Doctor of Nursing Science
Encyclopedia
The Doctor of Nursing Practice (DNP) is a terminal professional degree
that focuses on the clinical aspects of nursing
rather than academic research. The curriculum for the DNP degree generally includes advanced practice, leadership, and application of clinical research. The DNP is intended primarily to prepare registered nurse
s to become advanced practice registered nurses. Advanced practice roles in nursing include the nurse practitioner
(NP), certified registered nurse anesthetist (CRNA), certified nurse midwife
(CNM), and the clinical nurse specialist
(CNS). Although approximately 52% of nurse anesthetist
programs will award the DNP, the remaining 48% may use the title Doctor of Nurse Anesthesia Practice (DNAP) for their terminal degree.
According to the American Association of Colleges of Nursing
(AACN), transitioning advance practice registered nursing programs from the graduate level to the doctoral level is a "...response to changes in health care delivery and emerging health care needs, additional knowledge or content areas have been identified by practicing nurses. In addition, the knowledge required to provide leadership in the discipline of nursing is so complex and rapidly changing that additional or doctoral level education is needed." According to the AACN, "...benefits of practice-focused doctoral programs include:
The AACN recommends that all entry-level nurse practitioner
educational programs be transitioned from the Master of Science in Nursing
(MSN) degree to the DNP degree by the year 2015. The American Association of Nurse Anesthetists
has followed suit, requiring the DNP (or DNAP-Doctor of Nurse Anesthesia Practice) degree for entry-level nurse anesthetist
programs by the year 2025. Nurse practitioners and nurse anesthetists currently practicing with either an MSN or certificate will not be required to obtain the DNP for continued practice.
There are two terminal doctorate-level degrees in nursing: The Doctor of Nursing Practice (DNP), and the Doctor of Philosophy (PhD). Previous doctorate level degrees have been, or are in the process of being, phased out and converted to one of the two terminal degrees. The Doctor of Nursing (ND, not to be confused with Naturopathic Doctor ND) and the (DrNP) have transitioned into the DNP whereas the Doctor of Nursing Science (DNSc, DNS or DSN) has transitioned into the PhD. The PhD in nursing is generally considered the academic and research-oriented degree, whereas the DNP is the practice-oriented or professional terminal degree.
, comprehensively reviewed the DNP movement in the United States in 2006 in order to establish whether the degree is necessary to improve patient outcomes, and whether the degree overly complicates an already established system. They concluded that the existing master's degree requirement has satisfactorily prepared nurse practitioners to provide a wide variety of services to patients, and that a doctoral level of education should focus not just on clinical training but also on advancing the knowledge of nursing faculty.
Although controversial, the adequacy of existing master's-level education is further supported by other articles that show nurse practitioners provide a level of care that is rated similar to that of physicians in comparable level primary care
situations. In contrast, the level of training between physicians board certified in an area of specialty and a DNP working as a primary care provider is not intended to be comparable. A physician will typically have 4 years of undergraduate education, 4 years of medical school, and 3 to 8 years in paid residency
(e.g. family practice, internal medicine, radiology, neurosurgery, etc.). Physicians often continue by doing a subspecialty or fellowship (e.g. cardiology, nephrology, oncology, etc.). In contrast a typical DNP will have 4 years of undergraduate education, experience as a registered nurse, and 4 years of advanced practice education (e.g. women's health, pediatrics, anesthesia, etc.). Additionally, the prolonged education of physicians through specialty residencies has compounded primary care shortages in the United States and therefore the DNP offers a practical solution with its primary care emphasis and streamlined clinical focus.
