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Will It Create a Second-Class NP?

Posted January 6, 2009

It looks like the doctorate of nursing practice (DNP) will be part of our professional futures. By 2015, all new advanced practice nurses will need to have a DNP for certification. Those of us in practice before that date will not be required to get the degree; we will be grandfathered in.

Will the DNP make master's-prepared NPs appear unqualified to provide the services they have been competently providing for years? As NPs, we need to know how this will affect our lives. The push for the DNP has far-reaching consequences.

Expert Status
A master's degree has long been considered the terminal degree for nursing specialists to enter advanced practice. With master's degrees, NPs are highly educated specialists. We seek new and updated knowledge to serve our patients' best interests. We consult or refer to gain the input of others when faced with a particularly difficult case.

Our current system of certification and recertification demonstrates our commitment to stay current with knowledge. We attend conferences, seminars and other continuing education activities that have been accepted as credits toward recertification.

Most master's-prepared NPs have pursued patient-centered careers. Ongoing continuing education, as well as collegial discussions, are manifestations of our efforts to be the best we can be. I fear that the DNP will invalidate master's-level providers as experts and that only those with a DNP will be viewed as experts.

Financial Concerns
Several studies have proven that master's-prepared nurse practitioners provide safe and effective care equal to that of their physician counterparts. We sweat the details and immerse ourselves in the real world of health care, with its long hours and agonizing decisions. Will a DNP improve our income? Or will it send a message to insurance companies that master's-prepared NPs are no longer qualified? Will it reduce the opportunity to gain provider status on insurance panels?

Job Opportunities
As we gain experience, we get better at what we do as professionals. We also begin to think of our future - our retirement. Many of us will not have the resources to support a full-time retirement. Some of us just won't want to stop practicing completely. What we think about is a less stressed working life as we continue serving our communities. We think about relocating to a warmer or less busy environment.

Will I be qualified to get a job in another state? Will my qualifications be considered insufficient? Will I become an anachronism? As the DNP becomes the norm, will older, master's-level NPs be able to compete for jobs?

Independent Practice
The rush to implement this credential will seriously affect NPs' efforts to achieve independent practice. Advocates of the DNP speculate that the degree will lead to reforming statutory supervision and collaborative practice laws. But I predict that it will lead legislators and medical associations to clamp down on the independence of master's-prepared NPs.

The DNP push is ill timed, ill planned and controlled by forces that don't represent mainstream NPs. I urge my colleagues to search their souls and their wallets. Is this direction acceptable? Is it wise?

It's the bottom of the ninth for current NPs, and we are losing a game that we were never invited to. The sad part is that it's not a game. It is about authority, privilege and money. This is about our livelihood, and it is truly serious business.

Anthony Pucek is a psychiatric-mental health nurse practitioner in private practice in Lagrangeville and Chappaqua, N.Y.


I got my Nurse Practitioner certificate after going through a Womens Health certificate program in the early 90's. I would like to get my masters degree and I have no idea how to go about this. Does anyone know who to contact and possibly how this is done?
Thanks so much!

sherri crawford,  ARNP-CApril 20, 2014
Tampa, FL

I know that I could not afford to leave my present position to pursue a DNP. I could not afford the tuition for a DNP program. I also feel that my income as a DNP would not reimburse me for the expense of DNP education. Physicians especially are not generous employers and the NP will be the first to go no matter what the education level if the doctors in the practice feel they are not making enough money. I have seen this happen to many NPs. If I was younger and had unlimited funds I would love to go back to school for the challenge and for my own love of education. Then again, maybe I would have just gone to medical school if those conditions existed.

Karen ,  FNPFebruary 24, 2009

Did you ever check what percentage of physicians actually belong to the AMA ? Less than 30 percent !
They are not as united as all that eh?

Robert Dillon,  NPFebruary 18, 2009

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