Andrea Kelley wants to improve cancer care by better understanding the patient’s cancer experience through research. To accomplish this goal, she is working toward a Doctor of Philosophy (PhD) in Nursing at the University of Massachusetts in Dartmouth. “I wanted to pursue a PhD to be at the top of my field, to increase awareness of nursing as a legitimate science, and to change the way care is delivered to patients,” she explains.
Kelley is doing what nurses desiring a doctoral education have traditionally done—attain research-focused terminal degrees such as a PhD or a Doctor of Nursing Science (DNS, DNSc). In recent years, a variety of factors have led to the burgeoning development of a practice-focused degree option: the Doctor of Nursing Practice (DNP). Today over 150 DNP programs exist, another 160 are in the planning stages.
In contrast to PhD or DNS/DNSc programs, which prepare nurse researchers to develop new knowledge and advance nursing science, the DNP program prepares nurses to incorporate evidence into practice and policy in order to improve outcomes.
“The PhD [program] will prepare me to be a nurse scientist,” says Kelley. “[whereas] the DNP [focus] is to translate research into practice through research utilization.” Kelley’s comparison reflects that of the American Association of Colleges of Nursing (AACN), which defines the DNP role as one translates research to practice, evaluates and applies evidence, and implements innovative interventions to transform nursing practice.
When Nancy Cabelus, RN, MSN, DNP, learned about the DNP program in Forensics Nursing at the University of Tennessee, she thought it would be a better fit for her. “I was not striving to work in research or academia full time,” she explains. “The DNP degree has given me the knowledge, tools, and resources to conduct myself as an advanced practice nurse in leadership and program development, and also to work with systems and policy change.”
DNP programs are comprised of eight essential content areas: From The AACN DNP Essentials:)
- Scientific underpinnings for practice;
- Organizational and systems leadership for quality improvement and systems thinking;
- Clinical scholarship and analytical methods for evidence-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; and
- Advanced nursing practice
Despite its appeal, the DNP program has generated some controversy. The AACN endorsed the DNP degree in 2004 and proposed that it be the minimum entry-level education for all APNs by the year 2015. Though lauded by some as putting APNs on equal footing with other health care-related disciplines such as pharmacists (PharmD) or physical therapists (DPT), not everyone agrees with this requirement. “I don’t feel the DNP should be mandated as the entry level degree for APNs,” says Cabelus, “but [it] should be considered an option.”
Regardless of whether an NP holds a master’s of science in nursing (MSN) or a DNP, the scope of practice (as defined by the state) has not changed. However, a survey conducted by ADVANCE for Nurse Practitioners magazine in 2009 indicated that DNP-prepared nurse practitioners were earning nearly $8000 annually more than their master’s prepared counterparts.
Despite the controversies, the decision to pursue a PhD, DNS/DNSc, or DNP is largely based on an individual’s professional goals and interests. For Cabelus, the DNP was the right choice. “I feel that I am prepared to accept new challenges and opportunities that may come my way,” she says.
According to the AACN, following are the core ways in which DNP programs differ from PhD programs: (AACN, 2004)
- DNP programs have less emphasis on theory and meta-theory
- Considerable less research methodology content, with a focus being on evaluation and use of research rather than the conduct of research
- Different dissertation requirements, ranging from no dissertation to theses or capstone projects (termed dissertations in some programs) that must be grounded in clinical practice and designed to solve practice problems or to inform practice directly
- An emphasis on practice in any research requirement
- Clinical practica or residency requirements
- Emphasis on scholarly practice, practice improvement, innovation and testing of interventions and care delivery models, evaluation of health care outcomes, and expertise to inform heath care policy and leadership in establishing clinical excellence