Professionalization Crisis in Advanced Nursing Education: Competency-Based Frameworks and the Bifurcation of the DNP

 The environment of advanced nursing education is in the midst of a radical structural change. The move to a model based on Competency-Based Education (CBE) (formalized by the American Association of Colleges of Nursing (AACN) in the 2021 Essentials) in place of traditional, credit-based curricula is a radical effort to standardize professional preparation, both at the entry-level and at the advanced practice level.

Nevertheless, there has been a major division when it comes to the implementation of these standards. Whereas the clinical Doctor of Nursing Practice (DNP), including Nurse Practitioner, programs are framed by an inflexible 3 Ps framework, the nursing informatics profession does not have an enforced national curriculum. This has created a situation of extreme versatility of graduate preparation and what has been termed as a competency-based disguise on programs that are task-oriented in nature.

 

The Gold Standard: The APRN "3 Ps"

In clinical APRN tracks, the basic requirements are uncompromising. In order to become nationally certified, all students should take three, independent, graduate level classes:

1. Advanced Pathophysiology: The biological basis of disease.
2. Advanced Pharmacology: The precision management of therapeutics.
3. Advanced Physical Assessment: The synthesis of diagnostic reasoning.

These are 3 Ps, which are the fundamental pillars of clinical practice. Accrediting bodies audit them and are strictly enforced by ANCC PACE (Pre-Application Core Course Evaluation) service.

Illusion of Compliance: Bypassing Rigor in Programs

A common question arises: If all programs must follow the AACN Essentials, aren't they already teaching these skills? The solution is the flexibility of competencies mapping.

The programs under the CBE model will have to demonstrate that their students attain certain sub-competencies, yet the depth of such attainment is not given a federal mandate. For example, Domain 8.2 requires students to "facilitate the use of information technologies."

• This is fulfilled by a High-Rigor Program, which involves having students audit the security measures of a telehealth platform.
• A Task-Oriented Program achieves this through allowing students to engage in a Zoom meeting.

Both programs check the same box, creating an illusion of compliance. The universities have the freedom to teach a superficial curriculum in the name of the doctoral-level competency without a rigid, audited technical basis, an "Informatics 3 Ps."

The Credentialing Guardian: ANCC PACE (Rolled out Jan 2025)

The American Nurses Credentialing Center (ANCC) introduced PACE in January 2025 to solve the issue of the proliferation of the so-called express programs. This service enables certifying bodies to have a direct audit of a gap analysis of a university through primary source documents of the university; including syllabi and course descriptions when the student took the course. This is to guarantee that basic requirements are fulfilled as opposed to being purported on a form of validation of education.

The Fraud of Specialization by Proxy

The most important problem is when a specialized project and a specialized degree are mixed. Numerous programs enable nurses to complete with a Generalist DNP (Systems Leadership) and sell the notion of "specializing" by a project with an informatics theme.

• The Specialized Degree: This needs to contain a specific informatics core. This profound science in practice is the application of the project.
• The Specialized Project (Proxy): A student completes 30 credits of general leadership and only in the last months of the year, the student specializes.

Unless they have taken the prerequisite coursework in database schema or systems engineering, these specialists by proxy perform the role of project coordinators, not informatics scientists. They do not have the technical language to talk with engineers or C-suite executives, which contributes to the Noctor debate, which is a critique of interprofessional colleagues at the perceived lack of rigor in DNP education.

The Testimony of the "Task-Oriented" Gap

This gap in proficiency when using the Self-Assessment of Informatics Competency Scale (SICS) is highlighted by research. Statistics indicate that whereas DNP students perceive themselves as being above proficient in basic technology (email, searches), they have a below competent rating (average of 2.7-2.9 on a 5.0 scale) in:

• Deriving information out of clinical data.
•  Handling consolidated information using technical applications.
•  Use of structured languages (e.g. SQL).

Defining the Solution: The Informatics Triad

In order to eliminate this gap, we need to consider The Informatics Triad to be the technical standard that no DNP informatics leader can afford not to have - the 3 Ps of our specialty.

• Advanced Systems Architecture (The "How")
• Knowledge of Systems Development Life Cycle (SDLC), interoperability standards (HL7, FHIR) and database management.
  
  
• High-tech Data Analytics and Modeling (The "What")
• Technical independence to extract data independently with SQL, analyze it with R or Python, and assess predictive algorithms to the clinical validity and ethical bias.

• Developed Systems Strategy & Advocacy (The "Why")

• The application of Usability Science (HCI) to curb clinician burnout and alignment of IT efforts with the financial health of an organization.

 Summary: A Professional Reset

The DNP must not be a title grab which can be attained through academic expediency. It is by reclaiming the technical science of nursing informatics and implementing the Informatics Triad that we can be assured of the DNP graduates being considered the invaluable planners of the future of healthcare.

DNP Informatics Rigor Checklist: Guide to Future Students

Transcript and Degree Alignment

• Major vs. Project: Is the degree title of the specific degree Nursing Informatics, or a leadership degree with a tech project?
• The Informatics Core: Does the program possess at least 25-30 credits of informatics science?

Technical Architecture Markers

•  SDLC & Interoperability: Does it have mandatory courses on SDLC and Data Standards (FHIR/HL7)?
•  Database Logic: Does the curriculum include database schema and data normalization?

Analytical Science Markers

•   SQL Proficiency: Are you going to learn to write your own query?
•  Advanced Tools: Is the program R, Python, or SPSS?

The DNP Project Integrity

•  Implementation: Does it need a live technical implementation or a literature paper only?
• Specialized Mentorship: Does your project chair practice in Informatics Scientist?

References

American Association of Colleges of Nursing. (2021). The Essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2021.pdf

American Nurses Credentialing Center. (2025). APRN Faculty Toolkit: Validation of Education and PACE. https://www.nursingworld.org/certification/aprn-faculty-toolkit/

Choi, J., & Zucker, D. M. (2013). Self-assessment of nursing informatics competencies for doctor of nursing practice students. Journal of Professional Nursing, 29(6), 381-387. https://doi.org/10.1016/j.profnurs.2012.05.014

Gray, K. (2025, January 13). The gap in perceptions of new grads' competency proficiency and resources to shrink it. National Association of Colleges and Employers (NACE). https://www.naceweb.org/career-readiness/competencies/the-gap-in-perceptions-of-new-grads-competency-proficiency-and-resources-to-shrink-it

Himss Nursing Informatics Community. (2024). Nursing informatics scope and standards of practice. https://www.ania.org/nursing-informatics-scope-and-standards-of-practice