Doctor of Philosophy in Nursing versus Doctor of Nursing Practice

[elkpark]

I would question the assertion that there are "two main" doctorates in nursing. While I recognize that is an "aspirational goal" for some in the nursing community, over the years I've been in nursing I've run into the ND (Nursing Doctorate), DNS (Doctor of Nursing Science), DNSc (not really sure how this differs from the DNS, besides my v. personal opinion that it looks cooler :)), the DSN (Doctor of Science in Nursing), plus, I'm sure, others that I've forgotten at the moment. And now the DNP is being added to the heap. IMHO, a big part of the "problem" with higher education in nursing is that there are all these doctorate degrees out there and nobody outside of nursing (and even many of us within nursing) have no idea what all these "non-PhD doctorates" (or "quick 'n dirty" doctorates, as some of the faculty in my grad program used to call them) mean or what people accomplished in order to get them (unlike the PhD, which is fairly standarized across all academic disciplines -- everyone knows what a PhD is and what the person who holds one had to do to get it).

I will say that the idea, in some nursing circles, of thinning this "alphabet soup" down to just the PhD and DNP is a worthwhile goal. But I'm not a fan of the DNP concept in general. I don't think the existing system is "broken." Perhaps because I came to nursing from a fine arts background, where the way higher education worked was that the Master's degree was the advanced, expert performance degree and the PhD was the teaching/research/scholarship degree, it makes perfect sense to me that the MSN is the appropriate preparation for advanced practice and the doctoral degree(s) is the appropriate preparation for teaching/research/scholarship. I think that's a perfectly reasonable, robust, defensible model -- but I've yet to see or read anything I consider "robust" or "defensible" about the DNP concept. If there were some obvious problem or flaw with the performance of all the Master's-level advanced practitioners who have been out there providing care all these years, I might feel differently, but I just don't see it ...

[llg, PhD, RN]

Another thing to consider: I know some faculty members with only MSN's who have gotten tenure.

[VickyRN, MSN, DNP, RN]

both the phd and dns/dnsc are research-focused doctoral degrees. the difference between the two degrees is minimal. the phd generally places greater emphasis on theory construction and research methods (specifically the development of expert knowledge within the scholar's area of interest). the dns, on the other hand, places greater emphasis on clinical content, nursing issues, and nursing science. both the phd and the dns prepare graduates to conduct original research (theoretical and applied).

many dns programs are being phased out and converted into phd programs. examples are the yale university school of nursing (dns converted to phd), rush university college of nursing (offers phd and dnp), and the university of buffalo (converted to phd). still other nursing programs are transitioning the dns into the dnp. eventually, there will only be two main doctoral programs in nursing - the phd and the dnp. (another term for the dnp is the nd [nursing doctorate]).

the dnp is not equivalent to the phd, in terms of academic rigor and focus. in most cases, only 2-3 semesters are added to existing masters advanced practice programs to create the practice doctorate. the dnp programs are very rigorous - don't get me wrong - but just not as rigorous as the phd. the phd takes years and years to complete and requires candidates to create and publish their own original research. the phd-prepared graduate becomes an expert in a focused area of study.

the purpose of this blog is not to debate the merits or the necessity of the dnp - this "hot" area of discussion has already been widely and wildly debated on this site in a few threads. rather, the purpose of this blog is to explore the place of the dnp-prepared nurse educator within nursing academia.

this entire subject is only beginning to be discussed, with no consensus in sight. at my college of nursing, for instance, there are a few educators who are pursuing their dnp. they expect to be placed in the tenure track upon completion of their degrees. however, our college offers them no such guarantee. right now, only faculty with a phd, dns, or edd are being allowed tenure. so, the introduction of the dnp has not only stirred significant debate within clinical practice areas among numerous healthcare professionals, but it has also significantly muddied up the waters within academia.

this is what the aacn has to say about tenure and the dnp:

though primarily an institutional decision, the aacn is confident that a dnp faculty member will compete favorably with other practice doctorates in tenure and promotion decisions...

hmmm... they may be confident, but it is certainly not a sure thing in many institutions.

again, concerning the original focus of this blog, what do you think? should dnp faculty be allowed tenure and placed on equal footing with their phd-prepared counterparts? why or why not? does your nursing institution grant dnp faculty tenure? i welcome your input :)

references

aacn comparison of dnp and phd/dnsc/dns programs

doctor of nursing practice (dnp) programs - frequently asked questions

mcewen, m., & bechtel, g. a. (2000). characteristics of nursing doctoral programs in the united states. journal of professional nursing, 16(5), 282-292.

[BBFRN, BSN, PhD]

In agreement with VickyRN, many schools are also re-auditing and awarding PhDs to their DNS alumni in an attempt to further streamline things. Indiana University is currently doing this now.

[elkpark]

At the last school in which I taught, a pretty run-of-the-mill state university, this was already being discussed and the word was that DNPs would not be eligible for tenure -- they would be second-class academic citizens, like us MSN-prepared faculty.

[Moogie]

I was told by the director of a graduate program that "of course" the DNP would be appropriate education for nursing faculty. The school did not offer a PhD but offered----surprise---a brand new DNP program for which they were having difficulty recruiting students.

From the AACN White Paper on the DNP:

What about the opportunity for tenure and promotion for faculty with a DNP?

Though primarily an institutional decision, AACN is confident that a DNP faculty member will compete favorably with other practice doctorates in tenure and promotion decisions, as is the case in law, education, audiology, physical therapy, pharmacy, criminal justice, public policy and administration, public health, and other disciplines. AACN data from 2009 show that doctoral students who also teach are just as likely to have a DNP as a PhD. This indicates that graduates of both types of doctoral programs are finding teaching positions.

