DNP — Nurse or Doctor?

June 22nd, 2011

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By , BSN, RN

There's a new doctor in town, and she's a nurse. The Doctor of Nursing Practice (DNP) is an advanced-level practice degree that focuses on the clinical aspects of nursing rather than academic research and education, which earns qualified graduates a PhD. In other words, make an appointment at your doctor's office, and the person making diagnoses and writing prescriptions is more and more likely to be a nurse with the highest degree found in nursing healthcare.

While the DNP has been around for a number of years, interest in the advanced degree has grown mightily in the past 10 years. According to data released in March by the American Association of Colleges of Nursing (AACN), enrollment in doctoral nursing programs — both practice and research-focused — has grown.

The DNP prepares registered nurses (RNs) to become advanced practice nurses. Advanced practice nursing careers include nurse practitioner (NP), certified registered nurse anesthetist (CRNA), certified nurse midwife (CNM), and the clinical nurse specialist (CNS).

“Bringing more nurses into master’s and doctoral nursing programs must be a priority given the critical need for nurses to serve as scientists, faculty, primary care providers, specialists, and leaders within the healthcare system,” said AACN President Kathleen Potempa. “In response to calls for a more highly educated nursing workforce, our nation’s nursing schools are taking decisive action to expand programs that prepare expert nurses to deliver high quality, cost-effective care in a healthcare system undergoing reform.”

In October 2010, the Institute of Medicine and the Robert Wood Johnson Foundation released a landmark report on The Future of Nursing, which recommended a doubling of the number of nurses in the U.S. workforce who have doctoral degrees. Nursing is well on the way to achieving this recommendation given the widespread growth in the number of Doctor of Nursing Practice (DNP) programs. In just five years, the number of schools offering the DNP has increased from 20 programs in 2006 to 153 programs in 2010, with another 106 programs in the planning stages. Last year, enrollment in these programs grew by 35.3% with 7,034 students now enrolled in DNP programs.

In 2004, the AACN recommended that all nurses seeking to be credentialed as nurse practitioners earn a DNP degree. The phase-in date is 2015. The National Organization of Nurse Practitioner Faculties (NONPF) endorsed this recommendation, and other nursing organizations agreed that it should be an option. This degree and plan for nursing practice has caused some debate.

Confusion, Concern and Controversy

The first version of a clinical doctorate, a nursing doctorate (ND), was established at Case Western Reserve University, in 1979. A few other schools followed suit, but the nursing profession did not have a clear understanding of either the ND or the doctorate of nursing science degree. Some people confused the ND with the MD degree. For these reasons and because the degree required a research dissertation despite the clinical concept, the clinical doctorate did not expand quickly.

The more recent programs focused on clinical practice are much more popular. Seven schools — the University of Kentucky, the University of Colorado, Rush University, the University of Tennessee in Memphis, the University of South Carolina, Case Western Reserve University, and Columbia University — are considered the DNP's "seven sisters," or pioneers.

Each DNP program contains a minimum of 1,000 clinical hours, and graduates complete a 1-year residency to become NPs. The DNP will also be the educational baseline for certification in the three advanced practice nursing roles: nurse midwife, nurse anesthetist and clinical nurse specialist.

Criticism of the DNP has come from many fronts including nurses, nurse practitioners, physicians, and other groups. In a 2006 article published in the Journal of Nursing Education, two advanced practice nurses came to the conclusion that the existing degree system satisfactorily prepares nurse practitioners, and the new degree requirements overly complicate the already existing system.

The title of "doctor" has its own critics, claiming the the prefix confuses and misleads patients. When making an appointment for healthcare, patients may be led to believe they are being treated by a doctor of medicine (MD) or a doctor of osteopathy (DO), not a DNP. Some physician organizations also dispute the quality of care a patient will receive from a DNP, since they receive far less training than MDs and DOs.

While the years of training is a distinct contrast between the two professions, it is the prolonged education of physicians through specialty residencies that has helped compound the primary care shortages in the United States. The DNP offers a practical solution with its primary care emphasis and streamlined clinical focus.

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