In the United States, patient choice between physicians and nurse practitioners has become a point of contention, especially as nurse practitioners gain greater autonomy. Although MDs, DOs, and DNPs all nominally hold a doctorate degree by education, in a medical setting the term "doctor" has historically referred to Doctors of Medicine (MD), Doctors of Osteopathic Medicine (DO), Podiatrists (DPM), Dentists (DDS or DMD), and Optometrists (OD) but not to Nurse Practitioners (NP) since they generally did not hold doctorate degrees. However, the DNP has evolved much like the other clinical doctorates, and the some argue that the public uses the term "doctor" generically to describe that person who is a licensed professional and is in the primary decision making role for their care. The American Association of Colleges of Nursing and six other professional nursing organizations contend that the term "doctor" is an appropriate term to describe a Doctor of Nursing Practice. However, some feel the "doctor" title in healthcare should only apply to MDs and DOs to avoid confusion between physicians and nurse practitioners. The American Medical Association (AMA) also believes vague distinction between physician and non-physician providers poses a "threat to conventional practice".
Terminal degree
A terminal degree is, in some countries, the highest academic degree in a given field of study. This phrase is in common use in the United States, but is not universal in an international context: the concept is not in general use in the United Kingdom, for example, and the exact definition varies...
that focuses on the clinical aspects of nursing
Nursing
Nursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from conception to death....
rather than academic research. The curriculum for the DNP degree generally includes advanced practice, leadership, and application of clinical research. The DNP is intended primarily to prepare registered nurse
Registered nurse
A registered nurse is a nurse who has graduated from a nursing program at a university or college and has passed a national licensing exam. A registered nurse helps individuals, families, and groups to achieve health and prevent disease...
s to become advanced practice registered nurses. Advanced practice roles in nursing include the nurse practitioner
Nurse practitioner
A Nurse Practitioner is an Advanced practice registered nurse who has completed graduate-level education . Additional APRN roles include the Certified Registered Nurse Anesthetist s, CNMs, and CNSs...
(NP), certified registered nurse anesthetist (CRNA), certified nurse midwife
Nurse midwife
In the United States, a Certified Nurse-Midwife is an Advanced Practice Nurse who has specialized education and training in both Nursing and Midwifery. CNM's function as primary healthcare providers for women and most often provide medical care for relatively healthy women, whose birth is...
(CNM), and the clinical nurse specialist
Clinical nurse specialist
A clinical nurse specialist is an advanced practice registered nurse, with graduate preparation from a program that prepares CNSs. According to the APRN Consensus Model for Regulation "The CNS serves a unique APRN role in integrating care across the continuum and through three spheres of...
(CNS). Although approximately 52% of nurse anesthetist
Nurse anesthetist
A nurse anesthetist is a nurse who specializes in the administration of anesthesia.In the United States, a Certified Registered Nurse Anesthetist is an advanced practice registered nurse who has acquired graduate-level education and board certification in anesthesia...
programs will award the DNP, the remaining 48% may use the title Doctor of Nurse Anesthesia Practice (DNAP) for their terminal degree.
According to the American Association of Colleges of Nursing
American Association of Colleges of Nursing
The American Association of Colleges of Nursing is the only remaining national organization of nurses in the United States that is dedicated exclusively to advancing nursing education at the baccalaureate and graduate levels. Established in 1969, it now represents nursing schools at 547...
(AACN), transitioning advance practice registered nursing programs from the graduate level to the doctoral level is a "...response to changes in health care delivery and emerging health care needs, additional knowledge or content areas have been identified by practicing nurses. In addition, the knowledge required to provide leadership in the discipline of nursing is so complex and rapidly changing that additional or doctoral level education is needed." According to the AACN, "...benefits of practice-focused doctoral programs include:
- development of needed advanced competencies for increasingly complex clinical, faculty and leadership roles;
- enhanced knowledge to improve nursing practice and patient outcomes;
- enhanced leadership skills to strengthen practice and health care delivery;
- better match of program requirements and credits and time with the credential earned;
- provision of an advanced educational credential for those who require advanced practice knowledge but do not need or want a strong research focus (e.g. clinical faculty);
- parity with other health professions, most of which have a doctorate as the credential required for practice;
- enhanced ability to attract individuals to nursing from non-nursing backgrounds;
- increased supply of faculty for clinical instruction; and
- improved image of nursing."
