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In 2004, the Doctor of Nursing Practice (DNP) was established by the American Association of Colleges of Nursing (AACN) with a directive to be adopted by all advanced practice nurses (IOM, 2011). The degree was designed as the highest attainable degree in nursing practice. A DNP seeks to address the underlying needs of nursing practice, including: patient safety and quality of nursing care, the shortage of nursing leaders, increasing education expectations, and the shortage of doctorally prepared nurses (IOM, 2011). For members interested in undertaking translational research, the AACN recommended a DPN in combination with a PhD. Nursing and physician organizations have highly criticized the DPN program. Doctorates, DNS and PhD, focusing on 'science developed in research', are supposed to be incorporated with the curriculum set up by DNP. However, unlike a PhD, the DNP graduates are not expected to make scientific discoveries or oversee research studies. Thus, a DNP may create a shortage of nurse scientists (IOM, 2011).
In the past, nurses in academia earned PhDs in sociology, education, physiology, or any other field and their education was often related to nursing research or education roles and professions. In the 1970s, the nursing profession faced the challenge of convincing university administrators that the discipline of nursing had created a substantive knowledge base of its own, hence justifying the possibility of getting a PhD degree (Allen, 2010). This did not go down well with the university administrators forcing the nursing schools to establish their own professional degrees, which were only granted by parent universities. With time, these professional degrees quickly resembled PhD programs in universities and the PhD degree in nursing was finally embraced (Allen, 2010).
In the event of this development in the nursing education, nursing leaders face the dilemma of which advanced degree should be awarded in their schools. The major challenge is whether nurses should continue to earn more established and renowned research-focused PhD degrees which permit their entry to university tenure tracks or whether they are expected to earn terminal professional degrees like DNP which are practice focused (Chism, 2009). The recent trend in nursing schools is the setting up of the DNP programs. This leaves the stakeholders questioning the criteria under which the degrees, DNP and PhD, will differ, especially in their objectives, standards, and curricula (Harnes, 2009).
To promote the clear understanding of the two advanced degrees in nursing, DNP and PhD, there is a need to evaluate the history and research conducted on the subject. Clear definitions of both degrees, including their competencies, will be discussed in this section. The nursing field faces challenges on the proper advanced studies when it comes to the practicing nurses. When it comes to advanced degrees, there is still a question what will serve more efficiently for the advanced nurses as there are research-focused and practice-focused degrees (Harnes, 2009).
Nursing research is categorically a systematic approach utilized to study phenomena which are significant to nursing, as well as nurses (Webb, 2012). Since nursing is a practice profession, it is pertinent that clinical practice is anchored on scientific knowledge. Many advances have been exhibited in nursing and nurses have been proactive in employing nursing research in order to have a more significant impact on care for individuals, as well as aggregate groups (Ellis, Berger, & Hartley, 2009). On the other hand, the doctor of nursing practice (DNP) has been recommended by the American Association of College of Nursing as the terminal degree in nursing practice by the year 2015 (Chism, 2009).
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According to the American Association of Colleges of Nursing, AACN, 2006, the doctor of nursing practice (DNP) is a practice-focused doctorate and terminal degree for professional nursing practice (Chism, 2009). Since the announcement of the DNP as the minimum degree for preparation for advanced practice nurses in 2004, more than 90 universities offer such programs. The growth coupled with acceptance of this new doctoral degree in the field of nursing has resulted into some confusion among nurses regarding the doctoral level education in the field of nursing. In the history of nursing, doctoral education for nurses has grown along a number of paths (Harnes, 2009). The 20th century had no doctoral programs that were tailor-made for nurses. In turn, nurses had minimal options but to earn doctorates outside of nursing. This was the time of emergence of PhDs in the nursing field, especially of those earned in the basic science fields like physiology and anatomy (Harnes, 2009). The first doctoral program tailored for nurses was established in 1924 at Teacher’s College, Columbia University, New York. This doctorate was meant to prepare nurses to teach at the college level. A review of literature in relation to the DNP illustrates that the debate is complicated in nature, focusing on both clinical and academic issues together with issues related to the professional practice of nursing. A major element in the transition from PhDs to DNP for practice entry is the identification of strengths as well as weaknesses of the new option and interests and prejudice held by various nursing stakeholders (Harnes, 2009). The nursing profession’s extensive history of various doctoral educations avails a prime environment for the DNP versus PhD debate. In the past, many nurses have chosen to pursue doctoral degrees in neighboring disciplines, like the Doctor of Public Health. PhDs offer nurse scientists a formidable platform in research methodology. The purpose of research is to establish empirical knowledge in the nursing profession (Webb, 2012).Through the research, there is refinement and validation of existing knowledge and this gives room for the development of new knowledge. Research findings form the basis for practice behaviors and decision. Nurses with PhDs are proficient in undertaking primary researches and they publish their dissertation research projects; it is one of the graduation requirements. However, the DNP curriculum ensures that nurses are trained as highly skilled clinicians with in-depth knowledge concerning the utility and synthesis of research (Chism, 2009). The pinnacle of DNP education is undertaking a practice-focused project which may assume various configurations depending on the program’s focus.
