By Dorsey Griffith
Contributing Writer

It’s well documented that more and more nurse practitioners are seeking doctoral degrees. The American Association of Colleges of Nursing (AACN) reports growth in both research and practice-focused doctoral programs. But the increase in the Doctor of Nursing Practice (DNP) programs is markedly greater than that of the longer-established Doctor of Philosophy (PhD) nursing programs.

There are 366 DNP programs nationwide, and since 2018, enrollment in DNP programs has gone up by 9.2%, while PhD enrollment has risen 1%, as it was projected to decline according to data presented by Susan Bakewell-Sachs at a 2021 AACN conference.

Connections spoke with three PhD-prepared NPs who are nurse educators about the growth of the DNP, differences between the DNP and PhD, and how these nurse professionals can work together to improve health care delivery and quality:

• Ellen Daroszewski, PhD, APRN, Associate Dean, Graduate Nursing Programs, Samuel Merritt University in Oakland
• Kathryn Sexson, PhD, FNP-BS, Director, proposed DNP-FNP Program, UC Davis Betty Irene Moore School of Nursing in Sacramento
• Alexa Curtis, PhD, MPH, FNP-BC, Assistant Dean, Graduate Nursing, University of San Francisco

Why DNP Program Growth is Surging

Curtis said DNP program growth is largely due to the AACN’s expected shift from the master’s to doctorate degree as the single-entry degree for advanced nursing practice beginning in 2025. The proposed change was first endorsed in 2004 to take effect in 2015 but was delayed. 

“Additional degree requirements at that time didn’t seem to make sense due to the economic impact of the 2007 recession, critical lack of nursing faculty, and the need to protect a robust workforce pipeline for underserved communities” she said.

All the while, DNP programs continued to develop, however, as demand increased for nurses who have doctoral-level competencies to improve patient outcomes in an increasingly complex health care environment, she said. 

Another driver of the growth, Curtis said, was the Institute of Medicine’s 2010 goal of doubling the number of doctorally prepared nurses by 2020, which was reached. Concern that the popularity of the DNP will diminish the role for PhDs is valid, she added, but emphasized that the competencies developed for each are different and that both degrees are essential to the field.

“Overall, the DNP education focuses on implementation of quality improvement processes based on the best available evidence, not on research methodology, design, advanced data analysis, etc. DNPs absolutely are prepared to engage in research, but they generally do not receive as robust an education in research design as the PhD. Ideally, the DNP collaborates with PhD prepared researchers on the generation of new practice knowledge.”

Educational and Career Courses Vary Depending on Doctorate Choice

Daroszewski, who earned her PhD in 1996, said the PhD prepares a nurse to conduct research and educate health professionals. A PhD student, for example, would have heavy coursework in statistics, research methodology and philosophy of science. PhD graduates will likely conduct research at a university or private drug or device company. NPs who have PhDs don’t typically practice bedside nursing.

It can take 8-9 years to complete a PhD in nursing, she said, then up to a decade to establish a well-funded research program. Challenges include a relatively small pot of federal funding for nursing research and the extensive lag time between research publication and application of research findings in the clinical setting.

“When knowledge is created, it takes a very long time for that to be used because PhDs are often not associated with practice,” Daroszewski said. “You make a monumental discovery, and the publication is brilliant, and no one finds it, maybe because you are not tied to a hospital system.”

DNPs, on the other hand, are prepared in just 2-3 years to work in most health care settings. A DNP student’s coursework might focus on population health, policy development and implementation, clinical technology and health care informatics. They work within health care settings leading the translation and implementation of research findings to improve care and patient outcomes.

A DNP, for example, comes into the health care environment as a practice expert who can take new knowledge, a new cancer treatment, for example, and bring it to patients in the clinical setting. 

“They know how to take the evidence, translate it and evaluate it,” Daroszewski said.

Sexson, who is launching a proposed 3-year hybrid DNP-FNP program at UC Davis Betty Irene Moore School of Nursing, agreed. If a student is on the fence about which track to take, she said, they should ask themselves where they want to make an impact.

“Do you want to take the evidence and move it more quickly into practice and effect change at the patient or population level? Or have you identified a problem that we don’t understand and you want to study the full nature of it?”

Sexson said the nursing school decided to add the DNP program to its PhD and master’s programs both because of the practice requirement changes beginning in 2025 and because the university wanted to prepare nurses to lead change in a collaborative environment.

“While we felt confident that we were developing safe and competent NPs at the bedside, we asked, how do we effect that system change through collaborative relationships that is so integrated into our mission and vision for the school?” she asked. “The DNP made sense from that standpoint so that we are educating NPs to make system-level changes to improve the outcomes of patients and populations.”

Sexson differentiates the master’s prepared NP and the DNP this way: The master’s level NP would know how to take care of the person who came in with a gunshot wound. The DNP would have the additional skill to look at what is contributing to gun violence and how we partner with our communities to reduce it.”

How The DNP Enables Nurse Leadership

Barbara Quinn, a clinical nurse specialist, is completing her DNP at Samuel Merritt University while working as Director of Professional Practice and Nursing Excellence for Sutter Health. 

“I wish I had done this a decade ago,” said Quinn, whose position focuses on meeting the organization’s professional practice goals and standardizing evidence-based practice across the system. 

“I work on opportunities for growth and development for nurses and run several nurse practice councils for specialties,” she said. “I needed the DNP because it really helps thinking about how to get best practices through the organization. It’s not enough to say this is what we all should be doing. You have to understand how you get to the best practice from the head to the bed.”

For example, she is leading the charge to update IV change practices based on PhD-generated research that found that changing IVs based on a set schedule, as has been the practice, causes more complications than changing them only when clinically necessary. 

“It’s not enough to write the policy. There has to be a change management component,” Quinn said. “It’s super important for me to have the people who will be affected at the table, to have an opportunity to ask questions, be involved in finding evidence, reading guidelines and helping revise the policies so this is their practice. Their policy.”

Nurse educators agree it’s that kind of symbiotic relationship among the work of both PhDs and DNPs that ultimately will improve patient care, quality and outcomes.

For a list of NP schools throughout California, click here.