Q: I hear there are states where using the title “doctor” is illegal if you are not an MD. Which states are these, and how would a DNP graduate introduce him- or herself to patients in those states?

A: To begin, I hope that all of us who have earned our doctorate degrees, be it the PhD, DNSc or DNP, step back to realize that any efforts to expand a body of knowledge unique to a professional discipline should be applauded rather than criticized. I feel fortunate that, in my personal experience, I have received only positive feedback from the physicians I practice with. They have been inquisitive and positive in giving their feedback as I moved through my capstone project and began to address the clinical problems I identify from a new perspective. As with most of the barriers I have read about in terms of nurse practitioner scope of practice, this comes down to a lack of knowledge regarding the content of our educational programs, clinical learning requirements for practice, and the certification process. And equally unfortunate is the fact that, unless our colleagues in other health professions take the time to listen, they will not learn that the DNP is not an effort to further move toward the medical model, but to empower nurse practitioners by educating them on how to engage in evidence-based practice.

There are negative commentaries and (in my opinion) unfounded accusations that DNPs attempt to misrepresent themselves as medical doctors. The AMA, as represented by the Scope of Practice Partnership (SOPP) continues to methodically challenge the scope of practice of advanced practice nurses (among other groups) from state to state. Among the charges of the SOPP is an effort to prohibit the use of the title “doctor” by DNPs in the clinical setting. This was temporarily successful in the state of Illinois some years ago, but was corrected through revisions in that state’s Nurse Practice Act. The bottom line is this ... no one can prevent an individual who has earned an academic title, doctor or otherwise, if that person has earned and been awarded the degree.

Would it be completely unethical and inappropriate for a DNP to represent themselves as a medical doctor? Absolutely! Our patients may become easily confused by the title of Doctor of Nursing Practice. It is hard enough for many of them to decipher who is a nursing assistant versus who is a registered nurse, and who is a dietician or physical therapist. The healthcare environment is a sea of scrubs, and the patient is often perplexed about who is actually responsible for their care. I often correct my patients several times when they refer to me as “doctor,” simply because I want to be clear with them that I am not a medical doctor. I always introduce myself with, “I'm Meg Carman, I am a nurse practitioner here,” and explain what my role is. Likewise, most of my ED physician colleagues enter the room giving their first name, followed by, “I’m one of the emergency physicians here.” It is important to help our patients understand who is providing their care. At the same time, the DNP should always be proud of the hard work it took to accomplish this goal. No one has a right, and no law exists, to take that away. We need to work as a group to assure that such an injustice is not allowed to happen.

Editor's note: Here at the DNP Answers blog we take your questions about the DNP and answer them as best we can. This question is answered by blogger Meg Carman, DNP, ACNP-BC, CEN, who serves on faculty in the ABSN program at the Duke University School of Nursing in Durham, N.C. She also practices with Wake Emergency Physicians in Raleigh. Comment below to discuss this topic, or send new questions to jford@advanceweb.com.

Return to blogs home page.   Return to ADVANCE for NPs & PAs home page.

Q: I have a question about the DNP versus PhD or DNSc. I just began to research this subject and am confused as to why the PhD or DNSc is not eligible for accreditation by CCNE. Therefore is a PhD or DNSc inferior? Or are there other organizations that give accreditation to the PhD nurse?

A: By no means are any of these degrees inferior. They just have differing foci. The DNP is a practice doctorate degree while the PhD is a research doctorate. Graduates of PhD programs are typically prepared to conduct independent research. DNP programs typically provide graduates with abilities to assess the evidence in nursing research, evaluate the impact on their practice, and make changes as needed to enhance quality of care. Scholarship and dissemination is an essential component of these degrees.

Schools and universities obtain accreditation for their programs of study. PhD programs are typically offered by colleges and universities that are accredited regionally. Six associations in the United States provide regional accreditation. These include the Middle States Association of Colleges and Schools, New England Association of Schools and Colleges, North Central Association of Colleges and Schools, Northwest Commission on Colleges and Universities, Southern Association of Colleges and Schools, and Western Association of Schools and Colleges.

