Doctor of Nursing Practice (DNP): My Personal Proís and Conís

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    Nursing opens a wealth of opportunities through academic advancement. One such option is the Doctor of Nursing Practice (DNP). This article does not aim to endorse or discredit this degree, rather, it attempts to explain the author's thoughts on how the degree fits in with his professional goals.

    The Doctor of Nursing Practice or DNP degree has been one of the biggest buzzwords in Advanced Practice Nursing. The mere mention of it creates a stir of emotions and strong opposing opinions perhaps of the same magnitude as the liberal versus conservative views prevalent in our current political climate. Unlike nursing buzzwords that come and go depending on what is en vogue at the moment, current Advanced Practice Nurses (APNís) who hold stronger feelings of opposition rather than agreement with the degree would be foolish to ignore the issue. There are strong indicators that support the argument that this degree is here for good.

    For one, Advanced Practice Nursing while a smaller subgroup within the larger nursing milieu has shown tremendous ability to self-regulate and adapt to change. Indeed, the speed at which change have occurred in the APN environment is astonishing. The Nurse Practitioner movement, for instance, borne out of an idea in the 1960ís, have now blossomed into a membership of more than 180,000 professionals (Pearson Report, 2011). In that period of time, Nurse Practitioner (NP) training completely transitioned to post-licensure nursing programs leading to a certificate to the current graduate degree offerings at the Masterís and Doctoral level. The Centers for Medicare and Medicaid Services (CMS) have even kept up with this change and will only grant provider status to NPís who are trained in a graduate degree program.

    One can argue that the number of DNP programs have consistently grown in numbers since the first discussion on building a practice doctorate in nursing began in 2002. The American Association of Colleges of Nursing (AACN) lists 139 institutions with DNP programs around the country, roughly 20% of the total number of member institutions totaling 670 (AACN Program List). Twenty percent may seem small but bear in mind that not all AACN member institutions are offering graduate-level programs that have a potential to be transitioned to DNP. Also, the current program list does not include online DNP programs offered by for-profit institutions that have various locations in different states of jurisdiction. My take home message from these data is that while the recommendation for making the DNP a requirement for entry to practice as an APN is farther from becoming a reality by 2015, the pace at which programs are opening up will continue and the degree is here to stay whether we like it or not.

    The DNP was just an idea when I finished my training as an Acute Care Nurse Practitioner (ACNP) in 2003. At the time, academic options were clear to me: pursue a Masterís degree with my preferred nurse practitioner focus; get certified in the specialty, and voila, I am all set to practice as an ACNP. The option for further academic advancement at the Doctoral level was also very clear: the next step is a PhD or a DNSc both of which have become identical in content. In fact, numerous faculty members encouraged us to consider returning to the halls of the same university (or maybe even another institution) as a PhD student at some point in our career. The idea had a glamorous appeal to it in my mind at the time and I did entertain the thought of following through. Even to this day, I still struggle with the idea and have not come to a conclusion on what the right Doctoral education path to take. Whatís worse, this whole DNP agenda threw a curveball in my decision-making process.

    As an Acute Care Nurse Practitioner since 2004, I have matured and continue to grow professionally in my knowledge and skills as a clinician. I have stayed in the field of Critical Care as an NP since 2005 and have felt this to be my niche early in my career. In my personal quest both for academic advancement and to grow as a healthcare provider, I do not share the sentiments that the ideal MSN to DNP Bridge should be loaded with clinical content by adding so called ďresidenciesĒ. Donít get me wrong, I feel strongly that clinical content could undeniably be improved in the current manifestations of BSN to MSN or BSN to DNP programs for NPís. But Iím being selfish in my personal goals: since I already practice in a heavily patient care-based setting where knowledge and skills already get tested daily, my needs are different. In other words, I do not need a DNP to get a ďresidencyĒ in Critical Care because I live and breathe in this specialty day in and day out.

    DNP courses that deal with leadership, management, the politics of healthcare, and the financial aspect of providing healthcare can be appealing to individuals in my professional level. This is the reason why there already exist multidisciplinary degree options outside of nursing that addressed this content even before the DNP was conceived. I remember a Cardiothoracic Surgeon I knew who went to a prestigious graduate school of business for a Masterís degree in Healthcare Administration. The guy had big dreams of being a division chief or a CEO. A nurse manager in one of the units pursued a Masterís degree in Nursing Service Administration because she had high hopes of climbing the ladder ultimately as a Chief Nursing Officer one day. Though I consider myself a clinician foremost, a business degree is a must should I decide to pursue a role in administration. That said, I do not think a DNP is necessary if I was to pursue this direction in my career given the other degree options that already exist.

    It seems to me like the DNP marketing machine has been trying to convince NPís like me to think that we need a DNP in order to learn from courses that focus on translating research evidence into clinical practice. I find this to be untrue and insulting to currently practicing NPís trained under the Masterís degree model who use evidence-based practice in providing care to their patients every day. However, a Capstone Project utilizing Translational Research is a great idea in itself and though such an activity can be accomplished outside of academia, the DNP student who conducts this endeavor is provided with structure and mentoring from experts in any field of inquiry they are interested in. This particular aspect of the DNP convinces me of the value in getting this degree.

