Awareness and availability of the Doctor of Nursing Practice (DNP) degree have been consistently on the rise in the 21st century. According to statistics from the American Association of Colleges of Nursing (AACN), there were more than 350 DNP programs offered nationwide across all 50 states in 2019 — compared to about 50 programs in 2013.
But, the question on many nursing professionals’ minds is “When will a DNP be required for nurse practitioners?”
While the DNP is the terminal degree for practice-focused nurses, the Master of Science in Nursing (MSN) is still the degree requirement for licensure as an advanced practice registered nurse (APRN).
Though there has been sustained movement in making the DNP the benchmark degree for practice as an APRN, progress has been slow in installing the doctorate as the preferred education requirement for nurse practitioners (NPs), as well as certified registered nurse anesthetists (CRNAs) and certified nurse midwives (CNMs).
However, that does not mean the DNP may not eventually become the standard for APRN practice. Let’s take a closer look at what exactly a DNP program is and why the nursing community is focused on elevating NPs to the doctorate level.
What is a DNP?
The DNP is the terminal degree for practice-focused nurses. That means there is no higher degree attainable than the doctorate. Although the Doctor of Philosophy (Ph.D.) exists for nursing, it is largely designed for nurses with career ambitions in research or academia.
A DNP program is meant to prepare nurses for the highest levels of advanced practice. Advanced practice is defined by the AACN as “any form of nursing intervention that influences health care outcomes for individuals or populations, including the provision of direct care or management of care for individual patients or management of care populations, and the provision of indirect care such as nursing administration, executive leadership, health policy, informatics and population health.”
Practically, DNP studies build students’ competencies in the following core areas:
- Evidence-based practice
- Primary care
- Prescriptive authority and medication management
- Health care policy
Nurse practitioners, including family nurse practitioners (FNPs), often seek a DNP to develop the skills, knowledge and experience needed to deliver high-quality care at the highest levels of practice, or to manage the performance of nursing staff and health care organizations.
Why Did the AACN Make Its Recommendation?
In October 2004, the member schools affiliated with the AACN voted to endorse the DNP degree as the benchmark level of preparation necessary for advanced practice nursing. The decision was nearly four years in the making and influenced by a number of trends in health care, like an aging U.S. population and increased care demands.
One solution to these challenges would be to ensure the nursing workforce is as skilled and knowledgeable as possible, which explains the move from a master’s to a doctorate.
Some of the underpinning factors supporting the move included:
- The rapid expansion of knowledge underlying practice
- Increased complexity of patient care
- National concerns about the quality of care and patient safety
- Shortages of nursing personnel, which demands a higher level of preparation for leaders who can design and assess care
- Shortages of nursing faculty with doctorates
- Increasing educational expectations for the preparation of other members of the health care team
Another motivating factor cited by the AACN was that nursing master’s degree programs in the U.S. often carry credit loads that are equivalent to doctoral degrees in other health professions. The AACN task force assembled to investigate the shift to a DNP found:
- Master’s degree-prepared APRNs expressed a need for additional knowledge to support a higher level of advanced practice
- The time spent in master’s level nursing programs is not congruent with the degree earned
With a transition to the DNP, nurses who have career goals of becoming an NP, FNP, CRNA, CNM, nurse educator, nursing director or nursing executive can benefit from:
- 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
- Greater preparation in evidence-based practice, quality improvement and systems leadership
This focus on leadership is integral to the DNP education experience, as well as the future of the nursing workforce. In its 2004 statement, the AACN said:
“Expert leadership should be a core component of practice-focused doctoral programs. Nurses with superb leadership skills at the most advanced clinical and organizational levels are most likely to be able to identify emerging trends and initiate policy and programmatic efforts to address critical clinical issues. They should be prepared to mobilize interdisciplinary teams of clinicians, administrators, policymakers and members of the public to solve highly complex clinical problems. It is no longer sufficient to apply clinical, organizational or economic skills to the resolution of complex health problems in a singular fashion.”
When Will a DNP Be Required for Nurse Practitioners?
The question of “When will a DNP be required for nurse practitioners?” is still a query without a definitive answer.
Nearly 20 years after the AACN’s initial DNP requirement position statement, there is scant clarity or assurance the transition will take place. At the time of the vote, the AACN had targeted 2015 as a rough transition date for the shift to doctoral preparation for advanced nursing practice.
In 2015, the AACN commissioned the Rand Corporation to complete a study on the progress toward the DNP, as well as what barriers continue to remain. The Rand report found MSN programs enrolled three times as many students as DNP programs on average, despite wide and growing adoptions of DNP degree programs.
The popularity of the MSN was one of the main challenges impeding a shift to the DNP requirement. Another somewhat related factor was a limited employer demand for and awareness of the DNP. The report found employers largely did not differentiate between the two when hiring, with few exceptions.