Some PhD programs may be accredited by additional agencies. The Commission on Collegiate Nursing Education (CCNE) and the National League for Nursing (NLN) do not provide additional accreditation for PhD programs. Program-specific accreditation pertains to specific academic programs within a university or school. CCNE and NLN accredit clinical programs of nursing at colleges and universities essentially for the protection of the public and ensure standards are met for clinical programs, including DNP. Although a PhD program in nursing is not accredited by CCNE or NLN, they are most likely accredited by one of the regional accreditation agencies as a part of the university's accreditation.

Editor's note: At the DNP Answers blog we take your questions about the DNP and answer them as best we can. This post is written by blogger Michael Zychowicz, NP, chairman for master's programs at Duke University School of Nursing. Comment below to discuss this topic, or send new questions to jford@advanceweb.com.

Return to blogs home page.   Return to ADVANCE for NPs & PAs home page.  

Q: I am currently applying for MSN programs to become an acute care nurse practitioner. I am looking at applying for the DNP program instead since I expect to finish the MSN degree by 2015. My questions are: 1. If I graduated in 2015 with an MSN-ACNP, will I be grandfathered with that? Is it mandatory to have a DNP degree by 2015? 

A: The DNP as entry to practice for a nurse practitioner (NP) by 2015 is still a recommendation and not a mandate. Therefore, I do not anticipate that you will have a problem being "grandfathered in" when you graduate with an MSN-ACNP degree. For more information regarding this recommendation and how to choose a program see blog posts dated December 2, 2011 (Current MSN Status and the DNP Transition) and October 22, 2010 (The Official Switch to the DNP). 

Choosing a DNP project can be a challenging task (also see the blog post dated March 30, 2012, Picking a Capstone Before Starting a DNP Program). You can start by evaluating areas of interest. Choose an area that you are willing to live, sleep and dream about for the next 3 to 5 years (BSN to DNP).  Understand that this may become your area of expertise that acts as a catalyst for your future career. However, don't be intimidated by this process, as most likely this topic can be altered during the program as opportunities arise or as interests develop or change over time.

To summarize the answer to the question, "Should you attend a master's or a DNP program to become an ACNP?"  You may want to check into different programs. Many DNP programs offer an "early exit" option after achieving a master's degree, such as the one at the University of Florida. I hope this blog and the references provided will help alleviate some of your concerns regarding the requirements for NP education, licensure and practice. Good luck!

Editor's note: Here at the DNP Answers blog we take your questions about the DNP and answer them as best we can. This question is answered by blogger Mai Kung, NP, DNP. Comment below to discuss this topic, or send new questions to jford@advanceweb.com.

Return to blogs homepage.   Return to ADVANCE for NPs & PAs homepage. 

Q: I'm currently in a DNP program and I'm trying to fine tune my PICOT question. I want to focus my translational project on increasing the African American population on the bone marrow donor registry. African Americans tend to have low representation on both blood and tissue donor registry/program. Being an African American myself with a son with sickle cell disease, it is an important topic to me. How can elevate this concern to a doctoral-level project? I was contemplating doing an educational intervention for the staff on ways/methods to educate/encourage this population during blood/marrow drives.

A: Figuring out a DNP project is very challenging but you are smart to tackle something that is of interest to you. The important goal of a DNP project is to contribute something that is applicable to practice, trying to shorten research-to-practice gap. I believe education interventions are very pertinent and good ideas for projects. You could develop an educational tool for staff and pilot it. Start with a pretest questionnaire, present the tool, then posttest the staff -- easy to evaluate from a quantitative perspective and IRB won’t be a huge challenge. Keep it simple: the hardest part of a DNP project is narrowing it down. Then you could submit your findings to an education journal. Remember to submit to a journal with similar mission to your work. Good luck!

Editor's note: At the DNP Answers blog we take your questions about the DNP and answer them as best we can. This post is written by blogger Lisa Chism, NP, DNP, NCMP. Lisa was selected as the 2011 North American Menopause Society Certified Menopause Provider of the Year. Comment below to discuss this topic, or send new questions to jford@advanceweb.com.      

Return to blogs home page.   Return to ADVANCE for NPs & PAs home page. 

Q: What are some tips for financing my DNP education?

A: Returning to school or continuing in the pursuit of a higher academic degree is a pivotal life-changing milestone. The decision to obtain the DNP should be weighed from all angles. You need to consider the time, commitment, social, family, professional and personal costs. A tool that can help you make the decision is a “pros and cons” spreadsheet. At the top of this list of important considerations is the actual financing cost of doctoral education.

