DNP vs. PhD for Advanced Practice Nurses

Introduction

The health sector comprises of varied issues, which call for the attention of all the stakeholders. Some have received the necessary attention, while other issues still face challenges in regards to the final decision. One major issue revolves around the recommended level of education for practicing nurses. In the recent past, there has been no clear cut recommendation on the advanced training that nurses can undertake in an effort to advance their knowledge. Nurses face a dilemma when it comes to further studies, and it is a tough task to choose between the Doctor of Nursing Practice (DNP) and Ph.D. degree (Carty, 2011).

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This subject is relevant, since major institutions in the world and the US, in particular, have indicated that a clinically focused advanced practice degree should become the entry into practice requirement for advanced practice nurses. For instance, the recent announcement by the Commission on Collegiate Nursing Education that only practice doctorate programs, which award the DNP degree, will be considered for CCNE accreditation is a sign of major conflicts to come. This implies that the move will offer nurses with a professional degree commensurate with that earned by physicians, pharmacists, or other health care providers (Carty, 2011).

In the past, nurses in academia earned PhDs in sociology, education, physiology, or any other field, and their education was often related to nursing research or education roles and professions. In the 1970s, the nursing profession faced the challenge of convincing university administrators that the discipline of nursing had created a substantive knowledge base of its own, hence justified to get a Ph.D. degree (Allen, 2010). This did not go down well with the university administrators forcing the nursing schools to establish their own professional degrees, which were only granted by parent universities. With time, these professional degrees quickly resembled Ph.D. programs in universities, and the Ph.D. degree in nursing was finally embraced (Allen, 2010).

In the event of this development in nursing education, nursing leaders face the dilemma of which advanced degree should be awarded in their schools. The major challenge is whether nurses should continue to earn more established and renowned research-focused Ph.D. degrees, which permit their entry to university tenure tracks, or whether they are expected to earn terminal professional degrees like DNP, which are practice-focused (Chism, 2009). The recent trend in nursing schools setting up the DNP programs leaves the stakeholders questioning the criteria, under which the degrees DNP and Ph.D. will differ, especially in their objectives, standards, and curricula.

Literature Review

To promote a clear understanding of the two advanced degrees in nursing, DNP, and Ph.D., the pertinent history and research done into the subject is necessary. Clear definitions of both degrees, including their competencies, will be discussed in this section. The nursing field faces challenges in the proper advanced studies when it comes to practicing nurses. The tug of war remains on which will serve efficiently for the advanced nurses when it comes to advanced degrees as there are research-focused degrees and practice-focused degrees.

Nursing research is categorically a systematic approach utilized to study phenomena significant to nursing, as well as nurses (Webb, 2012). Since nursing is a practice profession, it is pertinent that clinical practice is anchored on scientific knowledge. From the progression of the nursing research endeavors, nurses have been proactive in employing nursing research in order to have a more significant impact on the care of individuals, as well as aggregate groups (Ellis, Berger, & Hartley, 2009). On the other hand, the doctor of nursing practice (DNP) has been recommended by the American Association of College of Nursing as the terminal degree in nursing practice by the year 2015.

According to the American Association of Colleges of Nursing (AACN), in 2006, the doctor of nursing practice (DNP) was a practice-focused doctorate and terminal degree for professional nursing practice (Chism, 2009). Since the announcement in 2004 for the DNP to be the minimum degree for preparation for advanced practice nurses, more than 90 universities offer the programs. The growth coupled with acceptance of this new doctoral degree in the field of nursing has resulted in some confusion among nurses regarding doctoral-level education in the field of nursing. In the history of nursing, doctoral education for nurses has grown along with a number of paths (Harnes, 2009).

The 20th century had no doctoral programs meant for nurses. In turn, nurses had minimal options but to earn doctorates outside of nursing. This saw the emergent of PhDs in the nursing field, especially those earned in the basic science fields like physiology and anatomy (Harnes, 2009). The first doctoral program that was tailored for nurses originated from Teacher’s College, Columbia University New York in 1924. This doctorate was meant to prepare nurses to teach at the college level. A review of literature in relation to the DNP illustrates that the debate is complicated in nature, focusing on both clinical and academic issues together with issues touching the professional practice of nursing.

