What does a “Doctor of Nursing Practice” Mean to You?
The facts speak for themselves: nurses are the largest part of the health care workforce [1] and the practice of nursing is one of the most diverse as the profession addresses clinical, leadership, public policy, and public health care needs. Nurses also have a wide range of educational credentials, ranging from associate to doctoral degrees.
With a diverse mix of roles, titles, degrees, and practice settings, it is little wonder that many people – including health care providers – become confused about how the Doctor of Nursing Practice (DNP) degree fits into the nursing profession along with the health care team.
Why does this range of degrees exist? Why do we need a Doctor of Nursing Practice degree? What makes a nurse with a DNP different than one with a Ph.D. or Master’s Degree? Is a Doctor of Nursing Practice different than a Nurse Practitioner?
Although there are 16 million results on Google for “Doctor of Nursing Practice,” there seems to be more questions than answer
What Is the DNP?
In response to the Institute of Medicine’s 2001 report titled “Crossing the Quality Chasm,” the American Association of College of Nursing (AACN) examined nursing’s critical role in both ensuring the highest quality of health care for patients and the broader community.
Nursing – and nurses – are essential to high-quality health care, coordinating care transitions, and activating patients into advocates for their own health.
As a result, in 2004 the AACN published a position statement supporting the Doctor of Nursing Practice as both the terminal degree for clinical nursing education and the graduate degree for advanced nursing practice preparation.
This new DNP degree, built on the foundation of the previous Nursing Doctorate (ND) degree, is focused on practice competencies rather than the Ph.D.’s in-depth focus on academic research. The degree prepares students to address the critical skills needed to translate evidence-based care into practice, improve systems of care, and measure outcomes of groups of patients and communities. [2]
While the AACN’s DNP Roadmap report outlines that the entry level-degree for advance practice nurses should be the DNP, there are many who disagree about when this change will take place.
Roles vs. Degrees: Who Has a DNP?
In many parts of health care, professional roles are directly connected with the letters after their name. It’s easy to spot: MHA’s are in finance, PharmD’s are in pharmacy, and the DDS works on teeth.
In nursing however, these distinctions are not always so clear.
There are several confusing terms, like NP, APRN, MSN, DNP, which are often incorrectly used interchangeably, but have very different meanings.
Looking for a post-licensure program? Visit our database of Michigan-based nursing programs that offer MSN and DNP degrees. Visit now.
Advance Practice Registered Nurse (APRN)
This is a job title for a nurse with advanced training in a specialized nursing role, who passes the national certifications. These nurses most commonly have a Masters’ of Science in Nursing (MSN) and successfully pass a national examination to use the title APRN. Nurses who have earned a DNP (either with or without a MSN) may also sit for the national examination and become APRNs.
Advanced Practice Registered Nurses may also have additional specializations in their training, and use the following titles: Nurse Practitioner (NP), Certified Nurse Anesthetist (CRNA), and Certified Nurse Midwife(CNM).
Currently, the vast majority of APRNs hold master’s (MSN) degrees. Clinicians with doctorate degrees (DNP) may also be considered APRNs. Some APRNs may have both MSN and DNP degrees, having completed both levels of education.
These two types of nursing degrees provide addition knowledge in nursing science:
Masters of Science in Nursing (MSN)
This is a degree, not a role. As a full-time student, this degree takes two years to complete, however, many nurses will work full time while pursuing graduate work part time.
Doctor of Nursing Practice (DNP)
Just like the MSN, the Doctor of Nursing Practice is a degree, with a clinical or a systems focus, and whose graduates may have a wide range of different responsibilities.
In addition to clinical responsibilities, there are a variety of administrative and leadership roles nurses may fill in education, informatics, public policy, public health, or administration.[3] The DNP prepares students for organization leadership and systems change, and nurses with an DNP would be ideally suited for high-level health system, academic, and policy making roles.
The curriculum for the Doctor of Nursing Practice degree, as outlined in the AACN’s Essentials of Doctoral Education, provides DNP graduates with a wide range of skills that any of these important nursing roles demand.
Where Does the DNP Fit in Today’s Health Care Environment?
In today’s era of reform, with a focus on the “Triple Aim” of reducing costs, better population health, and improved patient experiences, the role nursing plays as part of a high-functioning health care team is more important now than ever before. [4]
Other professions have responded to this need by increasing the amount of academic rigor in the professional degrees in other health care fields. A practice-focused doctorate ensures nursing’s most skilled professionals are prepared with similar academic rigor as other professional doctoral degrees like Doctors of Podiatric Medicine (DPM), Doctors of Dental Medicine and Surgery (DDS), Doctor of Pharmacy (PharmD), Doctors of Physical Therapy (DPT) and Occupational Therapy (DOT) , and Doctor of Psychology (PsyD).