Doctoral education is not cheap, but it can be funded in various ways. Student loans, personal investments and bank loans are means of funding on a personal level. Most employers, especially in the healthcare industry, offer tuition reimbursement. Check with your human resource departments. Other forms of funding are available as free funding and grants. Many national, state, community and employer agencies provide funding to those who have the resources to pursue them.

The Institute of Medicine has issued a statement called The Future of Nursing Report, which outlines the need for an increased number of primary care providers and provider education to enable patients to navigate our increasingly complex health care system. In accordance with the Affordable Care Act, these agencies supply funding to assist with the education of nurse practitioners and potential primary care providers. Some avenues for doctoral funding are listed here:

National

Health Workforce Information Center — A national organization supplying funding opportunities based on type of funding, such as awards (honorary), awards (monetary), educational opportunities, fellowships, free or discounted registrations, grants and contracts, incentive programs, loan repayment programs, loans, scholarships, technical assistance.

Robert Wood Johnson Foundation (RWJF) — A national, philanthropic foundation providing grants and funding in multiple disciplines and health care initiatives. An excellent document published by the RWJF sites multiple venues to pursue for nursing education funding. See “Charting Nursing’s Future: A Publication of the Robert Wood Johnson Foundation.”

Rita and Alex Hillman Foundation — A “New York-based philanthropy dedicated to improving the lives of patients and their families through nurse-led innovation” (University of Pennsylvania School of Nursing, 2011). The Hillman Scholars Program in Nursing Innovation was recently introduced, assisting in the funding of direct BSN to doctoral education. With the backing of the RWJF, the Hillman Foundation initiative is available currently at the University of Pennsylvania, and is being duplicated at multiple universities nationally. Check with your University for availability.

John A. Hartford Foundation — U.S. leading philanthropy focused on interest in aging and health. Geriatric healthcare is emphasized, with grants and funding opportunities. Currently partnering with the Jonas Center for Nursing Excellence (see below).

Jonas Center for Nursing Excellence — The Jonas Center is a philanthropic organization dedicated to building the effectiveness of America’s professional nurses in three key ways: (1) developing outstanding faculty, (2) advancing scholarship and (3) sparking innovative practice. The organization offers grants and funding for all nursing education.

State

A specific example of a statewide initiative is in my home state of Michigan and has been approved by former governor Jennifer Granholm. This initiative is being duplicated presently in states nationwide, and many are being expanded to encourage providers to practice primary care in underserved areas. The Michigan Department of Community Health partners with the federal government to administer the National Health Service Corps Tuition Reimbursement program to place primary care providers, including physicians, PAs and NPs, around the state. The loan repayment program provides up to $50,000 to help repay student loans for graduates who agree to practice for 2 years in Health Professional Shortage Areas, which are generally rural or inner-city locations. Through this program, Michigan placed more than 30 healthcare professionals by the end of 2010. The Patient Protection and Affordable Care Act of 2010 authorized an additional $11 billion nationwide to support this program over 5 years beginning in 2011. This additional funding could greatly increase placement of primary care providers in underserved areas. This program may be attractive to PAs and NPs, with average degree program costs of $31,210 (average in state, public school) and $16,624 (average in-state, public school), respectively.

To review other opportunities in Michigan, the Michigan Center for Nursing is an excellent resource (http://www.michigancenterfornursing.org/). Check your state Center for Nursing excellence and your State Department of Community Health for your funding opportunities in your region.

Pursuing the DNP degree is a valuable and career changing experience. With a little initiative and drive for funding, the DNP can be realized and utilized to develop excellence in healthcare for the coming millennium.

Editor's note: Here at the DNP Answers blog we take your questions about the DNP and answer them as best we can. This question is answered by blogger Catherine Nichols, MSN, ANP-BC, a DNP student and adult nurse practitioner. Comment below to discuss this topic, or send new questions to jford@advanceweb.com.

Return to blogs home page.   Return to ADVANCE for NPs & PAs home page.

Q: How do you find a DNP-level preceptor when even MSN NP students can't find preceptors?

