How to Complete 1,000 Clinical Hours for the DNP

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Q: Although I support the addition of clinical time for an entry-level DNP (new to the APN role), I question the usefulness of my practicing additional hours after 11 years of practice, which has included formal precepting of MSN APN students and informal precepting of medical interns/residents. Although practice with a DNP-prepared NP might be beneficial, there are too few at this time. As for practice with an MD, all that will do is increase the exposure to the medical model of practice. I suppose that if I could study full-time, the hours would not be an issue but not many nurses can afford that option. How does an NP working full-time fit in that many clinical hours?

A: This is a very good question. Yes, DNP programs do require a total of 1,000 clinical hours with roughly half of those hours transfered in from MSN education. The remaining DNP hours are typically tailored to meet the needs of the student and are many times not "clinical" in the traditional sense that we think of those hours. For a practicing clinician who is an expert in his or her field, a program that requires the traditional guided clinical practicum of seeing patients throughout the day may not be the best fit to meet their educational and career goals.

Many programs allow the student to define their clinical hours, in conjunction with their faculty member, very broadly to meet their educational goals. One example is a DNP program in which the focus is to prepare clinician leaders to be effective health systems change agents. The clinical hours these students perform are in support of the capstone, which is focused on improving practice. The students identify and define a health system issue at a practice, perhaps this may be a practice where the DNP student is employed as a practicing NP. The student then implements a quality improvement project, based upon the available literature, and evaluates the outcome of this project.

The hours spent implementing this clinical site capstone project may be counted and utilized as clinical practice hours. Although these are not direct patient care, these hours may be counted as clinical hours. The DNP student spent time in a clinical practice performing a health system quality improvement capstone to improve healthcare delivery.

Most schools will spread these hours over several semesters. The DNP student may have the ability to move along faster or slower depending upon the structure of the program. I believe DNP programs are definitely hard work but I believe the working clinician with a full-time practice can definitely complete the required credit and clinical hours. As always, everyone contemplating entering DNP education must do their research and find the program that is the right fit for their professional and personal goals.