Last week I went to my primary care office and saw a nurse practitioner. She was great. Super easy, listened to my problem (a minor one), knew just what to do, didn’t press a bunch of tests on me that I didn’t need, and generally appreciated my goals for the visit and acted accordingly. It was nice. I didn’t ask this NP if she had a master’s degree or a doctorate. Until fairly recently I was unaware that a person could get a clinical doctorate in nursing. My professors in nursing school had PhDs in nursing.
About 10 years ago member schools affiliated with the American Academy of Colleges of Nursing (AACN) voted to endorse the Position Statement on the Practice Doctorate in Nursing, which called for moving the level of preparation necessary for advanced nursing practice from the master’s degree to the doctorate by the target year of 2015. On October 28th of this year, the AACN, an advocacy organization that has an independent program certification arm, published the results of a RAND corporation study about how far nursing schools have gone in transitioning advanced practice training from the master’s level to the doctorate.
Since I’m writing a book about medicine and nursing, and since this nursing doctorate thing seems to be happening, I took the opportunity to look into the matter.
Advanced nursing practice is defined by the AACN as “any form of nursing intervention that influences health care outcomes for individuals or populations, including the direct care of individual patients, management of care for individuals and populations, administration of nursing and health care organizations, and the development and implementation of health policy.” (http://www.aacn.nche.edu/publications/position/DNPEssentials.pdf). That’s kind of a broad definition and could be used for doctors as well. The AACN seems to want to emphasize the management, administration, and policy components of this definition, couched in the language of Improved Patient Care. The AACN has made curricular recommendations for the Doctorate of Nursing Practice (DNP) called DNP Essentials. They include:
Scientific Underpinnings for Practice
Organizational and Systems Leadership for Quality Improvement and Systems Thinking
Clinical Scholarship and Analytical Methods for Evidenced-based Practice
Information Systems/Technology and Patient Care Technology for the Improvement and Transformation of Health Care
Health Care Policy for Advocacy in Health Care
Interprofessional Collaboration for Improving Patient and Population Health Outcomes
Clinical Prevention and Population Health for Improving the Nation’s Health
Advanced Nursing Practice
What does all this policy-speak mean? I don’t think anybody is quite sure yet. Do these eight points help you understand why you might want to do a DNP? Not really. Currently DNP degrees generally require an MSN, but the projected model is to go straight from the BSN to the DNP. Practically speaking, DNP programs are supposed to be the ultimate nursing clinical degree. DNPs are supposed to be three-year programs instead of two, with 1000 hours of clinical practicum, rather than 600. Rather than a research-based dissertation, DNP programs sometimes require some other form of final project, like a practice portfolio or a practice change initiative. It remains to be seen whether DNP programs grow in favor as the preferred preparatory path for nurse practitioners.
What did RAND find? Well, here are the key points as found on the AACN website:
- DNP programs – either at the post-baccalaureate (BSN-DNP) or post-master’s (MSN-DNP) level – are now offered at more than 250 schools nationwide.
- The study authors found near “universal agreement” among nursing’s academic leaders regarding the value of DNP education in preparing nurses to serve in one of the four APRN roles, specifically Nurse Practitioners, Clinical Nurse Specialists, Certified Registered Nurse Anesthetists, and Certified Nurse-Midwives.
- Though the master’s degree remains the dominant route into APRN practice at this point in time, the educational landscape is changing. Approximately 30% of nursing schools with APRN programs now offer the BSN-DNP, and this proportion will climb to greater than 50% within the next few years.
- The national movement toward offering the BSN-DNP and closing master’s level APRN programs is expected to accelerate. Currently, up to 14% of schools with APRNs programs only offer the BSN-DNP as their entry-level option into advanced practice. An additional 27% of schools with or planning a BSN-DNP intend to close their master’s level APRN programs within the next few years.
- Student demand is strong for all types of programs – BSN-DNP, MSN-DNP, and the MSN – that prepare APRNs. Approximately 65% of schools with BSN-DNP programs also offer master’s level APRN programs.
- Many employers are unclear about the differences between master’s-prepared and DNP-prepared APRNs and could benefit from information on outcomes connected to DNP practice as well as exemplars from practice settings that capitalize on the capabilities of DNPs.
It is this last that I think is going to cause problems for the DNP advocates. Nursing educators and APRNs are themselves not sure what the differences are. But the DNP seems to be on it’s way, nevertheless.