How Is the DNP a Practice Doctorate?
Q: I am a nurse practitioner currently working in an emergency setting and I am considering the DNP. I have worked as an associate professor at the local university. I have been doing some research into the curriculum and I do not find any evidence of this being a "practice" doctorate. Am I just not understanding the curriculum? It appears that this additional degree has lots of "filler" classes that could easily be dumped or replaced with more "practice" appropriate classes. For instance, there are IT classes (who in this day and age needs an IT class at the doctoral level that isn't in an IT program?). It seems to me that the majority of the class work is not "practice" related. I am all about increasing my education but I am having a hard time understanding why there is a push to obtain a DNP other than to have more doctorally prepared Nurses with the ability to teach. I'm looking for help from those who have obtained the degree, because from the advisors I've talked to they say "you'll understand once you have the degree" that doesn't fly well with me. Please help me understand why pursuing this degree would help my practice.
A: You pose a great question and a very common concern among folks inquiring about returning to school for a DNP degree. I think the best way to answer you would be to address your concerns with a few different points.
I think a better understanding of "nursing practice" would help. The AACN (2004) position statement specifically defines the DNP degree as a “practice focused” doctorate degree with "nursing practice" being defined 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. (p. 3)
Preparation at the practice doctorate level is considered to be the highest level of preparation for nursing practice, hence the terminal degree for nursing practice (AACN, 2004). Understanding that "nursing practice" truly encompasses much more than the diagnosis and treatment of illness is paramount to understanding how the DNP degree improves nursing practice. Within our masters preparation we have clinically focused curricula that prepares us for specific nursing specialties. The DNP degree is not meant to add to our already established clinical skills. The DNP degree builds on other aspects of practice such as information technology, health policy and advocacy, leadership, and the evaluation and translation of evidence-based practice.
If you question the curricula of the DNP degree, you need to review the Institute of Medicine (IOM) reports from 2000, 2001, 2003 and more recently 2010. The IOM and the National Academy of Sciences have recommended that all health professions acquire skills in interprofessional collaboration, leadership, information technology (beyond average skills and including statistics/IT/data mining techniques and IT), health policy, and the evaluation of translation of evidence-based practice. These recommendations came from IOM reports that evaluated the errors made in medicine and deemed that these skills were necessary for all health professionals in an effort to reduce errors and improve patient centered care. The IOM also recommended that all health professionals be prepared at the doctoral level.
Your comment about your advisors is interesting and I understand your concerns. However, I did not fully appreciate the extent that the DNP degree would improve my practice until I had graduated and returned to my practice. I am a clinician but am now much more invested in patient-centered care and advocacy for nursing education. For myself, this meant publishing a DNP textbook (something I never thought I could do), presenting on relevant topics to promote nursing and the DNP degree, teaching as adjunct faculty, obtaining additional certification as a menopause practitioner, developing a patient education booklet at my center for cancer survivors on menopause management, and now the development of a subspecialty within my setting caring for patients with a history of cancer experiencing menopausal symptoms. I am much more aware of the role of nursing to improve patient centered care, whether directly or indirectly through policy and advocacy, leadership, or evidence-based practice.
The most recent DNP Perspectives column specifically describes the wonderful work some of my colleagues have been doing since graduating with their DNP degree. I suggest you speak to folks in your community who have a DNP degree to gain a better understanding of the wonderful impact DNP graduates are making on healthcare and nursing practice.