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Doctor of Philosophy in Nursing versus Doctor of Nursing Practice

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Specializes in Gerontological, cardiac, med-surg, peds. Has 16 years experience.

There are two main doctoral degrees in nursing: the Doctor of Philosophy (PhD) in nursing and the Doctor of Nursing Practice (DNP).

Doctor of Philosophy in Nursing versus Doctor of Nursing Practice

The PhD is a research-oriented degree, whereas the DNP is a practice-oriented or clinical doctorate. How do these degrees differ and are they equal in status?

Doctor of Philosophy

The Doctor of Philosophy in nursing is a research-based degree that prepares learners for both research and teaching positions (AACN, 2001). The typical program is science-intensive and requires four to five years for completion (Worldwidelearn, 2010). It is designed to prepare nurse scholars, educators, and researchers for a lifetime of scholarly inquiry to build up the body of nursing knowledge (AACN, 2001). The degree is also valuable for obtaining senior management positions, publishing in professional journals, influencing public policy decisions, and advocating for positions through research (Worldwidelearn, 2010). The PhD is considered the top-of-the line degree for academic work. It places great emphasis on theory construction and research methods: specifically, the development of expert knowledge within the scholar's special area of interest (AACN, 2001; Blais, Hayes, Kozier, & Erb, 2006; Finn, 2005; McEwen & Bechtel, 2000). The PhD in nursing, as a terminal degree, has a core of theory, science, and research that provides the prerequisite knowledge and expertise for the development, evaluation, and testing of theories in nursing (AACN, 2001).

Doctor of Nursing Practice

The Doctor of Nursing Practice, by way of contrast, is a practice-focused doctoral nursing degree. It prepares graduates for clinical practice, administration, or public-policy roles, but the degree concentration is not research-focused (AACN, 2001; Blais et al., 2006; Edwardson, 2004). It was formally created by the AACN in 2004 to replace masters in nursing programs in preparing advanced practice nurses. This type of nursing doctoral program emphasizes advanced practice nursing roles, leadership, and application of clinical research for better patient outcomes. It produces expert nurse clinicians who provide primary patient care and direct clinical policies (AACN, 2004). The nursing practice doctorate is similar to other discipline-specific practice degrees, such as the MD, DDS, JD, EdD, or PharmD. The practice doctorate is the highest-ranking professional practice degree, but requires less academic preparation than research-priority doctorates (Edwardson, 2004).

Since the nursing practice doctorate is a relatively new degree program, there is growing controversy within nursing academia concerning the deep, uncharted waters created by the DNP. The DNP does not require the same level of academic rigor as the PhD. Does the practice-oriented degree command equal standing with the PhD, even though the PhD requires considerably more time and effort for completion? Will DNP-prepared faculty be marginalized within nursing academia? A particularly thorny area of dispute is whether an educator with a DNP is eligible for tenure status within the university system. A possible solution is the creation of two separate tenure tracks in nursing education: one for academia (didactic faculty with a PhD in nursing) and one for practice (clinical faculty with a DNP).

What do you think?


References

American association of colleges of nursing (AACN). (2001). Indicators of quality in research-focused doctoral programs in nursing. Retrieved from American Association of Colleges of Nursing (AACN) > Home

American association of colleges of nursing (AACN). (2004). AACN position statement on the practice doctorate in nursing. Retrieved from American Association of Colleges of Nursing (AACN) > Home

Blais, K. K., Hayes, J. S., Kozier, B., & Erb, G. (2006). Professional Nursing Practice: Concepts and Perspectives (5th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.

Edwardson, S. R. (2004). Meeting Standards and Needs in Doctoral Education in Nursing. Journal of Professional Nursing, 20(1), 40-46.

Finn, J. A. (2005). Getting a PhD: An Action Plan to Help Manage Your Research, Your Supervisor, and Your Project. New York: Routledge.

Mcewen, M., & Bechtel, G. A. (2000). Characteristics of Nursing Doctoral Programs in the United States. Journal of Professional Nursing, 16(5), 282-292.

Worldwidelearn. (2010). How to Get a DNP, DNS, or PhD in Nursing.

VickyRN, PhD, RN, is a certified nurse educator (NLN) and certified gerontology nurse (ANCC). Her research interests include: the special health and social needs of the vulnerable older adult population; registered nurse staffing and resident outcomes in intermediate care nursing facilities; and, innovations in avoiding institutionalization of frail elderly clients by providing long-term care services and supports in the community. She is a Professor in a large baccalaureate nursing program in North Carolina.

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29 Comment(s)

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

Specializes in Nursing Professional Development. Has 44 years experience.

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

VickyRN, MSN, DNP, RN

Specializes in Gerontological, cardiac, med-surg, peds. Has 16 years experience.