The AACN recommends that all entry-level nurse practitioner
Nurse practitioner
A Nurse Practitioner is an Advanced practice registered nurse who has completed graduate-level education . Additional APRN roles include the Certified Registered Nurse Anesthetist s, CNMs, and CNSs...
educational programs be transitioned from the Master of Science in Nursing
Master of Science in Nursing
A Master of Science in Nursing is an advanced-level postgraduate degree for registered nurses and is considered an entry-level degree for nurse educators and managers. The degree also may prepare a nurse to seek a career as a nurse administrator, health policy expert, or clinical nurse leader...
(MSN) degree to the DNP degree by the year 2015. The American Association of Nurse Anesthetists
American Association of Nurse Anesthetists
The American Association of Nurse Anesthetists is the professional association of nurse anesthetists in the United States. The organization states that it has a membership of 39,000, includes certified , recertified, and student members. The organization represents around 90 percent of nurse...
has followed suit, requiring the DNP (or DNAP-Doctor of Nurse Anesthesia Practice) degree for entry-level nurse anesthetist
Nurse anesthetist
A nurse anesthetist is a nurse who specializes in the administration of anesthesia.In the United States, a Certified Registered Nurse Anesthetist is an advanced practice registered nurse who has acquired graduate-level education and board certification in anesthesia...
programs by the year 2025. Nurse practitioners and nurse anesthetists currently practicing with either an MSN or certificate will not be required to obtain the DNP for continued practice.
There are two terminal doctorate-level degrees in nursing: The Doctor of Nursing Practice (DNP), and the Doctor of Philosophy (PhD). Previous doctorate level degrees have been, or are in the process of being, phased out and converted to one of the two terminal degrees. The Doctor of Nursing (ND, not to be confused with Naturopathic Doctor ND) and the (DrNP) have transitioned into the DNP whereas the Doctor of Nursing Science (DNSc, DNS or DSN) has transitioned into the PhD. The PhD in nursing is generally considered the academic and research-oriented degree, whereas the DNP is the practice-oriented or professional terminal degree.
Criticism of the DNP
The development of the DNP has spawned much criticism, from nurses, nurse practitioners, physicians, and other groups. For example, Chase and Pruitt, two doctorally prepared educators who are also master's-level advanced practice nurses writing for the Journal of Nursing EducationJournal of Nursing Education
The Journal of Nursing Education is a monthly peer-reviewed nursing journal. It was established in 1962 and is abstracted and indexed in MEDLINE.-History:...
, comprehensively reviewed the DNP movement in the United States in 2006 in order to establish whether the degree is necessary to improve patient outcomes, and whether the degree overly complicates an already established system. They concluded that the existing master's degree requirement has satisfactorily prepared nurse practitioners to provide a wide variety of services to patients, and that a doctoral level of education should focus not just on clinical training but also on advancing the knowledge of nursing faculty.
Although controversial, the adequacy of existing master's-level education is further supported by other articles that show nurse practitioners provide a level of care that is rated similar to that of physicians in comparable level primary care
Primary care
Primary care is the term for the health services by providers who act as the principal point of consultation for patients within a health care system...
situations. In contrast, the level of training between physicians board certified in an area of specialty and a DNP working as a primary care provider is not intended to be comparable. A physician will typically have 4 years of undergraduate education, 4 years of medical school, and 3 to 8 years in paid residency
Residency
Residency is the act of establishing or maintaining a residence in a given place.-United States of America:It is important in terms of politics, as candidates must maintain residency within the district in which they intend to run. Requirements vary by jurisdiction, and sometimes by the political...
