Letters to the Editor
Article Outline
To the editor: Reflections on the DNP Regional Meeting in Boston, MA September 14-15, 2005
Several nursing leaders have raised concern regarding the potential impact of the practice doctorate on PhD enrollment. In a thoughtful article focused on the possible negative effects of the Doctor of Nursing Practice (DNP) programs on our profession, health care, and society as a whole, Dracup et al1 argued that the availability of the DNP might reduce already small numbers of PhD graduates, in part because students may opt to pursue what they perceive to be a less rigorous route to the doctoral credential. The authors note that should such a pattern emerge, knowledge generation in nursing would be adversely affected because fewer nurses would be prepared to develop independent programs of research, thus threatening our ability as a profession to secure sufficient numbers of tenure track positions in academic institutions, the primary avenue by which new knowledge evolves. Several participants at the first DNP regional conference convened in September by AACN also voiced this concern. Interestingly, however, early data describing DNP and PhD enrollment figures in Schools of Nursing, which currently offer both doctoral programs point to a different trend, albeit early in the development of the DNP movement. At both the University of Kentucky and The University of Tennessee Health Science Center at Memphis, PhD enrollment has actually increased since the introduction of the DNP.
Although increasing numbers of PhD students in the face of introducing DNP programs might seem puzzling at first, it may be useful to borrow a key concept (differentiation) from the family therapy literature to inform a way of thinking about this occurrence. To the extent the DNP represents a move toward a more differentiated position for our profession, it is likely to promote growth throughout nursing. Bowen theorists,2, 3 for example, posit that differentiation is a lifelong process, rooted in family relationships (in this instance, the nursing “family”) of striving to keep one’s being in balance through the reciprocal internal and external processes of self-definition and self-regulation. At its core, the practice doctorate is envisioned as an integral component of nursing’s self-defined response to the self-regulation challenge issued by the Institute of Medicine4 for the health professions to reform education in the service of enhancing health care reform. Issues of establishing parity with other professions, resolving the “credit creep” in Master’s programs, and even ameliorating the faculty shortage, are important but secondary reasons for moving forward with the DNP. Drawing from our essential purpose as nurses and equipping ourselves with the sophisticated tools required to contribute meaningfully with our interdisciplinary colleagues to the health care reform virtually all agree is sorely needed is a relatively differentiated response to the complex issues that must be resolved if we are to make a substantive response to fixing our health care system.
A more differentiated position is one that arises primarily out of one’s own self (as opposed to primarily in reaction to others’ positions). It is an emotional concept that refers to taking responsibility for defining positions on matters of importance that are consistent with one’s own values and goals, and to holding onto such positions even in the face of reactivity from others.2, 3 The concept is rooted in biology and rests on the notion that “cells lack identity and purpose until they are separate from the their progenitors.”2 A differentiated cell is one that is well defined with a clear beginning and end. Yet differentiation also requires that a distinct cell stay connected to the cells surrounding it. Cells that get cut off from the larger body cannot survive. In addition to understanding the importance of well-defined boundaries and connection to an organism’s health, it also is useful to remain mindful that the process of defining a self promotes growth not only in one’s self, but also in those surrounding the self. Thus, differentiation is on the side of appealing to the health in one another by building on the strengths in one’s self. This basic process is operationalized in the way Bowen therapists work to promote differentiation with their clients—it is through the clinician’s own differentiating efforts (including reflecting and tending to his or her family of origin issues) that client health is catalyzed and optimized. This is in contrast to other clinical models that require a primary focus on the client in the context of his or her family.2, 3
The emergence of the practice doctorate has been a differentiating move for nursing because a newly formed program (cell) is in the process of being defined within the context of the larger whole (body) of the profession. Defining the distinction between the PhD and the DNP has been central to developing the vision for the DNP. Greater differentiation in the body of nursing can be expected with increasing boundary definition between the two degrees as well as with increasing clarity and refinement of the educational pathways to the DNP. And to the extent Bowen theorists are correct, with greater differentiation, we should anticipate growth not only in DNP programs but also in the cells (such as PhD programs) that surround the practice doctorate.
References
- . Reflections on the doctorate of nursing practice . Nurs Outlook . 2005;53:177–182
- . Bowen theory and therapy . In: Gurman AS , Kniskern DP editor. Handbook of family therapy, vol 2 . New York: Brunner/Mazel; 1991;p. 134–170
- . Family evaluation (an approach based on Bowen theory) . New York: Norton; 1988;
- . Health professions education (a bridge to quality) . Washington (DC): The National Academies Press; 2003;
PII: S0029-6554(05)00234-4
doi:10.1016/j.outlook.2005.11.003
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