According to some scholars in the field, a DNP seems to be the most appropriate step for advanced training in nursing (Chism, 2009). Others deem that it is a retrogressive step that will negatively impact on research. In 2004, AACN defined advanced practice nursing as any form of nursing intervention, which has impacts on individual and population health outcomes, including the direct patient care, management of care for individuals and populations, administration of nursing and health care organizations, and the development and implementation of health policy (Chism, 2009). Emerging healthcare issues have led to the need for practitioners with an expanded knowledge base and an advanced educational background (Frith & Clarke, 2012). The doctoral preparation of both expert researchers and practitioners may provide a stronger professional knowledge base needed to expand the science of nursing. For instance, the hour requirements for Masters Degree in nursing have steadily increased, leading to a degree which is not representative of the educational time commitment. Many advanced practice nursing degrees call for 45 to 50 credit hours as compared to 30 hours in other disciplines. The augmented intricacy of healthcare is progressively requiring more education in the case of advanced practice nurses. A major concern is the continuous growth of the Masters programs in a manner that is no longer socially responsible (Harnes, 2009).
There is a major concern being raised over the entry-level doctorates of other health care fields and DNP. It is evident that the practice doctorates of neighboring health care providers differ greatly from the introduced DNP. The nurses` desire to copy the practice doctorates of other disciplines have resulted to unfortunate development of multiple nursing doctorates and titles (Carty, 2011). In addressing the DNP versus PhDs subject in the nursing field, it is essential to consider the views and opinions of potential doctoral students who may ultimately fill the faculty positions. The practice-focused DNP may be appealing to contemporary practicing nurses who do not want a doctorate with a research foundation. 55% of students of 5 different DNP programs exhibited an interest in pursuing nursing education (Chism, 2009). A majority of these students considered the DNP to be in tandem with their professional goals and demonstrated a lack of interest in a doctorate that is holistically research-based. Further, researchers estimate that the program will boost the number of nursing educators with doctorates in the long run. Another concern, however, arises in relation to university guidelines on minimum requirements for DNP faculty positions. In addition, some scholars hold that the DNP plays an important role in preparing nurses to incorporate evidence-based practice in nursing. The graduates can take up faculty positions even without a research-based doctorate (Chism, 2009). Their knowledge as expert clinicians is viewed as essential in the education of competent nurses at all levels.
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Other scholars prefer the PhD prepared educators as the best option in the debate. The missing emphasis on primary research is indisputably a major handicap to the quality of a member of the faculty who is DNP prepared. Proposers of PhDs discuss the lack of research methodology as an epistemological mistake in the development of the DNP. They believe that without a background in research methodology, the DNP will lead to a void in the production of nursing knowledge (Reilly, 2010). Another concern is that devoid of the extensive knowledge to execute scholarly research, such as seen with PhD prepared faculty, the DNP prepared educator is predisposed to be passive in the academic world. Subsequently, DNPs will compromise nursing standards; hence, forfeit its leadership function at a university level (Reilly, 2010). Additionally, the DNP is seen as a threat to enrollment in PhD programs, and a stumbling block to the performance of the nursing faculty and its contribution to a scholarly nursing research. The number of applicants seeking doctoral study is already limited, and it is proposed that students may unwillingly end up in the DNP programs when their intention was to pursue the traditional research-based doctorate approach (Helvie, 2008). Practice-based programs understandably place greater emphasis on practice and less focus on theory, meta-theory, research methodology, and statistics than their counter-part research-focused programs. Scholars indicate that practice-focused doctoral programs generally encompass integrative practice experiences coupled with an intense practice immersion experience (Harnes, 2009). Rather than a knowledge-generating research effort, the learner in a practice-based program generally advances knowledge in evidence-based practice. Research and practice-based doctoral programs in nursing have multiple analogous and demanding expectations. Each approach calls for a scholarly approach to the discipline, and a commitment to the advancement of the profession. Both doctorate approaches are terminal degrees in the discipline with one being practice-based and the other one being research-based. Despite the above identified similarities, the approaches exhibit major differences. They contribute to the present debate regarding a practice application-oriented approach, which is the major part of the integrative practice experience (Harnes, 2009).
