Doctor of Nursing Practice(DNP)

MSN nurses have a choice between: a Doctor of Nursing Practice and a Doctor of Philosophy in Nursing (Ph.D.). While both are terminal degrees for APRNs, their focus differs significantly. Broadly speaking, PhDs are more research focused while DNPs have a greater emphasis on clinical practice. Is one inherently better than the other? Which degrees fit best for certain nursing careers? Read on to find out. 

 

DNP

 

Nurses with a DNP specialize in providing the best possible nursing care in clinical settings. As leaders in advanced nursing practice, DNP nurses are expected to utilize evidence-based practice and high-level training to improve patient outcomes and take up leadership positions in both clinical and academic facilities. 

 

Though APRNs like Nurse Practitioners can practice with Master’s Degrees, this is gradually changing. Organizations like the American Association of Colleges of Nursing (AACN) have pushed to make DNPs the minimum educational requirement for APRNs, in the past. Due to an increasingly complex and changing healthcare landscape, the advanced knowledge and training of DNPs have been deemed necessary to adapt. 

 

In short, the benefits of the DNP according to the AACN are thus: 

 

• The advanced knowledge necessary for improving patient care outcomes and nursing practice as a whole 

• Improved leadership skills 

• More clinical instruction faculty 

• The advanced competencies required to handle increasingly complicated leadership, faculty, and clinical roles. 

 

DNP Tasks and Responsibilities 

 

While DNPs can work in a hands-on clinical setting, their main concern is adding to the healthcare knowledge pool in a substantial manner.

For the most part, clinical DNPs can expect to carry out the following: 

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• Ordering diagnostic tests, evaluating the results, and interpreting them

• Overseeing general patient care

• Recording and analyzing diagnostic data, symptoms, and medical history

• Giving prescriptions for medications

• Educating and counseling patients, their families, and/or caretakers on healthy lifestyle choices and care plans 

• Utilizing and maintaining medical equipment 

• Carrying out physical examinations

• Providing care for chronic, acute, and common illnesses/conditions.

• Working together with specialists, physicians, and other healthcare professionals

 

Outside the clinical setting, DNPs can find work in education, leadership/administration, or research. In this setting, tasks include: 

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• Developing or updating healthcare policy and procedure 

• Utilizing informatics to lead to improvements in healthcare outcomes

• Providing healthcare education for their patients and the public 

• Improving healthcare outcomes with innovative and creative solutions 

 

A DNP’s autonomy heavily depends on state policy. In 23 states, DNPs have “full practice authority,” that lets them operate without doctor oversight. For states with restricted practice or reduced practice, DNP nurses require approval from the doctor for certain decisions regarding patient care. You can find a map that charts the practice authority for every state here. Meanwhile, DNPs can prescribe medications in 50 states and apply controlled substances in 49 states. 

 

Salary 

 

More advanced education has a strong correlation with higher salaries. In 2020, the Bureau of Labor and Statistics projected that Nurse Practitioners, Certified Nurse Midwives, and Nurse Anesthetists were estimated to earn an average of $117,670 per year. Even the lowest 10% of APRNS earn $84,120, which is still higher than the RN average. Unfortunately, the report did not make distinctions between APRN nurses with MSNs and ones with DNPs.

 

Per Payscale, the current median pay for DNP nurses sits at $107,000. What will best determine your actual salary, however, is the profession and specialization you choose. Most Chief Nursing Officers will earn more than most Nurse Educators, for example. In general, DNP-certified nurse anesthetists, hospital administrators, and nurse midwives are the highest paying professions. The BLS placed the Nurse Anesthetist’s median annual salary at $183,580, while Nurse Midwives earn around $111,130 annually. 

 

Best DNP Schools, Program Length, and Curriculum 

 

US News & World Report currently ranks the following as the top DNP programs in America: 

 

1. John Hopkins University

2. Duke University

3. Rush University

4. University of Washington 

5. Columbia University

 

Though subject to change, John Hopkins, Duke, and Rush have been at or near the top over the past few years.  John Hopkins has the largest student population at around 800, while Duke and Rush hover at the 200 range. 

