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There are several doctorate-level degrees in nursing: Doctor of Nursing Practice (DNP or DrNP), Doctor of Nursing Science (DNSc, DNS or DSN) and Doctor of Philosophy (PhD) in Nursing. The Doctor of Nursing (ND) degree has been phased out and most universities have transitioned to the DNP. The PhD and DNS degrees are generally considered research-oriented degrees, whereas the DNP is a practice-oriented or clinical doctorate.^[1]

[edit] Doctor of Nursing Practice

The Doctor of Nursing Practice (DNP or DrNP) is an advanced-level practice degree that focuses on the clinical aspects of nursing rather than academic research. The curriculum for the DNP degree generally includes advanced practice, leadership, and application of clinical research related to nursing. The DNP is intended primarily to prepare registered nurses (RN) to become advance practice nurses. Advanced practice roles in nursing include the nurse practitioner (NP), certified registered nurse anesthetist (CRNA), certified nurse midwife (CNM), or clinical nurse specialist (CNS).

According to the American Association of Colleges of Nursing (AACN), transitioning advance practice nursing programs from the graduate level to the doctoral level is a "...response to changes in health care delivery and emerging health care needs, additional knowledge or content areas have been identified by practicing nurses. In addition, the knowledge required to provide leadership in the discipline of nursing is so complex and rapidly changing that additional or doctoral level education is needed."^[2] According to the AACN, "...benefits of practice-focused doctoral programs include:

• development of needed advanced competencies for increasingly complex clinical, faculty and leadership roles;
• enhanced knowledge to improve nursing practice and patient outcomes;
• enhanced leadership skills to strengthen practice and health care delivery;
• better match of program requirements and credits and time with the credential earned;
• provision of an advanced educational credential for those who require advanced practice knowledge but do not need or want a strong research focus (e.g. clinical faculty);
• partly with other health professions, most of which have a doctorate as the credential required for practice;
• enhanced ability to attract individuals to nursing from non-nursing backgrounds;
• increased supply of faculty for clinical instruction; and
• improved image of nursing."^[3]

The AACN requires that all entry-level nurse practitioner educational programs be transitioned from the Master of Science in Nursing (MSN) degree to the DNP degree by the year 2015.^[1] The American Association of Nurse Anesthetists has followed suit, requiring the DNP (or DNAP-Doctor of Nurse Anesthesia Practice) degree for entry-level nurse anesthetist programs by the year 2025.^[4] Nurse practitioners and nurse anesthetists currently practicing with an MSN will not be required to obtain the DNP.

[edit] Criticism of the DNP

The development of the DNP has spawned much criticism, from nurses, nurse practitioners, physicians, and other groups. For example, Susan Chase and Rosanne Pruitt, two master's-level advanced practice nurses writing for the Journal of Nursing Education, comprehensively reviewed the DNP movement in the United States in 2006 in order to establish whether the degree is necessary to improve patient outcomes, and whether the degree overly complicates an already established system ^[5]. They concluded that the existing master's degree requirement has satisfactorily prepared nurse practitioners to provide a wide variety of services to patients, and that a doctoral level of education should focus not just on clinical training but also on advancing the knowledge of nursing faculty. The adequacy of existing master's-level education is further supported by other articles that show nurse practitioners provide a level of care that is rated at or above that of physicians in comparable level primary care situations ^[6][7][8].

In the United States, patient confusion between Medical Doctors (MD), Doctors of Osteopathic Medicine (DO), and Doctors of Nursing Practice (DNP) has become another point of contention, especially as nurse practitioners gain greater or complete autonomy.^[9] Although MDs, DOs, and DNPs all nominally hold a doctorate degree by education, in a medical setting the term "doctor" is generally understood to refer to physicians only (i.e. DO's and MD's), and the level of training varies greatly. Inconsistencies in current DNP programs, such as internet-only coursework or variance between state requirements, feed criticism that DNP graduates may not necessarily deserve a title of "doctor" in a patient care setting. The specific concern with the DNP and similar movements such as the transition of physical therapist certification from a master's degree to a Doctor of Physical Therapy degree is that the amount of education required is not sufficient for the title of "doctor," otherwise known as degree inflation ^[10]. Some states have laws regulating how the phrase "doctor" can be used in representing health care services, although these do not seem to specifically prohibit use of the title "Doctor" by doctoral-level nurse practitioners ^[11][12]..

[edit] Doctor of Nursing Science, Doctor of Philosophy in Nursing

The Doctor of Nursing Science (DNSc, DNS, DSN) is a professional-level research degree in nursing, whereas the Doctor of Philosophy (PhD) in Nursing is considered an academic degree, which prepares candidates for both research and teaching positions. When first introduced in the 1970s, the Doctor of Nursing Science was intended to be the "clinical," or practice, based doctorate. However, the DNSc curriculum was found to be very similar to the research based PhD program. The DNSc requires writing and defending a dissertation or completing a substantial project for graduation. With the introduction of the Doctorate in Nursing Practice as a clinical-oriented degree, some schools of nursing have begun to phase out doctor of Nursing Science programs. The Nursing programs at Yale University and Rush University, for example, which formerly offered the DNSc, have now begun offering only the Doctor of Philosophy degree.

[edit] See also

• Diploma in Nursing
• Associate of Science in Nursing
• Bachelor of Science in Nursing
• Master of Science in Nursing
• Doctor of Nursing Practice
• Nurse education
• Nursing school

[edit] References