On the Doctor of Nursing Practice (DNP)

Abstract

Doctoral degrees in nursing fall into two categories. The first is the researchfocused doctorate, the Doctor of Philosophy (PhD) or Doctor of Nursing Science (DNSc or DNS); and the second is the practice doctorate or Doctor of Nursing Practice (DNP). Nurses who graduate from research-focused doctoral programs are or should be prepared to generate new evidence for the profession. Nurses who graduate from the practice-focused doctorate are or should be prepared to be experts in advanced nursing practice and leaders in applying the best evidence to improve nursing practice, whether it be clinical, academic, or administrative. The authors should indicate our bias upfront. We believe that the DNP degree is meant to prepare leaders to improve practice and thus the focus of the degree should be on implementing practice change that improves outcomes for patients, nurses, and/ or students. Thus there should be a strong evidence-based practice (EBP) component in the curriculum, and the capstone in these programs should be on evidence synthesis and/or practice improvement projects (which can also be administrative or educational in nature), not research. The DNP degree has continued to blossom since the American Association of the Colleges of Nursing (AACN) released their Position statement on the Practice Doctorate in Nursing in 2004. There are currently 153 DNP programs in the United States with an additional 160 nursing schools planning similar programs (AACN, 2011). Existing DNP programs follow either a clinical, educational, or administrative track to prepare leaders in each of these areas. All DNP programs are expected to include in their curriculum the seven Essentials of Doctoral Education for Advanced Practice Nurses developed by the AACN (2006). Included in the Essentials is the edict that DNP graduates be able to . . . demonstrate refined assessment skills and base practice on the application of biophysical, psychosocial, behavioral, sociopolitical, cultural, economic, and nursing science as appropriate in their area of specialization (AACN, 2006, p. 16). The DNP degree was conceived as an educational program to prepare graduates to be experts and leaders in evidence-based practice. The DNP clinician is ideally prepared to improve healthcare outcomes by facilitating the translation of current, best evidence into clinical practice. The DNP is proposed by AACN as the terminal degree for advanced practice nurses. DNP graduates may continue to work in the same practice environments with other nurses with different educational levels as well as other health care disciplines. Many organizations are still trying to determine how to utilize the DNP graduate within their practice environments. With pending health care reform, the threat of reduced reimbursement for poor outcomes, and the ongoing shortage of primary care providers, it is crucial for current best evidence to be quickly translated into clinical practice to improve outcomes for the patients and communities we serve. In addition, many healthcare organizations are applying for Magnet status, a recognition program developed by the American Nurses Credentialing Center (ANCC) for high-quality nursing care. Magnet hospitals must demonstrate their contribution to generating knowledge, innovations, and improvements for the professions through the translation and application of existing evidence and by identifying areas where new research is needed (ANCC, 2011). Despite the Institute of Medicine's (2011) challenge for nursing to reconceptualize the role of nurses while developing innovative solutions to care delivery, many barriers to full implementation of evidence-based practice still exist. Nurses continually report lack of time as the most common barrier to applying evidencebased practice approaches to clinical practice (Bertulis, 2008; Brown, Wickline, Ecoff, & Glaser, 2009; Pravikoff, Tanner, & Pierce, 2005). Other barriers that have been reported include the difficulty accessing resources, poor computer skills, poor understanding of statistics and research technique, inadequate preparation to critically appraise research, lack of support from administration and other staff, and a disbelief that evidence-based practice can improve outcomes (Bertulis, 2008; Brown et al. …