If you're looking for an executive role in nursing, you'll need to pursue advanced education through a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP) degree program. The DNP, the highest-level nursing practice degree, prepares individuals for such jobs as nurse manager, chief nursing officer (CNO), and other advanced roles in clinical practice and healthcare policy leadership.
The Doctor of Nursing Practice (DNP) degree, established in 2004, provides doctorate-level preparation to help professionals keep up with the changing landscape in healthcare and quality patient outcomes. Member schools affiliated with the American Association of Colleges of Nursing (AACN) voted in 2006 to start advancing nursing practice preparation from the master's degree to the doctorate level. Their rationale was that advanced practice nursing was one of the few healthcare disciplines that prepared its practitioners at the master's degree level rather than a doctorate level.
That transition is a long way from completion, but it has made some strides. From the DNP's inception in 2004 to 2021, more than 60,500 students have graduated with the degree. DNP programs have continued to grow over the years and are now available in all 50 states and the District of Columbia. They are not poised to replace MSN programs, however; as a recent white paper points out, "While DNP program growth has been dramatic in the last decade… there has been only a modest reduction in MSN programs."
As nursing shortages become widespread, the need grows not only for advanced nurse practitioners but for nurse leaders with the skills to design and assess patient care using evidence-based practice. DNP graduates fit the bill. What is a Doctor of Nursing Practice (DNP) degree? This article answers that question and discusses the following:
A Doctor of Nursing Practice (DNP) is the highest professional degree advanced practice registered nurses (APRNs) can earn. APRNs include certified nurse practitioners, clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists. Before the DNP, schools initially offered the Doctor of Nursing (ND) as a practice-focused degree. However, following the Position Statement on the Practice Doctorate in Nursing in 2004, all ND programs shifted to the DNP.
The position statement highlights the following benefits of Doctor of Nursing Practice degree programs:
Not all APRNs hold a DNP degree. Many advanced nurse practitioners graduate with a Master of Science in Nursing (MSN) degree and maintain the proper licensure through continuing education credits and certifications. However, for some APRN specialties, such as nurse anesthetists, the Council on Accreditation of Nurse Anesthesia Educational Programs requires master-degree level programs to transition to doctorate programs this year or risk losing their accreditation.
The rollout to transition from the master's degree level to the doctorate has been slow, but progress is steadily being made, primarily impacting incoming nursing students.
Although both are terminal degrees, a Doctor of Nursing Practice (DNP) is a practice-focused degree, while a Doctor of Philosophy in Nursing (PhD) is research-focused. The degree programs differ in admission requirements, curriculum, program length, specializations, and career paths.
PhD degree holders typically land roles in research or academia working in research facilities, labs, colleges, or universities. In contrast, DNP degree holders commonly work in hospitals, healthcare facilities, or private practices, using evidence-based practice, informatics, and quality improvement to deliver patient-centered care.
In many professions, higher education results in higher salaries. That's certainly the case in nursing. Roles with complex responsibilities require advanced education through a doctoral program, extensive clinical practice hours, years of experience, certifications, an active registered nurse (RN) license, and management experience. According to The State of Doctor of Nursing Practice Education in 2022, the DNP graduate respondents surveyed primarily work as nurse practitioners, certified registered nurse anesthetists, certified nurse midwives, nurse executives, administrators, nurse faculty, and additional positions.
Advanced practice or nurse leadership roles and the average salaries that DNP holders can expect include:
The DNP curriculum has two main components: foundational competencies and specialty competencies. The Essentials of Doctoral Education for Advanced Nursing Practice outlines eight DNP Essentials to incorporate into all DNP programs:
DNP post-graduates can choose from careers with direct or indirect patient care responsibilities, such as APRNs with expertise in a focus area or as leaders practicing at the aggregate, system, or organizational level. That's why DNP programs build upon the foundational essentials with specialized competencies. This curriculum can include credit hours dedicated to nursing administration or advanced clinical practice electives.
DNP programs have varied tracks, from advanced practice to executive leadership. Coursework depends on the selected specialty. Sample course titles that expand across all practice areas include:
More targeted coursework depends on the focus area. DNP specialties include:
In addition to classroom instruction, DNP programs require a specified number of credits, clinical hours, and DNP practicum hours, all of which lead to a final DNP project at the program's conclusion.
A Doctor of Nursing Practice program can take as little as six semesters to complete. Some top-ranked DNP programs provide multiple entry points.
BSN-to-DNP programs can take three years of full-time study for registered nurses seeking to become advanced practice registered nurses (APRNs) in a specialized area. For registered nurses who already have a master's degree and are seeking the APRN credential , MSN-to-DNP programs require three years of full-time study. APRNs with an MSN can complete a DNP program through six semesters of full-time study.
Applicants pursuing a DNP with a non-nursing baccalaureate degree may take longer than three years to complete, because they will need to complete non-degree prerequisite courses before commencing degree work.
Getting into a Doctor of Nursing Practice (DNP) program is a competitive process. Academic history, years of clinical practice experience, leadership qualities, and a pre-admission interview all factor into enrollment decisions. Standard admission requirements, whether post-BSN to DNP or post-MSN to DNP, include the following:
More than 250 schools use the Centralized Application Service for Nursing (NursingCAS) to upload the standard application requirements listed above. In addition, schools may also request that prospective students complete an English language proficiency exam, submit Graduate Record Examination (GRE) scores, show proof of RN license with full-time RN experience, and complete prerequisite courses.
BSN-to-DNP or MSN-to-DNP program applicants must have a bachelor's or post-master's degree from an accredited nursing program designated by one of the following accreditation and certification bodies:
Finally, licensure requirements vary by program; some offer hybrid or fully online learning. For example, the Columbia University School of Nursing and the Johns Hopkins University School of Nursing strongly recommend licensure within the school's state. Alternatively, the University of Michigan School of Nursing requires a valid RN license in the state where the student will complete their clinical training.
Although the AACN aimed for all programs to transition APRN preparation from the master's degree to the DNP degree by 2015, the MSN remains the predominant degree for APRNs. In addition, although some nursing schools have added DNP preparation programs, they still offer MSN programs.
Another challenge for DNP programs is the varied backgrounds and experiences of applicants. For instance, DNP programs have BSN-to-DNP and MSN-to-DNP options. Also, applicants include post-baccalaureate prospects from non-nursing backgrounds with little clinical experience. These differences can cause strain on some programs working to implement consistent curricula to meet varied student needs while adhering to the DNP Essentials criteria.
While there are some challenges and inconsistencies, a DNP degree can be a career changer for those interested in leadership roles, such as chief nursing officer (CNO) or nurse manager. Advancing to nurse executive roles impacts patient outcomes at a broader level and can evolve into rewarding careers with salaries to match. In addition, nurses wanting to move from floating the nursing floors to making decisions from an executive office would benefit from a doctoral degree to advance in their nursing careers.
Fr APRNs in clinical roles, most DNP programs have the working nurse in mind. Online or hybrid degree programs provide flexibility so practitioners can remain in clinical practice while learning advancements in patient care to practice at the highest level.
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