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.

Edited by VickyRN

BBFRN, BSN, PhD

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research. Has 15 years experience.

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.

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

Specializes in Gerontology, nursing education.

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

Specializes in Nursing Professional Development. Has 44 years experience.

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

Specializes in Nursing Professional Development. Has 44 years experience.

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

Specializes in Acute Care Psych, DNP Student. Has 4 years experience.

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

Specializes in Gerontology, nursing education.

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.

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!

SharonH, RN

Specializes in Med/Surg, Geriatrics. Has 20 years experience.

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.

I'm very surprised to read this. I thought I read somewhere that one of the reasons advanced for the DNP was to prepare more clinical faculty. Did I misunderstand?

VickyRN, MSN, DNP, RN

Specializes in Gerontological, cardiac, med-surg, peds. Has 16 years experience.

good question, sharonh, rn. simply having a phd or a dnp does not imply that one is a good teacher. nursing education is an art and science and a specialty area of its own. in addition to the dnp or phd courses, the aspiring educator also needs to take nursing education courses. this is already required in north carolina by our board for schools of nursing.

the dnp is a clinical practice degree, not a teaching degree. the phd is a research degree - not a teaching degree. neither degree teaches one "how to teach." the focus of the dnp is primary care of patients in the clinical setting. the focus of the phd degree is generation of knowledge within one's professional specialty area.

learning how to teach is often not taught to university faculty. that is one of the weaknesses of our system of higher education in general. just because someone has a phd in biochemistry (for instance) and is a brilliant researcher doesn't necessarily make the same person a good teacher.

in most universities, the academic role of the professor has four functional components: the scholarship of discovery, integration, application, and teaching.

scholarship of discovery = independent research that has been published and is subject to peer review. this role is highly valued and expected in most university settings and takes an enormous amount of time and effort to fulfill.

scholarship of integration = interdisciplinary activities such projects, grants, poster presentations, and policy papers

scholarship of application/ practice = professional practice, consultation, and service (such as serving on committees or on the faculty senate)

scholarship of teaching = the teaching role, curriculum development, and program evaluation. for a fully tenured faculty member, teaching is only 25% of the expected responsibilities.

one important but often not recognized role of the university is generation of new knowledge and guardianship/ repository of a profession's knowledge base. this is accomplished by the scholarship of discovery, or research. astounding medical breakthroughs, new pharmaceutical devices, cures for diseases, etc. - most often take place in the university setting.

http://www.sfsu.edu/~acaffrs/faculty_manual/docs/other/scholarship_reconsidered.doc

http://www.aacn.nche.edu/publications/positions/scholar.htm

VickyRN, MSN, DNP, RN

Specializes in Gerontological, cardiac, med-surg, peds. Has 16 years experience.

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.

Excellent points, Moogie.

Edited by VickyRN

KaroSnowQueen, RN

Specializes in Telemetry, Case Management. Has 30 years experience.

My daughter is getting her PhD in Nursing from the University of Louisville. Part of her curriculum is to teach classes to undergraduates. She is definitely going into the research sector when she completes her courses, but I thought I would throw this into the fray, as people are saying no one is being equipped to teach in either post-graduate track.

Just to clarify a little about the DNS, as some incorrect information regarding that degree has been posted:

I earned a DSN over 10 years ago from a university that is consistently ranked among the top 10 nursing graduate schools. I was accepted in other PhD programs, and decided to obtain my DSN after much review and debate. One big thing that solidified that decision was that when I compared the currucula, I noticed they were essentially the same. The DSN curruculum was not at clinically focused, as was incorrectly posted earlier. The DSN curriculum was steeped in research and theory, and was quite rigorous. In fact, I have some colleagues who attended PhD programs who did not have the same amount of rigor in their program, and who were not as well prepared for a tenure track position as they could have been. I studied under internationally known researchers and was able to meet and study under under prominent nurse leaders, theorists and scholars who were visiting professors. Following graduation, I have a productive scholarly record, good teaching evaluations, and much professional service. I have earned tenure and promotion. I would say that the DNS has prepared me well for the role of the nurse educator.I wouldn't be so quick to criticize any nursing doctorate, as they each have their merits and place in healthcare. When we lkive in a time where a sigbificantly small number of nurses even have a doctorate, we need to have more of an open mind and be more inclusive with our beliefs of where everyone fits in.

VickyRN, MSN, DNP, RN

Specializes in Gerontological, cardiac, med-surg, peds. Has 16 years experience.

Thank you for sharing your valuable insights and experience concerning the DNS, Penguin67.

What do you think about the trend for many DNS programs now being converted to either a PhD or DNP?