The Institute of Medicine, the Joint Commission, Robert Wood Johnson Foundation, and other authorities have openly stated their support for a higher standard in nursing education as a way to ensure the nation’s healthcare providers are able to keep up with the demands of an ever-growing population of patients in an increasingly complex healthcare environment.
As of 2019, Doctor of Nursing Practice (DNP) programs were available in all 50 states and the District of Columbia, as well as through online programs that offer the flexibility working nurses need to earn a degree while maintaining professional commitments.
As more BSN-prepared RNs look to future proof their credentials and MSN-prepared RNs and APRNs look to advance further by earning the highest terminal practice-focused degree available, the number of students in DNP programs has been increasing dramatically. In fact, the number of nursing students enrolled in BSN-to-DNP or MSN-to-DNP programs rose by nearly 3,500 in just one year between 2017 and 2018 (from 29,093 in 2017 to 32,678 in 2018).
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Just a few of the factors influencing the growing momentum for a better educated nursing workforce include:
- National concerns about the quality of care and patient safety
- A need for nursing leaders who can design and assess patient care
- A growing shortage of doctoral-prepared nursing faculty
- The increased complexity of patient care
- The rapid expansion of nursing practice
The American Association of Colleges of Nursing (AACN) supports the call to produce more doctoral-prepared nurses, citing the fact that many other health professions have already completely transitioned to the doctoral-prepared provider model, as is the case with psychology (PsyD), dentistry (DDS), medicine (MD), pharmacy (PharmD), physical therapy (DPT), and audiology (AudD).
Post-Bachelor’s (BSN-DNP) and Post-Master’s (MSN-DNP) Options
The Commission on Collegiate Nursing Education (CCNE) and the Accreditation Commission for Education in Nursing (ACEN) accredit qualified online and campus-based DNP programs. With 348 accredited online and campus-based DNP programs available in the US, and with another 98 programs in the planning stages, nurses looking to secure their careers with the highest terminal practice-focused nursing degree available have no shortage of options.
Today’s CCNE-accredited DNP programs often provide two points of entry:
- Post-Bachelor’s BSN-to-DNP: Designed for bachelor’s-prepared nurses, BSN-DNP programs provide BSN-educated RNs with a seamless pathway to the DNP by providing both MSN and DNP curriculum in a progressive program that results in earning both an MSN and DNP. These programs allow students to specialize their MSN in an advanced practice nursing role and population focus and achieve national certification before moving to the DNP portion of the program. BSN-DNP programs are also available with an aggregate/systems/organizational focus.
- Post-Master’s MSN-to-DNP: Traditional MSN-DNP programs require candidates to possess an MSN and, if applicable, national certification in an APRN role and patient population focus. MSN-DNP programs are also available with an aggregate/systems/organizational focus.
Many of today’s DNP programs are offered in a partially or fully online format, recognizing that working nurses require a greater level of flexibility than campus-based programs can provide. Online DNP programs allow students to complete most or all of the didactic components of the program through interactive, web-based study and then satisfy the clinical requirements of the program at partner sites close to home.
Depending on the program, students may need to attend an on-campus immersion experience at some point throughout the program. Immersion experiences provide students with an opportunity to meet with faculty and peers and network with industry professionals.
In addition to offering students the choice of campus-based or online DNP programs, many institutions offer part-time and/or accelerated DNP programs. While part-time programs provide a more relaxed curriculum, accelerated programs provide a more rigorous course of study that allows students to earn their DNP in less time.
Curriculum Requirements for DNP Degree Programs
American Association of Colleges of Nursing (AACN) member institutions endorsed the AACN’s Essentials of Doctoral Education for Advanced Nursing Practice, which defines the curricular elements and competency outcomes of DNP programs in the U.S.
The Doctor of Nursing Practice focuses heavily on innovative, evidence-based practice, preparing students to apply research findings.
