Pediatric Nurse Practitioner Certification and the Doctorate of Nursing Practice
As the complexity of our current health care systems has increased, national nursing education organizations have recommended that the 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.
The purpose of certification is to validate the knowledge and entry-level clinical 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 “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 exam.
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.
The intention of moving to the DNP is not 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.
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 (NONPF 2016) 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. 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 and the lack of evidence to support the superiority of one program over another in contributing to clinical competence.
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. 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.
PNCB will continue to conduct national role delineation research to determine the influence of DNP education on the changing nature of PNP clinical practice. PNCB also tracks the numbers and types of PNP programs and the overall number and percentages of DNP PNP exam candidates and 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. 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. 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 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