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Choosing a pathway

PhD or DNP?

Smith, Linda S. PhD, MS, RN, CLNC

doi: 10.1097/01.NURSE.0000469245.89222.6e
Department: LEARNING CURVE
Free

Linda S. Smith is vice president for research at Data Design, Inc., in Horseshoe Bend, Ark., and a member of the Nursing2015 editorial board.

The author has disclosed that she has no financial relationships related to this article.

MORE AND MORE NURSES are earning doctoral degrees in nursing by pursuing a doctor of philosophy (PhD) in nursing, which is a research-focused doctorate, or the doctor of nursing practice (DNP), which is a practice-focused doctorate.1 (See Growth in doctoral programs.) Nurses considering advancing their nursing education to the doctoral level must decide which type of program is the best fit based on their ambitions and goals. This decision is just the first of many.

This article explores the rationale behind doctoral education in nursing, the two basic types of nursing doctorates, and some decision-making steps to take when determining which program is the right fit.

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Expanding need

The nation is aging, becoming more diverse, and experiencing a dramatic shift in healthcare needs. For example, chronic diseases require most of our healthcare resources, making care coordination and collaboration across disciplines, systems, and communities essential.2

As scholars, doctorally prepared nurses improve health outcomes for patients and populations. Both types of doctoral degrees are considered terminal degrees (that is, the highest academic degree in the field of nursing), and both program types provide our profession with highly educated, well-prepared nurse leaders and change agents. Nursing needs both types in order to formulate, implement, evaluate, and translate nursing science. Nurses are on the front lines of healthcare, having a direct and long-lasting effect on patient-care outcomes; our ability to make healthcare system changes is unique and far-reaching.2

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Time for self-reflection

Nurses thinking about doctoral nursing education need to reflect on their choice of program type by contemplating their personal and career goals, personalities, values, and conceptual frameworks, as well as their primary nursing interests and passions. Besides different goals, program types require different skill bases and motivations.

Beyond program type, the quality of the nursing program needs to be carefully evaluated so that opportunities and options can be developed and enhanced and career goals accomplished. The quality of the DNP program is assured through program accreditation by the Commission on Collegiate Nursing Education or Accreditation Commission for Education in Nursing. Certification as an advanced practice nurse customarily depends on graduation from an accredited program.3

The quality of a PhD in nursing program is assured by the graduate school and the university achieving accreditation or certification by an accrediting body officially recognized by the U.S. Department of Education or the Council for Higher Education Accreditation.3

Program costs, completion time, levels of family and collegial support, full- or part-time study requirements, and online or distance-based (or a combination) versus face-to-face tracks are also important considerations. The nurse's preferred learning style is critical as are considerations such as the time cap (maximum length of time allowed for completion); program graduation, admission, and attrition rates; accessibility of resources such as the library; computer hardware and software requirements; availability of financial aid; and administrative and mentor support.3

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Focusing on the PhD

The PhD in nursing is the traditional, universally recognized academic research-centered degree. Its purpose is to prepare nurse scientists and scholars to generate and share new nursing knowledge. A nationwide shortage of nurse educators, created in part by retiring professors of nursing, creates a great need for nurses with a PhD in nursing to fill these academic positions.

This degree facilitates professional goals that include original theory-based research that's shared through presentations and publications. It appeals to nurses who have a lifetime commitment to generating and testing nursing theories and interventions.4

Type of education. PhD in nursing curricular requirements can be extensive. Philosophy of science, theoretical, and research foundations course work are integrated throughout the program of scholarship, which culminates with an oral and written defense (that is, a dissertation) of the PhD candidate's original, theory-based research investigation. Research foci may include areas that improve quality of life and help patients live with chronic illness such as incontinence, neurologic impairment, autoimmune disorders, cancer, and diabetes.

The prospective PhD student may be accepted into a PhD program while the student is in a baccalaureate nursing program or any time after that. Healthcare work experience isn't necessarily required.

The research advisor, usually assigned at the time of admission, helps PhD students to convert investigation ideas and goals into planned and implemented original research. The sooner these research goals are identified, the more efficient the program of study will be.

Depending on the program and school, PhD in nursing students may be permitted to take advanced practice nursing courses. A few nursing programs even offer a combined PhD/DNP track. The time required to complete research is in addition to the time needed for course completion.

Career and employment options. The PhD in nursing is considered the terminal degree for nurses wishing to advance nursing science concepts and processes.5 Besides holding faculty positions within colleges and universities, PhD-prepared nurses work in a wide variety of settings, including businesses focused on healthcare services or products, government agencies and facilities (for example, the FDA or CDC), and research centers. Entrepreneurial self-employment is another option.6

Nurses holding PhD in nursing degrees are needed as educators and mentors for the next generation of research scholars. As instructors and professors, PhD in nursing graduates experience promotion and tenure within an academic setting that includes scholarship activities such as original research (with related publications and presentations) as well as teaching and service.

