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Make the switch to a terminal degree
Nurses, universities embrace doctor of nursing practice degree
Lisette Hilton
Lisette Hilton is a freelance writer.
Demand for the doctor of nursing practice degree is growing rapidly. The number of nurses enrolled in U.S. DNP programs climbed from 29,093 in 2017 to 32,678 in 2018. DNP graduates spiked from 6,090 in 2017 to 7,039, in 2018, according to
published by the American Association of Colleges of Nursing.
While research-focused PhD programs in the profession have experienced slight growth since 2006, the growth chart for practice-focused DNP programs has increased with each year, growing from a few handfuls of DNP programs in 2006 to today’s 303 DNP programs nationwide. An additional 124 DNP programs are in the planning stages, according to AACN.
Jane Foote, EdD, MSN, RN, nursing department chairwoman and associate professor at Winona State University, in Winona, Minn., said she’s seeing increasing demand for the DNP. “What we’re seeing in our little part of the world may be unique because our graduate nursing programs are based in Rochester, Minn., home of the Mayo Clinic,” Foote said. “There is an emphasis by employers on having DNP-prepared nurse practitioners. I also teach in the nurse anesthetist program for Mayo School of Health Sciences and nurse anesthetist colleagues, APRNs, have fully adopted doctoral preparation for entry into the role. Nurse anesthetists are leading the way with requiring the doctoral credential for educational preparation.”
In essence, the DNP is about taking the evidence from the best research that’s available, and applying it to improve the quality of care that nurses provide, according to Foote. “The idea that nurses who love being in practice could have a terminal practice degree, where they would take the evidence in the literature and be able to really transcribe that into the work they do and improve patient care, inherently, delights a lot of nurses,” Foote said. “We tend to be very practical types of people. We like doing things with our hands and caring for patients. We focus on the impact that our care can provide families and systems.” Depending on the university, the increase in training for a baccalaureate-prepared nurse is about 70 to 75 credits to achieve a DPN, according to Foote. Winona State University offers DNP programs for nurses who have their master’s degrees, as well as a DNP program for bachelor’s-prepared nurses. Nurses with bachelor degrees who pursue higher education often choose the master’s program initially. They realize a year or so into it that the DNP is attainable, and they transfer to the terminal degree, according to Foote. “Graduate education does involve scholarship, but it’s very practice-oriented,” Foote said. “It is about caring for patients in new ways and looking at the quality of published peer-reviewed evidence. We focus in the program helping nurses to look at the quality of the evidence that they’re reading — that the PhD nurses and others are producing — to determine what the best actions might be to improve care for patients in all kinds of healthcare settings.”
DNP demand grows
Behind the momentum
In 2004, AACN member schools voted to endorse moving preparation necessary for advanced nursing practice from the master’s degree to the doctorate level by 2015. An increasingly complex healthcare environment requires the highest levels of scientific knowledge and practice expertise to assure quality patient outcomes, according to AACN. Nurses are in a position to lead the charge for improving quality in an increasingly transparent and complex healthcare system, according to Foote. “We know we have to improve care; we know we have high cost issues,” she said. “Nurses see themselves and are seen by others as providing high-quality, cost-effective care to many populations. When I look at my DNP students and the kinds of projects they’ve implemented and evaluated, and where they’ve done those in communities, it’s amazing to me how effective a nurse or two working on a team can be to actually change systems in a way that helps our patients be safer, get healthier quicker or have end-of-life unfold really the way that the family wants it.”
Focus on evidence-based practice
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Move forward
How a DNP might impact a nurse’s career path depends on the employer, according to Foote. The advanced degree can open doors not only at hospitals, healthcare systems and other corporations, but also at universities. “In our community, employers are requiring advanced education for leadership and teaching roles,” Foote said. Foote said teaching is appealing to many in the profession because nurses want to share what they know and lead new people into the profession. Foote said her advice for anybody going back to nursing school, but especially for nurses who are thinking of getting the terminal degree, is to ask how this commitment to education fits their lives, work and careers. Moving forward is ideal if employers are supportive and support nurses pursuing DNPs; if families and home lives are supportive of the commitment; and if nurses believe that they have the capacity and drive to be able to complete the DNP. “We in nursing need more nurses who are capable leaders, good scholars and expert practitioners to be able to advance the profession in a way that is needed,” Foote said. “Nursing leaders will be called upon to have the highest education available because of the complexity of the patients and the systems in which they work.” Still, nursing is nowhere near switching completely to the doctorate, according to Foote. Employers, she said, continue to value baccalaureate-degree nurses at the bedside because they are seasoned, experienced and wise. “I was a dean for 10 years at a fabulous two-year nursing program in Minneapolis, and I loved those students and what they were able to do in the world because they were so diverse. There’s room for everyone at the table,” Foote said. “My advice for students is always that timing is everything. Time your education in a way that allows you to be successful. Take the time you need to plan and garner support from employers and your families, so you can actually experience what a privilege it is to learn more about this fabulous profession.
There are
50 post-baccalaureate
48 post-master’s
DNP programs in the works.
More DNP stats from AACN
286 DNP programs have received accreditation
from the Commission on Collegiate Nursing Education, the leading accrediting agency for baccalaureate- and graduate-degree nursing programs in the U.S. since Fall 2008.
DNP programs are now available in
all 50 states plus the District of Columbia
. States with the most programs (10 or more) include California, Florida, Illinois, Massachusetts, Minnesota, New York, Ohio, Pennsylvania and Texas. 
“Nurses are in a position to lead the charge for improving quality, in an increasingly transparent and complex healthcare system.”
— Jane Foote, RN
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