State of the DNP

¶ … DNP today a clash of culture, power, politics or none of these?

When first instituted, the DNP (Doctor of Nursing Practice) degree was thought to address a very important deficit within the nursing profession, namely a need for greater preparation of nurses to enter an increasingly complex and technologically sophisticated medical environment while still staying true to the practice-based focus of nursing. Before the DNP, nurses could either effectively remain stalled at the master's level of education or they could pursue a PhD, a research-focused degree. The DNP was designed to 'bridge the gap' between these two degrees for nurses who wished to remain in clinical practice yet gain a greater grounding in evidence-based medicine. Today, "there are many enthusiasts toward the DNP. Seen by some as a symbol of social progressivism…better parity with other practice disciplines such as medicine, audiology, physical therapy, and pharmacy, which all require a doctoral degree for entry into practice" (Bellini 2012:6). Thus, the DNP is not without precedent in other fields and can be seen as another step towards parity and the demand that nursing be regarded as an equal to, rather than as an auxiliary to other fields of medicine. It is patient-focused like all nursing degrees, and based upon the core principles of the nursing profession and nursing theory but invests those principles with a greater degree of academic focus.

The DNP also provides additional training for nurses to meet the new responsibilities they must shoulder. Nurses are increasingly asked to take on managerial tasks as well as many of the diagnostic and medical treatment capabilities once thought to be solely the realm of physicians. "In relation to the goals for health care reform, the need for advanced practice nurses with an additional skill set encompassing policy making, quality improvement, and evidence-based practice is clear" (Bellini 2012:6). However, perhaps most importantly is the fact that there is a severe faculty shortage of qualified nurse educators. In fact, despite the nursing shortage and the upsurge of individuals wishing to enter the profession, many qualified potential students are turned away from nursing schools because of a lack of qualified teachers. "The preparation of more nurses holding doctoral degrees will expand the pool of educators qualified to teach at the University level, so important to replace the large number of nurse educators expected to retire in the next few years" (Bellini 2012:6).

Opponents to the DNP argue that it is an extraneous degree, that master's level preparation is adequate for clinical practice and that a clinical degree in nursing should never be hybridized with a research degree. They also argue that this dual focus means the DNP will never be regarded as equivalent to a PhD within the academy. "The DNP degree is not intended to prepare educators in the pedagogy of teaching; and DNP-prepared faculty will not be successful academicians at some universities, where a more traditional view of discovery scholarship alone is the accepted norm" (Bellini 2012:6). The DNP has also been criticized as needlessly costly for nursing students. Nursing students have "families to support" and recommending a degree of dubious additional value will be an "additional financial liability for their own education" while they are "at the same time saving for their children's" despite a lack of available funding (Bellini 2012:5). However, the presumption of this criticism is that the DNP is not valuable to patients and the nursing profession and does not enable nurses to offer additional expertise and service. The concerns about adequate preparation of nursing and often confusing and contradictory evidence-based studies would seem to be a strong argument in favor of nurses in clinical practice better able to understand research evidence.