ALPHABET SOUP: PhD, DNP, CRNA
What is the difference between a PhD and DNP? I am sure there is a fantastically funny, off color joke in there, but I won't tackle that right now (fill up the comments section for me, won't you?) Both of these degrees are considered "terminal" degrees, meaning neither is considered "further" than the other. In addition to these two terminal degrees, nursing also has the Certified Registered Nurse Anesthetist (CRNA). This degree can be a variation of the DNP or it can be a DNAP - Doctor of Nurse Anesthesia Practice. I won't cover that one here either, but the earning power is significantly greater (I am assuming this higher rate of pay is to cover the cost of liability insurance - salaries start around $200,000).
The difference between DNP and PhD lies in what I want to be doing with my time once I graduate. If I wanted to treat patients, or if my focus was on bedside nursing and best clinical practice, I would have considered the DNP; but I want to teach graduate level nursing courses and do research, so the PhD makes sense for me. The reality is that both are somewhat flexible. I have met DNPs who are faculty at undergraduate schools of nursing, and if I choose to, I could get a post-graduate certificate to practice as an NP; I will be looking into that (though my family may kill me if I go back to school). Here is a chart, summarizing the main differences between the two degrees:
PhD (Doctor of Philosophy)
DNP (Doctor of Nursing Practice)
Theories of nursing research
Translational research (evidence from and for the bedside)
Minimum of BSN, though MSN is typically preferred
BSN or MSN depending on the program
Credit Hours Required
Averages 60 hours
Includes dissertation hours
Between 70-95 depending on entry with BSN or MSN
Minimal to none
Up to 1000 hours
Theory-based research with support of faculty mentors, research residency hours is required. The goal is to learn to do research independently. The final project is a dissertation.
Clinical project that demonstrates intimate knowledge of evidence-based practice. The final project is a clinical paper.
Yes, many varieties from completely online to blended to seated
Yes, many varieties from completely online to blended to seated
Health Policy Positions
Nursing faculty positions
Leadership in nursing practice, management, health policy, administration, government, academia in practice-based programs.
Demand is high in areas where waves of retirement are expected (AACN, 2014)
At the highest levels. More DNP programs are needed; The AACN recommends a DNP for entry into practice (corrected statement, 4/3/18)
The mean salary for full-time nursing professors is $102,399, according to AACN data for the 2012-2013 academic school year. The 25th percentile is $82,005 and the 75th percentile is $117,075. The maximum salary, according to the AACN data, is $272,095.1
Average $98, 190; states with the highest average salary for NPs:
California ($137,040), Alaska, Hawaii, Massachusetts, Oregon ($120,980).2
HOW I GOT HERE
I have written about my origin story on my Allnurses blog, Safety Rules --please give it a read. I have known from the start that I wanted a PhD. I have always loved research and a doctorate has always been my long-term goal.
So what next? I had a freshly minted ADN and some old degrees in biology. There are programs out there that will take you from ADN to PhD, or from BSN to PhD, but none of them fit my needs financially, geographically or philosophically. Even though I knew a doctorate was my end goal, I felt a lack of confidence in my abilities, and I wanted to go slow. Have you ever played the game "little alchemy" where you add two things together to get a third? Well, that's what I did. I converted my ADN and my Bachelor of Science degrees into a BSN in three semesters. I had a wonderful experience - I so enjoyed community health, research and theory! I then looked into doctoral programs, and found out that most of the programs in the Western North Carolina area require an MSN. The MSN took about 2 years, and I also very much enjoyed it. I did my first qualitative research ever, The lived experience of older hospitalized adults with fall prevention education for my thesis. I highly recommend doing a thesis if you are planning to go on for a doctorate (the other option at my school was a project); the experience really prepared me for the process of writing my dissertation.
ONLINE OR SEATED?
Any of the degrees I have mentioned so far can be done fully online (which is what I did), blended or hybrid, or fully seated. I prefer the online experience, but it isn't for everyone. You really need to be self-motivated to do online programs, and very organized! I always put all my assignments on my calendar at the start of the semester - as smart phone technology has evolved, I have used reminders and notifications to help me stay on track. Online is not for everyone. Many people prefer having a professor in front of them, with predictable, scheduled class time and office hours. There are several quizzes you can take to determine if an online environment is right for you.3
HOW TO PAY FOR ALL THIS?
