Aligning Nursing Education to Reflect a Broad Approach

Will the DNP Be the New NP Requirement?

By Julia Quinn-Szcesuil

Initiatives to increase nursing education and training continue to evolve as the nursing industry and approach to patient care change over time. From the push to have nurses earn a BSN to current deliberations about requiring a doctorally prepared advanced nursing workforce, nursing education remains at the industry forefront. Currently, nurse practitioners (NPs), who now earn the NP credential with a master of science in nursing (MSN), might need a doctor of nursing practice (DNP) to be considered qualified as an NP.

Why a DNP?

While the switch would standardize the skills for NPs, if the industry moves to require a DNP for NP practice, nurses who want to pursue an MSN without the NP path will still be able to do so. Although the master of science degree in nursing will not be eliminated, the charge for NPs to earn a DNP addresses changes in the nursing industry and the broader healthcare system. As the increasingly complex approach to high-quality patient care requires in-depth knowledge and practice, the time requirements for preparing NPs increased.

Dr. Joan Stanley, the chief academic officer of the American Association of Colleges of Nursing (AACN) (AACN), says the move to DNP was first introduced decades ago.

“Since 2003, AACN has convened a series of task forces which all recommend that nursing, particularly programs preparing advanced practice registered nurses, should raise the level of education to include a greater focus on quality improvement, system thinking, and the social determinants of health as well as additional time and opportunities for nurses to integrate these competencies into their practice,” she says. “This additional knowledge is needed to address the gaps and needs in the healthcare system and to prepare NPs and other APRNs for their full scope of practice.”

The DNP offers particular benefits for nurses who are especially interested in a clinical component. “I truly believe that DNPs have the advantage of still having the ability to practice clinically,” says Danielle McCamey, DNP, CRNP, ACNP-BC, FCCP, assistant dean for clinical practice & relationships at Johns Hopkins School of Nursing, and founder, president, and CEO of DNPs of Color. “The understanding of systems/leadership and the basic scholarly knowledge of putting together performance improvement, quality improvement, and evidence-based practice projects gives us a versatility to impact practice in a real-time sense.”

Aligning Degree Requirements

Several factors weigh into the initiative to see NPs achieve a standard DNP level of education, says Shannon Idzik, DNP, ANP-BC, FAANP, FAAN, professor and associate dean of the Doctor of Nursing Practice Program at the University of Maryland School of Nursing and the president-elect of the National Organization of Nurse Practitioner Faculties (NONPF).

Over time, she says, MSN credit requirements have grown faster and out of proportion to MS programs in other industries. Required credits for an NP could stretch to 45-50 for an MSN—far over the typical 30-35 credits for most master’s degrees. While this academic requirement was needed to help nurses gain all the necessary skills and knowledge for the roles they would fulfill, says Idzik, it also left nurses with degree credentials that didn’t reflect their extensive education. For example, some nursing specialties and nurse anesthesiology have already implemented the DNP requirement.

The additional credit creep was gradual and reflected the changing healthcare landscape.

“Healthcare is increasingly complex and complicated, and we were not able to put the content into the MS programs that were necessary for healthcare at that level,” Idzik says. Stanley agrees. “There is a growing body of research, which shows that higher levels of nursing education are linked to better patient outcomes,” she says. “The transition to DNP education increases the knowledge, skills, and abilities needed to address the many gaps in patient care.”

As with all individual nursing paths, the journey to DNP will look different for each nurse. The initiative doesn’t require nurses to take a straight path from BSN to DNP, says Idzik, although that is an option.

According to Stanley, some BSN to DNP programs build options for students to perform RN work while starting their graduate coursework. Just as many nurses today take time between the BSN and the MSN NP to work in the field and gain hands-on experience, nurses may continue to make that choice. “The transition to the DNP for NP education should also provide additional time and opportunities for clinical practice in the NP role,” says Stanley.

Parallel Credibility

Parity with other healthcare leaders is another factor, though smaller, that informs this initiative. When nurses sit at a table with other leaders, many of whom have required doctoral credentials, there may be a credibility issue in some instances, Idzik says. Stanley says the DNP addresses that gap. “The transition, in addition to this expanded knowledge and experience, will give the NP the credential which more clearly recognizes their preparation and is recognized as a health professional leader,” says Stanley.

McCamey says as more nurses earn a DNP, a greater impact will evolve. “DNP degree education is structured around leadership and digging deeper in clinical knowledge and understanding,” she says. “The nursing industry will benefit from a body of clinicians that can assess systems, policies/structures, and have the skill set to make changes that improve quality and performance so that care is aligned with an evidence-based practice that directly impacts care and outcomes.”

Clinical Focus Remains

Master’s level programs were traditionally relatively clinically focused, says Idzik, and a DNP curriculum raises that clinical training to a level that allows nurses to go deeper into skills that take in population health, data and informatics, and social determinants of health. Some nurses will use those broadened skills to work on national policy change or their gained leadership skills to advocate for nurses and patients in their workplace. Idzik says others will choose to use them for one-on-one patient care.

“The DNP lets nurses move the focus from the patient in front of you to the entire population,” says Idzik. “It is more of a systems level of looking at a patient population.” So for a patient being seen for asthma, nurses will broaden the scope to consider the impacts of housing, environmental exposure, or access to care.

“My DNP degree introduced me to a different level of networking and access to other doctorally prepared nurses to begin collaborating and creating transformative changes in nursing,” says McCamey. “Having access to these professionals and also creating ways to elevate others is probably my biggest benefit.”

Nurses are needed to lead healthcare, says Stanley. “Nursing as a profession needs to raise the benchmark for education, accountability, and in practice,” she says, “and step up and take the lead in the healthcare system.”