Foundations and Essentials for the Doctor of Nursing Practice

Answeringthequestion.pdf

Home >Nursing homework help >Foundations and Essentials for the Doctor of Nursing Practice

Column Editor: Mary Jo Goolsby, EdD, MSN, NP-C, FAANP, FAAN

Answering the question: Is the Doctor of Philosophy or Doctor of Nursing Practice right for me?

Tonja M. Hartjes, DNP, CNS, ACNP-BC, FNP-BC, CCRN-CSC, CNEcl, FAANP1, Donna Lester, DNP, ACNP-BC, MS, CC-CNS1, Lisa Arasi-Ruddock, DNP, ACNP-BC, FNP-BC1, Sharon McFadden Bradley, DNP, RN, CNL, CNE1, Shannon Munro, PhD, APRN, BC, FNP2, & Linda Cowan, PhD, ARNP, FNP-BC, CWS3

ABSTRACT Over the past decade, leading health care organizations have recommended doubling the number of doctorally prepared nurses to meet the future demands of health care. In 2018, the National Organization of Nurse Practitioner Faculties committed tomove all nurse practitioner degree programs to the Doctor of Nursing Practice degree by 2025. As more and more doctorally prepared nurses enter the workforce, other nurses are considering returning to school for a terminal degree. This column will review options for doctoral education in nursing and the strength, focus, and program requirements for PhD and DNP degrees. Keywords: nursing education; DNP; PhD.

DOI# 10.1097/JXX.0000000000000273

Many baccalaureate and master’s degree prepared nurses consider pursuing a doctoral degree. However, they are unsure. The purpose of this article is to inform pro- spective graduate nursing students regarding the need for doctoral prepared nurses, the strengths, focus, and pro- gram requirements of the Doctor of Philosophy (PhD) in Nursing and the Doctor of Nursing Practice (DNP) degrees.

The call for nurses to be prepared at the doctoral level The Institute of Medicine (IOM) has published a series of reports highlighting the most pressing issues in health- care, including those impacting the nursing profession. Later, the IOM partnered with the Robert Wood Johnson Foundation (RWJF) and recommended the number of doctoral-prepared nurses be doubled and that nurses receive further education in health policy, evidence-based practice (EBP), and quality improvement (IOM, 2010). This report entitled, “The Future of Nursing: Leading Change, Advancing Health,” described the positive impact of ad- vanced practice nursing on health care policy, delivery,

and access to care (IOM, 2010). A set of recommendations was provided and has served as a vision of nursing in 2020, to improve nursing education and nurses who practice to the full scope of their experience and education.

Doctoral programs in nursing Nurses who are considering a doctoral degree may choose from an education-focused degree, the Doctor of Education (EdD), a research-focused degree, such as the PhD in Nursing or the Doctor of Nursing Science, or a practice-focused degree, the DNP. With so many doctoral options within nursing and potential overlap of skills and knowledge, confusion exists within nursing as to which degree path should be pursued. Health care admin- istrators are also unsure how to best hire and use nurses with doctoral degrees based on their skill set and edu- cational background.

Historically, the PhD degree is research intensive and prepares the nurse for a career in academia and con- ducting independent research. The DNP degree prepares nurses to become clinical experts and leaders in health care innovation, influencing policy at the highest organi- zational level and may have many specialty track options (such as advanced practice or executive leadership).

