The Doctor of Nursing Practice (DNP) degree
emerged as an option for NPs in the first decade of this century. It is for those NPs who want a terminal degree but want to maintain a clinical, policy, or operations focus rather than produce, analyze, and evaluate research. Some DNP programs are aimed at those who already have a master’s degree in nursing. Others are for those with bachelor’s
degrees in nursing who will go straight through for a doctorate. Some universities admit both types of students for the DNP. Individuals who don’t already have a master’s degree will need more credit hours for completion.
The DNP emerged for some of these reasons:
PhDs and DNSs create the evidence base for nursing, but it was felt there was a need for clinicians who had advanced competencies other than research expertise to provide NP leadership within complex healthcare systems A need for enhanced knowledge about
information systems and technology for the purpose of improving nursing practice and patient outcomes
A need to translate research findings into clinical practice
A need for NPs who understand health policy A desire by NPs who wanted to continue as clinicians and wanted more education to have a suitable terminal degree that reflected their education
Curricula vary among DNP programs. One might find course content on:
Quantitative methods for evaluating healthcare practices
Financial management and budget planning Data-driven healthcare improvement
Evidence-based practice Effective leadership Scholarly writing
Transforming the nation’s health Health systems transformation
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The programs require a “capstone project,” that is, in the final year DNP candidates take what they have learned and apply it to examine, in writing, a specific idea applicable to health care.
While the DNP was originally thought to be a
“clinical doctorate,” the curricula in most programs have been oriented less toward pathophysiology and pharmacology and more toward policy, meta- analysis of research, and systems studies. The DNP is not equivalent to a medical doctorate.
There is very little law on DNPs. In some states, the degree is listed as one of the educational
credentials a successful applicant for a license as an NP might have. But while 40 states require NPs to have master’s degrees, no state requires an NP to have a doctorate.
In offering the DNP, the nursing profession is moving in the direction of other clinical health professions. Not only is there a doctorate in medicine (MD) and dentistry (DDS), but also in Pharmacy (PharmD), Psychology (PsyD), Physical Therapy (DPT), and Audiology (AudD).
NPs should understand that they are not required to get a doctorate to practice or keep practicing. There
has been much confusion about this issue, and here is why: In 2004 the American Association of
Colleges of Nursing (AACN) recommended that the doctorate be the entry-into-practice degree for
advanced practice nursing and that the target date for the implementation of this recommendation be 2015. In 2008, a group called the Nurse Practitioner Roundtable issued a statement in support of the DNP, implying that it could or should replace the master’s degree in nursing, saying:
The DNP degree more accurately reflects current clinical competencies and includes preparation for the changing health care system. It is congruent with the intense rigorous education for nurse practitioners. This evolution is comparable to the clinical doctoral preparation for other health care professions.
The Roundtable did not specify a target date for the change. Also, in 2008, a large group of nursing organizations got together to discuss goals for standardizing state requirements for advanced practice. That group addressed licensing,
accreditation, certification, and educational requirements and produced a document
“Consensus Model for APRN Regulations:
Licensure, Accreditation, Certification & Education.”
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The document is available on the website of the National Council of State Boards of Nursing
(NCSBN): www.ncsbn.org. The consensus model mentioned the doctorate as an appropriate
educational preparation for advanced practice, along with the master’s degree, but did not
recommend that the doctorate replace the master’s degree for entry into practice. The consensus model set a target of 2015 for the regulatory changes it recommended. On hearing about the consensus model, as well as the AACN recommendation and Nurse Practitioner Roundtable comments, some NPs thought they would be required to get a doctorate by 2015. That is not so.
Legislatures and boards of nursing set the educational standards for advanced practice
nursing. Associations and organizations can make recommendations, but cannot make laws.
Association and organization recommendations are simply recommendations that a legislature can accept or ignore. Obviously 2015 has passed, and as of the 2016 deadline for publication of this
edition, the organizations’ recommendation
regarding the DNP has not been adopted. No state requires a doctorate for NP practice for either new NPs or those who are already licensed and certified.
The NP who wants to progress as a faculty member at a university will need a doctorate, and the DNP is one way to fulfill a university’s requirement that assistant professors have terminal degrees. NPs with a DNP are finding executive positions in health facilities and networks and in government. However, it is the rare job description that requires a DNP.
And for NPs who want their day to be 100 percent patient care, it is not clear that a DNP will entitle the NP to anything—not a raise, a promotion, or even a job. The DNP is a degree; the role of an NP is
something else. Roles for an NP may include healthcare provider, educator, executive, analyst, policy maker, or research team member. At this time, an NP can fulfill those roles with or without a doctorate.