The doctor must obtain an undergraduate degree, maintain superior grades throughout school, and move onto a graduate level of education. The ambitious medical student must take the Medical College Admission Test (MCAT), which is similar to the GRE that is required by certain graduate schools. This is followed by the completion of prerequisites prior to hands-on curriculum. Although their educational pathway extends beyond graduation with residency and fellowship programs, their program does not require extensive instruction into research (AMA, 2012). Therefore, to stress the need to have this education to be a nurse practitioner lacks validity. If the nurse practitioner performs duties similar to that of a doctor, the educational framework of their classes should be similar, as well. The additional time spent on expanding knowledge in the area of research should be replaced with clinical focus similar to the physicianÕs residency.
Still with everything discussed, the question persists Ð what will come of those nurse practitioners currently working under a masterÕs degree in nursing? Although they should be grandfathered into the new degree requirements, change will have a profound affect on their future. As time progresses, the doctorate degree will become the norm for new graduates and employers will begin making it a requirement for employment. This will lead to a shortage of nurse practitioners due to those who do not wish to further their education. For those who do go on to pursue the higher degree, an additional financial burden awaits them. Therefore, this adds to the argument that experience should be valued over education. These experienced nurse practitioners are the valuable ones and the ones who will be shaping future practitioners.
On the other hand, doctorate degrees have great benefits for professional nurses. It extends the foundation of knowledge to a higher degree and incorporates the need for nurses to participate in the growth of the profession. With evidence-based practice driving the expectations behind giving proficient care, the ability to identify and become involved in such studies can assist the nurse in making the difference that is constantly sought after. However, these benefits are limited to just that, knowledge. Knowledge only becomes powerful when it is applied and used in practice. Therefore, the purpose behind the doctorate degree is more beneficial for those wanting to take part in the research aspect of nursing.
When comparing these benefits of a doctorate degree with the roles of the nurse practitioner, the additional schooling required does not add to the quality of care provided. It merely adds to the practitionerÕs understanding of how the research was conducted for the practices in which care is performed. In addition, one of the arguments made by the American Association of College of Nursing (AACN) (2004) is that the educational pathway of the masterÕs level nurse practitioner is expanding to the point that it is starting to resemble doctorate degrees. In this case it is best to go ahead and make a doctorate level degree required. However, if the higher expectations are comparable with those of the doctorate degree, this only gives strength to the argument that a masterÕs level degree will provide an appropriate level of education for the nurse to begin practicing.
Supporters of the doctorate nurse practitioners believe that the advanced degree will provide the nurse with the tools to cause change as opposed to just participating in change. Basically they will be the ones who conduct the research for change and write the papers furthering education (Dreher & Glasgow, 2011). This belief makes the definition of the nurse practitioner become an individual who conducts research and advocates change.
Although this is important to incorporate within practice, it should not be the basis of its purpose. In the State of Indiana, the definition of a practitioner is:
A registered nurse qualified to practice nursing in a specialty role based upon the additional knowledge and skill gained through a formal organized program of study and clinical experience, or the equivalent as determined by the board, which does not limit but extends or expands the function of the nurse which may be initiated by the client or provider in settings that shall include hospital outpatient clinics and health maintenance organizations. (ISBN, 2012)
Based on this definition, being an active participant in conducting research is not necessary. If the purpose for obtaining an advanced degree is to participate in research as a way to make a difference in the world, there are many other degrees that the nurse can obtain without becoming a nurse practitioner. After all, a practitioner is someone who participates in a profession (Merriam-Webster, 2012). Being linked with nursing, this would mean actively providing care as a nurse. Providing direct patient care satisfies this stipulation more appropriately than conducting the research behind evidence-based practice.
In the end, one of the key pushes for the doctorate degree comes from the need to better prepare the nurse practitioner to practice effectively upon completion. Preparation is important regardless of profession that is sought. If a higher degree provides additional skills to perform the duties of a healthcare provider, then changing requirements are justified. However, research into the differences between the two degrees has been unsubstantial in providing such evidence.
