Welcome to the Nursing Outlook Blog – “3 Questions” – Timely Interviews with Thought Leaders in Nursing

Doctorate in Nursing Practice – DNP – Impact on education, practice, and the profession…

These are among the hot topics of the day. All the critical issues that are important to nursing warrant rapid dialogue among informed readers and traditional modes of publishing cannot keep up with the pace of information available. “Agility” is needed to deliver contemporary arguments electronically for persuasive commentary for building consensus that is timely, substantive and prepared for discourse. Blogging and blogs are increasingly providing a paperless platform for professionals to present and debate ideas in the socially connected evolving web. Nursing Outlook is now hosting an online environment – “3 Questions” – to engage nurses with nursing leaders in discussions around focused topics that are important for the profession. Interviews will be routinely edited and posted for readers to learn from thought leaders of the American Academy of Nursing and a variety of other nursing and health care megastars.

We invite commentary that is thoughtful and provocative! Join the online dialogue!

Veronica D. Feeg, PhD, RN, FAAN



Kathy Dracup

Kathy Dracup – Past Editor, Heart & Lung and the Journal of Critical Care,  member of the American Academy of Nursing and Institute of Medicine

On the Doctorate in Nursing Practice

Question 1: The “Future of Nursing” IOM Report has made a variety of bold recommendations including the need to increase dramatically our doctorally-prepared nursing workforce by 2020. How do you see nursing education leaders responding to this need?

Many nursing education leaders have urged the adoption of a professional doctorate (DNP) and the proliferation of these programs suggest that these same leaders believe that the DNP is both good for the profession and good for their individual schools. There are some of us who have to questioned the wisdom of creating a professional doctoral tract in our profession. In the short term, it will certainly increase the number of nurses with a professional doctoral degree. Many nurses working as advanced practice nurses (ANPs) or as educators on nursing faculties have returned to school to obtain a DNP and the ever-increasing number of DNP programs across the country — 153 to date with another 106 in the planning stages — insure that the programs will be available for nurses interested in obtaining a professional doctorate. Moreover, for nurses who already have a MS degree, the DNP only requires an additional one to two years to complete compared to the average three to four years for a PhD.

Question 2: As one of our distinguished thought leaders, you have voiced some concern about the rapid proliferation of DNP programs and challenges to the current masters-level preparation of advance practice nurses. Can you talk briefly about these areas of concern?

What could possibly be wrong about nursing programs offering another tract to obtaining a doctorate? As a nurse educator, I find myself a bit amazed to be in the position of questioning whether nurses should continue their education. But I am concerned that the DNP may have unintended negative consequences for our profession. First, we have argued convincingly for several decades that ANPs provide health care that is safe, high quality, and cost-effective, as well as enhancing access for patients. If we were correct in our assertions, how can we now say that ANPs require additional education to attain these same outcomes? Second, it appears that employers will not preferentially hire or pay for the DNP over the MS degree, a reality that is often not made clear to applicants of these programs. Third, research-intensive universities are unlikely to award tenure to DNP graduates because they are not prepared to conduct the research expected at these institutions, but again this is often not made clear to applicants who are planning on joining a nursing faculty. Fourth, applicants to PhD programs in nursing have remained flat over the past decade, despite a major economic recession that has caused increases in almost all other disciplines’ doctoral graduates. I am concerned that DNP programs will “siphon off” potential applicants to PhD programs at a time when the need for a PhD-prepared nursing work force has never been greater to generate the science needed to support our clinical practice. Finally, requiring a longer educational trajectory for APNs at a time in our country’s history when millions of new patients will be seeking care because of changes in health care reform seems unwise.

I look at the history of other professions to see how they have dealt with this same issue and think that we can learn from their experiences. For example, engineering views itself as an applied science and some schools began offering a professional doctorate rather than a PhD degree in past years. However, when Schools of Engineering looked at disciplines that adopted a professional doctorate early in their development (e.g., education with the EdD and public health with the DrPH) the engineering profession decided that a professional doctorate was confusing to the public and resulted in second-tier programs. Therefore, all engineering doctoral programs in the United States now award the PhD. I wonder if we might come to the same conclusion a few years from now.

Question 3. What suggestions would you give to academic program leaders to plan for impending changes while meeting current needs of preparing nurses in advanced practice for the health reform-related new patients on the horizon?
I do think that three concepts are key to an era of health reform and must be embraced by both nursing and medicine:  population health, disease management and the health care team. All three of these are relatively new concepts for some members of the health care team. We have focused on individual patients in our educational systems and have not emphasized disease management or team dynamics and communication. All that must change.

Related to the DNP, one of the favorite phrases of DNP advocates is “the train has left the station.” I do understand that many School s of Nursing have embraced the concept of this degree and have been eager to create programs to attract a new market of students. Given that reality and our profession’s important commitment to the MS degree for advanced practice, I hope that academic program leaders will continue to offer the DNP as a post-Masters degree. Currently no state Board of Registered Nursing has made the DNP mandatory for advanced practice and that CCNE has continued to accredit MS programs for advanced nursing practice. So this is the time to gather the data essential to the argument. Proponents of the DNP insist that these programs will not threaten enrollments in PhD programs and are necessary to meet the challenges of health care today. Let academic program leaders gather the data  essential to the argument.

Call for Commentary:

A recent 2011 issue of Nursing Outlook published a variety of points of view on the topic of the DNP. Now it is the time for the dialogue to expand. Give voice to your thoughts on the issue here – but be sure to include your name and institution with your response! Please consider the following 3 questions to post your opinions:

1. What do you think the DNP offers the profession beyond what the existing masters preparation provides for advanced practice nurses? Marketability? Quality of service? Nursing faculty supply? Research expertise?

2. How do you think the DNP and PhD prepared nurse will be identified in the market place? How do they relate to each other? How will they interact in the same job arenas?

3. What impact will the DNP education track have on the university’s bottom line? Impact on resources? Impact on student supply in the future?