DNPs: Healthcare change agents

Author(s): Rebecca Shipley, MSN, APRN, FNP-C; Barbara Chapman, MSN, APRN, FNP-C; Chiquesha Davis, MSN, CMSRN, RN-BC; Christian Garrett, MSN, APRN, FNP-C; Sonya Grigsby, MSN, APRN, AGACNP-BC; and Cyndi B. Kelley, MSN, RNC-LRN

Find the right program to meet your professional goals.

After feeding your curiosity about the differences between the doctor of nursing practice (DNP) and doctor of philosophy (PhD) in nursing and how they complement each other, you may be inspired to take the next step in your career and earn a DNP. When you start with an online search, you’ll find many full- and part-time programs offered online or in traditional classroom settings. How do you decide which program is right for you? Are all DNP programs created equal? What should you take into consideration before you make your final choice?

Let us help you make this decision by exploring how to pick a school or program, what courses should be included, tips for success, and potential DNP roles. (See DNP career paths.)

Selecting the right school and program

In addition to considering your professional and personal preferences, choosing a DNP program requires assessing several scholastic characteristics, including program reputation. National accreditation, such as from the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN), ensures consistency and uniformity among degree requirements. Talk to alumni and other professionals familiar with the schools and programs you’re interested in to validate their character. Appraise the professional development and career advancement of the program’s graduates and ask former students about their role transition and overall preparedness. Also, review attrition rates across all the programs you’re considering. Doctoral study is rigorous, so it’s not uncommon for programs to experience drops in enrollment over time. However, high attrition rates (> 10%) should prompt further investigation.

Look for experienced faculty to guide and facilitate the learning experience. Many programs have PhD-prepared faculty teaching in their DNP programs. You want a program with a diverse collegiate teaching staff that includes DNP-prepared faculty.

DNP programs should be true to their clinical and evidence-based practice roots. They shouldn’t be heavily grounded in research, as is the case with the PhD in nursing.

In addition to programs’ academic attributes, think about what you personally need to succeed, including flexibility, length, track options, cost, and work/school balance. A variety of program lengths, semester requirements, and flexibility options exists in programs across the country. Finding a program to fit your personal and professional schedule is critical to success. You’ll also want to find the learning option that’s right for you—online, traditional classroom, or a mix of both.

DNP career paths

Nurses with a doctor of nursing practice (DNP) work in various nursing roles that impact healthcare directly and indirectly.

Advanced practice RN (APRN). The clinical, leadership, economic, and organizational skills of APRNs with DNPs can significantly enhance healthcare delivery and patient outcomes. The DNP degree emphasizes evidence-based practice and systems change. The role of APRNs with a DNP is different than their colleagues with a master’s degree in nursing. This is attributed to additional training to influence clinical education, healthcare policy, and executive leadership. The four nationally recognized APRN roles are nurse practitioner, clinical nurse specialist, nurse anesthetist, and nurse midwife.

Clinical education. DNP-prepared nurses have roles within academia as clinical educators and organizational leaders who affect curriculum, educational costs, and program efficacy. Their didactic experience enables them to apply theoretical frameworks, translate nursing education research, and use information technology to influence educational institutions.

Healthcare policy. Because of their unique training to impact health – care policy, DNP-prepared nurses can influence complex, universal change by becoming involved in politics. Their experience in using professional collaboration to achieve outcomes makes them ideal candidates for advancing nursing agendas through legislative venues. They can bring attention to healthcare concerns by collaborating with politicians at the local, national, or global level.

Administrative leadership. The DNP degree prepares nurse leaders to transition beyond traditional leadership responsibilities into more advanced areas of healthcare governance, including executive administrative positions. DNP training encourages the use of innovative, evidence-based management practices to achieve efficient, collaborative, and sustained healthcare advancements.

Curriculum

The program you choose should have a curriculum built on the foundation of a bachelor’s degree in nursing (BSN) and/or a master’s degree in nursing (MSN), depending on the student’s level of entry. A DNP program will prepare you to translate evidence into practice; at the completion of the program, you’ll need to have accumulated a minimum of 1,000 practice hours.

Program entry pathways

DNP programs can be BSN-DNP or MSN-DNP, but they all incorporate The Essentials of Doctoral Education for Advanced Nursing Practice (DNP Essentials) and any additional professional standards and guidelines required by the university’s bylaws. The CCNE requires that institutions seeking DNP program accreditation use the DNP Essentials, which outline the competencies that are core to all advanced nursing practice, including the four nationally recognized advanced practice RN roles: nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives. DNP Essentials one through eight are the foundational outcome competencies necessary for all graduates of a DNP program regardless of specialty or focus.

Focus track

Students in a DNP program are required to have a bachelor’s or master’s in nursing. The core knowledge and competencies of BSNprepared nurses are based on the Essentials of Baccalaureate Education for Professional Nursing Practice; MSN-prepared nurses’ knowledge and competencies are based on the Essentials of Master’s Education in Nursing.