Strength and focus of Doctor of Philosophy prepared nurses Doctor of Philosophy nursing programs are directed toward expanding nursing science, theory, and re- search methods, as well as developing knowledge in

1College of Nursing, University of Florida, Gainesville, Florida, 2Department of Veterans Affairs Medical Center, Research and Development Service, Salem, Virginia, 3James A. Haley Veterans’ Hospital, Tampa, Florida Correspondence: Tonja M. Hartjes DNP, CNS, ACNP-BC, FNP-BC, CCRN-CSC, CNEcl, FAANP, College of Nursing, University of Florida, 1225 Center Drive, P.O. Box 100187, Room #3232, Gainesville, FL 32610-0187. Tel: 352-215-6278; E-mail: [email protected] Received: 4 February 2019; revised: 30 May 2019; accepted 6 June 2019

Journal of the American Association of Nurse Practitioners August 2019 · Volume 31 · Number 8 439

The Fellows Speak

leadership, education, policy, and health care delivery (American Association of Colleges of Nursing [AACN], 2010). The PhD nurse is prepared to conduct in- dependent research with a high degree of scientific rigor and develop programs of research, which lead to discovery of new knowledge for the nursing profession and health care. This research is translated into prac- tice to advance nursing science and health policy. Doctor of Philosophy programs prepare nurses to be experts in research methodology and regulatory com- pliance (Table 1). Additional information regarding the scope and focus of the PhD nurse and program, as well as a link to find a PhD program, can be found on the AACN website (https://www.aacnnursing.org/Nursing- Education-Programs/PhD-Education).

Strength and focus of Doctor of Nursing Practice prepared nurses The DNP degree was created to critically appraise cur- rent evidence, translate research into practice, and im- plement quality, process, organizational, and operational improvement methods to positively impact

patient outcomes and the delivery of health care (AACN, 2004). The DNP prepared nurse holds a broad founda- tion of knowledge fromnursing, ethics, psychosocial and biophysical sciences, as well as from organizational and change theories. As a change agent, the DNP nurse uses this knowledge and is able to quickly and accurately appraise the evidence and then translate it into practice. This allows the DNP nurse to critically examine provider practices, and develop and evaluate new deliveries of care based on theories from nursing and other dis- ciplines. Additionally, the DNP nurse is poised to in- fluence practice models and regulations while assuring care is both financially feasible and of high quality and supports policies that will improve health care (Table 1).

The AACN (2015) stated, “The DNP is an academic degree, not a role” (p 1), and created eight “DNP Essentials” to guide educational curricula and compe- tencies, and provide the underpinnings of DNP practice (AACN, 2004, 2006). Currently there are 289 DNP pro- grams and an additional 128 DNP programs are in the planning stages (AACN, 2017). The AACN DNP Position Statement on the Practice Doctorate in Nursing

Table 1. PhD and DNP strengths PhD DNP

Independent research investigator with expertise in design, implementation, and statistical analysis and interpretation

Clinical expert

Research methodologies Quality improvement methodologies

Theory development Translating research to practice

Generalizing and replicating findings Clinical contacts

Secondary analysis of results from quality improvement projects

Evaluating provider practices

Grant writing Clinical education design and implementation

Regulatory compliance Access to quality data/quality indicators

Academia Evaluating sustainability, performance measures, and financial impact

Retrospective chart reviews

Overlapping strengths of the PhD and DNP

Nursing leadership

Health policy and finance

Interprofessional collaboration

Mentoring

Nursing scholarship through dissemination of findings (e.g., publications, presentations)

Publication peer and editorial review

Note: References: AACN (2004, 2006, 2010, 2017); Cowan et.al, (2016). DNP = Doctor of Nursing Practice; PhD = Doctor of Philosophy.

440 August 2019 · Volume 31 · Number 8 www.jaanp.com

Is the PhD or DNP right for me?The Fellows Speak

program, as well as a link to find a DNP program, can be found on the AACN website (https://www.aacnnursing. org/Nursing-Education-Programs/DNP-Education). Moreover, additional information regarding the edu- cational preparation of various nursing roles (e.g., nurse educator, nurse practitioner [NP], clinical nurse spe- cialist, and nurse informaticist) may also be found in the above link.

Navigating the degree of difference (within the Doctor of Philosophy and Doctor of Nursing Practice degrees) A discussion of the similarities and differences, as well as some key questions to ask before admission, is provided below.

