Doctor of Nursing Practice
||The examples and perspective in this article deal primarily with the United States and do not represent a worldwide view of the subject. (December 2010)|
The Doctor of Nursing Practice (DNP) is a terminal professional degree that focuses on the clinical aspects of a disease process. The curriculum for the DNP degree generally includes advanced practice, diagnoses, and treatment of diseases. The DNP is intended to prepare a registered nurse to become an independent primary care provider. Furthermore, the DNP is intended to be a parity degree with other health care doctorates such as psychology, medicine, and dentistry. Primary practice roles in nursing include the nurse practitioner (NP), certified registered nurse anesthetist (CRNA), certified nurse midwife (CNM), and the clinical nurse specialist (CNS). Although approximately 52% of nurse anesthetist programs will award the DNP, the remaining 48% may use the title Doctor of Nurse Anesthesia Practice (DNAP) for their terminal degree.
Education requirements in the United States
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." 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);
- parity with other health professions, most of which have a doctorate as the credential required for practice;
- 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
The AACN recommends that all entry-level nurse practitioner educational programs be transitioned from the Master of Science in Nursing (MSN) degree to the DNP degree by the year 2015. 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. Nurse practitioners and nurse anesthetists currently practicing with either an MSN or certificate will not be required to obtain the DNP for continued practice.
There are two terminal doctorate-level degrees in nursing: The Doctor of Nursing Practice (DNP), and the Doctor of Philosophy (PhD). Previous doctorate level degrees have been, or are in the process of being, phased out and converted to one of the two terminal degrees. The Doctor of Nursing (ND, not to be confused with Naturopathic Doctor ND) and the (DrNP) have transitioned into the DNP whereas the Doctor of Nursing Science (DNSc, DNS or DSN) has transitioned into the PhD. The PhD in nursing is generally considered the academic and research-oriented degree, whereas the DNP is the practice-oriented or professional terminal degree.
Controversy in the United States
DNP and the use of the "Doctor" title
Currently there is a controversy over the title “Doctor” being used within the clinical setting by the DNP. Although MDs, DOs, and DNPs all nominally hold a doctorate degree by education, in a medical setting the term "doctor" has historically referred to Doctors of Medicine (MD), Doctor of Osteopathic Medicine (DO), Podiatrists (DPM), Dentists (DDS or DMD), and Optometrists (OD) but not to Nurse Practitioners (NP) since they generally did not hold doctorate degrees. However, the DNP has evolved much like the other clinical doctorates, and, some argue, that the public uses the term "doctor" generically to describe that person who is a licensed professional and is in the primary decision making role for their care. The American Association of Colleges of Nursing and six other professional nursing organizations contend that the term "doctor" is an appropriate term to describe a Doctor of Nursing Practice. However, a 2008 survey revealed considerable confusion among Americans regarding the credentials and qualifications of many healthcare providers, and that an overwhelming majority favor all healthcare providers to clearly designate their skills, training, and level of education. These findings prompted the American Medical Association to launch the "Truth in Advertising Campaign" in 2011 to promote transparency in how all healthcare providers market themselves, stating, "Patients deserve to know who is providing their care." They further contend that "Confusion among Americans about who is and who is not qualified to provide specific patient care undermines the reliability of the healthcare system and can put patients at risk.".
As of 2013, only a few states specifically prohibit DNP's from using the title "Doctor" with their patients (Arkansas, Connecticut, Maine, Oklahoma, Oregon), while four more states require them to clarify that they are not physicians (New York, Pennsylvania, South Dakota, and Virginia).
Masters vs Doctorate
Although controversial, the adequacy of existing master's-level education is further supported by other articles that show that in resource poor areas with Medicaid clientele, nurse practitioners provide a level of care that is rated similar to that of physicians in comparable level. It is however, unclear whether patient rating of care correlates with equal outcomes. In contrast, the level of training between physicians board certified in an area of specialty and a DNP working as a primary care provider is not intended to be comparable. A physician will typically have 4 years of undergraduate education, 4 years of medical school, and 3 to 8 years in paid residency (e.g. family practice, internal medicine, radiology, neurosurgery, etc.). Physicians often continue by doing a subspecialty or fellowship (e.g. cardiology, nephrology, oncology, etc.). In contrast a typical DNP will have 4 years of undergraduate education, experience as a registered nurse, and 4 years of advanced practice education (e.g. women's health, pediatrics, anesthesia, etc.). Additionally, the prolonged education of physicians through specialty residencies has compounded primary care shortages in the United States and therefore the DNP offers a practical solution with its primary care emphasis and streamlined clinical focus.
Nurse practitioner vs Physician Assistant
There is much controversy between the DNP and the Physician assistant, in that each have a similar scope of practice. The DNP in general has more autonomy as a health care provider. The greater autonomy for the DNP largely comes from education requirements and the governing bodies that influence each professions scope of practice. The PA scope of practice is largely determined by the American Medical Association, individual State, and physician delegation. While the DNP scope of practice is determined by the individual State Board of Nursing. The PA will take a certification via the PANCE exam given by the National Commission on Certification of Physician Assistants. While practicing the PA will work under a physician as their assistant, hence the term physician assistant. However, the DNP has a licensing exam which is determined by the practicing state (commonly administered by the American Academy of Nurse Practitioners). PA programs have transitioned to a master's level with an average length of 27 months. The nurse practitioner may complete a bachelors degree in nursing, practice as a nurse for at least one year, and then either completes the master's level NP in 2 years or the DNP in 3 years. To be accepted into a Nurse Practitioner program, at a minimum, one must at least be Registered Nurse. The requirements vary widely depending on the NP program. Overall, the scope of practice of a DNP and a PA vary from state to state and depend entirely on the law of the practitioner's state.
Nurse practitioner vs physician
- Nurse Practitioner, Nurse Midwife, Clinical Nurse Specialist, and Nurse anesthetist
- Diploma in Nursing
- Associate of Science in Nursing
- Bachelor of Science in Nursing
- Master of Science in Nursing
- Nurse education
- Nursing school
- As primary care providers the DNP treats and diagnosis medical disease http://www.aanp.org/NR/rdonlyres/A1D9B4BD-AC5E-45BF-9EB0-DEFCA1123204/4710/2011FAQswhatisanNPupdated.pdf
- http://nann.org/pdf/DNPEntry.pdf DNP as parity with medicine
- Report of the Task Force on the Clinical Doctorate[dead link]
- 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.
- American Association of Nurse Anesthetists (2007). AANA Position on Doctoral Preparation of Nurse Anesthetists. Available at http://www.aana.com/uploadedFiles/Members/Membership/Resources/dtf_posstatemt0707.pdf
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