The Doctorate of Nursing Practice: A Review

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The push for higher levels of education in the nursing profession has become evident with an increased focus on nurses earning a Bachelor of Science in Nursing (BSN).  Beyond that, nurses earning a Master of Science in Nursing (MSN) are able to function in an advanced practice capacity.  Taking education one step further, the Doctorate of Nursing Practice (DNP) is a terminal degree that will place the RN at the highest level of nursing.

The DNP prepares nurses to provide direct care of individual patients as well as populations, and to provide leadership, develop and manage health policies, utilize practice management, and incorporate process and outcomes evaluation (Huston, 2017).  Because the DNP offers the opportunity for nurses to be their best self, it is becoming a more sought-after degree for those nurses wanting to become an advanced practice registered nurse (APRN).  According to the American Association of Colleges of Nursing, the number of DNP graduates from 2015 to 2016 increased from 4,100 to 4,855 and DNP programs are offered in all 50 states (Lucci, 2019).

Impact of the DNP

 Doctoral studies within the nursing realm provide nurses with the capacity for developing and cultivating leadership competencies that can lead to the improvement of outcomes and processes (Ferguson, & Forest, 2012).  A DNP prepared nurse is also able to more comprehensively analyze the current literature and research and apply it to nursing practice.  As change agents, the DNP utilizes translational research to move new ideas and concepts from the bench to the clinical setting (Ferguson & Forest, 2012). 

 With an enhanced level of professional and clinical autonomy, DNP’s are readily equipped to promote their knowledge and expertise within their chosen clinical setting.  They are able to provide legitimate, positive care to their patients by virtue of their professional credibility and the resultant personal confidence derived from their level of training (Smith, 2013).

The DNP in Advanced Practice Nursing

 With the increasing complexity and innovation of newer health care delivery methods, the need for APRN’s to earn a DNP is becoming more apparent.  Many APRN programs are recognizing the need to increase the “number of didactic and clinical clock hours far beyond the requirements of master’s education in virtually every other field” (Huston, 2017, p. 49).  This is not to discount the importance or need for the MSN.  It merely suggests that the additional clinical hours obtained from doctoral level studies can provide the doctoral APRN with the additional knowledge and skillset needed to manage a rapidly evolving healthcare system.

 To provide a more concrete foundation for DNP’s in advanced practice, the American Association of Colleges of Nursing (AACN) created a document titled “The Essentials of Doctoral Education for Advanced Practice Nursing” in 2006.  This document was developed after the AACN’s endorsement of a position statement to recommend that all APRN education change from requiring master’s degrees to requiring doctoral degrees by the year 2015 (Huston, 2017). 

 The DNP Essentials document is comprised of eight key areas that the AACN developed to be included in DNP curriculum.  Some of these areas include: scientific underpinnings for practice, health care policy for advocacy in healthcare, inter-professional collaboration for improving patient and population health outcomes, and clinical scholarship and analytical methods for evidence-based practice (Huston, 2017). Despite this forward motion of DNP education, the American Nurses Association (ANA) stated in 2010 that it “supports both master’s and doctoral level of preparation as entry into APRN practice through a period of transition” (Huston, 2017, p. 49).  The key point in this statement is that the process is in a period of transition, which this author feels makes it a fair and accurate reflection of the current state of the DNP. 

The Role of the DNP

 The role of the DNP within the clinical spectrum is a continuous cultivation of a relatively new level of nursing.  As such, research is being conducted to more closely identify their roles and how they compare to nurses in other capacities, to include those in leadership roles.  One study conducted by the American Board of Comprehensive Care used a convenience sample of 375 DNP graduates working in an APRN capacity.  The study concluded that 70% of their time was spent providing direct patient care, 16% of the time was spent teaching, 8% providing administrative oversight, 2% consulting, and 2% conducting research; while this study helped illustrate the role of the DNP/APRN role in the clinical setting, it did not expound on the role of the DNP in other settings such as in executive, managerial, or educational positions (Beeber, Palmer, Waldrop, Lynn, & Jones, 2019). 

 In another study, an online survey of DNP programs was conducted to examine the inner workings of education provided in DNP curriculum and look at the types of institutions that hire DNP graduates.  The 242 AACN and Commission on Collegiate Nursing Education (CCNE) accredited DNP programs were utilized as a recruitment database for the survey.  Combining this with an internet search of DNP programs yielded 288 DNP programs to include in the survey (Beeber et al., 2019).  Of the search results, 130 DNP program directors completed the survey.  The survey results reported that 40% of DNP programs used an online teaching approach, 51% used a blended (online and in-person) program, and 9% used in-person teaching methods (Beeber et al., 2019).  Moreover, and to broaden the scope of the survey, 23 primarily nurse leaders with an advanced degree such as a DNP or PhD participated in phone interviews to help clarify the role of the DNP.  Results indicated that employers felt that DNP prepared nurses are still amongst a new albeit evolving realm of nursing.  In the APRN role, they felt DNP’s function in a primarily direct clinical care capacity.  Administratively, DNP’s served in roles such as chief nursing officers, director of quality care, and director of clinical operations (Beeber et al., 2019).

DNP compared to the PhD

 When deciding on a nursing degree beyond the master’s level, nurses have the option of the DNP or a PhD in nursing.  One major consideration in deciding which area to pursue depends on the area of focus the nurse wants to practice in.  For those nurses wanting to concentrate their efforts and continue to practice in the clinical setting, the DNP would be the appropriate choice.  However, if research is the focus, then the PhD is the overwhelmingly popular choice.  The PhD in nursing affords the nurse with opportunities to apply and develop theories and develop research programs.  Additionally, PhD nurses can achieve professional leadership positions in hospitals and healthcare systems that will benefit from their invaluable research findings (Rice, 2016).

Conclusion

 Nursing has come a long way with PhD programs beginning toward the end of the 20th century (Rice, 2016).  And even though the DNP is still in a relatively new stage, it has become an option for nurses wanting to take their careers, knowledge-base, and skillset to the highest level.  As a consideration for entry-level APRN’s, the DNP has the potential to further the spectrum and scope of this area to a more enhanced field of nursing that facilitates the best patient outcomes.

References

  • Beeber, A.S., Palmer, C., Waldrop, J., Lynn, M.R., & Jones, C.B. (2019). The role of doctor of nursing practice-prepared nurses in practice settings. Nurse Outlook, 00(00), 1-11.  https://doi.org/10.1016/j.outlook.2019.02.006.
  • Ferguson, L.A., Forest, S. (February, 2012). The practice doctorate in nursing: perspective on how the DNP changes practice and improves clinical care. Pelican News, p. 11.
  • Huston, C.J. (2017). Professional issues in nursing: challenges and opportunities (4th ed.). Philadelphia, PA: Wolters-Kluwer
  • Lucci, A. (Winter, 2019). A reflection on the doctorate of nursing practice (DNP). ASORN Insight.
  • Rice, D. (March, 2016). The research doctorate in nursing: the PhD. Oncology Nursing Forum, 43(2).
  • Smith, N.J. (2013). Professional doctorates and nursing practice contribution: a systematic literature search and descriptive synthesis. Journal of Nursing Management, 21, 314-326. doi: 10.1111/j.1365-2834.2012.01446.x

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