Terminal professional degree in nursing
The Doctor of Nursing Practice (DNP) is a professional degree in nursing in the United States of America.
In the United States, the DNP is one of three doctorate degrees in nursing, the other two being the research degree PhD and the Doctor of Nursing Science.[1] The DNP program may include clinical/residency hours, in some cases as many as 500 hours,[citation needed] as well as a final project which is usually a clinical practice research project which is often implemented through direct clinical nursing care.[clarification needed]
International Perspective
Internationally, since the 1990s, there have been a number of doctorate level degrees available for nurses, including Doctor of Professional Studies (DProf), PhDs and others. All such doctoral nursing degrees outside of North America usually include mandatory research elements and take longer than a single year to complete.[citation needed] The DNP is also unique in that it is significantly shorter at one years duration than a standard doctoral degree anywhere in the world (e.g. 3-5 years in Europe or 4-6 years in the USA).[2][3] In areas of the world other than North America, nurses complete standard doctoral degrees of the same length as other healthcare professions, academics and researchers. There is no short course doctorate equivalent to the DNP in Europe or elsewhere in the world.
DNP in North America
The curriculum for the United States DNP degree builds on work completed during previous master's level courses. It provides education in evidence-based practice, quality improvement, and systems leadership, and is typically more clinically oriented than a PhD.[4] Although approximately 52% of nurse anesthetist programs will award the DNP, the remaining 48% may use the title doctor of nurse anesthesia practice (DNAP).[citation needed]
Rationale for the existence of the DNP
According to the American Association of Colleges of Nursing (AACN), transitioning advance practice registered nursing programs from the graduate level to the doctoral level is a "...response to changes in health care delivery and emerging health care needs, additional knowledge or content areas have been identified by practicing nurses. In addition, the knowledge required to provide leadership in the discipline of nursing is so complex and rapidly changing that additional or doctoral level education is needed."[5] According to the AACN, "...benefits of practice-focused doctoral programs include:
- development of needed advanced competencies for increasingly complex clinical, faculty and leadership roles;
- enhanced knowledge to improve nursing practice and patient outcomes;
- enhanced leadership skills to strengthen practice and health care delivery;
- better match of program requirements and credits and time with the credential earned;
- provision of an advanced educational credential for those who require advanced practice knowledge but do not need or want a strong research focus (e.g. clinical faculty);
- enhanced ability to attract individuals to nursing from non-nursing backgrounds;
- increased supply of faculty for clinical instruction; and
- improved image of nursing."[5]
Transitioning toward the doctorate
In the United States, the American Association of Colleges of Nursing (AACN) recommended that all entry-level nurse practitioner educational programs be transitioned from the Master of Science in Nursing (MSN) degree to the DNP degree.[6] The American Association of Nurse Anesthetists has followed suit, requiring the DNP (or DNAP - Doctor of Nurse Anesthesia Practice) degree for entry-level nurse anesthetist programs by the year 2025.[7] Meanwhile, the National Association of Clinical Nurse Specialists (NACNS) announced in July 2015 its endorsement of the doctor of nursing practice (DNP) as the required degree for CNS entry into practice by 2030.[citation needed] Nurse practitioners and nurse anesthetists currently practicing with either an MSN or certificate will not be required to obtain the DNP for continued practice.[citation needed]
Comparison to other doctorates
Critics have described the development of DNP courses as "a major mistake for [the] profession of nursing as well as the discipline of nursing knowledge".[8] The required clinical practice hours to be accepted on a DNP course can be as little as zero hours.[9] In other cases where clinical hours are required to gain the DNP, these can include clinical hours undertaken as part of a prior degree.[10]
This places the DNP at odds with clinical doctorate degrees which require significant amounts of clinical practice hours. A doctorate in clinical psychology for example encompasses 1.5 years of clinical practice time[11] while a medical doctorate includes around 75 weeks of clinical practice[12] (with further instructional clinical hours required to gain specialty medical licenses).
When viewed as an academic doctorate (rather than a clinical doctorate), it has been argued that the DNP lacks academic credibility due to the fact that the schools awarding the qualification may be accepting nurses with little or no postgraduate experience, with course curricula requiring few academic credits compared to other doctorates (e.g. 35 compared to 65) and requiring only a small project, rather than the large piece of research required for a traditional PhD.[13][14] The DNP is also significantly shorter (1 year) than a standard doctoral degree (3-5 years in Europe).[2]
Title confusion in the clinical setting
Some critics have argued that there is scope for patients or service users to be confused about whether they are consulting a physician or a nurse if nurses use the title "doctor" in a clinical setting.[15][16] Lawsuits have also resulted from this confusion, where holders of the DNP have referred to themself with the title doctor in clinical settings.[17][18] In some US states, there is a legal basis limiting nurses using the title of doctor in clinical practice.[19] However, in other US states nurses are bringing their own legal arguments to facilitate their legal use of the title.[20]
