The Doctor of Nursing Practice (DNP) is designed to prepare experts in clinical nursing practice or in systems-focused roles outside of direct patient care. It is the pinnacle of practice-focused nursing degrees, building upon previous nursing knowledge with advanced courses in quality improvement, evidence-based practice, and systems leadership. In addition to traditional post-master’s options, BSN-to-DNP programs are also available to provide a terminal degree entry-point into advanced practice nursing.
For nurse practitioners and other advanced practice registered nurses (APRNs), the DNP aligns with the predominant model in healthcare where advanced practitioners with demonstrated expertise hold doctoral-level degrees. In this sense, it can be compared to the doctor of medicine (MD), doctor of physical therapy (DPT), doctor of psychology (PsyD), and doctor of pharmacy (PharmD), among others.
DNP Nurses: Advanced Practitioners, Clinical Leaders, Change Agents and Much More …
DNP-prepared nurses bring a blend of clinical, leadership, economic, and organizational skills that puts them in a unique position to incisively critique nursing practice and design patient care programs that are economically feasible, locally acceptable, and that significantly impact healthcare outcomes.
Nursing practice for DNP nurses can include both:
- Direct patient care in an APRN role (nurse practitioner, nurse midwife, clinical nurse specialist, nurse anesthetist) and patient population focus (family/individual across the lifespan, adult-gerontology, women’s health/gender specific, neonatal, pediatrics, psychiatric/mental health)
- Aggregate/Systems/Organizational role (public health, healthcare policy, nurse education, executive leadership/ administration, informatics)
This means DNP nurses are prepared to perform nursing interventions that influence healthcare outcomes for individuals or populations by:
- Providing direct patient care
- Managing the care of patients and patient populations
- Administrating in nursing and healthcare organizations
- Developing and implementing health policy
The Value of the DNP
Unlike the PhD, the research-focused doctorate, the DNP is designed for nurses seeking a terminal degree directly related to nursing practice and is chosen by nurses seeking some of the highest level positions in clinical nursing leadership, administration, and management.
Since May 2018, after publishing a white paper entitled The Doctor of Nursing Practice Degree: Entry to Nurse Practitioner Practice by 2025, the National Organization of Nurse Practitioner Faculties (NONPF) has been the organization carrying the torch in support of the DNP becoming the minimum education requirement for NPs and championing the campaign for universities to migrate MSN programs for APRNs to the DNP level. But this kind of support for the DNP is actually nothing new.
In fact, more than 15 years ago, in 2004, AACN member organizations voted in support of the Position Statement on the Practice Doctorate in Nursing. The gist of the AACN’s official statement is that the nation’s changing healthcare environment increasingly requires advanced practice nurses with the highest level of scientific knowledge and practice expertise to ensure optimal outcomes and patient safety as healthcare itself becomes more complex and technical in nature. Amid a growing physician shortage, many also see this as the best and only way to improve access to high-level primary and preventative care comparable to what people get from MDs.
Some of the factors behind AACN and NONPF support of advanced practice nursing education at the doctoral level include:
- The rapid expansion of nursing practice knowledge
- The increased complexity of patient care
- National concerns about quality of care and patient safety
- A shortage of nursing personnel, which demands doctoral-educated leaders who can design and assess care
- A shortage of doctoral-prepared nursing faculty
- Increasing expectations for the preparation of other members of the healthcare team
The Essentials of the DNP: The Components of the Doctor of Nursing Practice
A couple years after the official position statement was released, the AACN and its member institutions came together and formed a set of essential curricular elements and competencies for DNP programs, drawing them all up in a document entitled the Essentials of Doctoral Education for Advanced Nursing Practice, followed by the DNP Roadmap Task Force Report outlining recommendations for how institutions can implement that curriculum. These documents remain the primary guidelines for DNP curriculum development and implementation today.
The DNP builds upon the generalist foundation of a bachelor’s or advanced generalist master’s in nursing and establishes a base for advanced nursing practice in an area of specialization. Depending on the program, students may enter a DNP program with a bachelor’s degree (usually a Bachelor of Science in Nursing – BSN) or a master’s degree (usually a Master of Science in Nursing – MSN).
Many institutions design DNP programs in part-time, accelerated, and/or online formats to accommodate working nurses with demanding schedules and professional responsibilities. Online DNP programs provide students with a unique opportunity to complete all or most of the didactic requirements through interactive, web-based study, relieving the burden of having to adhere to a strict academic schedule.