Similarities Both the PhD and the DNP degrees are terminal nursing degrees. Students may enter either program with either a bachelor’s or master’s degree in nursing and as a registered nurse or other advanced practice nurse (e.g., NP, clinical nurse specialist, certified nurse mid- wife, and certified registered nurse anesthetist). Both PhD and DNP graduates can work as advanced practice nurses once they earn the proper specialty education and certification. That said, many DNP programs incorporate a NP specialization, whereas PhD prepared nurses must typically pursue a postgraduate certificate to become an NP.

Both the PhD and DNP nurse are educated to be leaders in health care, with a resultant positive impact on patient and health care/system outcomes. This is ac- complished through interprofessional collaboration, mentoring, education, and dissemination of work prod- ucts in presentations (poster and podium), as well as peer-reviewed publications.

Differences The most notable difference is the focus of the degree (research vs practice focused); additionally, the scope of the coursework also differs significantly. The PhD nurse will have a focused line of research and funding to generate new nursing or health care/systems knowl- edge. Traditionally, PhD programs have also focused on preparing individuals for tenure track faculty appoint- ments (academia) (Cowan et al., 2013; Cowan, Hartjes & Munro, 2019). The DNP nurse will have a specific practice area or specialty and will translate research or EBP knowledge into practice. Although many DNP nurses are entering academia to fill the many vacant faculty roles, the typical DNP curricula do not include higher educa- tion pedagogy. Nurses seeking a faculty member posi- tion should consider educational coursework in their doctoral studies.

Requirements for admission, the length of the pro- grams and the graduation requirements, as well as the overall cost also differ. The PhD program is typically an “on the ground” program, with smaller class sizes, al- though more online PhD programs are now available. For admission, a student is expected to identify a mentor from the faculty and match their line of scholarship; this mentoring relationship is highly valued during the course of study. Admission is typically set once per semester and the curriculum plan is structured and not easily altered. Grant and scholarship monies are available from the university; however, students may be expected to “work” as a teaching assistant during the program. Often PhD students are not able to work outside of the college due to time constraints. Graduation requirements include completion of a series of progression exams and de- fense of a dissertation on the research focus. The pro- gram may take three full-time or five part-time years to complete.

DNP programs are often online or a hybrid of online and in person courses, which allows for larger class sizes. Because of the larger classes and online format, student engagement and sense of community are often difficult to achieve. Identification of a practice focus is required for the application process to a program/track (e.g., NP, executive leadership, and information technology). Many DNP programs have “rolling admissions” and courses are taught each semester, which provides more flexibility for the student. Identification of a faculty mentor is not re- quired before admission and will typically occur during the practice focus and/or project coursework. Many DNP students continue to work during their program, because the online format allows for flexibility in scheduling. Grant and scholarship monies are often less available from the university, when comparedwith PhD students. However, if the DNP student remains employed, many employers will pay for school in exchange for continued employment post-graduation. After graduation, federal loan forgive- ness programs exist for employment in low income/low resource communities. Graduation requires completion of a scholarly project, which is focused on improving clinical practice and patient or health care/system outcomes. The scope and expectations of this project vary widely between universities and should be dis- cussed before admission. The program may take two full-time or three part-time years to complete (AACN, 2017).

The PhD and DNP program oversight and accred- itations are also different. The PhD program is typically overseen by the graduate school of the university. It will also be accredited by a regional or national nursing body. The DNP program is often not recognized by the graduate school of the university, instead receives accreditation by a regional or national nursing certifying body. Finally, all programs are not equal. To identify a quality university

Journal of the American Association of Nurse Practitioners August 2019 · Volume 31 · Number 8 441

T. M. Hartjes et al.

and program, ask questions to determine 1) the length of time the university and program have been in existence, 2) its reputation, 3) the accredited (regional or national), 4) the school’s ranking with US News and World Report, 5) the graduation rates, 6) the certification pass rates for a NP program, and 7) the research funding and studies in place for PhD programs.