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Another major concern of the debate is the impact of the chosen approach to patients. Proponents of DNP argue that DNP prepared advanced practice nurses may be able to fill increasingly required roles as primary care providers (Chism, 2009). The aging population in the USA and other parts of the world faces complicated chronic illnesses with contributing factors, which are not only genetic in nature but also influenced by patient behaviors and lifestyle choices. Doctoral-prepared advanced practice nurses have the knowledge to manage aspects of chronic illnesses as well as influence patient behaviors as a result of the unique nature of nurses’ educational background. In this case, the patient-centered approach, which is aligned with DNP, makes nurses contribute greatly to patient care through education (Helvie, 2008).
Despite the highlighted benefits and weaknesses of each doctoral approach, there is a need for further research. The nursing field needs to ensure the chosen approach provides the nurses, patients and other stakeholders with value for time and money spent. The chosen approach on advanced studies in nursing should be the one which will help the nursing field to grow both practically and academically. In addition, there is a need to incorporate evidence-based practice (EBP) in nursing (Ubbink, Guyatt, & Verneulen, 2013; Tagney & Haines, 2009). Thus far, education efforts have failed to address the application of EBP in routine clinical problem-solving.
Doctor of nursing is a practice-based medical course. This course began in the early 1970s. It focuses on advanced clinical practices which are in contrast to the PhD which focuses on research. The key objective of this course was to lift nursing as to equate it with other professionals and disciplines in the country. This course gathers its ideas on clinical proficiency and skills, although it emphases that an individual should have a capability of doing any form of scholarly research (Carty, 2011). The current issue at hand is the fact that majority of students pick DNP course instead of PhD when they want to advance their education. This is evident since statistics indicate that approximately 184 DNP curriculums are enrolling students at various schools of nursing across all states. This is an indication that the government also assists the schools in supporting this form of advanced education. Additional DNP courses are on the planning stages awaiting implementation. These programs are available in approximately 40 states, while other states have up to five schools offering the same courses. The number of students enrolling to this advanced course is increasing rapidly; for example, 7,034 students enrolled in 2010 and 9,094 enrolled in 2011. This is an indication that a majority of students prefer the DNP programs over the PhD ones (Smith, Duel, & Martin, 2012). This study carried out in all the states of America indicate that the number of students enrolling in a PhD program has been steady over the years, and although it is increasing, the rate is slower when compared to the number of students enrolling in the DNS programs.
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The two degrees differ since the DNP degree is focused on practice, while the PhD degree is focused on research in the medical field. It is evident that the DNP degree adequately prepares an individual to be an expert in practice during work. The program focuses on key areas such as leadership, clinical information technology, inter-professional collaboration and all the relevant health care policies. The DNP places less importance on the research methodologies and theory as compared to the PhD program (Harnes, 2009). The scholarly project that is a prerequisite of the DNP is based on clinical activities and ways in which the research affects practice. The PhD dissertation, on the other hand, is focused on the generation of new knowledge or inventions, which can be applied in nursing practice (Harnes, 2009). This made nursing students confused, since they are not aware of these integral differences. Nevertheless, both programs are an avenue for advanced training in nursing.
Identification of the Stakeholders
The main stakeholders in nursing education are the nurses, nursing leaders in charge of policy making, and educators. Evaluation of both the DNP and the PhD is most critical. A growing number of institutions in the United States recently directed that a clinically focused advanced practice has to be validated to become a requirement for advanced practice nurses. The DNS in nursing emerged because the PhD was geared towards education, for example, physiology, sociology etc. that led to other roles (Allen, 2010).
The DNS course was created to equalize nurses with other medical professionals such as psychologists, optometrists and dentists. This course also trains the nurses to become reliable leaders who are able to socialize professionally in order to alleviate the medical condition of the community at large (Smith, Duel, & Martin, 2012). This course has become popular since nurses are capable of making independent decisions while taking care of patients without the presence of doctors or their assistance.
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The requirements for pursuing the DNS program are flexible since nurses from any college can enroll and advance their training. This program is aimed at training nurses on the ways of direct care for patients. In addition, it improves their service delivery, management of clinical schemes and patient outcome (Harnes, 2009). The group of nurses, who can join this program, includes: the clinical nurse specialists, nurse midwives, and anaesthetists, since they have the basic education required to undertake the course (Harnes, 2009).