 

You can opt to take traditional or online classes, depending on your situation or preferences. Note that DNP programs usually require you to have your BSN and MSN degree. There are programs that accept students with no MSN, but they are the exception. Program length will depend on your school and whether you study full-time or part-time. DNP programs can take just 1 year to complete, to as many as 4 years. You are usually expected to complete 30-40 credit hours and 1,000 clinical hours. Sometimes, a percentage of your MSN clinical hours will carry over. 

 

As for classes, you can expect to take up the following: 

 

• Advanced Health Assessment and Measurement

• Advance Leadership

• Advance Healthcare Policy

• Clinical Pharmacology

• Health Promotion and Risk Reduction Across the Lifespan

• Clinical Information Systems

• Research

• Statistics

• Clinical Reasoning

• Epidemiology

• Evidence Appraisal

• Project Development

• Clinical Information Systems

• Ethics for advanced nursing practice

 

DNP Requirements

 

Specifics will differ from school to school, but most schools will ask for the following requirements from you: 

 

• MSN from an accredited nursing school 

• Active U.S Registered Nurse license in good standing, acquired in your state of practice

• APRN License

• Minimum 1 to 2 years of nursing experience

• Proof of completion for prerequisite courses

• Letters of recommendation

• Completed application with all the necessary fees and documents (Transcripts from previous colleges/universities, resume, personal statement, and/or essay) 

• Interview with faculty

• If needed, the International English Language Testing System (IELTS) or Test of English as a Foreign Language (TOEFL) 

• Minimum master GPA of 3.0 or higher 

 

 

PhD

 

Doctor of Philosophy in Nursing is a degree that primarily focuses on research for the sake of progressing nursing science. For the longest time, this was considered the best possible terminal degree for nurses, and at a time was even the only doctorate option available. This degree best suits nurses inclined towards research and teaching. 

 

Tasks and Responsibilities 

 

Ph.D. Nurses can work as bedside nurses, but they do not have any additional, advanced tasks and responsibilities (Unless they become CRNPs). Instead, most nurses with a Ph.D. tend to work as educators or researchers within the healthcare space. Nurse researchers can expect to carry out the following tasks: 

 

• Determining scientific questions, and answering them with thorough research

• Collecting scientific data, analyzing your findings, and publishing detailed reports 

• On-the-job training and supervision for other nurses, scientists, and laboratory staff. 

• Writing grant proposals and applications for research funding 

• Writing nursing articles and research reports for the nursing journals, medical professional journals or other publications

• Presenting your scientific findings in gatherings like conferences or meetings
   

Meanwhile, nurse educators work in academic institutions like colleges or universities. There, they are tasked with: 

 

• Planning out and revising nursing curriculum and material

• Carrying out lectures to nursing students (undergraduate or graduate) 

• Developing study programs and writing/appraising class materials like textbooks

• Speaking at nursing conferences, professional meetings, and more 

• Evaluating student performance in class, clinical rotations, or laboratory work and grading them appropriately 

• Examining class outcomes and adapting their approach accordingly

• Researching and publishing scholarly writings

• Writing grant proposals

• Providing career advice and counseling to students regarding their future career prospects

 

Ph.D. Program Length And Curriculum 

 

Ph.D. programs have a total of 45 to 70 credit hours. Full-time study lasts a minimum of 3 years, but most students take 5 to 7 years. While there is no practical direct patient care, you are expected to complete a dissertation. Dissertations are long, complex research papers that are requirements for all Ph.D. degrees. The point is to show just how much you have grown and learned, over the course of your studies. After a presentation, you must defend your writings and methodology to an inquiring committee. 

 

Ph.D. Requirements

 

Though specific curricula may vary, most Nursing Ph.D. programs will have the following classes: 

 

• Grant Writing

• Measurement in Health Care Research

• Philosophical Perspectives in Health

• Scientific Perspectives

• Leadership in Science: The Role of the Nurse Scientist

• Statistical Methods

• Dissertation

• Longitudinal Methods

• Integrated Interdisciplinary Research Practicum

• Intervention Research Methods in Health Care

• Quantitative Research Design and Methods

• Qualitative Research Design and Methods

• Mixed Methods Research Design

• Responsibilities and Activities of the Nurse Scientist 

 

Final Comparisons: 

 

Which degree you prefer ultimately depends on your career goals and preferences. You want to consider your salary expectations, preferred career paths, and workplaces before you commit to either path. Listed below are a couple of key considerations: 

 

Program Length: 

• Ph.D.: 5-10 years (BSN to Ph.D.) or 3-7 years (MSN to Ph.D.) 

