Doctor of Nursing Practice
{{Short description|Terminal professional degree in nursing}}
{{Use dmy dates|date=December 2020}}
{{Globalize|article|USA|2name=the United States|date=December 2010}}
The Doctor of Nursing Practice (DNP) is a professional degree in nursing in the United States of America.
In the United States, the DNP is one of three doctoral degrees in nursing, the other two being the research degree PhD and the Doctor of Nursing Science.{{cite journal |last1=Reid Ponte |first1=Patricia |last2=Nicholas |first2=Patrice K. |title=Addressing the Confusion Related to DNS, DNSc, and DSN Degrees, With Lessons for the Nursing Profession: DNS, DNSc, and DSN Degrees |journal=Journal of Nursing Scholarship |date=July 2015 |volume=47 |issue=4 |pages=347–353 |doi=10.1111/jnu.12148|pmid=26078101 }} The DNP program may include clinical/residency hours as well as a final scholarly project.
DNP in North America
The curriculum for the United States DNP degree builds on work completed during previous master's-level courses. It provides education in evidence-based practice, quality improvement, and systems leadership, and is typically more clinically oriented than a PhD.{{Cite web|title = American Association of Colleges of Nursing {{!}} DNP Fact Sheet|url = http://www.aacn.nche.edu/media-relations/fact-sheets/dnp|website = aacn.nche.edu|access-date = 2015-09-19}} Although approximately 52% of nurse anesthetist programs will award the DNP, the remaining 48% may use the title doctor of nurse anesthesia practice (DNAP).{{Cn|date=October 2023}}
= Rationale for the existence of the DNP =
According to the American Association of Colleges of Nursing (AACN), transitioning advance practice registered nursing programs from the graduate level to the doctoral level is a "...response to changes in health care delivery and emerging health care needs, additional knowledge or content areas have been identified by practicing nurses. In addition, the knowledge required to provide leadership in the discipline of nursing is so complex and rapidly changing that additional or doctoral level education is needed."[https://www.nursingfacultyjobs.com/DNPpositionstatement.pdf Report of the Task Force on the Clinical Doctorate] According to the AACN, "...benefits of practice-focused doctoral programs include:
- development of needed advanced competencies for increasingly complex clinical, faculty and leadership roles;
- enhanced knowledge to improve nursing practice and patient outcomes;
- enhanced leadership skills to strengthen practice and health care delivery;
- better match of program requirements and credits and time with the credential earned;
- provision of an advanced educational credential for those who require advanced practice knowledge but do not need or want a strong research focus (e.g. clinical faculty);
- enhanced ability to attract individuals to nursing from non-nursing backgrounds;
- increased supply of faculty for clinical instruction; and
- improved image of nursing."
= Transitioning toward the doctorate =
In the United States, the American Association of Colleges of Nursing (AACN) recommended that all entry-level nurse practitioner educational programs be transitioned from the Master of Science in Nursing (MSN) degree to the DNP degree.American Association of Colleges of Nursing (2004). AACN Position Statement on the Practice Doctorate in Nursing. Available at http://www.aacn.nche.edu/DNP/pdf/DNP.pdf {{Webarchive|url=https://web.archive.org/web/20110928212553/http://www.aacn.nche.edu/DNP/pdf/DNP.pdf |date=28 September 2011 }}. The American Association of Nurse Anesthetists has followed suit, requiring the DNP (or DNAP - Doctor of Nurse Anesthesia Practice) degree for entry-level nurse anesthetist programs by the year 2025.American Association of Nurse Anesthetists (2007). AANA Position on Doctoral Preparation of Nurse Anesthetists. Available at {{cite web|url=http://www.aana.com/uploadedFiles/Members/Membership/Resources/dtf_posstatemt0707.pdf |title=Archived copy |access-date=2008-04-20 |url-status=dead |archive-url=https://web.archive.org/web/20071030134717/http://www.aana.com/uploadedFiles/Members/Membership/Resources/dtf_posstatemt0707.pdf |archive-date=30 October 2007}} Meanwhile, the National Association of Clinical Nurse Specialists (NACNS) announced in July 2015 its endorsement of the doctor of nursing practice (DNP) as the required degree for CNS entry into practice by 2030.{{Cn|date=October 2023}} Nurse practitioners and nurse anesthetists currently practicing with either an MSN or certificate will not be required to obtain the DNP for continued practice.{{Cn|date=October 2023}}
Comparison to other doctorates
The DNP, as a professional degree, has a different focus from a research doctorate such as the PhD in Nursing. The DNP is a practice-focused degree intended to prepare nurses to practice at a higher level, while the PhD in Nursing is a research-focused degree intended to prepare nurses to carry out academic research within their profession. This is reflected in significant differences between the curricula for the two degrees, such as the PhD not requiring any clinical hours and the DNP having a scholarly project rather than the PhD's original research dissertation.{{Cite web |title=DNP-PhD Comparison {{!}} Duke University School of Nursing |url=https://nursing.duke.edu/academic-programs/dnp-program-nursing/dnp-phd-comparison |access-date=2023-10-18 |website=nursing.duke.edu |language=en}}{{Cite web |title=Comparing the PhD & DNP |url=https://nursing.umn.edu/academics-and-admissions/which-program-right-me/comparing-phd-dnp |access-date=2023-10-18 |website=School of Nursing |language=en}} The PhD also takes longer to complete on average, taking 5.0–5.1 years for students entering post-master's compared to 2.43 years for the DNP and 5.2–5.9 years for students entering post-bachelor's compared to 3.8 years for the DNP. The faculty profile differs between DNP and PhD programs, with DNP program faculty teaching being more likely to be active in clinical practice and to hold a DNP, while PhD program are more likely to be active in research and to hold a PhD.
