What’s the impact of the doctor of nursing practice?

Two landmark reports have shaped the future of nursing leadership: the Institute of Medicine’s (IOM’s) The Future of Nursing: Leading Change, Advancing Health and the American Association of Colleges of Nursing’s (AACN’s) The Essentials of Doctoral Education for Advanced Nursing Practice. These reports provide critical insights into the evolving role of the doctor of nursing practice (DNP) in advancing nursing leadership.

DNP overview

In 2008, the IOM and the Robert Wood Johnson Foundation (RWJF) launched a 2-year initiative to transform nursing education and practice. This effort culminated in the pivotal 2011 The Future of Nursing report, which emphasized the need for nurses to fully leverage their education, pursue advanced training, collaborate as equals with physicians, and play an active role in policymaking. The report’s recommendations resulted from a collaborative process involving key nursing stakeholders. Recognizing the potential of nurses to shape healthcare, the IOM and RWJF called for improved education systems that promote seamless academic progression, enabling nurses to take on expanded roles and responsibilities.

These recommendations led to significant changes in nursing education pathways. The AACN issued a directive for nursing schools to phase out master’s-level preparation for advanced practice RNs (APRNs) and transition to DNP programs by 2015. This marked a pivotal shift, fundamentally reshaping the profession’s educational landscape.

All 50 states and the District of Columbia have DNP programs in place. There are 433 DNP programs in operation across the nation, the AACN states, with 87 new DNP programs being developed (42 post-baccalaureate and 45 post-master’s). Similarly, post-baccalaureate DNP programs were offered at 299 schools in 2023; post-master’s DNP programs at 397 schools; and entry-level DNP programs (prelicensure) at eight schools.

This growth reflects the increasing importance and acceptance of the DNP model in nursing education. (See DNP program growth.)

The AACN reports that, from 2020 to 2021, the number of students enrolled in DNP programs increased from 39,530 to 40,834. Likewise, the number of DNP graduates increased from 9,158 to 10,086. The Future of Nursing reported 4,855 DNP graduates in 2016. Key findings from AACN noted the following 2023–2024 baccalaureate and graduate program enrollments and graduations (the survey represented 975 schools; 90.1% responded):

• Sustaining enrollment in graduate nursing programs remains a challenge in the United States.
• Master’s in nursing program enrollment decreased for the third year in a row, indicating 1,176 fewer students since 2022.
• PhD nursing program enrollment has declined over the past 10 years, with a 3.1% decrease from 2022 to 2023.
• DNP program enrollment increased by 2.0%, demonstrating two decades of steady enrollment.

According to the National Council of State Boards of Nursing, nurses represent the largest segment of healthcare professionals, with over 5 million active RN licenses in the United States. For this reason, nurse leaders must serve at the forefront of decision- and policymaking rather than in solely traditional bedside or practice roles. Although few changes have occurred over the past few years, nursing leadership transformation requires more effort. (For more details, visit campaignforaction.org/resource/number-people-receiving-nursing-doctoral-degrees-annually.)

One of the key messages in The Future of Nursing report emphasized the need for nurses to collaborate with physicians and other healthcare professionals in restructuring the nation’s healthcare system. The report also noted, “Strong leadership is critical if the vision of a transformed healthcare system is to be realized. To achieve this vision, the nursing profession must produce leaders throughout the system, from the bedside to the boardroom.”

DNP leadership continues to impact the healthcare infrastructure and delivery systems. However, nursing leaders must push for equal respect among peers in the decision-making and implementation of healthcare policies at all levels.

Why a DNP degree?

Carnevale and colleagues describe the DNP as establishing an individual’s clinical expertise. It also focuses on evidence-based practice, policy changes, and innovation. Nurse leaders are essential to shaping the nation’s ever-changing complex healthcare system and policies. Doctoral-prepared nurses can bridge the gaps in our healthcare delivery system and implement organizational, local, state, and national changes. In addition, nurses with DNP degrees understand the needs of individual patients and specific target populations.

Rather than research (the emphasis of PhD programs), the DNP offers a practice-focus for nurses seeking advanced clinical expertise. DNP-prepared nurses excel in using information technology, applying evidence-based practice, and collaborating across various disciplines. The increasingly complex and dynamic demands of 21st-century healthcare require these competencies. The National Research Council described the DNP as playing a critical role in preparing expert practitioners and providing an option for mitigating the ongoing shortage of nursing faculty.

DNP, leadership, and clinical practice

The AACN’s Essentials report includes several key findings regarding DNP practice and nursing leadership, including the need for effective communication and collaborative skills to develop and implement practice models and guidelines, peer review, health policy, standards of care, and other scholarly products. These leaders direct interprofessional teams in analyzing complex practice and organizational issues, and they use consultative and leadership skills to create change within complex healthcare delivery systems.

The DNP degree equips nurse leaders with the evidence-based knowledge necessary to improve patient outcomes and make a positive community impact. These leaders enhance patient care through evidence-based practice, quality improvement projects, patient advocacy, care-model development, technology integration, and policy reform. In management roles, DNP-prepared leaders improve healthcare system efficiency by guiding interdisciplinary teams, engaging in strategic planning, managing finances, and fostering professional development and mentorship.