• DNP 5-6 years (ADN to DNP), 3-4 years (BSN to DNP), or 2 years (MSN to DNP)

 

Median Income:

• Ph.D.: $ 82,040/yr (for Nurse Educators, per BLS) or $81,500/yr (For Nurse Researchers, per Payscale) 

• DNP: $120,000-150,000/yr, depending on the workplace

 

Best Job Opportunities

• Ph.D.: Academia. 1,715 faculty vacancies and 138 additional positions are needed, in 2018.

• DNP: Academia as well. National nurse faculty vacancy of 7.9% and 90.7% of vacancies prefer or require a doctorate. 

 

Certification Renewal

• Ph.D.: None

• DNP: Retake exam or fulfill 1000 clinical practice hours and 75 CEUs every 5 years.  

 

Career Paths

• Ph.D.: Research, Education, Health Policy

• DNP: Administrative/Leadership/Management positions in nursing, Healthcare policy, government office, Academic institutions 

 

Location

• Ph.D.: Academic institutions (Colleges or Universities), research centers, hospitals, government facilities, medical laboratories 

• DNP: Hospitals, public health offices, specialty or autonomous practices, Healthcare Administration, Healthcare Policy Advocacy    

   

 

RN to DNP guide 

                                                                                                                                                                   

Becoming a DNP is a long and costly commitment, with fruitful rewards at the very end. Thankfully, RNs do not need to start from scratch. BSN, ADN or MSN nurses can choose from a multitude of DNP programs and tracks. 

 

Why You Should Consider A DNP Degree

 

RNs happy with their career may be wondering why they would ever need a DNP. Though the investment is considering acquiring your doctorate comes with a host of professional benefits: 

 

• More Efficient: The American Association of Colleges of Nursing reports that most APRN Masters's courses have the same credits as their DNP counterparts. In other words, you will spend roughly the same amount of time in your DNP as you would your MSN.

• Increased career flexibility: DNP nurses gain access to a number of different, highly-demanded healthcare professions. They can work as advanced clinical practitioners, educators or even leadership/management roles in important organizations. 

• Significantly higher salaries: In 2018, a salary survey was conducted by Lippincott Solutions.  DNP nurses earned around $7000 more than MSN nurses, annually.  

• More career advancement: To achieve “magnet’ status, hospitals want DNP nurses as nursing managers or nursing leaders. This gives DNP nurses even more employment opportunities and chances to advance their careers. 

• Working within policy reform: DNPs can opt to work in healthcare policy spaces or government offices. Through collaboration and evidence-based practice, nurses have a genuine chance at improving healthcare outcomes.

 

RN to DNP Programs

 

According to the AACN, there are 289 schools with DNP program offerings in America. Students can choose between brick-and-mortar traditional programs, or classes that combine on-site and remote learning. In addition, there are a host of different tracks available. 

 

• RN to DNP: These tracks are for RNs with no other advanced degrees. Though limited, RN to DNP programs allows RNs to study for their DNP without working towards their MSN or BSN. At the bare minimum, you will require an RN License, a diploma degree or an ADN, and a BSN within or outside of nursing.

• MSN to DNP: The most common option available, students with MSNs can directly enroll in graduate-level courses. 

• BSN to DNP: These tracks are available for BSN nurses without their MSN. At bare minimum, you will usually require your RN license, a diploma or ADN degree and your BSN.

• ADN-MSN-DNP: Though limited compared to other courses, there are a couple of schools that allow ADN students to pursue their MSN and DNP at the same time. Students need to possess either their ADN or diploma degree, along with an RN license in good standing. 

• DNP-PhD: Some students may be interested in earning their Doctor of Philosophy in Nursing (PhD) and their DNP simultaneously. To qualify for such programs, you will need an MSN or another applicable graduate degree. 

 

Online RN to DNP programs 

 

Most DNP students already have a host of professional and personal obligations on their plate. Because of this, online learning has gained popularity as a way of studying while working or spending time with their families. 

 

Online RN to DNP programs are the perfect option for a busy HCP. These platforms afford you the flexibility to complete course requirements remotely while you work around your schedule. If you are a working nurse, have a family to tend to, a cramped schedule or a host of miscellaneous responsibilities, this may be your best option. 