A major element in the transition from PhDs to DNP for practice entry is the identification of strengths as well as weaknesses of the new option, interests, and prejudice held by various nursing stakeholders. The nursing profession’s extensive history of various doctoral educations avails a prime environment for the debate of DNP versus Ph.D. In the past, many nurses have chosen to pursue doctoral degrees in neighboring disciplines like the Doctor of Public Health. PhDs prepare nurse scientists with a formidable platform in the research methodology. Research is for the purpose of establishing empirical knowledge in the nursing profession (Webb, 2012).

In terms of conducting this research, there is a refinement and validation of existing knowledge, which gives room for the development of new knowledge. Research findings form the basis for practice behaviors and decisions. Nurses with PhDs are proficient in undertaking primary research and have a dissertation requirement for graduation. However, analysis into the curricula of DNPs indicates that nurses are being conceptualized as highly skilled clinicians with in-depth knowledge concerning the utility and synthesis of research (Chism, 2009). The pinnacle of DNP education is comprised of undertaking a practice-focused project, which may assume various configurations depending on the program’s focus.

The conundrum regarding the doctorate practice introduces an obstacle to the nursing profession. According to scholars in the field, DNP seems to be the most appropriate step to be followed in nursing education to some stakeholders (Chism, 2009) and a regressive step to others. In 2004, AACN defined an advanced nursing practice as any form of nursing intervention, which impacts on healthcare outcomes for individual populations, including the direct care of individual patients, management of care for individuals and populations, administration of nursing and health care organizations, and the development and implementation of health policy.

Many scholars agree on the change in health care making it more complex and demanding; hence, there is a need for evolution. Emerging issues in health care have led to the need for practitioners with an expanded knowledge base and advanced educational background (Frith & Clarke, 2012). The doctoral preparation for both expert researchers and practitioners may provide a stronger professional knowledge base to expand the science of nursing.

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For instance, the hour requirements for a Master’s degree in nursing have steadily increased, leading to a degree, which is not representative of the educational time commitment. Many advanced practice nursing degrees call for 45 to 50 credit hours as compared to 30 hours in other disciplines. The augmented intricacy of healthcare is progressively requiring more education in the case of advanced practice nurses. A major concern is a continuous growth in breadth, as well as the depth of the Master’s programs in a manner that is not any more socially responsible (Harnes, 2009).

There is a major concern being raised over the entry-level doctorates of other health care fields and DNP. It is evident that the practice doctorates of neighboring health care providers differ from the introduced DNP to a considerable degree. The nurse's desire to copy the practice doctorates of other disciplines has resulted in the unfortunate development of multiple nursing doctorates and titles (Carty, 2011).

In addressing the subject of DNP versus PhDs in the nursing field, it is essential to consider the views and opinions of potential doctoral students, who may ultimately fill faculty positions. The practice-focused DNP may be appealing to contemporary practicing nurses, who are devoid of the desire to further the education by undertaking a doctorate through a research foundation. 55% of students studied from 5 DNP programs exhibited an interest in pursuing nursing education (Chism, 2009).

A majority of these students deemed the DNP to be in tandem with their professional goals and demonstrated a lack of interest in a doctorate that is holistically research-based. Furthermore, researchers estimate that the program will augment the number of nursing educators, who are of doctoral degree prepared in the long run. Another concern, however, arises in relation to university guidelines regarding minimum requirements for the faculty, which may serve a function in determining DNP positions in the faculty.

In addition, some scholars believe that DNP plays a significant role in preparing nurses through the research translation into their practicing in an appropriate position to take up faculty positions despite their lack of a research-based doctorate. Their knowledge as expert clinicians is viewed as essential in the education of competent nurses at all levels.

