Nursing education. The very term can ignite a debate—one that’s as old as nursing education itself. The debate is expanding as options for nursing education and degrees have grown. Current concerns focus on the potential for poor collaboration among nurses with different terminal degrees, and between doctors of nursing practice (DNPs) and medical doctors (MDs). Some people believe the DNP may widen the gap between academia and clinical nursing. In some cases, collaboration between DNPs and nurses with doctor of philosophy (PhD) degrees is poor, partly because of misunderstandings about the roles of these nurses.
Poor collaboration can impede both healthcare delivery and nursing education. Nursing has a rich history of using research in practice, pioneered by Florence Nightingale. This history lends itself to collaboration between DNPs and PhDs—and nurses should gravitate toward this collaborative model.
Doctoral nursing education began with doctoral programs in nursing education. The first doctoral program was offered by Columbia University in 1924 and granted an education doctorate (EdD). By the mid-1950s, only two additional doctoral programs in nursing education had emerged, and the first doctor of philosophy (PhD) in nursing was awarded. Since then, doctoral nursing programs have grown rapidly in the United States.
Today, debate centers on whether the terminal degree in nursing should be a teaching degree, a research degree, or a practice degree. The two primary terminal degrees now offered are the DNP and PhD. The PhD, which first became common in the mid-1970s, is research oriented. Nursing research degrees offered from the mid-1970s forward included the PhD and the doctorate in nursing science (DNSc/DNS). Many DNS and DNSc programs have since transitioned to PhD programs. (The doctor of education remains the terminal degree for teaching but isn’t widely offered in graduate nursing programs.)
How the DNP evolved
The DNP was first offered as a clinical doctorate at Case Western Reserve University in 1979, when it was called the nursing doctorate (ND). It soon became the DNP, with the University of Kentucky offering the first DNP program in 2001. In 2004, the American Association of Colleges of Nursing recognized the DNP as the highest level of preparation for clinical practice in nursing. Designed for nurses seeking a terminal degree in nursing practice, the DNP is an alternative to research-focused doctoral programs. The nurse with a DNP is equipped to fully implement the science developed by the nurse researcher with a PhD, DNSc, or other research-focused doctorate. From this perspective, the practice degree (DNP) and research degrees (PhD, DNSc) are complementary.
Putting research into practice: Role of the DNP
Until the mid-1900s, few nurses contributed to the use of research in practice. But recently, the nursing profession has provided major leadership for improving care by applying research findings in practice. Today, the application of research findings in practice is called evidence-based practice (EBP)—the conscientious and judicious use of the best and most current evidence, in conjunction with clinical expertise and patient values, to guide healthcare decisions. The evidence is developed by PhD-prepared nurse scientists, who share it through publication and presentation.
The best evidence includes:
- empirical evidence from randomized controlled trials
- evidence from other scientific methods, such as descriptive and qualitative research
- information from case reports, scientific principles, and expert opinion.
Once enough evidence is available, DNPs evaluate it and apply it in practice. Thus, nursing practice is guided by evidence from nurse scientists (PhDs) in conjunction with the expertise of doctorate-prepared clinician (DNPs), who incorporate patient and family values and wishes into the evidence-based and patient- and family-centric plan of care. The DNP becomes, in a sense, the “end user” of the evidence, adopting it, implementing it, and institutionalizing it as protocol.
Changing practice to apply evidence-based information in a particular context takes considerable effort at both the individual and organizational level. As the bedside clinician, the DNP understands the complex system of health care. Historically, bedside clinicians have relied on familiar practices rather than those based on scientific evidence. To introduce EBP, healthcare providers must navigate around political landmines. The DNP has the training, education, and practice expertise to lead multidisciplinary teams to embrace EBP to improve patient care.
Better collaboration between DNPs and PhDs
Ideally, DNPs and PhDs collaborate by getting organizations, teams, and individuals to adopt and consistently use evidence-based research findings and innovations in everyday practice. Suppose, for example, a PhD nurse and a DNP collaborate to improve care for patients with heart failure. The PhD nurse conducts randomized controlled trials, which show heart failure can be delayed or prevented through lifestyle modifications. The DNP develops this research and implements it at the practice level as a quality-improvement project—implementing the recommended lifestyle modifications, monitoring patient outcomes, and evaluating barriers created by actual practice that may not be evident in the laboratory setting. The DNP also follows patients longitudinally to determine the impact of the intervention.
As this example shows, PhDs develop the evidence and DNPs apply it to nursing practice. Working hand-in-glove in clinical and translational science in this way, DNPs and PhDs can maximize care of patients and their families.
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Kate Moore is an associate professor, clinical director of the Evans Center and Simulation Lab, Adult-Gerontology Acute Care Nurse Practitioner Specialty Coordinator, and Adult-Gerontology Primary Care Nurse Practitioner Specialty Coordinator at the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta, Georgia.