A: Great question. The DNP role immersion or “residency” is designed to expose a DNP student to a role they wish to pursue or gain more knowledge in. The roles of DNP graduates may range from leadership, policy, education to clinician roles. DNP graduates may find themselves designing new roles or combining several roles in their position. The focus of the DNP role immersion or residency should therefore focus on one or more of these areas.

Further, I don’t feel that this experience has to be with a DNP prepared nurse. The experience may be with someone in an administrator role if the student wishes to pursue a leadership role or a PhD prepared educator if the student wishes to pursue a role in academia. A DNP student who wishes to pursue policy may work with someone who develops or evaluates policy. The point is to be exposed to these roles and specialized knowledge in order to further your expertise in these areas.

It is important to realize that the role immersion/residency does not have to be clinically focused. As I have said many times, DNP students/graduates are already clinical experts. It is the added, specialized knowledge in leadership, evidence-based practice, information technology, policy and population health that students should try to gain expertise in while in a DNP program.

Editor's note: At the DNP Answers blog we take your questions about the DNP and answer them as best we can. This post is written by blogger Lisa Chism, NP, DNP, NCMP. Lisa was selected as the 2011 North American Menopause Society Certified Menopause Provider of the Year. Comment below to discuss this topic, or send new questions to jford@advanceweb.com.      

Return to blogs home page.   Return to ADVANCE for NPs & PAs home page. 

Q: Hi, I am hoping to start my doctor of nursing practice program in the fall but would like to have a great capstone project ready to go for the application. I work as a CRNA now in a community hospital. There are so many issues that could be discussed, i.e. obesity, pain management, beta blocker compliance. Any suggestions on where to start? Thanks!

A: This is a great question. Most DNP students I know have had some idea about their capstone prior to entering the program. It is only natural for persons who aspire to a degree in translational science to approach it with a million ideas for applying their newfound knowledge! My best advice is to keep it simple. Many of us came into our experience with grand ideas about effecting change within our practice settings, systems and even on a population level using the capstone. But the capstone is intended to be a demonstration of the skills learned in the DNP curriculum: the ability to analyze best practice through the available evidence and apply this to problem solving in the clinical setting. As nurses, we have demonstrated out competence through testing (NCLEX) and certifications at the graduate level. For the DNP, our “entry into evidence-based practice” is this culmination through the capstone project.

Examine the things in your daily practice that create barriers to optimal patient care or smooth processes. Things that concern you, because you recognize a risk for error or lapses in safety. Areas in which you recognize an inconsistency in the approach to patient care. If you have an issue that you are especially passionate about, consider a capstone that might be used as a pilot study. This would allow you to examine what the question really is, explore the available literature and develop the project in a manner that is manageable for the timeline you need to move through the program.

As a CRNA, I would begin by looking at the processes in place. Can you see room for improvement in the areas of pre-op teaching and expectations? Intra-operative issues involving team communication? Pain management techniques in the PACU? I imagine that your question would be greatly affected by the number of day surgery vs. inpatients seen; this would have a substantial impact on the processes in place. Break it down into a PICO format: the population you are interested in, the intervention you are proposing, comparison to other possible interventions and the desired outcome of the project.

After you have successfully developed your skills and graduated, it is time to move on to that project that really burns in your soul, the one that you had considered when applying to the DNP program. Now, you have the experience to consider the various factors impacting adoption and plan an intervention that is more likely to become accepted practice in your clinical setting. For the capstone, keep it small (perhaps a pilot for your big idea) and manageable.

Editor's note: Here at the DNP Answers blog we take your questions about the DNP and answer them as best we can. This question is answered by blogger Meg Carman, DNP, ACNP-BC, CEN, who serves on faculty in the ABSN program at the Duke University School of Nursing in Durham, N.C. She also practices with Wake Emergency Physicians in Raleigh. Comment below to discuss this topic, or send new questions to jford@advanceweb.com.

Return to blogs home page.   Return to ADVANCE for NPs & PAs home page.