The differences between the two degrees include doctorate degrees requiring twice as many clinical hours as the masterÕs degree. Another difference is in the way the material is delivered. In the masterÕs program, essential areas of knowledge are integrated within the curriculum while doctorate degrees separate them into their own areas of study (Dea III, 2008). Seeing as the certification exam that is taken to obtain the nurse practitioner license after graduation is the same for both degrees, this difference in curriculum and clinical hours is inconclusive evidence to validate extending the educational requirements.
With everything taken into consideration, it is hard to argue that skills can be best developed in practice. It is within this practice that the nurse can determine what they wish to bring to it and what additional knowledge they need to obtain the goals they set out for themselves. By changing the level of education required to obtain a professional license to a doctorate degree, the nurse will have reached the peak of education before establishing themselves in their field. Although continuing education is an expectation within the scope of practice, the next level of care above this degree would be to exit nursing and enter the medical realm as a physician. If a nurse wanted to become a doctor, then entering medical school rather than nursing have been a more appropriate decision.
Instead, the nurse practitioner is a growing profession that provides to the high demand and need for health care providers. If the minimum level of education is increased to a doctorate degree, the desire to obtain this title is negatively affected. Due to the high costs of education, being able to financially afford the degree becomes a problem. The undergrad nurse may find it difficult to find the resources to complete this degree. Another issue present pertains to the type of students who would be pursuing this licensure Ð most are working full-time, with kids, and little extra time to devote to the highly demanding curriculum. The personal desire may be present, but the resource, time, and means prevent the nurse from acting upon it.
At the same time, nurse practitioners currently practicing will be faced with uncertainty in regards to what these changes will mean for them in the future. Although immediate effects may not be felt, as the transition becomes more permanent and accepted, these practitioners will need to make the decision on whether to further their degree. Also, this will limit the job opportunities these nurse practitioners will have moving forward. Emphasis on their degree will overshadow the extensive experience in practicing. Employers will begin to make doctorate degrees a requirement in order to hold the position of nurse practitioner. Difficulty staffing with experienced nurse practitioners will be the next challenge employers will face.
There is a reason the AANP has not changed the requirements in order to achieve a nurse practitioner license. Finding evidence that such change would benefit healthcare and society continues to halt any progression towards mandating the doctorate degree. Healthcare will benefit from utilizing the expertise of the experience nurse practitioners currently practicing. Utilizing them to shape future practitioners, and help them gain experience in providing care, will benefit healthcare and society. Fixing something that is not broken wastes time. Focus should be on fixing the true problems in healthcare, such as the shortage of nurses, not contributing to them.
Agosta, L. (2009). Patient satisfaction with nurse practitioner-delivered primary healthcare services. Journal of The American Academy of Nurse Practitioners, 21(11), 610-617. doi:10.1111/j.1745-7599.2009.00449.x
American Association of Colleges of Nursing. (2004). AACN position statement on the practice doctorate in nursing. Retrieved from www.aacn.nche.edu
American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Nursing World Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf
Dea III, J.E. (2008). Differences between doctoral level nurse practitioner programs and master level nurse practitioner programs as reflected in the terminal objectives and curricular patterns. Montana State University, Bozeman, MT.
Dreher, M. & Glasgow, M. (2010). Role development for doctoral advanced nursing practice. New York, NY: Springer.
Effect of Criminal Convictions of Licensed or Registered Persons, 1 ISBN Ind Code and Ind Admin Code.ÊIC ¤ 25-23-1-1 (2012).
Kearny-Nunnery, R. (2012). Advancing your career: Concepts of professional nursing (5th ed.). Philadelphia, PA: F.A. Davis Company
Monteiro, L. A. (1985). Florence Nightingale on Public Health Nursing.ÊAmerican Journal Of Public Health,Ê75(2), 181-186.
practitioner. 2012. In Merriam-Webster.com. Retrieved November 8, 2012, from http://www.merriam-webster.com/dictionary/practitioner
IS A DOCTORATE DEGREE NECESSARY 12
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