The Real Scoop on The Doctor of Nursing Practice Degree

The Future of Nursing: Leading Change, Advancing Health report compiled by the  Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine (IOM) was released in October 2010.  The report has generated lively discussions from multiple disciplines about scope of practice, educational preparation and training, and leadership roles of nurses at all levels.  Eight recommendations are included in the report:

1.     Remove scope-of-practice barriers.

2.     Expand opportunities for nurses to lead and diffuse collabora¬tive improvement efforts.

3.     Implement nurse residency programs.

4.     Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020.

5.     Double the number of nurses with a doctorate by 2020.

6.     Ensure that nurses engage in lifelong learning.

7.     Prepare and enable nurses to lead change to advance health.

8.     Build an infrastructure for the collection and analysis of inter¬professional health care workforce data. (http://iom.edu/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Future%20of%20Nursing%202010%20Recommendations.pdf)

I will comment on Number 5 which addresses doubling the number of nurses with a doctorate by 2020 – the research PhD and the clinical Doctor of Nursing Practice (DNP).  Questions that are commonly asked about DNP preparation include: (1) Why should there be a shift to doctoral preparation for advanced practice nurses (APNs)? (2) Will master’s prepared nurses no longer be qualified to continue to provide services as APNs? (3) If the goal is to address the primary care shortage, how does extending training achieve that? (4) Will increasing the debt load of potential providers but not the income generate the same specialization migration that has plagued physicians?  Quick responses are: (1) The time has come; (2) No, this change will not disenfranchise currently licensed and certified APNs; (3) APNs will have a value-added skill set to help improve quality of care and health outcomes; (4) Specialization will not become the norm.

The DNP degree is designed to prepare advanced practice nurses with increased value-added skills in leadership, systems thinking, evidence-based practice, health care policy, health information technology, and population health.  Current master’s curricula are already overloaded with trying to provide all of these essential inputs to creating the optimal nursing workforce.  Adding more credits to include mandatory content in basic curricula is not realistic.  Graduates are expected to demonstrate competencies in broad areas reflecting the increasing complexity of care delivery.  Many master’s programs are beyond 60 credits now; on average, students take 2 years full-time and 3-5 years part time to earn a master’s degree.  The DNP is 2 years post-masters and 3 years post baccalaureate for full-time study.  The trade off of a few more months in school for a more highly prepared APN should not even be a point for discussion.  APNs will still be prepared at the master’s level unless the DNP becomes entry level to practice by 2015, as recommended by the American Association of Colleges of Nursing (AACN).

Many nurses have not entered doctoral studies because they were not interested in pursuing research careers; the DNP degree provides an option for those who want to earn a final degree in nursing.  The investment of time and money does pose challenges for nurses who are working full-time and have multiple other life responsibilities.  Personal motivation is a major driving force for APNs who do enroll in DNP programs.  DNP programs have been attractive to nurses from diverse backgrounds – primary care and specialty care, rural and urban settings, and the experienced and the novice.  A number of APNs already work in specialty practices and emerging changes in APN educational preparation through the Consensus agreement (http://www.aacn.nche.edu/Education/pdf/APRNReport.pdf) creates more standardized curricula, education and training, for all APNs.  The number of APN graduates who might opt for specialties instead of primary care probably will not increase in most areas of practice.  Opportunities for clinical faculty positions in academic institutions secondary to the nursing faculty shortage is another driving force encouraging enrollments in DNP programs.  As the DNP role becomes more defined, the value of their added skills will be recognized, and compensation will follow accordingly.

The IOM report offers strategies for achieving greater numbers of nurses with doctoral degrees.  Two main actions required from schools of nursing are to review current curricula and revise to make progression from basic preparation to more advanced degrees a more seamless process and to obtain increased levels of financial assistance from private and government sources.  Without addressing these two areas, especially in tough economic times, preparing nurses at any level becomes increasingly difficult.

Downloadable free copy of full report: http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx.

Burman et al. (2005): http://ajcc.aacnjournals.org/content/14/6/463.full.pdf+html

Newland (2011): http://journals.lww.com/tnpj/Fulltext/2011/04000/The_Doctor_of_Nursing_Practice__What_are_your.1.aspx

Miller (2008): http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2605113/

American Association of Colleges of Nursing (2009): http://www.aacn.nche.edu/DNP/DNPFAQ.htm

Clinton & Sperhac (2009): http://www.con.ohio-state.edu/attachments/Doctoral_programs/DNP_Issues_and_Consequences_article.pdf

Barry (2009): http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=856423