 

Program length will vary depending on the track you take and your educational background. Without a Bachelor’s or a Master’s, these DNP programs will take longer thanks to the Master-level curriculum and core competencies. MSN-to-DNP programs are considerably shorter, since students already have graduate experience. In most cases, an 8 to 9 semester DNP course will take 3 to 4 years to complete full time, and as long as 6 years part time. This is assuming you take classes year-round. 

 

Like with any traditional program, you want to make sure that your Online RN to DNP course is accredited. If not, then you will have problems with exam eligibility and employment in the future. To be specific, you want accreditation from The American Association of Colleges of Nursing (AACN) and the Commission on Collegiate Nursing Education (CCNE.) Though technically optional, the AACN also recommends enrolling in schools accredited by the Alliance for Nursing Accreditation to ensure a standard of excellence across all APRN specialties. 

 

Key Differences

 

Though online programs can be just as recognized and quality as any traditional course, there are a couple of key differences that you should consider. Depending on your program, your online course might not assign you with a practicum site or preceptor and you will have to settle these yourself. The practicum section, where you gain hands-on experience together with an instructor, is at the end of most online RN to DNP courses. Finally, some online programs will require that you go to at least one in-person event. This could be for certain lectures or even an immersion weekend at the start of the course. 

 

RN to DNP requirements 

 

Pre-enrollment requirements will differ, depending on the program and your prior education. For example, Post-Baccalaureate DNP students will require their BSN, while Post-Master’s Students need either their MSN or an applicable graduate degree. Other than that, there are a number of other DNP requirements: 

 

The specifics for your DNP program will depend on which type you enter into and whether you’re beginning at a post-baccalaureate or post-master’s level. Post-Baccalaureate DNP applicants will need a Bachelor’s degree in Nursing, while a post-master’s degree will require an MSN or another applicable graduate-level nursing degree. 

 

Outside of your beginning degree requirement, you will need the following to enroll in a DNP program:

 

• Active U.S Registered Nurse license in good standing, acquired in your state of practice

• APRN License

• Minimum 1 to 2 years of nursing experience

• Proof of completion for prerequisite courses

• Minimum 3 letters of recommendation, 1 from a current supervisor

• Completed application with all the necessary fees and documents (Transcripts from previous colleges/universities, resume, personal statement, and/or essay) 

• Interview with faculty, phone or in-person 

• Additional testing for international students 

• Minimum master GPA of 3.0 or higher 

 

Note that for most universities, your RN license must be applicable in the state where you will carry out your clinical. Online DNP courses are a bit more flexible, however. For many schools, you can communicate with your class and set your clinical hours at a facility in your area. 

 

Core Competencies

 

Per the AACN, DNP programs are structured around the outlines provided by Essentials of Master’s Education for Advanced Practice Nursing and the Essentials of Master’s Education in Nursing. In addition to what was established by a student’s prior Master’s Program, DNP programs are meant to instill the following core competencies in their students: 

 

• Health care policy for advocacy 

• Interprofessional collaboration for improving patient and population health outcomes

• Clinical prevention and population health for improving the nation’s health

• Advanced nursing practice

• Practice skills 

• Organizational and systems leadership for quality improvement and systems thinking

• Clinical scholarship and analytical methods for evidence-based practice

• Information systems/technology and patient care technology for the improvement and transformation of health care

 

NP Licensure

 

Should you choose to pursue a career as a Nurse Practitioner, you need to meet the following requirements in order to be licensed: 

 

• Complete the following core APRN courses: advanced pathophysiology, advanced pharmacology, advanced physical assessment 

• Complete an NP program with national competencies aimed at primary, adult-gerontology or family care

• Minimum 500 hours of faculty-supervised direct patient care clinical hours 

• Not taking the certification test more than twice per calendar year

 

Curriculum

 

DNP students can generally expect around 500 hours of clinical work. Your coursework will also depend on your career track since the lessons for APRNs can differ from the courses with a focus on the executive or educational skills. Broadly speaking, however, a DNP curriculum usually looks something like this: 

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• Semester 1-2: Quality Improvement, Patient Safety, Scholarly Writing, Evidence-Based Practice, Informatics, Statistics

• Semester 3-4: DNP Application I and II, Informatics II, Epidemiology, Systems Management, Health Care Economics

• Semester 5-6: Healthy Policy, Legalities, and Ethics, DNP Application III, Electives, & Completion of DNP Project

 

DNP Tuition Costs

 

Program tuition fees are highly variable. Generally, public schools are more expensive than private ones and online courses are more affordable than on-campus programs. Enrolling in in-state programs will also save you money, compared to costlier out-of-state DNP courses. Living on-campus or signing up for residential meal plans will also raise the price tag. On the other hand, hourly tuition costs for DNP classes are nearly identical to MSN rates. Though it is important to note that DNP lessons are longer than graduate courses. 

