Doctor of Nursing Practice (DNP): My Personal Pro's and Con's
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.
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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 (APN's) 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 1960's, 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 Master's 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 NP's 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 Master's 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. What's 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 "residencies". Don't 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 NP's. But I'm 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 "residency" 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 Master's 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 Master's 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 NP's 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 NP's trained under the Master's 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 DNP's 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 I've 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.