Other scholars prefer the Ph.D. prepared educator as the best option in the debate. The missing emphasis on primary research is indisputably a major handicap to the quality of a member of the faculty, who is DNP prepared. Proposers of PhDs discuss the lack of research methodology as an epistemological mistake in the development of the DNP and fear that without a background in research methodology, the DNP will lead to a void in the production of nursing knowledge (Reilly, 2010).

Another concern is that devoid of the extensive knowledge to execute scholarly research, such as seen with Ph.D. prepared faculty, the DNP prepared educator is predisposed to be passive in the academic world. Subsequently, the DNP will compromise nursing standards; hence, forfeit its leadership function at a university level (Reilly, 2010). Additionally, the DNP is seen as a threat to enrollment in Ph.D. programs and a potential negative factor, influencing the performance of nursing faculty and its contribution to scholarly nursing research. The number of applicants seeking doctoral study is already limited, and it is proposed that students may unwillingly end up in the DNP programs when their intention was to pursue the traditional research-based doctorate (Helvie, 2008).

Practice-based programs understandably place a greater emphasis on practice and less focus on theory, meta-theory, research methodology, and statistics than its counter-part research-focused programs. Scholars indicate that practice-focused doctoral programs generally encompass integrative practice experiences coupled with an intense practice immersion experience (Harnes, 2009). Rather than a knowledge-generating research effort, a learner in a practice-based program generally gains in the practice and application of the nursing profession. Research and practice-based doctoral programs in nursing have multiple analogous and demanding expectations.

Each approach calls for a scholarly approach to discipline and a commitment to the advancement of the profession. Both doctorate approaches are terminal degrees in the discipline with one being practice-based and the other having the focus on research. Despite the above-identified similarities, the approaches exhibit major differences, which contribute to the present debate that carries out an application-oriented practice, which is a major part of the integrative practice experience (Harnes, 2009).

Another major concern, in the debate, is the impact of the chosen approach on patients. Proponents of DNP argue that DNP prepared advanced practice nurses may be able to fill increasingly required positions of primary care providers (Chism, 2009). The aging population in the US and other parts of the world faces a complicated chronic illness with contributing factors, which are not only genetic in nature but also influenced by patient’s behaviors and lifestyle choices. Doctoral prepared advanced practice nurses to have the knowledge to manage the aspects of this chronic illness as well as influence the patient’s behavior as a result of the unique nature of the nurses’ educational background.

In this case, the patient-centered approach, which is aligned with DNP, prepares nurses to contribute to patient care through education vastly (Helvie, 2008). Despite the highlighted benefits and weaknesses of each doctoral approach to nursing, there is a need for further research on the subject. The nursing field needs to ensure that the chosen approach gives the nurses, patients, and other stakeholders’ value in terms of their money and time. The decided upon approach to advanced studies in nursing should be the one, which will help the nursing field to grow both practically and academically. In addition, there is a need to incorporate evidence-based practice (EBP) in nursing (Ubbink, Guyatt, & Verneulen, 2013; Tagney & Haines, 2009). Thus far, education efforts have failed to address the application of EBP in the routine clinical problem-solving.

Discussion

Current Scope of the Issues

Doctor of nursing is a course that is a practice based in the medical field. This course began in the early 1970s. It focuses on advanced clinical practices, which are in contrast to the Ph.D., which focuses on the research. The key objective of this course was to lift nursing in order to equate it with other professionals and disciplines in the country. This course gathers its ideas on clinical proficiency and skills, although it emphasizes that an individual should have the capability of doing any form of scholarly research (Carty, 2011).

The current issue at hand is the fact that the majority of students pick the DNP course instead of a Ph.D. when they want to advance in their education. This is evident since statistics indicate that approximately 184 DNP curriculums are enrolling students at various schools of nursing across all states. This is an indication that the government also assists schools by supporting this form of advanced education. Additional DNP courses are on the planning stages, awaiting implementation. These programs are available in approximately 40 states, while other states have up to five schools offering the same.

The number of students enrolling in this advanced course is increasing rapidly; for example, 7,034 students enrolled in 2010 and 9094 enrolled in 2011. This is an indication that the majority of students prefer the DNP program over the Ph.D. (Smith, Duel, & Martin, 2012). This study carried out in all the states in America indicates that the number of students enrolling for the Ph.D. curriculum has been steady over the years, although its increasing rate is lower than the number of students enrolling for the DNS.