Advantages and disadvantages. The PhD, as a degree choice, is often regarded as the gold standard and its rigor and application are recognized worldwide as a distinction of academic scholarship and achievement.4 PhD-prepared nurses are needed as research-focused faculty members who mentor nursing students in PhD programs.7 With a sustained program of research, they earn positions as nursing program tenured professors, deans, and directors in academic settings.7,8 University professors may have access to free or low-cost tuition for themselves and immediate family members, flexible life-work schedules, and academic sabbaticals. In addition to institutions of higher education, PhD-prepared nurses implement research programs within community or national policy, government, clinical practice, and private foundation settings.9

Disadvantages may include a longer program of study, including postdoctoral research work. Additionally, easy access to enhanced research environments in the area(s) of interest may be problematic.1

Salary, benefits, and career advancement. The Institute of Medicine has recommended that academic administrators and trustees create a salary and benefits structure for nurse educators that's competitive with industry standards to recruit and retain doctorally prepared nurse educators.2 In contrast, corporate and noneducation government and industry employers often provide better salary and benefits packages.10

Nurses with PhDs generate and test nursing knowledge through independent research and share that knowledge as authors and teachers, regardless of work setting. PhD in nursing programs provide a wide range of scientific areas in which to focus. For example, my nursing focus of study at the doctoral level was transcultural nursing and health policy. Additional career options include healthcare (clinical care) executives, clinical research leaders, and research mentors.

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Spotlight on DNP

If the nurse's goal and primary passion is clinical practice and the nurse wishes to improve healthcare delivery and practice without committing to a dedicated research focus, then the DNP program may be a good fit. DNP graduates have comprehensive clinical expertise and can apply cutting-edge nursing science to clinical practice as advanced practice providers and clinical care experts.11 According to American Association of Colleges of Nursing (AACN) members, transitioning into the practice doctorate (for advanced practice) in nursing is important to the advancement of nursing as a discipline.1

As with any nursing program of study, the program graduate earns a degree or academic certificate, not licensure. Information about specific DNP programs should address advanced practice and national certification requirements and how program graduates qualify for both.

Type of education. Certification as an advanced practice nurse is often a prerequisite for the MSN-to-DNP tracks; BSN-to-DNP tracks have greater curricular requirements but include advanced practice nurse coursework within the program.12 Instead of a dissertation and oral defense, DNP candidates complete a final project often called a capstone or quality improvement project that may take additional time beyond didactic course completion.

The DNP program of study prepares graduates to use the nursing science generated and developed by PhD-prepared nurse scholars to provide excellence in clinical practice and teaching. Though not a comprehensive list, coursework will likely include focused study in life sciences, systems leadership, clinical scholarship, healthcare advocacy and technology, population health, and advanced nursing practice.13 Evidence-based practice, quality improvement at the individual and systems levels, and the implementation of technology data systems for improved patient and population health are emphasized.12

The credit load for DNP candidates should be equivalent to that of practice doctorates in other health professions (such as pharmacy and physical therapy) and build on evidence-based practice, continuous quality improvement, and leadership at the systems level. This alternative to research-based PhD programs may include research-based coursework within a DNP/PhD program plan of study (track).

Career and employment options. DNP graduates perform as advanced practice nurses in a variety of settings and with diverse population groups. They can be CNOs in acute or long-term-care facilities, executive directors of healthcare systems, and clinical nurse educators within colleges and universities.14 In these positions, DNP graduates implement evidence-based practice strategies and apply clinical prevention and population health strategies that improve patient outcomes.14 As healthcare executives, DNP graduates lead nurses who are conducting original research.4

Some advanced practice foci include psychiatry, public health, women's health, geriatrics, anesthesia, pediatrics, management, and family issues.

Advantages and disadvantages. As the number of nurses holding DNP degrees increases, any confusion involving this degree will decrease and great support from key groups (such as patients, insurers, colleagues, administrators, and legislators) will occur.15 DNP salaries are also expected to increase. In 2012, NPs holding the DNP degree (versus an MSN degree) earned about $4,000 more per year.16

Salary, benefits, and career advancement. Salary, hours worked per week, and benefits vary greatly depending on geographic location and position. As doctorally prepared nurses, DNP graduates have clinical, faculty, and leadership roles and responsibilities. The average annual salary for DNP graduates holding positions as assistant professors ($60,000) and assistant clinical professors ($62,000) is less than the average NP salary of $95,000;8 note, though, that teaching positions may include significant time off for breaks, summers, and holidays. Additionally, when DNP graduates hold faculty positions, the research and scholarship expectations associated with that position will need to be carefully defined.17 For example, in lieu of an original externally funded research trajectory, DNP faculty members may be able to substitute clinical practice, manuscript authorship, or collaborated research endeavors.