The DNP curriculum provided me with tools to understand healthcare systems, policies, politics, finances, public health and more. It enhanced my clinical skills and knowledge. It also provided me with opportunities to work toward my goals. One of my goals was to publish; therefore, I submitted papers to journals, and many were published. I worked with leaders and professional organizations to remove barriers to nursing practice through legislation as part of my DNP residency. This paved the way to my current patient and nursing advocacy efforts. After graduation I transitioned to a full-time faculty position. I love teaching and the opportunity to influence the next generation of nurses. I also serve as a member of an interdisciplinary team working in a rural clinic for the underserved with the capacity to continuously improve and expand its services. I could continue to name examples of how the DNP has positively influenced my professional career. More importantly, the DNP enriched my life by giving me the personal satisfaction and confidence to work toward my dream.

What do you aspire to do in life, and what is your dream? Is it practice or research? Is it affecting one patient at a time or more on a population level? Do you desire clinical skills or leadership and management skills? The interesting part is that none of these competencies are mutually exclusive. The question is: What do you love most? What are your personal and career goals and dreams? Is a DNP or a PhD better suited for you? Will having a DNP or a PhD fulfill your every need? Most likely not, but a doctoral education will equip you with the ability to problem solve and will open doors for you. One great thing about doctoral education is that you have the ability to focus and direct your learning needs.

Your future is in your creative hands. It involves acquiring the right tools, combined with the right elements (opportunities, personal ability/passion, resources …), and being willing at times to endure some painful shaping and reshaping before the creation of that timeless masterpiece. Enjoy and have fun on this life’s journey! 

Editor's note: Here at the DNP Answers blog we take your questions about the DNP and answer them as best we can. This question is answered by blogger Mai Kung, NP, a recent DNP graduate. Comment below to discuss this topic, or send new questions to jford@advanceweb.com.

Return to blogs homepage.   Return to ADVANCE for NPs & PAs homepage. 

Q: I am a nursing student at the moment working on my BSN. I noticed a lot of you are talking about more money on top of the master's degree, however what about the schools that offer the RN-DNP? I have looked in to a school that offers this, a very well-known school. I for one think that this would be just as worth my time as completing their master's program, since the requirements are nearly the same. I am still researching it and would love to have more information if anyone has any regarding this.

A: BSN to DNP programs are developing in multiple universities across the country (see the American Association of Colleges of Nursing list of schools). A few have developed in my surrounding area of Metropolitan Detroit, including Wayne State University. According to the AANP, “course work currently required in NP master’s programs is equivalent to that of other clinical doctoral programs” (2010). The emerging terminal clinical practice degree, DNP, comparatively seems to be an additional year beyond current MSN curriculum guidelines. Those universities that have developed the BSN to DNP track typically show four years to complete. However, clinical hours may increase especially in light of the current debate of a DNP nurse residency program.

Making this decision can be complex and difficult. There are resources to help make that decision. Again, access the AACN website and download the “DNP Fact Sheet” to help with this decision. I would also direct you to Lisa Chism’s book, “The Doctor of Nursing Practice: A Guidebook for Role Development and Professional Issues” (2nd ed.) and the chapter on “how to make the big decision.” In it, she provides tables and grids to develop your own pros and cons of this consideration. It is an excellent practical resource.

Pursuing the DNP degree is a major life commitment and should be considered carefully. As a current DNP student, with my final capstone project separating me from the degree, I can’t tell you how profoundly this educative experience has broadened and enhanced both my views of the nursing profession and the scope and breadth of my NP practice. Coupled with the current recommendations by the American Association of Colleges of Nursinf for a mandated DNP as the clinical entry point, it is a prudent decision to go forward with completing your DNP from your BSN.

Editor's note: Here at the DNP Answers blog we take your questions about the DNP and answer them as best we can. This question is answered by blogger Catherine Nichols, MSN, ANP-BC, a DNP student and adult nurse practitioner. Comment below to discuss this topic, or send new questions to jford@advanceweb.com.

Return to blogs home page.   Return to ADVANCE for NPs & PAs home page.