The DNP curriculum consists of two components:
- DNP Essentials: Foundational outcome competencies deemed essential for all graduates of DNP programs, regardless of their specialty or functional focus
- Specialty Competencies/Content: Practice and didactic learning experiences that prepare DNP graduates in a particular specialty; specialty areas are always delineated by a national specialty nursing organization
The foundational outcome competencies of a DNP program consist of 8 Essentials:
Essential I: Scientific Underpinning for Practice
DNP programs prepare graduates to integrate nursing science with knowledge related to the biophysical, analytical, psychosocial, and organizational sciences as the basis for the highest level of nursing practice. DNP programs prepare graduates to develop and evaluate new practice approaches based on nursing theories and theories from other disciplines, describing the actions and advanced strategies necessary to enhance healthcare delivery.
Essential II: Organizational and Systems Leadership for Quality Improvement and Systems Thinking
DNP programs prepare graduates to develop and evaluate healthcare delivery approaches as to meet the needs of patient populations based on scientific findings in nursing and other clinical sciences, ensuring accountability for quality of care and patient safety. Graduates are able to employ principles of business, finance, economics, and health policy, develop strategies for managing ethical dilemmas in healthcare, analyze the cost-effectiveness of practice initiatives, and more.
Essential III: Clinical Scholarship and Analytical Methods for Evidence-Based Practice
DNP programs prepare graduates to utilize analytic methods to implement the best evidence for practice and design and implement any number of processes that allow them to evaluate the outcomes of practice, practice patterns, and systems of care within any type of practicing setting. DNP graduates are able to identify gaps in evidence for practice, disseminate findings from evidence-based practice and research to improve healthcare outcomes, design evidence-based interventions, and more.
Essential IV: Information Systems/Technology and Patient Care Technology for the Improvement and Transformation of Health Care
DNP programs prepare graduates to create, select, implement, and evaluate programs that are themselves designed to evaluate and monitor the outcomes of care, care systems, and quality improvement. Graduates are able to provide leadership to resolve ethical and legal issues within healthcare systems related to the use of information, information technology, communication networks, and patient care technology.
Essential V: Health Care Policy for Advocacy in Health Care
DNP programs prepare graduates to critically analyze health policy proposals, health polices, and related issues and demonstrate leadership in the development and implementation of institutional, local, state, federal, and/or international health policy. Graduates are able to educate others regarding nursing, health policy, and patient care outcomes, and advocate for the nursing profession and for social justice, equity, and ethical policies within all healthcare arenas.
Essential VI: Interprofessional Collaboration for Improving Patient and Population Health Outcomes
DNP programs prepare graduates to employ effective communication and collaborative skills in the development and implementation of practice models, practice guidelines, health policy, standards of care, and more. Graduates lead interprofessional teams and utilize their leadership skills to create change in healthcare and complex healthcare delivery systems.
Essential VII: Clinical Prevention and Population Health for Improving the Nation’s Health
DNP programs prepare graduates to analyze scientific data related to individual, aggregate, and population health and synthesize concepts related to clinical prevention and population health when developing, implementing, and evaluating interventions that address any number of efforts.
Essential VIII: Advanced Nursing Practice
DNP programs prepare graduates to conduct assessments of health and illness parameters in complex situations and design and implement therapeutic interventions based on nursing science and other sciences. Graduates possess advanced levels of systems thinking, clinical judgment, and accountability regarding the design, delivery, and evaluation of evidence-based care.
The DNP education is always specialized, allowing DNP graduates to assume a variety of roles upon graduation. While all DNP programs include the DNP Essentials, further preparation within the program falls into one of two general categories:
- An advanced practice nursing direct care focus
- An aggregate/systems/organizational focus
As a result, the specialty content of DNP programs differs substantially, with specialty organizations defining the specialized competencies. According to the AACN, all DNP programs should prepare graduates to sit for national, advanced specialty certification, when available.