The two degrees differ since the DNP degree is focused on practice, while the Ph.D. is a degree that focuses on research in the medical field. It is evident that the DNP degree adequately prepares an individual to be an expert in practice during work. The program of this course focuses on key areas such as leadership, clinical, information technology, inter-professional collaboration, and all the relevant health care policies. The DNP places less importance on the research methodologies and theory in relation to the Ph.D. program (Harnes, 2009).

In addition, the scholarly projects vary, since the Ph.D. program includes a dissertation. This scholarly project is based on clinical activities and ways, in which research affects practice. The dissertation, on the other hand, is a demonstration of the new knowledge or inventions, which can be brought into the discipline of nursing. This has created confusion among medical students because they are not aware of the difference and content in the courses. Both medical programs offer students advancement in the nursing profession.

Identification of the Stakeholders

The two stakeholders in this issue involve the students and the education providers in a society. Evaluation of both the DNP and Ph.D. is of relevance offering to nurse since a growing number of institutions in the United States of America recently highlighted that a clinically focused advanced practice has to be validated to become a requirement for advanced practice nurses. The DNS in nursing emerged because nurses, who were willing to obtain Ph.D. had to study a program that was geared towards education, for example, physiology, education, sociology that led to areas other than nursing (Allen, 2010).

A student might gain a DNS program, although there is a need to study a Ph.D. to attain a higher level of education in the nursing field. This is because both programs offer different approaches to the study, and for a student to be fully educated, it is vital to undergo a DNS and Ph.D. curriculum. Key findings indicate that DNS in nursing emerged to ensure that students, who graduate from college, have an extensive base in knowledge on their courses.

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This course was created to equalize them with other medical practitioners such as psychologists, optometry, and dentists. This course also trains nurses to become reliable leaders, who are able to socialize professionally to assist the medical condition of the community at large (Smith, Duel, & Martin, 2012). This course has become popular since nurses are capable of making independent decisions while taking care of patients without the presence or assistance of doctors.

The requirements for pursuing this form of the program are flexible since nurses from any college can enroll and advance their training. This education aims at training nurses on the ways of directly caring for the patients and improving their service delivery, management of clinical schemes, and patient’s outcome (Harnes, 2009). Although the DNS program is open for certain professionals, it is the advanced form of nursing studies that offer practical education. The group of nurses, who can join this program, includes clinical nurse specialists, nurse midwives, and anesthetists since they have the basic education required to undertake the course.

Accessing a Ph.D. admission is difficult since an individual has to attain a certain grade in the first degree; therefore, the majority of nurses shy away from enrolling in such a program. The majority of students attain nursing education in colleges, which do not offer a Ph.D. course, and these nurses are not likely to consider this area of study (Harnes, 2009). There has been a rapid development in the health care industry, which has forced many colleges to increase their curriculum by adding the DNS option. Employees recruit nurses with a DNS since they are aware that they have undergone an advanced level of nursing education.

The rapid expansion of health care information has increased the pursuit to have more nurses’ progress in their education and practical levels. Students are trained on the most realistic skills instead of memorizing the contents of the course. This way information amalgamates quickly, and the levels of critical thinking are being polished to ensure an improvement of patients’ outcomes in the health sector. The DNS course consists of an extensive program, which calls for the specialists’ assistance in choosing only the pertinent topics. A DNS graduate is supposed to acquire an extensive scope of information based on various vital areas of practice (Chism, 2009).

It is evident that nurses often work under the supervision of doctors; this leads to the introduction of the degree in DNS, where nurses gain knowledge, which allows them to work independently. This is because the clinical DNS concentrates on dealing with the care of patients directly. It also highlights the gaining of research skills and a superior delivery of care, which can be applied in the workplace (Allen, 2010). This course is widely sought since it bases its syllabus on the training of nursing in the pure clinical environment rather than the theoretic part in the Ph.D.

