EDITORIAL
An essential piece of nursing’s future: The continued development of the nurse practitioner as expert clinician and scientist As one of the largest groups in the healthcare industry, nurse practitioners (NPs) are in a unique position to improve the translation of clinical research into evidencebased practice; yet, unfortunately, few NPs work in clinical research settings. We believe that a variety of issues are contributing to the small number of NPs in both academic and nonacademic healthcare research positions. First, disagreements regarding the best educational trajectory for NPs interested in pursuing doctoral education has potentially contributed to the small number of PhD-prepared NPs (Brar, Boschma, & McCuaig, 2010; Loomis, Willard, & Cohen, 2007). Second, many bright motivated students fail to pursue a combined degree as an NP and clinical researcher (PhD/NP or PhD/doctorate of nursing practice [DNP]) as evidenced by the low enrollment in these programs (Broome, 2012). The goals of this editorial are to (a) highlight the advantages of the NP-scientist’s role in the current healthcare industry, and (b) outline potential strategies to encourage more nursing professionals to pursue degrees in advanced clinical practice (NP) and clinical research (PhD). We argue that nurses trained as both a PhD-prepared clinical scientist and either MSN-NP or DNP-NP are essential to successfully generate and translate nursing research into improved clinical practice.
Perspectives on doctoral education Historically, the role of the PhD-prepared nurse was to generate relevant scientific knowledge for application by the expert clinical nurse (Buchholz et al., 2013). The impetus for the DNP originated in the American Association of Colleges of Nursing’s (AACN) 2004 goal suggesting advanced practice nursing specialization preparation should be moved to the doctoral level, and the National Research Council’s 2005 report encouraging the nursing profession to develop a nonresearch, practice-based doctorate for expert practitioners who could also serve in clinical faculty roles (AACN, 2006). Since that time, increasing numbers of schools have developed post-MSN and/or post-BSN DNP programs for nurses wishing to pursue advanced clinical knowledge and/or NP certification. Following the 2004 AACN policy statement and the accreditation of DNP programs in 2008, the AACN has remained supportive of nurses pursuing a DNP, while simultaneously supporting and expanding the pipeline of PhD-prepared nurse 178
scientists who are “a critical resource for supplying the evidence base for nursing practice” (AACN, 2012). In 2008, enrollment in DNP and PhD programs were equally matched at approximately 4000 students; however, by 2012, DNP enrollments had more than doubled in comparison to PhD enrollments (14,699 DNP vs. 5110 PhD; Kirschling, 2014). As of September 2013, there were 243 DNP programs in the United States, with plans for an additional 59 programs in development; meanwhile, there were only 132 programs offering a PhD in nursing (AACN, 2014). Important to note, these numbers reflect only schools that are AACN members and do not represent the complete number of nursing DNP and PhD programs in the United States. Nationally, the number of DNP programs continues to outweigh the number of nursing PhD programs, suggesting the problem is actually greater than these numbers reflect.
Advantages of combined clinician/researcher Those trained as both clinicians and researchers will be the true leaders of clinical translational research with the ability to understand the most pertinent healthcare issues and design effective, scientifically appropriate programs of research to evaluate and implement best nursing practice. Few current NPs have the education background to develop researchable questions, design effective studies, and generate fundable grant proposals. Furthermore, those nurses with primary research training and limited clinical experience may not have the expertise to ask the most pertinent questions or design feasible interventions regarding the most pressing problems in today’s ever changing healthcare system. Only those with expertise in both clinical practice and research will be able to lead and interact with other scientists to successfully design and translate empirical research into improved patient care.
Problems with current NP-PhD programs A potential contributor to the small numbers of dually prepared DNP-PhD NPs may be the belief that the two roles need to be separate. Focusing on the differences between these two options fails to emphasize the usefulness of combined education and training. While some suggest a choice should be made between the two degrees, our position is that in order to develop and implement pertinent research in a timely manner, nurses trained Journal of the American Association of Nurse Practitioners 27 (2015) 178–180 C 2015 American Association of Nurse Practitioners
Editorial
K. Wysocki et al.
in both advanced clinical care and research methods are essential to positively impact clinical practice.
