Letter to the Editor on "Doctor of Nursing Practice..."

The Doctor of Nursing Practice (DNP): Need for More Dialogue

November 1, 2005
in response to topic The Doctor of Nursing Practice (DNP): Need for More Dialogue (Sept. 30, 2005)

Dear Editor:

The DNP proposal strikes a familiar note: another credential, another standard, and another claim that some category of nurses needs "more training." Once again we focus internally in the face of astounding external national and global health challenges. This issue might easily waste a decade of our collective energy. It has happened before.

We find ourselves amidst economic crises in health care, worldwide natural disasters, threats of pandemic infectious disease, unprecedented unemployment and displacement, and widening global conflicts oversimplified in the talk of "terrorism." Never before has it been so clear that health protection is the crux of human security. The world is learning that no health care system can function without nurses and without nursing knowledge. Now is not the time to mire nursing in yet another internal debate that is rooted in fears of inferiority and a scramble for status; a debate that is presumably justified by the demands of a "nursing shortage." We know the modus operandi. We lower a standard and hope that masses will come into nursing. We don't address the causes of health crises and the conditions that make care inaccessible to so many.

The proposed DNP degree is said to be driven by trends. Although disguised, it is in fact driven by individuals. The idea appears to have dropped from the sky as a product of the AACN's Task Force. Who decided upon the task? Rather than being clearly identifiable and accountable for their arguments, the proponents of this degree are being framed in the passive voice. The DNP is being fast-tracked and has little connection with specific needs in health services. The DNP role is being sold as one of "knowledge workers." To do so conveys amnesia about the struggle to integrate nursing science within the university structure and establish PhD-granting programs. To propose this degree is not to lead, but is to follow ambiguously articulated trends. Further, the trends clearly are not essential trends in the public sphere about the public's health.

This moment is nursing's greatest opportunity for genuine acknowledgment by the public that nursing is the core of any health care system, and the last line of defense against inhumane, inadequate, and inaccessible treatment. It is the moment when nursing experts should be visible and vocal in the media and in the policy-making debate. We need to devise new structures and processes of care for emergent public health needs. The current structures have failed those most in need. Nursing leaders must address universal human rights, easing of illness, healing from trauma, and protection from suffering and violence. We must finally expand the horizon of health to include safety, literacy, economic justice, and an end to racism and all the ugly "isms." It is time for externalized nursing vision.

Rather than disrupting our educational practices, we should act on health conditions. If we clearly lead in these arenas, there will be little need for another ribbon, another stripe, another medal, another title to legitimize ourselves. The message the DNP idea sends to nurses is also familiar: "You are not ready, not good enough, behind the times, less than, and powerless." The public will have greater awareness of nursing when we take clear public action to end famine, environmental catastrophe, greed, torture, war, and disregard for the health of billions. Why turn inward, away from the very public we say we want to acknowledge us?

Not only is this debate ill-timed, unoriginal, and irrelevant, it is an unethical preoccupation in the face of far greater priorities.

Joanne M. Hall, PhD, RN, FAAN
University of Tennessee College of Nursing
Knoxville, TN