Doctor of Nursing Practice

The Doctor of Nursing Practice (DNP) is a terminal professional degree that focuses on the clinical aspects of nursing rather than academic research. The curriculum for the DNP degree generally includes advanced practice, leadership, and application of clinical research. The DNP is intended primarily to prepare registered nurses to become advanced practice registered nurses. Advanced practice roles in nursing include the nurse practitioner (NP), certified registered nurse anesthetist (CRNA), certified nurse midwife (CNM), and the clinical nurse specialist (CNS). Although approximately 52% of nurse anesthetist programs will award the DNP, the remaining 48% may use the title Doctor of Nurse Anesthesia Practice (DNAP) for their terminal degree.

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."^[1] 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);
• parity with other health professions, most of which have a doctorate as the credential required for practice;
• enhanced ability to attract individuals to nursing from non-nursing backgrounds;
• increased supply of faculty for clinical instruction; and
• improved image of nursing."^[1]

The AACN recommends that all entry-level nurse practitioner educational programs be transitioned from the Master of Science in Nursing (MSN) degree to the DNP degree by the year 2015.^[2] 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.^[3] Nurse practitioners and nurse anesthetists currently practicing with either an MSN or certificate will not be required to obtain the DNP for continued practice.

There are two terminal doctorate-level degrees in nursing: The Doctor of Nursing Practice (DNP), and the Doctor of Philosophy (PhD). Previous doctorate level degrees have been, or are in the process of being, phased out and converted to one of the two terminal degrees. The Doctor of Nursing (ND, not to be confused with Naturopathic Doctor ND) and the (DrNP) have transitioned into the DNP whereas the Doctor of Nursing Science (DNSc, DNS or DSN) has transitioned into the PhD. The PhD in nursing is generally considered the academic and research-oriented degree, whereas the DNP is the practice-oriented or professional terminal degree.^[2]

Criticism of the DNP

The development of the DNP has spawned much criticism, from nurses, nurse practitioners, physicians, and other groups. For example, Chase and Pruitt, two doctorally prepared educators who are also master's-level advanced practice nurses writing for the Journal of Nursing Education, comprehensively reviewed the DNP movement in the United States in 2006 in order to establish whether the degree is necessary to improve patient outcomes, and whether the degree overly complicates an already established system.^[4] They concluded that the existing master's degree requirement has satisfactorily prepared nurse practitioners to provide a wide variety of services to patients, and that a doctoral level of education should focus not just on clinical training but also on advancing the knowledge of nursing faculty.

Although controversial, the adequacy of existing master's-level education is further supported by other articles that show nurse practitioners provide a level of care that is rated similar to that of physicians in comparable level primary care situations.^[5][6][7] In contrast, the level of training between physicians board certified in an area of specialty and a DNP working as a primary care provider is not intended to be comparable. A physician will typically have 4 years of undergraduate education, 4 years of medical school, and 3 to 8 years in paid residency (e.g. family practice, internal medicine, radiology, neurosurgery, etc.). Physicians often continue by doing a subspecialty or fellowship (e.g. cardiology, nephrology, oncology, etc.). In contrast a typical DNP will have 4 years of undergraduate education, experience as a registered nurse, and 4 years of advanced practice education (e.g. women's health, pediatrics, anesthesia, etc.).^[8] Additionally, the prolonged education of physicians through specialty residencies has compounded primary care shortages in the United States^[9][10][11] and therefore the DNP offers a practical solution with its primary care emphasis and streamlined clinical focus.^[12][13]

In the United States, patient choice between physicians and nurse practitioners has become a point of contention,^[14] especially as nurse practitioners gain greater autonomy.^[15][16] Although MDs, DOs, and DNPs all nominally hold a doctorate degree by education, in a medical setting the term "doctor" has historically referred to Doctors of Medicine (MD), Doctors of Osteopathic Medicine (DO), Podiatrists (DPM), Dentists (DDS or DMD), and Optometrists (OD) but not to Nurse Practitioners (NP) since they generally did not hold doctorate degrees. However, the DNP has evolved much like the other clinical doctorates,^[17][18][19] and the some argue that the public uses the term "doctor" generically to describe that person who is a licensed professional and is in the primary decision making role for their care.^[20] The American Association of Colleges of Nursing and six other professional nursing organizations contend that the term "doctor" is an appropriate term to describe a Doctor of Nursing Practice.^[17][21][22] However, some feel the "doctor" title in healthcare should only apply to MDs and DOs to avoid confusion between physicians and nurse practitioners. The American Medical Association (AMA) also believes vague distinction between physician and non-physician providers poses a "threat to conventional practice".^[23]