However, student demand for the DNP has remained strong since the time of the study. In 2019, there were more than 36,000 students enrolled in a DNP program, according to AACN statistics. In the same year, more than 7,000 nurses graduated with a DNP.
Despite the delay in shifting to the DNP as preparation for advanced practice, the nursing and health care communities at large continue to remain dedicated to bringing about the change for the betterment of the profession, populations and patients.
This was most recently evidenced by a 2018 position statement from the National Organization of Nurse Practitioner Faculties (NONPF), a group focusing on promoting excellence in NP education and advancing NP scholarship. The NONPF said it had “made the commitment to move all entry-level nurse practitioner (NP) education to the DNP degree by 2025.”
What Can NPs Gain from Earning a DNP?
As concluded in the Rand report, the value of the added education provided in a DNP program is “almost universally agreed upon.”
The content of a DNP education is closely aligned with the DNP essentials set out by the AACN. These are a collection of learning pillars underpinning the curriculum and experience of a DNP program and outlining the practice areas in which DNP students can expect to gain new skills and experience.
The eight DNP essentials are:
- Scientific underpinnings for practice: Using knowledge from biophysical, psychosocial, analytical and organizational sciences in conjunction with nursing science to inform the highest level of nursing practice. Developing and evaluating new practice approaches to improve patient care, safety, care delivery or organizational metrics.
- Organizational and systems leadership for quality improvement and systems thinking: Conceptualizing and executing delivery approaches that meet current and future patient populations’ needs. Leveraging insight into medical, organizational, political and economic sciences. Ensuring accountability by conducting cost analyses, raising awareness over cultural sensitivity and communicating ethics.
- Clinical scholarship and analytical methods for evidence-based practice: Applying analytical methods to evaluate patterns and then synthesizing those insights to be used in nursing practice. Designing, directing and evaluating quality improvement methodologies that promote safe, timely, effective, efficient, equitable and patient-centered care.
- Information systems/technology and patient care technology for the improvement and transformation of health care: Deploying the conceptual ability and technical skills to develop and execute an evaluation plan that leverages data from practice information systems. Providing leadership on ethical and legal issues within health care systems related to the use of information technology, patient data, communication networks and patient care technology.
- Health care policy for advocacy in health care: Advocating for the nursing profession by educating and advising policymakers. Taking an active part in the discourse through participation on committees, boards or task forces. Educating the public on nursing, health policy and patient care outcomes.
- Interprofessional collaboration for improving patient and population health outcomes: Leading interprofessional teams in analyzing clinical and organizational issues. Deploying effective interprofessional communication and collaboration skills when designing, implementing, managing and measuring new policies.
- Clinical prevention and population health for improving the nation’s health: Analyzing epidemiological, biostatistical and environmental data related to individual and population health. Evaluating care delivery models and strategies using concepts related to community, environmental and occupational health, and the cultural and socioeconomic dimensions of health.
- Advanced nursing practice: Demonstrating advanced levels of clinical judgment, systems thinking and accountability in evidence-based practice. Guiding, mentoring and supporting other nurses to achieve excellence in nursing practice.
In addition to focused coursework, DNP students also complete experiential learning components that reinforce learning, test their comprehension and help students sharpen their skills and knowledge. Often these opportunities take the form of clinical hours, internships, practicums and a thesis.
The sum advantage of earning a DNP is having the highest level of clinical preparation. NPs can use their education to achieve positive outcomes, drive quality improvement, engage with patients and populations, steer policy and provide organizational leadership.
Beyond the implications of a DNP on advanced nursing practice, this terminal degree can also open the door to opportunities for career advancement. A DNP is considered highly advantageous when applying to managerial and leadership roles like nursing director or nursing executive. Possessing a DNP may also enable NPs — as well as other APRNs — to earn a higher salary.
Earn Your DNP Degree at Bradley
A DNP can help fuel career growth and development for NPs, among many other health care professionals. If you’re interested in earning that terminal degree, consider studying online at Bradley University.
We maintain two online DNP programs:
- A bachelor’s entry track designed to prepare FNPs, which takes roughly 3.7 years to complete
- A master’s entry track focusing on cultivating leadership qualities, which takes roughly three years to complete
At Bradley, nurses will learn from world-class faculty and engage with courses that help build advanced practice nursing competencies. Some of the courses featured in our DNPs include:
- Health Promotion in Populations
- Ethics in Advanced Practice Nursing
- Advanced Pharmacology
- Advanced Health Informatics
- Health Care Policy
Also, the FNP-focused track features courses related to primary care across the lifespan, while the leadership track features courses aimed at shaping strong leaders with communication and interpersonal skills.
Want to learn more about completing a Bradley DNP program? Contact an enrollment advisor today for more information.