Q: The DNP seems to be the logical choice to further my education, but some programs require an additional 500 clinical hours in addition to the clinical hours already completed for my MSN/FNP. I do not see the value of additional clinical hours where the preceptor is another MSN-prepared nurse practitioner. I have been a nurse practitioner for 6 years and don't see the value of following another nurse practitioner with the same training. I can understand if this were a sort of "residency" where we would be learning from a physician. Are there programs that give credit for years of service in lieu of additional clinical hours? I currently run my own clinic without in office physician supervision. Considering the limited number of preceptors in my area due to a highly concentration medical environment, I anticipate probably having the same preceptor again. Heck, I've been a preceptor for DNP students in my 3 years post MSN! I understand that the coursework will be different and at a higher level, but what changes in clinical preparation? I work around 2,000 hours a year and keep current not only in treatment and diagnosis but also healthcare politics. Can someone adequately answer the question of the value added in spending thousands more dollars and hours of more time to receive a degree to do the same thing that I'm doing and not get credit for my professional experience?

A: Well, I actually agree with you. I too do not see the value of a DNP student doing clinical hours with an MSN prepared clinician. The 500 hours ideally should be with a DNP-prepared nurse in a role you may see yourself developing after your DNP degree. The “residency” has also been called a “role immersion” which may be a better term to describe the purpose of the clinical hours. Nurses who are already clinicians and return for a DNP degree are clinical experts and therefore do not need more “clinical” training. However, if a DNP student wishes to pursue an administrative role, a master’s prepared nurse in that role would be an appropriate placement. Also, if a DNP student wishes to pursue a role in policy, they should spend time with a nurse involved in policy.

For example, I am a DNP prepared clinician practicing as an NP in an academic setting. I still practice clinically but the DNP has enhanced my practice in ways which are difficult to articulate and better shown by example. I am precepting students currently from DNP programs to try to show how my role has been enhanced by the DNP degree. However, I will try to articulate what my experience has been.

The DNP is a practice doctorate but remember, practice is much more than the task of diagnosing and treating illness. The IOM, AACN, NONFP and NACNS have all agreed on competencies that nurses should have to improve practice from an individual and systems level, both directly and indirectly. That said, we know from the extensive work done by the IOM (2000, 2001, 2003, 2010), practice is improved and impacted by expertise in health policy, leadership, evaluation of and implementation of evidence-based practice, patient-centered care, information technology, and population health. The DNP degree was designed to give nurses expertise in these areas and considers nurses already clinical experts.

I never went back for a DNP for a salary increase or a significant change in my role. Instead, I returned to school to advance the profession of nursing and to improve patient care. The DNP has done that for me on many levels. I am much more proficient at evaluating and implementing evidence-based practice. I am a leader in my profession and feel responsible to mentor others and contribute to the profession. My contributions include teaching, presenting, publishing and most recently the development of a specialty clinic within my setting. Without the DNP degree, I would not have had the skills needed to develop my expanded clinician role.

Through precepting and mentoring DNP students I hope to share my experience and perception of the DNP degree and advance the profession of nursing. My advice to you, if you return to school, is to take the time to find a preceptor who matches your goals and the role you wish to pursue after graduation.

Editor's note: At the DNP Answers blog we take your questions about the DNP and answer them as best we can. This post is written by blogger Lisa Chism, NP, DNP, NCMP. Lisa was selected as the 2011 North American Menopause Society Certified Menopause Provider of the Year. Comment below to discuss this topic, or send new questions to jford@advanceweb.com.      

Return to blogs home page.   Return to ADVANCE for NPs & PAs home page. 

Q: I too have toyed with returning to school for my DNP. However, I am not wholly convinced this is the right route to ensure consistency with advanced practice nursing. If DNP shall be required, let's make it like a residency - everyone gets a similar degree (e.g. Family or Adult NP), and then the residency determines your practice. The residency could be incorporated in the DNP process, and would provide valuable learning experience. As a graduate within the past year, I have felt so overwhelmed learning all the ins and outs of basic practice that would have been so helpful to learn under another NP's supervision (or MD, experienced PA for that matter). I did my master's degree in Maine, where there is a required 2-year supervisory period post-graduation during practice. Although I don't think it should be state-mandated like that, I do value the opportunity for a safe learning environment to get my "NP legs" under me. I think residency in this context makes sense, rather than an advanced degree without reliable return on the investment. However I welcome others' perspective in this matter!