For additional information about DNP programs, see Resources at the end of this article.

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Two paths diverge

Doctorally prepared nurses are perfectly positioned to address future healthcare changes and will become even more important as healthcare decision makers and change agents. Visualizing oneself as a doctorally prepared nurse is the first step on an incredible journey. Good luck to all nurses who possess a passion for continued learning, patient advocacy, and scholarship.

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Growth in doctoral programs

Interest in doctoral nursing education is growing, with enrollments in PhD programs up 49% since 2004 and enrollments in DNP programs up nearly 27% in just 1 year (from 2012-2013). Between 2006 and 2013, program numbers have also increased, with PhD program numbers up from 103 to 132 and DNP programs increasing from 20 to 243. An additional 59 new DNP programs are being planned.1,18

These numbers are in accord with the Institute of Medicine's 2010 recommendation that the number of nurses with earned doctorates double by 2020,2 and the AACN's voted decision in 2004 to move “the current level of preparation necessary for advanced nursing practice from the master's degree to the doctorate-level by the year 2015.”18

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REFERENCES

1. Kirschling JM. Reflections on the future of doctoral programs in nursing. AACN Doctoral Education Conference, Naples, FL. American Association of Colleges of Nursing. 2014. http://www.aacn.nche.edu/dnp/JK-2014-DNP.pdf.

2. Institute of Medicine. The future of nursing: focus on education. Report at a glance. 2011. http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health/Report-Brief-Education.aspx.

3. Pieper B, Colwell J. Doctoral education for WOC nurses considering advanced practice nursing. J Wound Ostomy Continence Nurs. 2012;39(3):249–255.

4. Beal J, Bolg JR, Brostoff M. Is the doctorate of nursing practice an appropriate degree for executive nurse leaders. MCNAm J Matern Child Nurs. 2011;36(6):342–343.

5. Goodrich RS. Nurses' transition to academic nurse educator. Doctoral dissertation: Teachers College, Columbia University, 2012. http://gradworks.umi.com/35/08/3508265.html.

6. Villanova University College of Nursing. Doctor of Philosophy in Nursing: frequently asked questions. www.nurseweb.villanova.edu/archivenursing.villanova.edu/PhD/FAQs.htm.

7. Morton PG. Is transformation of PhD nursing education needed. J Prof Nurs. 2013;29(6):319–320.

8. Indeed. Salary search. 2015. http://www.indeed.com/salary.

9. American Association of Colleges of Nursing. The research-focused doctoral program in nursing: pathways to excellence. Report from the AACN task force on the research-focused doctorate in nursing. 2010. http://www.aacn.nche.edu/education-resources/PhDPosition.pdf.

10. American Association of Colleges of Nursing. Nursing faculty shortage. 2015. http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-faculty-shortage.

11. Ferguson LA, Forest S. The practice doctorate in nursing: perspective on how the DNP changes practice and improves clinical care. Pelican News. 2011-2012;67(4):11.

12. Dennison RD, Payne C, Farrell K. The doctorate in nursing practice: moving advanced practice nursing even closer to excellence. Nurs Clin North Am. 2012;47(2):225–240.

13. American Association of Colleges of Nursing. The Essentials of Doctoral Education for Advanced Nursing Practice. 2006. http://www.aacn.nche.edu/publications/position/DNPEssentials.pdf.

14. Swanson ML, Stanton MP. Chief nursing officers' perceptions of the Doctorate of Nursing Practice degree. Nurs Forum. 2013;48(1):35–44.

15. Newland J. The Nurse Practitioner salutes the DNP. Nurse Pract. 2012;37(4):5.

16. Salary averages according to academic degree. Advance for NPs and PAs. June 2013. http;//www.advanceweb.com/NPPA.

17. Nickitas DM, Feeg V. Doubling the number of nurses with a doctorate by 2020: predicting the right number or getting it right. Nurs Econ. 2011;29(3):109–110, 125.

18. American Association of Colleges of Nursing. DNP Fact Sheet: The Doctor of Nursing Practice (DNP). 2015. http://www.aacn.nche.edu/media-relations/fact-sheets/dnp.

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RESOURCES

American Association of Colleges of Nursing. The Essentials of Doctoral Education for Advanced Nursing Practice. 2006. http://www.aacn.nche.edu/publications/position/DNPEssentials.pdf.

Accreditation Commission for Education in Nursing. ACEN 2013 Standards and Criteria. Clinical Doctorate. http://www.acenursing.net/manuals/SC2013_DOCTORATE.pdf.

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