Pediatric Nurse Practitioner Certification and the Doctorate of Nursing Practice
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As the complexity of our current health care systems has increased, national nursing education organizations have recommended that the Doctor of Nursing Practice (DNP) become the terminal academic degree for all nurse practitioners. The American Association of Colleges of Nurses (AACN) published a position statement supporting the move to the DNP (2004) followed by their Essentials of Doctoral Education for Advanced Nursing Practice (2006), a resource for DNP curriculum development. The National Association of Nurse Practitioner Faculties (NONPF) also supports the transition and facilitated a revision of their nurse practitioner (NP) core and population-focused competencies to support the integrated DNP NP curriculum (2015).
Throughout its history, nurse practitioner education has evolved from non-degree, certificate-based training to accredited graduate nursing programs. Once the need for graduate education was recognized and programs became available nationwide in the late 1980s, the transition to master's level education occurred. PhD and Doctor of Nursing Science degree (DNS, DSN, or DNSc) programs began to increase in the early 1970s, with the DNP evolving more recently as the clinical practice doctorate. The DNP is considered a path to achieving parity and aligning the workforce with other health professions as seen in pharmacy (PharmD), psychology (PsyD), and physical therapy (DPT). As PNP education has evolved, so has PNP certification.
Certification does not establish new standards or guidelines, but instead reflects the integration of educational standards in day-to-day clinical practice.
CERTIFICATION compared to EDUCATION
The purpose of certification is to validate the knowledge and entry-level skills that are linked to competent PNP practice and achieved through completion of an accredited graduate PNP educational program. Certification does not establish new standards or guidelines, but instead reflects the integration of educational standards in day-to-day clinical practice. PNCB’s PNP certification exams have played a critical role in validating entry-level PNP competence, a regulatory/licensing requirement for most states. As required by certification accrediting agencies, PNCB conducts periodic national role delineation or job practice analysis research to identify the knowledge and tasks necessary for competent PNP practice. This important research provides the foundation for PNCB’s national PNP certification exams, resulting in updated exam content outlines which define what knowledge is tested.
As PNP education transitioned from certificate programs of varying lengths to accredited graduate nursing programs, PNPs with master’s degrees entered practice in greater numbers. Subsequently, PNCB’s periodic role delineation research revealed changes in PNP practice reflecting the influence of graduate educational standards. In 1992, PNCB's Board of Directors voted to require that all PNP exam candidates document completion of an accredited graduate PNP program. Prior to 1992, a master’s or doctoral degree was not required.
Each historical change in educational requirements for undergraduate or graduate education in nursing has been an acknowledgement of the many roles nurses fulfill in the health care system. Moving to require a DNP is not intended to devalue the practice and contributions of the certificate or master's prepared PNP. “Nurse practitioners have been providing safe, high quality, cost-effective, coordinated, and comprehensive clinical care grounded in evidence-based practice for over 50 years.” (NONPF 2015). What is gained with the DNP curriculum is additional integrated content on information technology, health policy, interprofessional collaboration, and organizational and systems leadership.
2022 PNCB Update
As an organization committed to excellence in education and clinical practice for PNPs, PNCB has monitored the development of educational standards for DNP programs and provided input into in the development of guidelines for evaluation of nurse practitioner education (National Task Force 2022) and population-focused pediatric NP competencies (NONPF 2013). While graduate PNP programs are gradually moving to the DNP, a significant number of PNP programs from around the country currently remain at the master’s level. As of June 2022, approximately 17% of PNP programs recognized by PNCB offer students a BSN-DNP or post-master’s DNP as the only degree offered.
PNCB exam eligibility currently accepts candidates from master’s, post-graduate certificate, and doctoral PNP programs due to the persistence of multiple educational entry points into PNP practice. PNCB will continue to conduct national job task analysis research to determine the influence of DNP education on the changing nature of PNP clinical practice, and anticipates accepting candidates from all these programs until the change to require a DNP for entry-to-practice is deemed realistic for all stakeholders, especially faculty.
If our Job Task Analysis research reveals that DNP education has influenced the knowledge and skills linked to competent entry-level PNP practice, then PNCB will consider revising its national exam eligibility to require completion of a DNP. PNCB will give sufficient notice as to when this eligibility change would take place, and it would apply to new graduates taking the exam for the first time. The new requirement will not affect PNPs who are already certified.
PNCB also tracks the number and types of PNP programs and the overall number and percentages of DNP PNP exam candidates with their passing rates. If our research reveals that DNP education has influenced the knowledge and skills linked to competent entry-level PNP practice, then PNCB will consider revising its national exam eligibility to require completion of a DNP.
While PNCB is supportive of the DNP as the entry-to-practice degree at some time in the future when it is truly feasible, our organization must also assess and monitor the landscape of PNP stakeholders and how they will be affected by this change. These concerns come from critical analysis of our stakeholders:
- The move to enforce DNP entry-to-practice will likely be less inclusive and less equitable and will delay PNP students’ entry into the workforce. This delay negatively impacts access to care for children, adolescents, and young adults.
- As of June 2022, the PNCB-certified PNP workforce currently consists of fewer than 3% of DNP-prepared PNPs.1 Only 18% of PNP certificants who identify as advanced practice nursing faculty in PNCB’s database hold the DNP.2
- The percentage of exam candidates over the past 7 years (2015-2021) who apply for either CPNP-PC or the CPNP-AC exam after graduation from a DNP program has averaged approximately 8%.
- State educational requirements may dictate if a state university program can add or transition to a DNP requirement, given the options currently in that state. Similarly, state universities may also need to get permission from the state legislature, college system or commissioners such as the Southern Association of Colleges and Schools before a program can be closed.
Research is ongoing to identify the key outcomes of the DNP degree and impact on quality patient care. PNCB will continue to evaluate the evidence as it relates to certification for entry-to-practice.
If a change to PNP exam eligibility is made to require graduation from a DNP program PNCB will give approximately 2 years notice to program faculty and students; the change in requirements would only apply to new graduates taking the exam for the first time, and would take into account program catalog transitions.
PNPs educated at the certificate or master’s level and who hold active certification with PNCB will not be required to obtain additional degrees to keep their current certification.
- American Association of Colleges of Nursing (2004) AACN Position Statement on the Practice Doctorate in Nursing
- American Association of Colleges of Nursing (2006) AACN Essentials of Doctoral Education for Advanced Nursing Practice
- National Academies (2021) The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity
- National Organization of Nurse Practitioner Faculties (2015) The Doctorate of Nursing Practice NP Preparation: NONPF Perspective
- National Organization of Nurse Practitioner Faculties (2013) Population-Focused Nurse Practitioner Competencies
- National Organization of Nurse Practitioner Faculties (2016) Criteria For Evaluation of Nurse Practitioner Programs
1, 2 Pediatric Nursing Certification Board database, accessed June 13, 2022.