When the DNP was proposed, critics described its development as "a major mistake for [the] profession of nursing as well as the discipline of nursing knowledge", due to it separating the missions of practice and research.{{Cite journal |title=The Case Against the DNP: History, Timing, Substance, and Marginalization |date=September 2005 |journal=Online Journal of Issues in Nursing |doi=10.3912/ojin.vol10no03man02|last1=Meleis |first1=Afaf |last2=Dracup |first2=Kathleen |volume=10 |issue=3 |page=3 |pmid=16225383 |s2cid=10883573 |url=https://repository.upenn.edu/bitstreams/d39b13d0-8747-4f11-9de0-53f00a2de3b9/download }}
The required clinical practice hours to be accepted on a DNP course range from zero to 1000 hours, compared to a minimum of one year of clinical experience for admission to a PhD. There is a requirement that DNP students are expected to complete at least 1000 post-baccalaureate clinical hours.{{cite web|url=https://www.aacnnursing.org/Portals/42/CCNE/PDF/DNP-FAQs.pdf|title=Frequently Asked Questions: DNP Programs & CCNE Accreditation|website=AACN|page=3|access-date=17 May 2024}} These can include clinical hours undertaken as part of a prior degree, and DNP programs do not specifically require additional clinical hours beyond those at the master's level, but many programs do include clinical components.{{Cite journal |last1=Dobrowolska |first1=Beata |last2=Chruściel |first2=Paweł |last3=Pilewska-Kozak |first3=Anna |last4=Mianowana |first4=Violetta |last5=Monist |first5=Marta |last6=Palese |first6=Alvisa |date=2021-11-15 |title=Doctoral programmes in the nursing discipline: a scoping review |journal=BMC Nursing |volume=20 |issue=1 |pages=228 |doi=10.1186/s12912-021-00753-6 |issn=1472-6955 |pmc=8591938 |pmid=34781935 |doi-access=free }}{{Cite web |title=Course Descriptions {{!}} DNP |url=https://online.simmons.edu/dnp-course-description/ |access-date=2022-03-24 |website=SC-UMT |language=en-US}}
Title confusion in the clinical setting
Some critics have argued that there is scope for patients or service users to be confused about whether they are consulting a physician or a nurse if nurses use the title "doctor" in a clinical setting.{{Cite journal |last=Gaddis |first=Gary |date=2022 |title=Nurses With a Doctorate in Nursing Practice (DNP) Should Not Call Themselves "Doctor" in a Clinical Setting |journal=Missouri Medicine |volume=119 |issue=4 |pages=314–320 |issn=0026-6620 |pmc=9462903 |pmid=36118817}}{{Cite journal |last=Miller |first=Jason E. |date=2008-11-04 |title=The Doctor of Nursing Practice: Recognizing a Need or Graying the Line Between Doctor and Nurse? |journal=The Medscape Journal of Medicine |volume=10 |issue=11 |pages=253 |issn=1934-1997 |pmc=2605113 |pmid=19099003}} Lawsuits have also resulted from this confusion, where holders of the DNP have referred to themselves with the title "doctor" in clinical settings.{{Cite web |title=NP Fined $20K for Advertising Herself as 'Doctor Sarah' |url=https://www.medscape.com/viewarticle/984389 |access-date=2023-10-29 |website=Medscape |language=en}}{{Cite web |last=JD |first=Ann W. Latner |date=2023-06-06 |title=DNP Sued for Referring to Herself as Doctor |url=https://www.clinicaladvisor.com/home/my-practice/legal-advisor/dnp-sued-for-use-of-doctor/ |access-date=2023-10-29 |website=Clinical Advisor |language=en-US}} In some US states, there is a legal basis limiting nurses using the title of "doctor" in clinical practice.{{Cite web |last=FNP |first=Julee Waldrop, DNP, PNP |date=2013-03-13 |title=State medical boards trying to limit who can be called "Doctor" |url=https://www.clinicaladvisor.com/home/the-waiting-room/state-medical-boards-trying-to-limit-who-can-be-called-doctor/ |access-date=2023-10-29 |website=Clinical Advisor |language=en-US}} However, in other US states, nurses are bringing their own legal arguments to facilitate their legal use of the title.{{Cite web |date=2023-09-08 |title=Nurse Practitioners Sue The State Of California Over Right To Use 'Doctor' In Titles {{!}} NurseJournal |url=https://nursejournal.org/articles/nurse-practitioner-doctor-title/ |access-date=2023-10-29 |website=nursejournal.org |language=en-US}}