I did both the BSN and MSN while working, though I was VERY lucky to be able to take 9 months off to have a baby (thanks to an incredibly supportive partner). Imagine the "fun" of being in an online course while breastfeeding. I angled the camera so it just got me from the neck up, but I always worried I would forget what I was doing and accidentally flash the entire class. In addition, I was so pleased to find that there are funds out there to support higher nursing degrees. The hospital where I worked had a tuition forgiveness option, which I took advantage of, and I was able to get scholarships, grants and loans to support all of my degrees. One big piece of advice I would give is to not let concern over finances be a barrier - there is a big pot of money out there, though you may have to do some serious work to get it. I received a scholarship from my school for my final semester, and was able to work very minimal hours as I finished my dissertation. I found this to be invaluable. I don't know how I would have written for 12 hours, looked after my kids, kept up the house, and gone to work at a full time job while keeping my sanity (even with my scholarship, I feel that sanity "left the building" at times). There is an even greater opportunity for financial support if you are a person of color. Let me know in the comments if you need help with resources. College Scholarships.org is a great place to start.4
WHAT IT TAKES TO FINISH.
There have been many stories in the news lately about grit and determination. You need both to finish a degree while working and raising kids. It was hard. I don't think I would have succeeded without the support of my family, financial support from various sources, and what I like to think of as "self-support" - I chose my programs wisely, and actively engaged in my courses. I formed friendships and developed relationships with my professors that continue to this day.
It took me seven long years to finish my PhD. I think back on all the barriers I overcame with pride and with horror (how did I do it? Was I NUTS?). During the first few weeks of my program, we took in three foster children (I know, what were we thinking?). The miracle of that was that three other people in my cohort had either fostered or adopted children - that was incredible. I remember having to open my mind to other ways of knowing. Despite my qualitative thesis, I hadn't fully grasped the world of qualitative research. It wasn't until I took the advanced nursing theory that I truly began to understand other ways of knowing. Statistics was so painful, I don't even want to write about it, but I got through it.
Part of a doctoral program involves developing a research topic and selecting a chairperson to guide you through the process. It took me a long time to arrive at my final topic: The effect of root cause analysis on senior nursing student safe medication administration practices. It's hard to choose a topic narrow enough to finish, but broad enough to give you room. There is a saying in graduate school, "don't try to save the world with your dissertation", and it is so true! (Hard, but true, because we all kinda want to save the world, don't we?)
In addition to choosing a chair, you have three committee members there to give additional perspective. I had my committee in place for a year when my dissertation chair quit on me! But I persisted. I went through a lull when I didn't do anything. Almost a year passed during which I simply read articles and thought my thoughts. At last I found a new chair, and new resolve. I wrote my proposal, which is the first three chapters of the dissertation, and presented them to my committee. Committee members asked me lots of questions about my literature review, and I fumbled my responses and felt inept. I remember thinking, "I can't imagine having mastered all of this... I can't imagine being an expert in THIS". But I kept going. I had more than enough research in my first three chapters to get a really nice publication out of it, and I got my certification as a patient safety professional. During my dissertation defense (that's after you write all FIVE chapters...over and over and over again), I was asked many excellent questions, and I answered them all with confidence. I knew the literature; I have become the expert!
A doctorate in nursing isn't for everyone, but it is perfect for some of us - for the almost 5,000 insanely dedicated individuals who graduate with a doctorate in nursing each year (and over 19,000 DNPs!!!), it is a huge celebration; the accomplishment of a lifetime5.
A report from the Institute of Medicine (IOM; 2010) The Future of Nursing: Leading Change, Advancing Health said in part, "Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression" A primary goal of the IOM report is to have 80% of nurses with BSNs by 2020, and right now we are only at 50%. "Research has linked higher levels of education for nurses with safer, high-quality care. The bachelor's degree is key: A nurse with a baccalaureate degree or higher typically has a greater understanding of cultural and economic issues that affect people, and with that context can assume more responsibility in making decisions and forging new approaches in health." I am part of that seamless progression now - you have to have PhDs to teach MSNs, and you have to have MSNs to teach BSNs. It's the circle of life in nursing!6
Faculty salaries: Nursing schools face faculty shortages
NP salaries: Nurse Practitioner Salary | Certified Nurse Midwife | Anesthetist Salaries
Online environment quiz: Are Online Courses for You? | CAREERwise Education; Online Learning Quiz | Online Degrees and Online Courses | University of Colorado Denver
Paying for college: Grants for Nursing School Students from Government, Private, and Alternative Funding
Number of Doctoral Degrees: Number of people receiving nursing doctoral degrees annually | Campaign for Action
Nursing Education Decade of Change: https://campaignforaction.org/wp-content/uploads/2017/12/NursingEducationDecadeOfChange-V508.pdf