The AACN provides a grid, which contrasts PhD and DNP doctoral programs with regard to program of study, students, program faculty, resources, and program as- sessment and evaluation (https://www.aacnnursing.org/ Nursing-Education-Programs/DNP-Education).

Conclusion For decades leading health care and nursing organizations like the National Academies of Medicine (NAM) (formerly the IOM), the RWJF, the Carnegie Foundation, and AACN have stressed the importance of the nursing workforce to obtain doctoral degrees tomeet the future needs of health care. Currently we have notmet the goals set in 2010 by the IOM. The NAM and RWJF are now completing a consensus study to extend the vision for nursing entitled “The Future of Nursing 2020–2030” (The National Academies of Medi- cine, 2019). Town hall meetings are taking place across the country this summer, providing opportunities for those who wish to be an active voice for nursing and nursing education. Information regarding upcoming town hall meetings can be found at https://nam.edu/pu- blications/the-future-of-nursing-2020-2030/.

Deciding to pursue a doctoral degree requires careful consideration of both degree programs. De- termining whether the desired career involves a focus on research or practice is paramount in the decision of which doctoral degree pathway to pursue. Experienced nurses or faculty with PhD or DNP degrees may provide valuable guidance to nurses to facilitate an informed decision. There is enormous value in each doctoral program and the roles of individuals holding either degree. Determining which degree best fits with career goals, professional interests, and personal interests

will be key to determining “Is the PhD or DNP right for me”?

Authors’ contributions: Each author has developed por- tions of the manuscript from conception to submission.

Competing interests: The authors report no conflicts of interest.

Disclaimer: Contents of this article do not represent the views of the Department of Veterans Affairs or the United States Government.

References American Association of Colleges of Nursing. (2004). Position state-

ment on the practice doctorate in nursing. Retrieved from http:// www.aacnnursing.org/DNP/Position-Statement.

American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. Retrieved from http://www.aacnnursing.org/DNP/DNP-Essentials.

American Association of Colleges of Nursing. (2015). The Doctor of Nursing Practice: Current issues and clarifying recommendations. Report from the Task Force on the implementation of the DNP. Re- trieved from http://www.aacnnursing.org/Portals/42/DNP/DNP- Implementation.pdf?ver=2017-08-01-105830-517.

American Association of Colleges of Nursing. (2017). Fact sheet: The Doctor of Nursing Practice (DNP). Retrieved from http://www. aacnnursing.org/News-Information/Fact-Sheets/DNP-Fact-Sheet.

American Nurses Association. (2010). Nursing’s social policy state- ment: The essence of the profession. Retrieved from http://nur- singworld.org/Social-Policy-Statement.

Cowan, L., Fasoli, D. R., Hagle, M. E., Kasper, C. E., Eagerton, G., Chappell, J., … Alt-White, A. (2013). Creating an infrastructure to advance nursing practice and care for Veterans. Nurse Leader, 11, 33–36.

Cowan, L., Hartjes, T., Monroe, S. (2019). Model of successful DNP&PhD collaboration. The Journal of the American Association of Nurse Practitioners, 31, 116–123.

Cowan, L. J., Hartjes, T., Munro, S. (2016). Webinar. Doctoral Nursing: Roles, Partnering, and Opportunities for DNP and PhD Collabora- tion. Veteran Healthcare Administration (VHA) Nursing Research Field Advisory Committee. https://www.va.gov/nursing/docs/re- search/DoctoralNursingNRFAC_9-15-16_FINAL.pdf?.

Institute of Medicine (2010). The future of nursing: Leading change, advancing health. Retrieved from http://books.nap.edu/open- book.php?record_id=12956&page=R1.

The National Academies of Medicine (2019). The Future of Nursing 2020-2030. Retrieved from https://nam.edu/publications/the- future-of-nursing-2020-2030/.

442 August 2019 · Volume 31 · Number 8 www.jaanp.com

Is the PhD or DNP right for me?The Fellows Speak