How will DNP graduates be prepared to assume the nurse educator role?

Though a doctorate is the appropriate degree for a faculty role, the DNP program is not designed to prepare educators per se, any more than a PhD does. Graduates from all doctoral programs (PhD or DNP) who wish to be educators should have additional preparation that adds pedagogical skills to their base of clinical practice.

How can we justify efforts to develop the DNP when we have an acute faculty shortage? Should we focus on increasing faculty salaries rather than the DNP?

Nursing cannot continue to have large numbers of faculty in full-time academic positions without doctorates. One of the frustrating aspects in today's world of academic nursing is the fact that we have been so slow in moving this agenda forward. Nursing permits a culture which is accepting of limited educational credentials in a variety of settings. In universities it is increasingly difficult to develop the kind of clinical scholarship and maintain the kind of credibility necessary for first rate programs without a higher level of education among our faculty. The faculty shortage is compounded by the fact that salaries in the academic setting have not kept pace with the service setting. We cannot expect improved salaries until we improve the educational level. The DNP will foster a more highly educated faculty workforce.

http://www.aacn.nche.edu/DNP/dnpfaq.htm

I find this to be rather confusing----I cannot argue that doctoral education is needed among nursing faculty but it seems that there's an implication that teaching nursing is still somehow less important than research and advanced practice. The additional preparation may vary---I know of one doctoral program that has its students take the nurse educator core classes that are required of the students in the MSN-NE track. I am not sure if it matters if the doctoral students already have graduate level courses in nursing education in their master's programs, unless they got their master's from that same school. Not to be impertinent, but it seems like a waste of time and resources to me and that doctoral students without previous coursework or teaching experience who want to hone their ability as educators should be taking education electives.

I just have this vision that, twenty years from now, the AACN will realize that we have nurse scientists with PhDs who can conduct research, expert clinicians with DNPs who kick advanced nursing practice up a notch, but there still won't be anyone who knows really how to TEACH. So perhaps there will be a new degree....let's call it the NED---Nursing Education Doctorate. (By then I shall hopefully be retired....anyway.....)

Vicky, thank you for an excellent blog and please pardon my cynicism. From the "worm's eye view" as a graduate student looking into a future that is as clear as mud, I am all for advanced education but increasingly feel that it is a "buyer beware" market for nurses seeking doctoral education. I think we all need to do our homework before we commit to various programs.

[llg, PhD, RN]

Tenure is complicated -- and a somewhat controversial subject as most universities have cut back on tenure track positions in recent years overall and there are calls by some people to abolish it completed. It's all tied up with "academic freedom" and exists to provide job security to those whose "worth" to the school has been so well-proven as to merit such protection even if their future work is controversial.

If you really thing about the root purposes of tenure, a person's academic degree should be irrelavent.

[llg, PhD, RN]

I just read in another thread about DNP programs for people who already have their Master's -- the DNP programs being 1 year in length.

If that is what the DNP programs are going to end up looking like, then there is no way they can be considered "on equal footing" to a PhD for a lot of things.

[Multicollinearity, BSN, RN]

llg,

The DNP programs I've been looking at are pretty typical of this one:

http://nursing.arizona.edu/DNP_ms-dnp.htm

However, I haven't looked at a lot of programs.

The program requires 43 credits to earn the DNP degree, and this is the entry option for those who have already earned MSN-NPs.

The BSN-DNP option requires 74 credits:

http://nursing.arizona.edu/DNP_bsn-dnp.htm

This is different than what you've seen?

[Moogie]

Again, pardon my impudence but I honestly don't understand why the AACN has pushed the DNP agenda so aggressively when there are still a multiple of educational levels for entry to practice. Shouldn't nursing streamline and standardize the entry level educational route BEFORE concentrating on a new, unproven degree for advanced nursing practice?

Economic realities being what they are, some schools are having to curtail or cut their baccalaureate offerings so they can offer the DNP. I know of one school that is eliminating its entry level BSN program---but it still offers a post-master's DNP----and another school that suspended its accelerated BSN program---but it, too, offers a DNP. I can think of yet another school that I think may have had to curtail its PhD program this year because it's starting up a DNP program. The school is sending faculty to another school so that they can get their DNPs and presumably teach in the DNP program this school is planning to start. I guess the school is stating, then, that as far as it is concerned, a DNP is the equivalent of a PhD in terms of qualifying someone to teach.

I admit that I have thought about the DNP route but it would be so I could do something in a clinical setting rather than in academia.

[spineCNOR]

I am currently a student in a DNP program, so I am not unbiased. While I agree that the DNP does not have the academic rigor of a PhD I am not aware of any one-year DNP programs (but I certainly can't say they don't exist. The program I am attending requires 40-ish hours, about the same as the MSN.)

I see the DNP as being similar to other healthcare practices doctorates, such as the PharmD and the Physical Therapy doctorate. Some people who have attended those programs have chosen to pursue PhDs due to their interest in research and I imagine that will be the case with some DNPs as well. Given that healthcare is growing more complex by the day I do think there is a place in nursing for a practice doctorate. One of my professors described the DNP role as being a "superuser of evidence-based practice". Does a nurse need a DNP to use EBP? Of course not, but having a broader knowledge base does help. One of my MSN professors used to say that the purpose of graduate education is to enable a person to see things "from the 30,000-foot level". Do you need a graduate degree to see things from the 30,000 foot level? No - but it does help!