A: Hello! First of all, having recently completed my program, I would strongly recommend the DNP! I have always felt that a clinical doctorate was the direction for me; I have wanted to teach for the past 12 years or so, but my inclination has been toward finding best practice, rather than generating research. I wanted to combine my clinical interests at the bedside with nursing education. The barriers I found in practice centered around finding the right fit for a solution. I would encounter a clinical issue, but lacked the skills to form a clinical question for investigation. Sometimes, I would find a guideline that could improve clinical practice, but because of the culture or processes within my practice setting, the change would not be adopted. I didn’t have a framework for translating the evidence into practice. The DNP has provided me with those skills.

Much has been written about the call for the DNP as the terminal degree for advanced clinical practice (versus a research doctorate) by 2015. The American Association of Colleges of Nursing (AACN) made this recommendation based on the need to take the explosion of research based knowledge and translate it into best practice. The intent is to build upon the current, masters’ level curriculum to promote practice that is linked to the current literature, systems leadership (including advocacy), and quality improvement initiatives as described in the 2006, Essentials of Doctoral Education for Advanced Nursing (Practihttp://www.aacn.nche.edu). To summarize, I think that it is natural to feel uneasy as if you move from the “expert” to” novice” role in beginning your NP practice. I remember it well! We learn the role and become clinically competent through the NP curriculum, then through residency, and practice. The DNP gives us not additional time to become more proficient for entry into practice, but the tools to recognize and develop best practice. With time comes experience, and as nursing evolves to meet the demands of exponential discovery in our field, the DNP provides an avenue for translation of evidence into practice.

As a note of hope, I took loans from the Nurse Faculty Loan Program (NFLP) to complete my DNP degree, and am currently teaching in an ABSN program. I love teaching; especially those moments when my students use their EBP skills to debate the evidence and discuss how it might improve their own practice. To help our profession move forward in adopting best practice as an everyday occurrence is about as good as it gets!

Last month I answered a question from a prospective DNP who was worried about time commitment. Here was her question:

Q: I haven't even begun college yet, but I pretty much have my mind set on becoming a DNP. But after doing some research on how tough the program is, it has me pretty scared! I read that at least 1,000 clinical hours are required, and you DON'T get paid for them, which is a bummer. I would really like to work full time and go to school full time. Would this be possible considering the amount of work I would have for clinical hours and coursework? Also, how many hours a week of homework should I expect? And, how many hours a week are required for in-class sessions? Somebody please help. I would really like to have a better understanding of this.  

I asked for a response from Stacy Kehl, a DNP student in the family nurse practitioner track:

DNP programs are very demanding – it’s good that you are carefully taking into consideration the amount of time you will need to commit to a DNP program. It sounds as though you have not enrolled in college yet, so I would first set your sights on getting into nursing school as an undergraduate. Most programs these days are highly competitive, as I am sure you know. It would be helpful for you to work part-time in a healthcare setting before enrolling in a nursing program. Most hospitals have nurse aide positions. Working in a hospital setting would really help you to make sure nursing is the career you want, along with giving you valuable exposure and experience to patient care. I highly suggest this. Once becoming a nurse, working in a critical care setting would be ideal experience before beginning the DNP program. While many nurses go directly from their undergraduate program to the DNP program, I personally believe that at least two years of experience as an RN would be extremely helpful for you in your studies to become an ARNP. You will find that most nurses in DNP programs are highly experienced RN's and many have already attained a Master's degree.

As far as DNP programs ... if you are planning to matriculate from your BSN to DNP as a full-time student, as I have done, working is an option, but a very demanding one. I quit my job after my first semester, but others in my group continued to work. It depends on your personal situation. Consider that once you start doing clinicals in your program, you will have about 20+ hours per week of clinical, plus a 40-hour work week, plus class time (12 semester hours = 12 class time hours/week), plus studying/coursework (another 15+ hours per week). It adds up very quickly. If you have other family or social obligations, you will be spreading yourself very thin. My DNP program was very heavy in paper-writing and projects in the beginning – this lightened a little bit as I began clinicals, but in its place I was studying for the nurse practitioner role.

As far as finances – the good news is that the U.S. government has recognized the need to have more NPs working, so there are grants and special loan repayment programs available that may mean you don't have to work. I am currently on a HRSA grant that was given to me by my College of Nursing (CON). The CON applied for and got the grant, then distributed it to full-time DNP students in the FNP track. I received a stipend of $22,000 per year (divided into monthly payments across fall and spring semesters) for the final 2 years of my program. The first year of my program, I received a university fellowship where I was awarded an annual stipend of $6,000, plus I worked as a teaching assistant where I was paid an hourly wage to teach in the undergraduate skills lab. So, don't overlook other ways of getting money once you are enrolled – there's a lot out there. I am thankful that I enrolled in a school that is very proactive in getting tuition assistance for its students.