Advanced Practice Nursing Focus
Advanced practice nursing roles are identified as:
- Certified nurse-midwife (CNM)
- Certified nurse practitioner (CNP)
- Certified registered nurse anesthetist (CRNA)
- Clinical nurse specialist (CNS)
DPN graduates prepared in an advanced practice nursing role must demonstrate practice expertise, specialized knowledge, and expanded responsibility and accountability in the care and management of individuals and families.
Post-bachelor’s BSN-to-DNP programs are available in tracks designed to prepare nurses for national certification in an advanced practice role and patient population focus prior to gaining APRN licensure. Post-master’s MSN-to-DNP programs for nurses that are already certified and licensed in an APRN role and patient population focus allow APRNs to further their expertise in their existing role and patient population focus as well as prepare for certification in an additional patient population focus or specialty.
Advanced practice registered nurses (APRNs) assess, manage, and evaluate patients at the most independent level of clinical nursing practice. Their highly refined assessment skills and their deep understanding of pathophysiology and pharmacotherapeutics allow them to make diagnostic and practice management decisions. Therefore, all DNP programs that include a master’s level curriculum with an APRN focus must contain three, separate courses in the following three content areas:
- Advanced health/physical assessment
- Advanced physiology/pathophysiology
- Advanced pharmacology
In addition to providing direct care, DNP graduates with an APRN focus are able to use their knowledge to:
- Make improvements in the care of their particular patient populations
- Document practice trends
- Identify potential systemic changes
DNP programs with an aggregate/systems/organizational focus do not focus on direct patient care responsibilities; instead preparing students in areas such as:
- Healthcare policy
- Information systems
DNP programs with an aggregate/systems/organizational focus prepare students to design aggregate-level health interventions and define actual and emerging problems. To prepare students in these activities, these programs must provide study in one or more of the following:
- Advanced organizational techniques
- Systems techniques
- Community system techniques
DNP programs with an aggregate/systems/organizational focus also prepare graduates to demonstrate an expert-level understanding of nursing and the related biological and behavioral sciences, which includes competencies in:
- Conducting comprehensive organizational, community, and system assessments to identify aggregate health or system needs
- Designing patient-centered care delivery systems or policy-level delivery models
- Working with diverse stakeholders
Doctor of Nursing Practice Curriculum Elements and Structure
The AACN recommends the following for the structure and design of DNP programs:
Although institutional, state, and accrediting bodies have policies in place dictating minimum or maximum program length and/or credit hours, the AACN recommends the following:
- BSN-DNP Programs: 36 months of full-time study (three calendar years or four years within a traditional academic calendar)
- MSN-DNP Programs: Based on the DNP candidate’s prior education, experience, and choice of specialization; the AACN recognizes that a minimum of 12 months of full-time study is necessary to acquire doctoral-level competencies
In order to achieve the necessary DNP competencies, DNP programs should provide at least 1,000 post-baccalaureate practice hours as part of a supervised academic program. Post-baccalaureate practice hours gained during MSN studies in a common track would be applied to the 1,000-hour total. Practice experiences should be related to the DNP Essentials and Specialty Competencies. Further, the AACN recommends they should:
- Be designed to provide opportunities for reflection and feedback
- Help students acquire knowledge in advanced nursing practice at a high level of complexity
- Include the opportunity to work with nursing experts and experts from other disciplines
- Provide opportunities for involvement in various practice environments
Final DNP Project
DNP programs are distinguished by the completion of a final DNP project, designed to demonstrate the culmination of a student’s work and lay the groundwork for future scholarship.
Final projects may take on a variety of forms, such as:
- Practice portfolio
- Practice change initiative:
- Consulting project
- Evaluation of a new practice model
- Integrated critical literature review
- Pilot study
- Program evaluation
- Quality improvement project
- Practice topic dissemination
- Systematic review
- Research utilization project
- Manuscript submitted for publication
The final DNP project:
- Documents the outcomes of the student’s educational experiences
- Provides a measurable medium for evaluating the immersion experience
- Summarizes the student’s growth in knowledge and expertise