In a world of increasing team-based care and collaboration across professions, increasing the numbers of doctorate-trained nurses is essential to ensure patients have access to a highly skilled nurse.
How Does the DNP Fit With Other Nursing Degrees?
The AACN has designated the DNP as the terminal degree in nursing practice. As such the DNP will play an important role in the education, mentorship, and leadership within the nursing profession. In clinical settings, DNP’s serve as advocates, problems solvers, and role models with all other types of professionals.[5]
Greater numbers of nurses holding DNP’s will increase the available number of available nursing faculty to train additional nurses at the bachelor’s level. Doctorate trained nurses will allow colleges to offer higher pay and more opportunities for advancement, allowing academic compensation to more closely align with clinical pay.[6]
As baby-boomer nurses move closer to retirement greater numbers of doctorate trained nurses are essential to ensure enough nursing faculty to meet the IOM’s goal of doubling the number of nurses with doctorates and increasing the number of nurses with bachelor’s degrees by 2020. [7]
Doctor of Nursing Practice Education
Nurses seeking a DNP degree can choose to focus their study on advanced practice nursing or systems and organizational leadership. Those choosing to focus on advanced practice nursing are required to take coursework on health and physical assessments, advanced physiology and pathophysiology and pharmacology. Graduates will also be prepared to sit for national specialty APN certification.
Those in the organizational track focus on systems level thinking and analysis. Health care policy leadership, information technology, and implementing and evaluating programs are essential skills in this organizational focus.
The American Association of Colleges of Nursing published the Essentials of Doctoral Education for Advanced Nursing Practice in 2006, outlining the core competencies for DNP education. The practice focus of the DNP education is highly tailored to developing innovative and evidence-driven nursing experts.[8]
Although the third essential element of DNP education, as outlined by the AACN, is analytical methods for evidence-based practice, the DNP differs from the research, theory, and meta-theory of the Ph.D. Research conducted in Ph.D. doctoral program is aimed at creating new knowledge, through research and writing a dissertation.
Students in DNP programs also conduct research as part of a final DNP project. However, these final DNP projects are designed to help students achieve mastery of an advanced nursing topic, which could include a practice portfolio of outcomes, a pilot study or program evaluation, or an integrated critical literature review.[9]
The other essential aspects of DNP education, as outlined by the AACN, include:
Scientific Underpinnings of Practice
Under this goal, the DNP program aims to integrate nursing science with biophysical, psychosocial, analytical and organizational sciences. Additionally, DNP graduates will be able to use science-based theories to understand the nature of health and health care delivery, and evaluate the effectiveness of interventions.
Organizational and Systems Leadership for Quality and Improvement
One of the key roles for DNP graduates is in nurse-led leadership roles. This competency demands a graduate understand practice management, quality improvement strategies, cost measurements, and risk management strategies.
Clinical Scholarship and Analytical Methods for Evidence-Based Practice
One of the hallmarks of doctoral degrees is advanced research scholarship. While professional doctorates do not require generating new knowledge, the DNP education requires graduates to integrate applied scholarship and evaluate clinical outcomes.
The DNP graduate is required to translate research into practice, evaluate and analyze practice data, improve the reliability of health care practice and outcomes, and participate in research.
Information Systems and Technology for Patient Care
Technology and informatics is an increasingly essential part of the transformation of health care. DNP graduates are distinguished by their abilities to use information systems to support and improve patient care, quality, and system organization.
Health Care Policy and Advocacy
The health of patients and populations is greatly impacted by health care policy decisions by governments and institutions in both formal and informal processes. The DNP graduate is prepared to design, influence, and implement health care policy options, with a focus on cost, efficacy, safety, quality, access, regulation, and equity.
Interprofessional Collaboration
The complex nature of modern health care delivery, patients with multiple co-morbidities, and policy goals of improving outcomes and reduced cost requires interprofessional skills on the part of DNP graduates.
Effective communications and collaborative skills are key competencies of the DNP graduate.
Advanced Nursing Practice
As health care has grown in complexity, so has the specialization of nursing science. DNP programs prepare their graduates for advanced clinical skills to systemically assess illnesses, design and implement interventions based on nursing science, and demonstrate advanced levels of clinical judgment and evidence-based care.
Key Takeaways
The Doctor of Nursing Practice is a degree, not a role
A practice doctorate ensures nursing has equal representation on the care team
The DNP is the terminal degree for nursing practice
The DNP prepares graduates for clinical and leadership roles
As American health care prepares for major reforms, nursing – as well as other professions – will continue to adapt to meet the needs of patients and families. Advance Practice Nursing will continue to be an essential part of patient and population health.
More research and continual work is still needed to determine the very best ways of delivering this care to Michigan families.
[4] IHI Triple AIM