I hope this is helpful. I encourage you to pursue becoming a DNP – nursing is very rewarding and NPs are in demand in many fields of healthcare.

Editor's note: Here at the DNP Answers blog we take your questions about the DNP and answer them as best we can. This question is answered by blogger Mai Kung, NP, a recent DNP graduate. Comment below to discuss this topic, or send new questions to jford@advanceweb.com.

Return to blogs home page.   Return to ADVANCE for NPs & PAs homepage.

As a soon-to-be DNP graduate, actualizing the DNP role has transformed my practice and views on nursing itself. Incorporating interdisciplinary knowledge, systems thinking and understanding of our current healthcare system’s complexities has revolutionized the way I see nursing and our profession.

As DNPs we have the awesome opportunity and challenge to change the shape of our profession. Through the DNP advanced practice role, nursing can become an autonomous, theory-guided, evidence-based profession of healthcare provision, grounded in theory, research and clinical practice. We are also in a position to transform the delivery of healthcare in this county. As nurses, we innately provide holistic, interdisciplinary care. This type of care is now reflected in the recently passed Affordable Care Act as the model of excellence in care. The concepts of “practice partners” and “patient-centered care” are not new to the nursing profession, but are the embodiment of holistic, interdisciplinary care — nursing’s basic definition.

As we unify and standardize our profession, on par with our interdisciplinary colleagues in PT, pharmacy and others, we are growing into leaders in primary healthcare. The DNP has championed my nursing practice to one of excellence in holistic practice. Through the actualization of my role as DNP clinician, I hope to transform my system, clinical practice and fellow colleagues into a “patient centered” caring system.

Recently, one of my closest friends applied and was accepted to University of Michigan’s DNP program and began taking her first courses. She is a pediatric nurse practitioner and has been practicing in various settings for over 10 years. She is a compassionate and highly skilled nurse practitioner. She is also an excellent problem solver, lifelong learner and strong advocate for her patients.

When she began her program, I openly offered my advice and assistance. My friends are accustomed to my enthusiasm about the DNP degree. After about two weeks in the program, I asked my friend if anything surprised her about the program. She responded with these comments:

“During the first week, I still compared the program to my master's program and figured graduate school was graduate school. It was during the second week that I began to understand that this program was much different than my master’s degree program. My master’s degree program was much more applicable to what I was doing at the time clinically. It built on the tasks and skills that I would need to succeed as a nurse practitioner. The DNP degree is so much more. There is much more depth in the content. I am beginning to understand how this degree will improve my practice on a different level. I am already an expert clinically but the DNP degree will prepare me with a very different perspective. I also think folks need to realize that pursing this degree is a tremendous responsibility and requires a great deal of accountability. This degree must be a priority in your life or it will not be achievable. Having said this, I believe the DNP degree should be the terminal degree for nursing practice. I am an advocate for transitioning to this degree as preparation for advanced practice nursing” (Tonya Schmitt, Personal Communication, January, 2012).

I am so proud of my friend and the journey she is on. She recently began a position which will enable her to grow as a leader and allow her to improve practice on a systems level. She is a wonderful exemplar of a highly skilled clinician who will be successful wherever her journey leads her.

I am excited to be writing for this blog, as I see the DNP role as one with infinite possibilities in improving the care of our patients. Many people inquiring about the DNP program ask me if I did it to get a better job or more money. My answer is that the DNP has helped me to do the job I love, but to improve the care I provide to my patients. As a clinical doctorate, we are poised to implement sound, evidence-based changes, bringing research to the bedside. At the same time, what I learned in my program was that the changes we propose will only be as successful as the time we take to tailor interventions to the setting in which we hope to have them adopted.

I look forward to your thoughts and comments. I would especially like to hear from individuals who have gone through other DNP programs or who have employed specific frameworks to develop their EBP projects. What projects have evolved after graduation? How do you all see present and future roles for the DNP? We have much to discuss. May the blogging begin.