Rutledge, Carolyn M. PhD, FNP-BC; Renaud, Michelle PhD, CNS
Currently, we spend more on healthcare than any other country (17% of gross domestic product), yet our outcomes are some of the poorest of the industrialized nations.1 Many nurse executives and managers are faced with addressing ways to cut costs while improving the effectiveness and quality of the care provided by their healthcare systems, but they realize that they aren't prepared to take on this momentous task without more knowledge and skills.
The Institute of Medicine (IOM) report TheFuture of Nursing: Leading Change, Advancing Health encourages CNOs and other executive nurse leaders to embody, exemplify, and participate in a climate of collaborative cooperation where all healthcare leaders can come equally to the table.2 This is difficult to accomplish without the educational background and credentials to support the needed expertise. For this reason, many nurse executives and managers are embracing the push toward doctoral education.
Are you considering going back to school for a doctor of nursing practice (DNP) degree? If so, you may be asking yourself: Is the DNP the best degree for me? How do I choose a DNP program that fits my needs? Will I have to do research? We provide information to assist you in your selection of a DNP program.
DNP versus PhD
There's ongoing debate about the benefits of DNP versus PhD education for nurses regarding program quality, focus, and appropriate postgraduation roles for DNP graduates. Many potential students struggle with the decision of which doctorate to pursue. Nurse executives and managers who are most interested in pursuing leadership roles in which they're responsible for conducting or overseeing research studies, mentoring others in research methods and statistics, and managing large databases may be better served by pursuing a PhD degree. Nurse executives and managers who are interested in roles in which they hold leadership positions, develop and implement system change, and develop policy initiatives would be well served by a DNP degree. (See Table 1.)
The basic curriculum model for all DNP programs is the American Association of Colleges of Nursing (AACN) Essentials of Doctoral Education for Advanced Nursing Practice.3 The DNP essentials address the focus area of aggregate/systems/organizational practice. These essentials mesh with the American Organization of Nurse Executives' competencies of communication, knowledge, professionalism, business skills, and leadership to provide the nurse executive with the expertise required to navigate both current and future challenges within complex healthcare organizations.4
DNP-prepared nurses are in executive and manager roles where the focus of their practice is on populations, organizations, and systems, including information systems. They must have advanced level skills in assessment techniques used to evaluate systems, organizations, and communities. They should also be skilled at working with stakeholders and able to design innovative care delivery models to maximize the care provided to their populations.
Collaboration between DNP and PhD students/graduates is becoming more prevalent and can be beneficial in solving healthcare system problems, as well as local and governmental policy issues.5 These two groups of professionals can work together to conduct projects that utilize the PhD nurse's expertise in research methodology and statistics and the DNP nurse executive or manager's understanding of and access to the practice environment.
Choosing a DNP program
There are a number of DNP programs available for nurse executives and managers. However, no two programs are the same. In order to select a DNP program, you need to obtain information on the program's accreditation status, practice requirements, education methods, and project/research expectations. You also need to research the credentials and expertise of the faculty, the flow of the curriculum, and the roles assumed by the program's graduates.
Accreditation. Because the DNP degree is a new doctoral avenue, many programs are actively engaged in achieving accreditation status. The national accrediting agencies for nursing programs are the Commission on Collegiate Nursing Education (CCNE) and the Accreditation Commission for Education in Nursing, formerly known as the National League for Nursing Accrediting Commission. Accreditation is a way of determining whether a program has met the requirements put forth by the specific accrediting organizations. For example, to be accredited by the CCNE, a program must incorporate the AACN DNP essentials into its offerings.3
Review the accrediting guidelines to better understand the focus of the DNP program and determine whether the program is accredited and by which organization. There are DNP programs that aren't accredited although they're nested in schools that have received accreditation. Some programs may be in the process of becoming accredited. Program accreditation is based on the date of the accrediting organization's site review. If the site review occurs before your graduation date, you'll graduate from an accredited program.
Practice requirements. The DNP is considered a practice degree, so it's important for the program to incorporate practice-oriented hours within the curriculum. Practice hours provide experiential learning opportunities that enable the student to integrate the AACN DNP essentials into a practice environment and demonstrate competence at functioning as a DNP in an executive or manager role.
Some programs consider the activities required to complete the capstone/DNP project as the sole source of practice hours. Consider if this is the experience you're looking for or if you would prefer a program that encourages hands-on practice that addresses the DNP essentials. For instance, some programs encourage practice hours that include activities such as attending a policy summit, leading teams, and working closely with expert nurse executives in developing higher-level practice skills in addition to conducting the project. (See Table 2.) It's important to consider what competencies you want to have accomplished by the end of the program.
According to the AACN, a DNP graduate must have a total of 1,000 documented postbaccalaureate practice hours.3 If the DNP program is offered as a postmaster's degree option, the required hours include those obtained during the student's master's program. The number of required practice hours varies tremendously between programs that provide master's level education. Students entering a postmaster's degree DNP program with minimal practice hours may face a challenge in achieving the required hours. In this case, it's up to the student and faculty to document that the student has the required 1,000 hours upon graduation from the DNP program. When reviewing programs, you may want to discuss how you can obtain additional practice hours to meet this requirement if needed.