    The last argument I have been trying to contend with is the DNPís future in terms level of acceptance in academic roles in schools and colleges of nursing. There has not been a straight answer on how universities determine academic ranking for DNP-prepared faculty as this continue to vary depending on the institution. In the years Iíve been at the bedside as a nurse and as an Advanced Practice Nurse, I have acquired a great deal of past experiences and lessons learned that are worthy of being passed on to new generations of nurses who wish to follow the path I took. A role in the academia, though not attractive at the present given the low earning potential, is inevitable in my future. However, I seek assurance that the degree I pursue is held at the highest regard in terms of advancement in the field of nursing education. It is still tempting to forego the DNP for the much respected PhD in Nursing.
    Last edit by Joe V on Aug 23, '12
    MandaRN94, Ixalia, Cauliflower, and 14 others like this.

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  2. About juan de la cruz, MSN, RN, NP

    The author is a certified Acute Care Nurse Practitioner trained at the Master's degree level who practices in Adult Critical Care at a major academic medical center in the West Coast.

    juan de la cruz has '20+' year(s) of experience and specializes in 'APRN, Adult Critical Care'. From 'California'; 45 Years Old; Joined Nov '06; Posts: 2,900; Likes: 2,751.

    Read more articles from juan de la cruz

    56 Comments so far...

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    Excellent article Juan - you have hit the nail on the head. The business degree is the way to go IMHO. I actually was enrolled in a dual MSN/MBA but dropped the MBA part because business was soooo boring. However, 7 years later I deeply regret it. Like you, I'm an experienced clinician, I've done over 1100 hours of clinical for my two CNS certificates and I've been a practicing APN since 2006. However, I would like more of a business focus as I (like you) feel that APNs need a business focus in order to succeed. Just curious - are you actice in your state's APN organization?
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    DNPs just make me feel like I'm being marketed to. More formalized education is not always better. I will graduate from my BSN program in 2015 then go on to a PMHNP program. I am quite confident that I will be able to get my certification between any laws actually change.
    Last edit by sirI on Aug 23, '12
    RNJohnny23, herring_RN, and dianacs like this.
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    one of my issues with the degree is that in the real world, NP and PA are somewhat interchangeable, meaning that most job listing ask for either or. then why force NP to be educated at a doctorate level's and somehow still compete with master's prepared PA's? Unless the DNP puts NPs at a preferred hires, it serves no significant purpose in the real clinical world. now someone who runs their own business, or seek to become an expert in their nursing field can and should pursue the DNP; it may prove beneficial as it adds credentials. other than that, forget it.
    Soon2bAGNP, MandaRN94, mmrb, and 4 others like this.
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    It is my understanding(and I hope I am wrong) that our state health dept is changing things and that by 2015 if you are not already practicing as a NP it will require a PhD or other doctoral degree to become a practitioner in our state.
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    Graceland University has posted the following on its website:
    "15. When will the DNP be required for the NP exam?

    Return to Top
    This is unknown. In 2004, the American Association of Colleges of Nursing (AACN) published a position statement endorsing the DNP as the preferred credential/level of preparation for APRNs by 2015. However, this was/is an academic initiative. Master’s level preparation remains the current required credential for APRN certification. Credentialing (AANP & ANCC) and licensing (State Boards of Nursing) agencies determine eligibility criteria, not academic or accrediting institutions. At this time, neither credentialing agency nor any State Board of Nursing has set a specific date for establishing the DNP as the required credential for APRN certification/licensure eligibility. It is important to keep current with the specific requirements for APRN licensure in the state where you plan to practice as an APRN. It is anticipated that when/if a date is set it will be for 5-6 years after the announcement to allow students currently enrolled in MSN programs to complete their program of study."
    So, even if your state formally issued a statement TODAY saying that the DNP will be required, this shift will not go into effect until 2017 at the earliest. NO states have even made such a statement yet.
    Ixalia and SweettartRN like this.
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    Quote from LCinTraining
    It is my understanding(and I hope I am wrong) that our state health dept is changing things and that by 2015 if you are not already practicing as a NP it will require a PhD or other doctoral degree to become a practitioner in our state.
    Would you be able to tell us which state this is?
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    Juan, That is some good experience you shared with the rest of us. I just heppened to read the similar type of article and was wondering , If I should ever pursue DNP. Becoming A Doctor of Nursing Practice(DNP) Is A Unique Career Choice But thanks to your Pros and Cons, I might not do it. I'm tired of studying anyway.
    Last edit by JustBeachyNurse on Aug 23, '12 : Reason: tos
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    Quote from traumaRUs
    Just curious - are you active in your state's APN organization?
    I am not and I should be. However, I live in a state where DNP programs have not become prevalent and only private institutions are currently offering them. I work for a university system that is now revisiting the possibility of offering a DNP, hence, my renewed interest in this topic.
    herring_RN and traumaRUs like this.
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    I am in PA. I did not get this information from an official source as I'm still trying to get my RN. It went on my radar as I want to eventually get to practitioner level, though. Like I said, I hope I'm wrong.

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