 

In-state online programs cost $27,745. In 2017, the most expensive programs could get as expensive as $60,000, while cheaper offerings hover at around $12,000. Covering costs will not be easy, but those who can shoulder those costs will be rewarded with exciting career opportunities, higher income, and more. 

 

Financial Aid 

 

Few people can pay for an RN to DNP program directly in cash. Luckily, students can avail themselves of multiple financial assistance programs. Some of the most trusted ones include: 

 

Tuition Reimbursement

 

Some employers offer reimbursement programs to aspiring DNP students. This can range from partial to full tuition repayment. Contact your employer or refer to your facility’s workplace policy for more information. 

 

Grant

 

Unlike loans, grants are financial aid that does not need to be reimbursed. They are commonly given out on the basis of need, though some grants set their criteria on merit or availability. They are most commonly handed out by the federal government, state governing bodies, or colleges.  

 

Payment Plans

 

If you can pay in cash, consult your school’s financial aid office regarding payment plans. If you are concerned about money in the future, some schools have plans where students can defer semesters thanks to financial concerns. 

 

Graduate students can avail of grants through one of several methods. First, they can submit a FAFSA form so that Federal Student Aid locates grants you may qualify for. Aspiring DNP students can also ask their school’s financial aid office for assistance. Finally, you can locate grants specific to your speciality field. You can contact relevant institutions or even your program director for more information on this.

 

Scholarships

 

Like grants, scholarships do not require repayment. Some scholarships cover the full tuition while others are more like partial monetary assistance. Both private and public programs are available for aspiring DNP student. You can check with your school regarding their scholarship offers, or you can search online for private institutions or wealthy individuals with their own scholarship offerings. You also want to look for offers specific to your field of expertise, if possible.

Savings

 

If you can afford to, setting aside some money before you enroll for your DNP can ease the financial burden down the line. Working while studying can be costly, and having some money stored for a rainy day could make all the difference. 

 

Student Loan

 

Unlike scholarships or grants, loans are financial assistance that you need to pay back. Because of interest rates, you usually pay more than what you borrowed in the end. The exact terms will depend on a tender and a number of other factors. There are two types of loans: Federal and Private. Thanks to government backing, interest rates for federal loans are lower and there are less to no hidden fees. You can find out what loans you qualify for by sending your FAFSA application. If you are in significant financial need, you may qualify for a loan that does not gain interest until you graduate college. 

 

Private loans are offered by private institutions like banks, loan firms, or other private entities. Interest rates are significantly higher, there are usually a few extra terms of agreement and you may incur some additional fees like late fees or origination fees. You can search for these loans online, but you must do so with scrutiny. Look for any hidden additional fees and inquire about things such as policy for when you can no longer keep up financially or payment structures. Your school’s financial aid may also help you with this. 

Deferring Undergraduate Loans 

 

Students still handling loans from their undergraduate degrees can defer paying these loans for the duration of their DNP program tenure. Though this postpones loan payments for the near future, remember that your loans will still gain interest. 

 

Loan Forgiveness

 

Though DNP degrees are not always eligible for loan forgiveness, Nurse practitioner degrees can be in the right circumstances. Studying NPs may qualify if they either work for a government agency, a qualifying area/school of need, or have worked for a National Health Service Corp site for around two years. You can contact the Department of Education for more specifics, regarding these loan forgiveness programs. 

 

Go out there! 

 

Making the move from RN to DNP is a daunting task. For those of you looking to advance beyond their station, however, these costs are more than worth it. A DNP represents a unique opportunity for further growth. With this degree, nurses can step into advanced nursing roles, take on educational jobs, or even administrative roles. DNPs have the capacity to change healthcare policy and patient outcomes for the better if they put their minds to it. Both within the hospital and beyond, the sky's the limit for DNP nurses.