The practice of doctorate in nursing is being advanced by trends in health care and education as well as societal drivers. The present renaissance of interest in the practice of doctorate during the training of a nurse practitioner could precipitate change that imitates the evolution to Master's level education from post-basic certificate. The NONPF (National Organization of Nurse Practitioner Faculties) is a foundation for studying the doctorate comparative to improve the education of the nurse practitioner. This paper will examine the future of doctorate in nursing practice. In doing so, the paper will give approaches into the movements towards practicing doctorate by illustrating the societal momentum for change, the historical perception of doctorate education, the four Ws (when, why, where and what) of the movement, and some realities and myths regarding the practice of doctorate in nursing
Approaches into the movement
According to O'Sullivan (2005), the query facing the nursing society is not whether practicing doctorate is "fringe or future," but the approaches into the movement so as to ensure educational programs that are of good quality. The key elements of doctorate have been examined by the NONPF since 2001, so as to determine the consequence of new echelon of education on nurse practitioner. As Shaver (2005) assert, the movement towards doctorate appears to have attained the "tipping point," in essence that institutions and educations that are critical are committed to developing this degree in future. However, the ground-breaking nursing programs had already started to implement doctorate movement other areas of APRN (advanced practice registered nursing) education as well as nursing practitioners may be transformed by current renaissance of interest in the doctorate, in a way that resembles the evolution to Master's degree in nursing practitioner (NP) education from post-basic certificate. Researchers, clinicians, and educators are anxious about the uncertainties and the early phase of development about doctorate in nursing. The American Association of Colleges of Nursing (2004) recommends that all APRN education should be transformed to practice doctoral-degree. Answers to how each role of the APRN will be affected by this echelon of education will be provided by nursing leaders.
Momentum for Change
Resurgence of interest in doctorate and new levels of practice in nursing are usually driven by societal trends. Nowadays, healthcare is related inextricably to business practices, health policy, and informatics. Didactic programs in nursing have reacted through: certifications so as to keep updated with the current skills and knowledge; expansion of the master's degree syllabus; and multiple master's degrees being attained by clinicians. It is no longer socially-responsible to continue expanding master's program in their depth and breadth. Until now, there are gaps between what is needed for the nursing practice that has been advanced and the coverage of master's degree. Therefore, the society ought to shift health-care delivery system that is complex, information society, and a more diverse and aging heath-care consumer, so as to emphasize quality care and workforce shortages in health-care.
Historical perceptions of Doctoral Education and nurse practitioner (NP)
Didactic programs in Nurse practitioner emerged in 1960s as certificate programs that varied in length. The release and development of NP didactic guidelines by 1980 was due to the increase in post-basic certificate programs (in 1970s). NONPF (1990) identified that "Advanced nursing practice as a nurse practitioner is grounded in graduate level preparation (doctoral, master's, or post master's study)." Didactic programs in nursing were set up in 20th century. The profession's espousal of Master's degree as the suitable degree for the nursing leader is what might have delayed the growth of PHD nursing programs. The Doctor of Nursing first emerged in 1979 at Case Western Reserve University so as to prepare nurses, who were college-graduates, at a higher level that was similar to other related health-professional doctoral programs, like optometry, medicine, dentistry, and veterinary medicine. The doctoral degree in nursing prepared the starting clinician at doctorate level and it was open to non-nurses. Additional programs were developed by the University of South Carolina, Rush University and the University of Colorado that prepared the clinician at a doctorate-level to enable him/her to exert leadership in education or management, evidence-based practice and health policy. The Doctor of nursing exclusively focused on preparing the nursing leader. The emerging and current doctoral programs in nursing programs in nursing share most curricular-components of the early nursing programs, which emphasized on clinical leadership, health systems and/or direct health care. Nonetheless, the AACN (2004) observes the adoption of DNP (Doctors of Nursing Practice) and the phasing out of the ND title. The previous nursing programs that followed this suggestion have altered their destination to DNP. Most universities are still developing DNP programs
The four Ws for the practice of doctorate in nursing
The historical perspective for nursing-education and the on going changes in the community for nursing education may assist us to know why nurse practitioners may be prepared for the evolution to doctoral-level preparation. Specifically, the most fundamental questions ought to be addressed to determine the impact and relevance of this question. The questions that are frequently asked by NONPF are: When? Why? What? and Where? As we gain new insights and new information with regard to how NP educational programs can be guided, recommendations from this statement and task force are continually shaped and fluid. Nonetheless, in order to offer guidance, some answers have emerged from this work.
Myths and Realities regarding the practice of doctorate in nursing
Reality: The practice of doctorate in nursing will assist to preserve the honesty of the PhD (as a true research degree). Myth: The practice of doctorate in nursing will have an undesirable consequence on the PhD degree. PhD degree is dedicated to research, and research achievements that are distinguished can be formed by nurses with PhD. They will be funded to put up the knowledge base of the discipline. The doctorate of nursing intends to meet the requirements of education and advanced clinical practice, but as Bellack and Lancaster (1999) observes, little difference can be revealed in the research intensive PhD programs and these programs. The doctorally prepared nurse programs that are research-focused has many roles that are demanding and is not expected to sustain expert echelons of clinical proficiency for teaching nursing practitioner students. Due to the fact that the practice of doctorate in nursing is limited, PhD, or other research degree in nursing is being sought by nurses. A negative issue may not be decline in the number of individuals seeking doctorate in nursing if it means that those persons who are seeking research-training will dedicate their profession to research. Students pursuing clinical teaching or clinical practice professions have program options that support their career path. Therefore, the practice of doctorate in nursing does not need to lead to other degrees and as such is a terminal degree. Often the disenfranchised, the poor, and most sick individuals who expanded the depth and scope of practice were taken care of by the nursing practitioners. So far, the evidence of doctorate in nursing practices supports the roles of nursing practitioners and this has a positive impact on the outcomes (Feldman & Crosby, 2003). More skills and knowledge will be possessed, and changing health-care system could demand this new expertise. The kind and amount of change that one expects on his/her future career will be determined by the following questions: will he/she use the opportunity to augment his/her knowledge and skill in a way that is formal; and where one is going with his/her profession.
The move to practice doctorate in nursing is no longer in question for advanced nursing practice, and especially for nursing practitioners of the future. A continued discussion is how the changes that are required in the didactic systems will be brought to enhance this move. The alterations will only come about with concern and anxiety. New directions have been chartered by the existing nursing practitioners in care of persons with regard to the future of doctorate in nursing practice.