It is difficult to get admission in PhD, since an individual has to attain a certain grade during the first degree program. Evidently majority of the nurses are locked out as they do not meet the requirements of the program. In addition, the majority of students study in colleges that do not offer the PhD course and these nurses are not likely to consider this area of study (Harnes, 2009). There has been a rapid development in the health care industry which has forced many colleges to increase their curriculum by adding the DNS option. Employees recruit nurses with the DNS since they are aware that they have undergone an advanced level of nursing education that is biased to clinical practice (Chism, 2009).
Rapid expansion of health care information requires nurses to advance their knowledge and embrace evidence-based research. Emphasis is made on acquisition of skills as opposed to memorization of course contents. This way information is effectively disseminated and a culture of critical thinking is inculcated to ensure an improvement of patient outcome in the health sector. The DNS course consists of an extensive program, which calls for specialists’ assistance in the development of the curriculum. A DNS graduate is supposed to acquire an extensive scope of information based on various vital areas of practice (Chism, 2009).
It is evident that nurses often work under the supervision of doctors. This led to the introduction of the degree in DNS where nurses gain knowledge that empowers them to work independently. This is because the DNS lays emphasis on direct patient care in a clinical setting. It also covers the acquisition of research skills and a superior delivery of care which can be applied in the work place (Allen, 2010). This course is widely sought since it bases its syllabus on pure clinical training rather than the theoretic aspect that is extensively covered in the PhD programs.
Another cause of the shift in attaining a DNP rather than a PhD is the fact that it catapults the rank of nurses in the medical profession. It is evident that establishment of a DNS program signifies the nursing profession among other medical disciplines (Reilly, 2010). The DNS graduates are great team leaders in comparison to the PhD graduates since they have experience in the work area and this makes them efficient leaders.
General Recommendations Reform
It is evident that the majority of individuals are shifting to enroll in the DNP rather than the PhD program. It is vital for students to identify the clear and distinctive goals of each program so as to make decisions wisely. An outcome of each program should also be evaluated to allow all the students to make decisions regarding the course they wish to study in relation to their career goals. It is recommended that students realize the existing differences between the two courses. DPN program prepares students for direct patient care and leadership roles in the work place, while the PhD ensures that nursing students are ready for advanced careers as research scientists in both academic and governmental positions (Smith, Duel, & Martin, 2012).
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The DNP creates a platform for nurses at advanced levels of practice and they are well placed in translating and applying all the research carried out in practice. On the other hand, a PhD program allows a graduate student to carry out research that elevates the theological basics of nursing and health care in the whole world (Reilly, 2010). The competencies and content of DNP programs facilitate in acquiring knowledge and ability to translate research into practice, which leads to incorporation and dissemination of new information in the health care industry. The PhD graduates gain knowledge and ability related to analytic approaches and theoretical methods which are used to discover and utilize knowledge in health care and nursing (Harnes, 2009).
The main objective of a DNP school is to ensure the student demonstrates advanced or rather specialized levels of clinical verdict, accountability in designing, systems thinking, evaluates evidence-based care and delivers leadership skills that will ensure there is improvement of patient outcomes (Chism, 2009). The expected outcome of the PhD study is a nurse scientist who is capable of researching academia issues and other research studies in the nursing career.
Reform Implementation PlanThese reforms are clear and simple to implement. The curricula of both programs must be relevant to nursing practice and advance nursing knowledge. Nurses should consider both programs and choose the most appropriate advanced training that is in tandem with their career goals. Both programs are essential. A PhD lays emphasis on research in order to advance nursing knowledge. Research in nursing practice is essential and should be a continuous process. A PhD is suited to nurses who aspire to be research scientists in the nursing profession. A DNP enables nurses to obtain advanced clinical practice. Such a program is suited for nurses who aspire to attain excellent nursing knowledge related to clinical practice (Reilly, 2010).
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Method to Evaluate a Policy Change
A comparative study should be carried on the curricula development of both programs. In addition, a follow-up should be made on the quality of graduates enrolled in both programs. This will entail an assessment of evidence-based practice in the nursing profession. The performance, relevance and importance of the two sets of graduate students should be noted.
The arrival of the DNP program became a source of contention in the nursing organization. This study focuses on the distinction between a DNP and a PhD in an effort to clarify the situation and make a policy recommendation. This research has also highlighted the major trend evaluated in the society regarding the shift of many students from the PhD to the DNS program. The DNP competencies have been evaluated in line with clinical expectations in nursing.
The roles of both DNP and PhD graduate students have been described in detail. It is obvious that a DNP program is beneficial to an individual who is interested in clinical practice studies whereas a PhD program is for nurses who want to engage in research. The majority of DNP nursing students have excellent skills such as direct patient care, leadership, decision making and system operations whereas a PhD graduate is efficient in research operations which bring positive change upon implementation of research findings in nursing care.
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