(e.g. family practice, internal medicine, radiology, neurosurgery, etc.). Physicians often continue by doing a subspecialty or fellowship (e.g. cardiology, nephrology, oncology, etc.). In contrast a typical DNP will have 4 years of undergraduate education, experience as a registered nurse, and 4 years of advanced practice education (e.g. women's health, pediatrics, anesthesia, etc.). Additionally, the prolonged education of physicians through specialty residencies has compounded primary care shortages in the United States and therefore the DNP offers a practical solution with its primary care emphasis and streamlined clinical focus.
In the United States, patient choice between physicians and nurse practitioners has become a point of contention, especially as nurse practitioners gain greater autonomy. Although MDs, DOs, and DNPs all nominally hold a doctorate degree by education, in a medical setting the term "doctor" has historically referred to Doctors of Medicine (MD), Doctors of Osteopathic Medicine (DO), Podiatrists (DPM), Dentists (DDS or DMD), and Optometrists (OD) but not to Nurse Practitioners (NP) since they generally did not hold doctorate degrees. However, the DNP has evolved much like the other clinical doctorates, and the some argue that the public uses the term "doctor" generically to describe that person who is a licensed professional and is in the primary decision making role for their care. The American Association of Colleges of Nursing and six other professional nursing organizations contend that the term "doctor" is an appropriate term to describe a Doctor of Nursing Practice. However, some feel the "doctor" title in healthcare should only apply to MDs and DOs to avoid confusion between physicians and nurse practitioners. The American Medical Association (AMA) also believes vague distinction between physician and non-physician providers poses a "threat to conventional practice".
See also
- Nurse PractitionerNurse practitionerA Nurse Practitioner is an Advanced practice registered nurse who has completed graduate-level education . Additional APRN roles include the Certified Registered Nurse Anesthetist s, CNMs, and CNSs...
, Nurse MidwifeNurse midwifeIn the United States, a Certified Nurse-Midwife is an Advanced Practice Nurse who has specialized education and training in both Nursing and Midwifery. CNM's function as primary healthcare providers for women and most often provide medical care for relatively healthy women, whose birth is...
, Clinical Nurse SpecialistClinical nurse specialistA clinical nurse specialist is an advanced practice registered nurse, with graduate preparation from a program that prepares CNSs. According to the APRN Consensus Model for Regulation "The CNS serves a unique APRN role in integrating care across the continuum and through three spheres of...
, and Nurse anesthetistNurse anesthetistA nurse anesthetist is a nurse who specializes in the administration of anesthesia.In the United States, a Certified Registered Nurse Anesthetist is an advanced practice registered nurse who has acquired graduate-level education and board certification in anesthesia... - Diploma in NursingDiploma in NursingA Diploma in Nursing or Nursing Diploma is an entry-level tertiary education nursing credential.In the United States, this diploma is usually awarded by hospital-based nursing schools. Students awarded a Diploma in Nursing are qualified to sit for the NCLEX-RN and apply for licensure as a...
- Associate of Science in NursingAssociate of Science in NursingAn Associate of Science in Nursing is a tertiary education nursing degree. In the United States, this type of degree is usually awarded by community colleges or similar nursing schools. Some four year colleges also offer this degree...
- Bachelor of Science in NursingBachelor of Science in NursingThe Bachelor of Science in Nursing is an American four year academic degree in the science and principles of nursing, granted by a tertiary education university or similarly accredited school...
- Master of Science in NursingMaster of Science in NursingA Master of Science in Nursing is an advanced-level postgraduate degree for registered nurses and is considered an entry-level degree for nurse educators and managers. The degree also may prepare a nurse to seek a career as a nurse administrator, health policy expert, or clinical nurse leader...
- Nurse educationNurse educationNurse education consists in the theorical and practical training provided to nurses with the purpose to prepare them for their duties as nursing care professionals. This education is provided to nursing students by experienced nurses and other medical professionals who have qualified or...
- Nursing schoolNursing schoolA nursing school is a type of educational institution, or part thereof, providing education and training to become a fully qualified nurse. The nature of nursing education and nursing qualifications varies considerably across the world.-United Kingdom:...