Making the Decision to Earn a Doctor of Nursing Practice Degree

All the way back in 2004, the American Association of Colleges of Nursing (AACN) and member organizations established an educational framework that would provide nurses with clinical preparedness at the doctorate-level. In the 15 years since, the proliferation of Doctor of Nursing Practice (DNP) programs has produced exceptional nurse leaders well prepared to translate research evidence to clinical practice, serve patients at the highest level, and ultimately improve patient outcomes.

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Just a year prior to the AACN’s DNP curriculum recommendations, the Institute of Medicine (IOM) went on record saying that the DNP provides a logical extension of nursing education, focused on safe, effective, patient-centered care. The IOM report, “Health Professions Education: A Bridge to Quality,” stated that advanced practice nurses must increase their knowledge and skills if they are to deliver enhanced clinical care across different domains and practice settings.

Today, the National Organization of Nurse Practitioner Faculties (NONPF) is leading the charge to promote the DNP as the appropriate minimum for nurse practitioners, championing their support in a document published in 2018 entitled the “Doctor of Nursing Practice Degree: Entry to Nurse Practitioner Practice by 2025” calling for all MSN programs for NPs to migrate to the DNP level.

Colleges and universities were quick to follow the AACN’s recommendations. In 2004, just three schools had DNP programs…. fast forward to the present and there are now nearly 350 of them and nearly another 100 under development at nursing schools throughout the U.S. as of 2018.  But it’s not just the colleges and universities taking note: From 2017 to 2018, the number of students in DNP programs rose from about 29,100 to nearly 32,700.

But is the DNP right for you? What are the benefits of a DNP, and how do you make the decision to earn a DNP? These are important questions, whether you’re considering a DNP as a final terminal degree that builds on your existing master’s, or as a path to initial advanced practice licensure or jobs outside of direct patient care as a bachelor’s-prepared RN.

The Doctor of Nursing Practice (DNP) Supports the Career Goals of a Diverse Group of Nurses

Who is the doctor of nursing practice right for?

MSN-prepared RNs and APRNs would pursue a conventional post-master’s DNP program to:

  • Further their clinical expertise in their current APRN role and patient population focus
  • Add certification in an additional patient population focus
  • Pursue a track with an aggregate/systems/organizational focus (administration, executive leadership, informatics, health policy, public health, nurse education) for careers outside of direct patinet care

BSN-prepared RNs would enroll in a post-bachelor’s BSN-to-DNP program to:

  • Achieve initial national certification and state licensure in an APRN role (nurse practitioner, nurse midewife, nurse anesthetist, clinical nurse specialist) and patient population focus (family/individual, adult-gerontology, women’s health/gender specific, neonatology, pediatrics, pyschiatrick/mental health)
  • Pursue a track with an aggregate/systems/organizational focus (administration, executive leadership, informatics, health policy, public health, nurse education) for careers outside of direct patinet care

The Doctor of Nursing Practice (DNP) is the ultimate practice focused degree awarded to nurses who want to achieve the highest level of proficiency in the delivery of complex care over the lifespan of the patient, or for those seeking to positively influence healthcare in roles that don’t involve direct patient care, working as administrators, executive leaders, informaticists, health policy specialits, public health advocates, nurse educators and more.

Prior to the DNP, there was no way for nurse clinicians and others to expand their expertise in the practice environment to the doctoral level since PhDs were the domain of researchers and academicians. Today, the DNP establishes a higher level of credibility for nurses with aspirations of translating evidence-based care into practice, improving systems of care, and measuring outcomes of groups of patients and communities.

Nurses pursuing a DNP may choose to study a population focus within an advanced practice registered nurse (APRN) role or turn their attention to any number of administrative or executive leadership roles, such as education, public policy, informatics, and public health.

Whatever the chosen focus of a DNP program, graduates are prepared to effect change in organizational and systems leadership and take on high-level roles in health systems, academia, and policy making.

The Benefits of Earning a Doctor of Nursing Practice: Higher Salaries and More Opportunities for Advancement

Currently, the MSN remains the minimum educational standard for advanced practice nursing roles. However, many nurses choose to look beyond the MSN in an effort to meet the increasing demands of patients, improve the quality and outcomes of care, and achieve senior-level leadership positions in clinical care and nursing systems.

Doctoral-trained nurses earn higher salaries and enjoy more opportunities for advancement; assuring that academic achievement and specialized expertise align with better pay.

Salaries for DNP nurses continue to outpace MSN nurse salaries, which motivates many nurses to earn the DNP. A 2018 salary survey by Advance Healthcare Network revealed that DNP-prepared nurse practitioners earned nearly $8,000 more than their master’s prepared counterparts.

The goal of the DNP is to integrate nursing science with biophysical, psychosocial, organizational, and analytical sciences. Therefore, DNP nurses are able to use science-based theories to better understand the nature of health and healthcare delivery and evaluate the effectiveness of interventions.

The DNP expands on the MSN concepts, providing an education that focuses on:

  • Scholarship in the practice setting
  • Innovation and testing of care delivery models
  • Practice improvement
  • Examination of healthcare outcomes
  • Proficiency in establishing clinical excellence

DNP graduates are poised to take on nurse-led leadership roles through a greater understanding of:

  • Practice management
  • Quality improvement strategies
  • Cost measurement strategies
  • Risk management strategies

Because the DNP prepares students to integrate applied scholarship and evaluate clinical outcomes, graduates are also able to accomplish a variety of goals in clinical practice, depending on their doctoral focus:

  • Translate research into practice
  • Evaluate and analyze practice data
  • Improve the reliability of healthcare practice and outcomes
  • Participate in research
  • Use information systems to support and improve patient care, quality, and system organization
  • Design, influence, and implement healthcare policy options
  • Assess illnesses
  • Design and implement interventions based on nursing science
  • Demonstrate advanced levels of clinical judgment and evidence-based care

How the DNP is Improving the Delivery of Evidence-Based Care

Since the AACN’s 2004 recommendation to move the minimum educational standard for initical certificaion and licensure in each of the four advanced practice registered nursing roles (nurse practitioner, nurse anesthetist, clinical nurse specialist, nurse midwife) from the master’s degree to the doctoral degree, the Commission on Collegiate Nursing Education (the accrediting arm of the AACN) expanded its accreditation offerings to include DNP programs, citing research and trends in healthcare delivery and health professional education as the impetus for this change. Just a few of the major drivers leading to the DNP policy included:

  • Research showing a clear link between more advanced levels of nursing education and patient outcomes
  • Increased complexities surrounding patient care
  • National concerns about the quality of care and patient safety
  • Shortages of doctoral-prepared faculty
  • The doctoral-level education requirement for other professions, such as pharmacy (PharmD), physical therapy (DPT), and audiology (AuD), among others

The DNP integrates seamlessly into healthcare reform and its focus on the “triple aim” of:

  • Reducing costs
  • Achieving better population health
  • Realizing improved patient experiences

The DNP plays an important role in education, mentorship, and leadership. DNPs are advocates, problem solvers, and role models. Increasing the number of DNP nurses can also translate into more nursing faculty available to train additional nurses at the bachelor’s level.

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