With this base, the DNP core competencies (for example, scholarship writing, theory, health policy, organizational culture, and evidence- based practice) provide a foundation for advanced nursing practice in a focused specialty, such as healthcare finance, organizational leadership, healthcare administration, technology, healthcare policy, and advanced practice nursing. For instance, tracks concentrated on healthcare administration or organizational leadership will emphasize organizational and systems’ leadership. (See Sneak peek: Sample course curriculum.)

Curriculum length

Curriculum length is based on institution, state, and various accrediting bodies that may require a minimum or maximum number of credit hours for a DNP. AACN recommends 3 calendar years or 36 months of full-time study, including summers, or 4 years on a traditional academic calendar.

Final DNP project

The DNP program you choose should include a final DNP project. Assess the practicality of the program’s DNP project requirements and review projects completed by alumni to determine the level of involvement and feasibility of the final evaluation. The following project examples from the DNP Essentials use the scholarly experience and application of evidence to affect healthcare policy, health systems, academia, and patient and practice outcomes:

portfolio that addresses the impact or outcomes related to a practice change and documents the final synthesis and scholarship
practice change initiative
pilot study
program evaluation
quality improvement project
evaluation of a new practice model
consulting project
integrated critical literature review

Tips for success

DNP programs have rigorous academic expectations. As you begin your DNP program, you may feel underprepared, frustrated, and overwhelmed. You’ll need to navigate a new educational platform, research databases, and course assignments. You’ll also need to maintain a healthy balance between family, work, and school. These tips will help you overcome some of these challenges and maintain balance for DNP success.

Uncover your passion. An essential prerequisite for any successful DNP student is a genuine passion for your topic. Choose a specialty area that energizes you and stimulates your thinking. Your education will monopolize a big part of your life for 3 to 5 years, so you’ll need serious and dedicated commitment to your chosen topic.

Read, learn, and network. Learn about the experts in your field of study and seek to collaborate with and be mentored by them. In addition, read about, watch, listen, and connect with leading authorities and researchers. These trailblazers, who apply innovative evidence into evidence-based clinical practice, will help you become a change agent.

Search the literature to establish what’s been uncovered in your field of study, what hasn’t been validated, and what’s been suggested, successful, or ignored. If you don’t know what already exists, you can’t make a substantial contribution to improving healthcare quality and enhancing clinical practice.

Persevere. Remain tenacious in pursuit of your DNP. You’ll face challenges but trust the process. The path to success requires a willingness to keep going. Relinquish perfectionist tendencies and anchor your mind to prioritize your work.

Transform patient care

Choosing a DNP program can be daunting, but you can find the right program to fit your financial, educational, personal, and professional needs. Your choice will ultimately increase your ability to transform patient care through the translation of evidence into practice and advocating for new approaches to cost-effective healthcare and improved patient outcomes.

All of the authors are DNP students at the University of Texas at Tyler. Rebecca Shipley is a family nurse practitioner at CHRISTUS Health System in Tyler, Texas. Barbara Chapman is a family nurse practitioner at The Community Health Clinic in McKinney, Texas, assistant clinical professor at Collin College, and clinical specialist at University of Texas at Tyler. Chiquesha Davis is manager of clinical faculty at West Coast University-Dallas Campus in Dallas, Texas. Christian Garrett is a family nurse practitioner at Medical Associates of Athens in Athens, Texas and an adjunct professor in the associate degree school of nursing at Tyler Junior College in Tyler, Texas. Sonya Grigsby is a critical care nurse practitioner at CHRISTUS Mother Frances Hospital in Tyler, Texas, and locum NP at OSF St. Francis Medical Center in Peoria, Illinois. Cyndi B. Kelley is a nurse manager in the special care nursery at Texas Health Presbyterian Hospital of Dallas. Chapman, Davis, Grigsby, and Kelley are fellows in the Texas Nursing Association’s 2018 DNP Policy Fellowship.

Selected references

American Association of Colleges of Nursing. The Essentials of Doctoral Education for Advanced Nursing Practice. 2006. aacnnursing.org/DNP/DNP-Essentials

American Association of Colleges of Nursing. Doctor of nursing practice (DNP) programs: Frequently asked questions. aacnnursing.org/Portals/42/DNP/DNPfaq.pdf

American Association of Colleges of Nursing. The doctor of nursing practice: Current issues and clarifying recommendations. August 2015. aacnnursing.org/Portals/42/DNP/DNP-Implementation.pdf

Degree Prospects. How to choose a DNP program.dnpprograms.com/faq/how-to-choose

Edwards NE, Coddington J, Erler C, Kirkpatrick J. The impact of the role of doctor of nursing practice nurses on healthcare and leadership. Med Res Arch. 2018;6(4).

Friedman J. 4 things to know about accreditation in online nursing programs. November 1, 2016. usnews.com/education/online-education/articles/2016-11-01/4-things-to-know-about-accreditation-in-online-nursingprograms

Grigsby S, Chapman B, Kelley CB, Shipley R, Garrett C, Davis C . DNP and PhD: Complementary roles. Am Nurse Today 2018 – 2019 Education Guide. 2018;13 (7):8-13.

The unique contributions of DNP-prepared nurse practitioners and other APRNs. doctorofnursingpracticednp.org/the-role-of-dnp-educated-nurses-in-advanced-clinicalpractice/

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