See also

Nursing portal

• Nurse Practitioner, Nurse Midwife, Clinical Nurse Specialist, and Nurse anesthetist
• Diploma in Nursing
• Associate of Science in Nursing
• Bachelor of Science in Nursing
• Master of Science in Nursing
• Nurse education
• Nursing school

References

1. ^ ^{a b} Report of the Task Force on the Clinical Doctorate^{[dead link]}
2. ^ ^{a b} American Association of Colleges of Nursing (2004). AACN Position Statement on the Practice Doctorate in Nursing. Available at http://www.aacn.nche.edu/DNP/pdf/DNP.pdf.
3. ^ American Association of Nurse Anesthetists (2007). AANA Position on Doctoral Preparation of Nurse Anesthetists. Available at http://www.aana.com/uploadedFiles/Members/Membership/Resources/dtf_posstatemt0707.pdf
4. ^ Chase, S.K. & Pruitt, R.H. (2006). The practice doctorate: Innovation or disruption? Journal of Nursing Education, 45[5], 155–161.
5. ^ Lenz, E.R., Mundinger, M.O., Kane, R.L., Hopkins, S.C., & Lin, S.X. (2004). Primary care outcomes in patients treated by nurse practitioners or physicians: Two-year follow-up. Medical Care Research Review, 61, 332–351.
6. ^ Mundinger, M.O., Kane, R.L., Lenz, E.R., Totten, A.M., Tsai, W.-Y., Cleary, P.D., et al. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized trial. Journal of the American Medical Association, 283[1], 59–68.
7. ^ Horrocks, S., Anderson, E., & Salisbury, C. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. British Medical Journal, 324, 819–823.
8. ^ "Doctor of Nursing Practice (DNP) | School of Nursing". Nursing.uw.edu. 3 October 2011. http://nursing.uw.edu/academic-services/degree-programs/dnp/doctor-of-nursing-practice-dnp.html. Retrieved 18 October 2011. 
9. ^ . PMID 15106867. 
10. ^ . doi:10.1097/00001888-200609000-00003. PMID 16936479. 
11. ^ [1]^{[dead link]}
12. ^ [2]^{[dead link]}
13. ^ [3]^{[dead link]}
14. ^ "Is A Nurse Practitioner A “Doctor?” – Better Health". Getbetterhealth.com. 14 April 2010. http://getbetterhealth.com/is-a-nurse-practitioner-a-doctor/2010.04.14. Retrieved 18 October 2011. 
15. ^ Dracup, K. & Bryan-Brown, C.W. (2005) Doctor of nursing practice—MRI or total body scan? American Journal of Critical Care, 14, 278–281.
16. ^ http://www.psychozapp.com+(23 June 2010). "More and more in rural Minnesota: 'The nurse practitioner will see you now'". MinnPost. http://www.minnpost.com/community_voices/2010/06/23/19140/more_and_more_in_rural_minnesota_the_nurse_practitioner_will_see_you_now. Retrieved 18 October 2011. 
17. ^ ^{a b} [4]^{[dead link]}
18. ^ Ford, Jennifer. "DNP Coming Into Focus on ADVANCE for NPs & PAs". Nurse-practitioners.advanceweb.com. http://nurse-practitioners.advanceweb.com/Article/DNP-Coming-Into-Focus.aspx. Retrieved 18 October 2011. 
19. ^ ""Doctor nurse": Not a contradiction in terms | Nurse Practitioner". Find Articles. http://findarticles.com/p/articles/mi_qa3958/is_200101/ai_n8951590/. Retrieved 18 October 2011. 
20. ^ "WordNet Search – 3.1". Wordnetweb.princeton.edu. http://wordnetweb.princeton.edu/perl/webwn?s=doctor. Retrieved 18 October 2011. 
21. ^ [5]^{[dead link]}
22. ^ [6]^{[dead link]}
23. ^ "The Integrator Blog. News, Reports and Networking for the Business, Education, Policy and Practice of Integrative Medicine, CAM and Integrated Health Care. – AMA Targets Nursing Doctorate and ND Licensing: Old Boys v. the Emerging Medical Matriarchy?". Theintegratorblog.com. 8 August 2006. http://theintegratorblog.com/site/index.php?option=com_content&task=view&id=123&Itemid=2. Retrieved 18 October 2011.