Education methods. Schools vary on how they deliver DNP education. Some programs stress the traditional model of student participation in didactic classroom sessions; others are strictly online programs. The hybrid program option divides the student's time between the classroom and online learning. You'll need to decide which format best suits your availability and learning style. (See Table 3.)
In our experience, we've found that students benefit from the hybrid format because they're able to get the best of both on-campus and online education. A hybrid program allows students to participate in on-campus activities, such as emotional intelligence workshops, and present projects in person, which provides the opportunity to develop comfort and skills in delivering presentations. The hybrid format also allows flexibility for students to review didactic materials online when it's convenient for them and as often as they desire. This is especially beneficial for those students who work while in school. Many of our DNP students have even said that they feel closer to the faculty in our hybrid program than they have during any of their previous on-campus programs.
Project/research expectations. According to the AACN DNP essentials, “the final DNP project produces a tangible and deliverable academic product that is derived from the practice immersion experience and is reviewed and evaluated by an academic committee.”3 There's some debate about whether the DNP project should have a research component. The argument against research being incorporated as an outcome for DNP programs is the view that DNP graduates should focus on practice. The argument for incorporating research is that to be consumers of evidence, students must be able to critically review the research.
The research skills applied to DNP projects should prepare the graduate to evaluate outcomes within systems and organizations. For the nurse executive or manager, the type of project may vary. (See Table 4.) When selecting a DNP program, determine if its curriculum will prepare you with the knowledge and skills you'll need within your intended practice setting. Keep in mind that, all too often, graduates have difficulty pursuing certain skills if they aren't introduced to them within their academic preparation. For instance, some programs feel that it's important to expose students to the Institutional Review Board process while in school, specifically to give them the skills to navigate the process after they graduate. Be aware that by seeking a less stringent program, you may be placing yourself at a disadvantage when pursuing future endeavors.
Faculty. Consider the qualifications of the faculty when choosing a DNP program. According to the AACN, a cohort of the faculty responsible for DNP course offerings should be actively participating in practice.3 With the rapidly changing healthcare environment, it's difficult for faculty to bring real world experiences to their students unless they're engaged in practice. Faculty members who are engaged in practice are able to provide students with the oversight needed to integrate their learning into the practice environment. Practicing faculty can assume several positions: They can be full-time nurse executives or managers who work with the school in adjunct roles where they provide didactic courses; they can provide opportunities for students to work with them in their practice settings; or they can provide oversight of the DNP project by serving as student advisors. The most important factor is to have faculty who can model the role of the nurse executive or manager.
A DNP program may include other faculty members who aren't nurse executives but who bring specific expertise to the program. For instance, a faculty member with expertise in policy should provide coursework and experiential activities in policy. It's important to have research courses delivered by an expert in research methods. Regardless of faculty members' focus areas, they should be able to articulate how the program addresses the AACN essentials to develop DNP-educated executives and managers for the healthcare arena.
Curriculum. DNP programs vary on their curricular sequencing approach, although an accredited program will include all of the DNP essentials. Make sure you understand the strategy behind course sequencing and how each course will apply to practice. Some programs follow a PhD model, with all classes frontloaded and the capstone/DNP project later in the program. Some programs integrate the DNP project throughout.
For example, our program begins the first semester by assisting full-time students with topic selection and research questions. Each aspect of the students' research project is developed concurrently with didactic classes. (See Table 5.) Research classes are offered as co-requisites with the first two internship/practicum classes, allowing students to create each part of their DNP project as they learn the research process. As the students learn about research design, they complete the design section of their DNP project and turn it in to their advisor.
This approach has resulted in educational opportunities for all learning styles, a deeper understanding of the content provided in the didactic classes and its implication to practice, timely completion of the capstone/DNP project, a decreased demand on faculty advisors, and a clearer understanding of the research process.
DNP education and the nurse leader role
Many executives enrolled in DNP programs have been functioning in an administrative role for years. However, they've become aware that they need to increase their knowledge and skills to address the demands inherent in the rapidly changing healthcare system. As a result of pursuing the additional education, they find themselves better prepared to:
- serve as leaders within organizations and healthcare systems
- transform systems through change implementations and strategic planning
- develop, implement, and evaluate healthcare initiatives and programs
- implement new models to improve the performance of organizations and systems
- use information technology to inform decision making and organizational change
- lead intra- and interprofessional collaboration efforts to enhance care and organizational outcomes
- inform policy initiatives.
In general, DNP-educated nurse executives and managers are prepared to use systems thinking to lead initiatives in quality improvement and organizational change to improve practice. They have enhanced skills in leadership, informatics, project management, financial planning, and technology. They're the transformational leaders within healthcare systems and organizations who are responsible for advocating for new approaches to healthcare. With the opportunities that have developed as a result of the IOM Future of Nursing report and the creation of the DNP degree, nurse leaders are poised to make the changes required to create quality, cost-effective healthcare for the citizens of our nation.