DNP students must implement evidence-based practice projects (usually in their place of employment). Even before graduating from the DNP program, they have gained experience in improving health outcomes and influencing change.

DNP impact on nursing education

Developing the future nursing workforce requires nurse educators with DNP degrees. According to an AACN survey, 79.8% of vacant faculty positions recommend or require a doctoral degree in nursing. The National Advisory Council on Nurse Education and Practice reports that about 30% of DNP graduates plan to pursue careers as nurse educators. The IOM’s 2011 report challenged academic institutions to double the number of nurses with doctoral degrees by 2020 to combat faculty shortages and enhance teaching capacity. However, in 2023, U.S. nursing schools turned away 65,766 qualified applications (55,111 from entry-level baccalaureate, 703 from RN-to-BSN, 5,491 from master’s, 4,225 from DNP, and 236 from PhD nursing programs) due to a lack of faculty, underscoring the ongoing need for DNP-prepared educators. (See Turning away applicants.)

Ultimately, the DNP will have a positive impact on both undergraduate and graduate nursing education by contributing to the creation of a workforce of nurses with terminal degrees capable of fulfilling educator and faculty roles. DNP- and PhD-prepared faculty function similarly in the academic environment with regard to teaching, scholarship, and service, with PhDs focusing on research and DNPs focusing on practice.

DNP faculty

The AACN 2024 Faculty Vacancy Survey offers valuable insights into staffing levels within nursing academic institutions. Out of 1,087 schools surveyed, 808 responded with a 74.3% response rate (slightly lower than the 84.5% recorded in 2023). The overall faculty vacancy rate increased marginally to 7.9%, up from 7.8% the previous year, reflecting a slight rise in unfilled positions. However, for schools reporting vacancies, the rate decreased from 10.1% to 9.9%. These findings suggest that, although vacancies remain an issue, fewer institutions are experiencing severe staffing shortages. The survey offers a snapshot of the ongoing challenges in nursing academia, showing a slight overall increase in vacancies but some improvement for institutions struggling with faculty gaps.

DNP limitations

Concerns persist about whether online DNP programs match the rigor of in-person courses. According to AACN, no evidence exists to suggest that online DNP programs yield lower-quality outcomes, skill sets, satisfaction, or preparation compared to traditional in-person programs. Understanding the clinical differences between APRNs prepared with a master’s degree and those with a DNP degree also remains limited. The AACN notes challenges in isolating distinctions in the clinical skills of these two groups. Martsolf and colleagues offer the first study to compare outcomes between APRNs with master’s degrees and those with DNPs and found no statistically significant differences in patient outcomes.

Limitations also exist in the data on outcomes specifically attributed to DNP-prepared clinicians compared to other nurses and healthcare professionals. Interviews conducted by the AACN with healthcare systems revealed that although the profession requires data on DNP outcomes, it’s not currently being collected. The AACN recommends that healthcare organizations establish processes for measuring DNP system-level outcome data, develop a plan for identifying appropriate metrics, and conduct research to isolate the impact of DNP graduates on patient and system-level outcomes.

Future recommendations

The DNP degree adds value to nursing; it has demonstrated improvements in evidence-based practice, organizational change, quality improvement, and leadership. In an AACN 2022 survey, 94% of the participants reported extreme or moderate satisfaction with their decision to acquire a DNP degree. The demand for DNP education continues to increase. According to the AACN, from 2010 to 2020, the number of DNP programs increased from 156 to 384, and the number of enrolled DNP students rose from 6,599 to 35,755.

Much progress has been made toward the DNP degree as entry to advanced practice nursing, with many programs adopting a BSN-to-DNP model. Recommendations by the AACN to transition fully to the DNP degree as entry to advanced practice nursing include conducting patient care outcome studies, providing organizations with data regarding the capabilities of DNP-prepared APRNs, documenting strategies on overcoming BSN-to-DNP barriers, showcasing examples of collaborative partnerships, and providing clarity around DNP projects.

The future of DNP education will be rooted in competency-based education, which shifts the nursing education teaching-learning paradigm from content to competencies and from student interactions to student engagement. Learner outputs—ability to analyze, formulate relevant actions, and perform those actions with confidence—serve as the core of competency-based education. Competency-based education addresses the call for improved quality and safety in healthcare. (See Nurse leader opinions.)

Meet evolving needs

The DNP degree plays a critical role in advancing healthcare systems and delivery models. However, nurse leaders must continue advocating for the equal recognition of DNP-prepared professionals, particularly in decision-making and policy development. Although critiques persist, DNPs serve as an essential bridge between research and patient care and they can help to reshape and advance healthcare infrastructure. Future research should focus on assessing the impact of DNP practice, identifying how to bridge the knowledge gap between DNPs and PhDs, and exploring the degree’s potential to meet the evolving needs of modern healthcare.

The authors are assistant professors at Bowie State University in Bowie, Maryland.

American Nurse Journal. 2025; 20(7). Doi: 10.51256/ANJ0725108

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