The American Association Colleges of Nursing (AACN) created the Doctor of Nursing Practice (DNP). The DNP was voted into existence through the member schools at AACN in 2004 (AACN, 2015a). The release of the Essential Document for the Doctor of Nursing Practice was finalized in 2006 (AACN, 2015b). The goal was to have the DNP as the entry into advanced practice by 2015. This has not happened as each state legislature must change legislation mandating such. Many of us probably remember all too well the American Nurses Association recommendation that entry into professional nursing practice be the Baccalaureate in Nursing. This recommendation was made in 1965 and has yet to come to fruition. There are also many forces that promote or stifle such change.
I remember all too well when the DNP was first instituted-many PhDs were adamantly against such a degree. Some stated that it was less of a doctorate. Even some deans of nursing were not in favor of this degree. I was speaking with a colleague of mine, a very well-noted nursing leader in our country, who viewed it this way: how can we not promote any nurse advancing their education? At the time, I was teaching nursing at a state college in New Jersey and was requested by the program director to explore the DNP with the possibility of creating such a program at this institution. I did this over the summer of 2007. I am a visual learner and need to experience things. Somehow, from my exploration, I enrolled in a DNP program. My PhD is in educational leadership with a concentration in infection control from the Graduate School of Education at the University of Pennsylvania. I always wanted a doctorate in nursing, so the DNP met that need, but my real reason for enrolling was to truly learn what the DNP was all about. I was probably one of the first nurses in the country to attain two doctorates, one being the DNP. From my perspective, it was one of the best things that I ever did for myself and nursing. I am a firm believer that a greater power, in my case, God, has a plan for everything and everyone. I had no idea at the time that our dean at Drexel would request me to be the Chair of Drexel's DNP program when the initial program Chair resigned that position. What enticed her with me was the fact that I had both doctorates and had a firm understanding of what a DNP did.
I must admit that, initially, I thought DNPs were relegated to advanced practice. As nursing is a practice discipline, the DNP focus is really on practice initiatives to improve care for the patients whom we serve.
AACN has clarified what advanced practice is:
The national dialogue about the DNP has amplified the need to clarify and restate how advanced nursing practice is defined. Advanced nursing practice, is any form of nursing intervention that influences healthcare outcomes for individuals or populations, including the provision of direct care or management of care for individual patients or management of care populations, and the provision of indirect care such as nursing administration, executive leadership, health policy, informatics, and population health (AACN, 2015b, p. 1).
As one can see from the statement above, it is about not only advanced practice nurses but also nurses who want to improve patient care. Nurse executives are in a pivotal position to affect such patient care improvement as, having been a Chief Nursing Officer/Chief Nursing Executive, the most important part of this role is the improvement of patient care.
DNPs translate research evidence into practice, whereas the PhD discovers the evidence. We need both types of doctorates. I view what a DNP does as implementation science.
One of the core courses and key focus areas of the DNP is health policy. Just think about how a health policy change based on research evidence can have a profound impact on patient care and the patient's health.
The chart below lists the key differences between both the DNP and the PhD.
So, how far has the DNP come, and where is it going?
The growth of both PhD and DNP programs have accelerated in the United States. A comparison of the growth of programs from 2006 to 2014 shows 134 PhD programs in the United States compared with 264 DNP programs in the United States (AACN, 2015a). The DNP programs have proliferated exponentially in the United States with more programs in the pipeline.
The American Association of Nurse Anesthesia programs have mandated that the class that enters an anesthesia program in 2022 must exit in 2025 with a DNP degree (American Association of Nurse Anesthesia, 2016).
There are many DNP programs now in existence that go from Baccalaureate in Nursing to DNP.
The reality is that the DNP is here to stay and will continue to grow. Each state will have to decide when implementation as the entry level into advanced practice needs to occur. As the DNP degree centers on practice, improvement of care for patients, leadership, systems change, and policy change, the DNP is in a perfect position to be the catalysts of such change in addictions nursing. Anyone of us in a leadership position needs to promote and encourage DNPs to be the change agents for improving care for those clients with substance use disorders.
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