Another cause of the shift in attaining a DNP rather than a Ph.D. degree is the fact that it allows an individual to attain a certain unique rank in the health care group. It is evident that obtaining a DNS practice signifies this profession to other available medical disciplines (Reilly, 2010). When arranging certain health care teams a DNS gets a higher rank in relation to other medical practitioners. Similarly, a Ph.D. holder will be placed in a higher rank, although the DNS will be immediate reporting to them. The DNS graduates are great team leaders in comparison to the Ph.D. ones since they have experience in the work area, which allows them to know how to lead effectively.

General Recommendations Reform

It is evident that the majority of individuals are shifting to enroll in the DNP rather than the Ph.D. program. It is vital for the students to identify the clear and distinctive goals of each program in order to make decisions wisely. An outcome of each program should also be evaluated to allow all the students to make decisions regarding the course they wish to study in relation to their goals in the study. It is recommended that students realize the existing differences between the two courses. The DPN program prepares students for direct patient care and leadership roles in the workplace, while the Ph.D. ensures that nursing students are ready for advanced careers such as research scientists in both academic and governmental positions (Smith, Duel, & Martin, 2012).

The DNP creates a platform for nurses at the advanced levels of practice, and they are well placed in translating and applying all the research carried out in practice. On the other hand, a Ph.D. objective is to allow a student to carry out research that elevates the theological basics of nursing and health care in the whole world (Reilly, 2010). The competencies and content in a DNP facilitate for a nurse the process of acquiring knowledge and the ability to translate the research into practice, which leads to the incorporation and dissemination of new information in the health care industry. A Ph.D. graduate gains knowledge and ability in analytic approaches, theoretical methods to discover and utilize knowledge in health care and nursing.

The outcome of a DNP school is to ensure that a student demonstrates the advanced or rather specialized levels of the clinical verdict, accountability in designing, systems thinking, evaluating evidence-based care, and delivering leadership skills that will ensure that there is an improvement of patients’ outcomes (Chism, 2009). A Ph.D. expected outcome is a nurse scientist who is capable of researching academic issues and other research studies in the nursing profession.

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Plan of implementations for reform. These reforms are clear and simple to implement. The curricula of both programs must be relevant to nursing practice and advance nursing knowledge. Nurses should consider both programs and choose the most appropriate advanced training that is in tandem with their career goals. Both programs are essential. Ph.D. lays emphasis on research in order to advance nursing knowledge. Research in nursing practice is essential and should be a continuous process. A Ph.D. degree is suited to nurses, who aspire to be research scientists in the nursing profession. DNP enables the nurse to advance in clinical practice. Such a program is suited for nurses, who aspire to attain a relevant mastery of nursing knowledge that pertains to the clinical practice (Reilly, 2010).

Method to evaluate policy change. A comparative study should be conducted on the curricula development of both programs. In addition, a follow up should be made on the quality of graduates rolled out by both programs. This will entail an assessment of evidence-based practice in the nursing profession. The performance, relevance, and significance of the two sets of graduates should be noted.

Conclusion

The arrival of the DNP program became a source of perplexity within the nursing society and education. This study focuses on the elements that explain the distinction between DNP and Ph.D. in an effort to clarify this situation. This research has also highlighted the major trend in the society regarding the shift of many students from the Ph.D. to the DNS program. Competencies in relation to DNP have been outlined and identified to the expectations of the students after their studies in college.

In addition, the detailed cases of both the DNP and Ph.D. graduates’ significance have been highlighted in the research. This is to explain that the larger part of the students do not understand that the degrees are related, but do not offer the same syllabus. It is obvious that the DNP practice is beneficial to an individual, who is interested in practical studies, then to a student, who finds interest in research work.

Students who have a DNP are excellent in skills, such as first aid, patient caregiving, leadership, decision making, and system operations, while the Ph.D. graduate are efficient in research operations, which bring change and improvement in the society at the moment. It is vital for students to make a decision on the program to study in order not to be mistaken due to the lack of knowledge in terms of the differences between the abovementioned curricula.

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