The DNP Curriculum and Foundational Outcome Competencies
The DNP curriculum consists of two components:
- Foundational outcome competencies
- Specialty competencies/content that prepare students for practice and didactic learning experiences for a particular specialty; national specialty organizations delineate competencies, content, and practicum practices for specific roles
Foundational outcome competencies consist of 8 Essentials:
- Essential I: Scientific Underpinnings for Practice – Scientific underpinnings of the DNP education reflect the complexity of practice at the doctoral level and conceptual foundation of nursing. This includes a focus on both the natural and social sciences:
- Human biology, science of therapeutics, psychosocial sciences, and the science of complex organizational structures
- Philosophical, ethical, and historical issues inherent in the development of science
- Essential II: Organizational and Systems Leadership for Quality Improvement and Systems Thinking – Organizational and systems leadership are critical to improving patient and healthcare outcomes and are consistent with nursing and healthcare goals to eliminate health disparities and to promote patient safety and excellence in practice.
- Essential III: Clinical Scholarship and Analytical Methods for Evidence-Based Practice – Clinical scholarship and analytical methods for evidence-based practice ensure a focus on the translation of new science, its application, and its evaluation.
- Essential IV: Information Systems/Technology and Patient Care Technology for the Improvement and Transformation of Healthcare – DNP programs prepare graduates to use information systems/technology to support and improve patient care and healthcare systems and provide leadership within healthcare systems and/or academic settings.
- Essential V: Healthcare Policy for Advocacy in Healthcare – Study in healthcare policy ensures DNP graduates are prepared to design, influence, and implement healthcare policies that frame healthcare financing, practice regulation, quality, access, safety, and efficacy.
- Essential VI: Interprofessional Collaboration for Improving Patient and Population Health Outcomes – DNP programs prepare graduates to function in highly collaborative teams through advanced preparation in the interprofessional dimension of healthcare and effective team leadership.
- Essential VII: Clinical Prevention and Population Health for Improving the Nation’s Health – A DNP program always has a focus on health promotion and disease prevention.
- Essential VIII: Advanced Nursing Practice – DNP programs allow students to refine their assessment skills as they apply to their area of specialization.
The DNP program is, by definition, a specialized program, as DNP graduates assume specific roles in the nursing workforce. While all DNP programs incorporate the DNP Essentials, further preparation falls into one of two categories:
- An advanced practice nursing direct care focus
- Nurse practitioner (NP)
- Certified nurse midwife (CNM)
- Certified registered nurse anesthetist (CRNA)
- Clinical nurse specialist (CNS)
- An aggregate/systems/organizational focus
- Organizational and professional leadership
- Health policy
- Nursing/health informatics
DNP Programs with an Advanced Practice Nursing Direct Care Focus
All DNP graduates prepared in an advanced practice nursing role must be prepared to sit for an advanced practice registered nurse (APRN) national certification examination. All APRN graduates of a DNP program must also be prepared to sit for national, advanced specialty certification, when available.
DNP graduates prepared in an advanced practice nursing role must be able to demonstrate practice expertise, specialized knowledge, and expanded responsibility and accountability in the care and management of individuals and families.
Because APRNs manage, assess, and evaluate patients, a DNP program must include a separate course for each of the following three content areas:
- Advanced physiology/pathophysiology
- Health/physical assessment
- Advanced pharmacology
DNP Programs with an Aggregate/Systems/Organizational Focus
DNP graduates in informatics, healthcare policy, administrative, population-based specialties focus on aggregates, which include:
- Systems (including information systems)
- State and national policies
DNP graduates preparing for advanced specialty practice at the population/organizational/policy level demonstrate competences in:
- Conducting organizational, systems, and/or community assessments to identify aggregate health or system needs
- Working with diverse stakeholders to achieve health-related organizational or public policy goals
- Designing patient-centered care delivery systems or policy-level delivery models
Doctor of Nursing Practice Program Structure
Although it is up to the institution, state board of nursing, and/or accrediting body to dictate the length and/or credit hours of a DNP program, the AACN recommends DNP programs consist of at least 3 calendar years, or 36 months of full-time study (four years on a traditional academic calendar).
The AACN also recommends that institutions design of post-master’s programs on the candidate’s prior experience, education, and choice of specialization; therefore, at least 12 months of full-time, post-master’s study is necessary to earn a DNP.
DNP Practice Experiences
DNP programs provide opportunities for practice experiences aimed at helping students achieve the necessary competencies. According to the AACN, DNP programs should therefore consist of at least 1,000 hours of post-baccalaureate practice as part of a supervised program.
Practice experiences should be designed to provide students with opportunities for feedback and reflection and should include in-depth work with experts in nursing, as well as experts from other disciplines, within practice environments.
End-of-program immersion experiences for DNP programs should provide the context within which the final DNP project is completed.
Final DNP Project
The DNP program is distinguished by the completion of a specific project designed to demonstrate the mastery of an advanced specialty within nursing practice. The final DNP project documents the student’s educational experiences, provides a way to evaluate the immersion experience, and summarizes the student’s growth in knowledge and expertise.
Final DNP projects may include:
- Practice portfolio
- Consulting project
- Pilot study
- Research utilization project
- Quality improvement project
- Program evaluation