Strategies to improve combined PhD/DNP programs We believe that the lack of nurses pursuing joint degrees is multifactorial and includes an increased emphasis on the DNP pathway in order to quickly generate a large number of doctoral-prepared nurses, a reduced focus on the research doctorate, the length of time required to complete a dual degree program (i.e., MSN-NP/DNP-PhD), the cost of dual degree programs, the income differential between clinically prepared NPs and research-prepared doctoral candidates, and the lack of perceived significance that a dually prepared DNP-PhD would bring to the academic or nonacademic setting. Information on the number of nurses with both a DNP and PhD has not been reported; however, because very few programs provide both degrees and are only recently developed, it is unlikely that they will create the number of well-trained individuals needed. To promote the dual PhD-DNP role, academic programs need to continue to provide education in research methods, find supportive environments for the dual degree role in academia, clinical settings, and other related healthcare venues, ensure adequate funding (i.e., state and national government sources), develop and disseminate empirical data regarding the advantages of nurses prepared with dual degrees, and refine dual degree programs in order to maximize learning opportunities without burdening the student with tremendous cost. The program length for NPs pursuing a research doctorate may be too long. Suggestions to address this issue would include providing an efficient educational method that insures students have time for clinical practice, establishing clinical and research mentorship programs, and keeping the dual degree under 5 years. Additional solutions may include providing advanced clinical training, statistics, and research design courses at the undergraduate level, which would benefit both students pursuing an advanced degree as well as those preparing to work at the bedside. Another significant barrier is the potentially prohibitive cost of a dual degree. With the added course work and time spent in academic settings comes the cost incurred for credit hours, loss of salary, and social costs. We suggest increased parity with medical school programs in government funding to additionally support both DNP and PhD programs. Additional funding would allow universities to provide the needed financial incentive for qualified nursing educators, enhanced educational programing, and the ability to provide the advanced practice nursing
student with the needed support throughout his or her academic journey. Additionally, income disparity between types of doctoral preparation may steer nurses in one direction over another. PhD-prepared nurses pursuing academic faculty or administrative positions find average salaries to be somewhat lower than those seen in clinical practice depending on the size and location of the program. The NP in a blended role (i.e., clinical, academic, and/or research) may find starting salaries, which meet or exceed the average starting salary for the DNP-only prepared NP. Either way, the point is economics. Nurses considering alternate career paths will factor in salary at graduation and salary trajectory when making academic career choices.
Summary In summary, we urge a transition in the current conversation. The national dialogue continues to focus on the differences between the DNP and PhD degrees and it needs to move to the benefits of combining the two degrees in order to provide an effective and efficient model for developing advanced practice NP clinical scientists (NP/PhD). Although the National Academy of Sciences has called for a nonresearch clinical doctorate to help bridge the nursing faculty shortage, this does not call for abandoning the idea of the combined PhD-DNP approach. Some universities have initiated dual degree PhD-DNP academic tracks. By design, the PhD-prepared NP, who is engaged in diagnosing and treating patients as well as the research process, will be able to decrease the time needed to translate science from the bench to the bedside and from the bedside back to the bench. We encourage our colleagues and leaders in the AACN, American Association of NPs (AANPs), National Organization of NP Faculties (NONPF), National Association of Pediatric NPs (NAPNAPs), as well as research institutes such as the National Institute of Nursing Research (NINR), Centers for Disease Control (CDC), Department of Defense (DOD) to continue the dialogue regarding the importance of encouraging NPs to pursue a research doctoral degree (PhD). In order to meet the need for PhD-prepared NPs in clinical, academic, research, there must be ongoing and continued discussion regarding the barriers to these programs as well as a broader look at the nursing educational traditions that do not serve the profession well. Kenneth Wysocki, PhD, FNP-BC, RN, FAANP1 , Patricia C. Underwood, PhD, FNP-BC, RN2 , & Susan Kelly-Weeder, PhD, FNP-BC, RN3 1
Matrix Medical Network, Scottsdale, AZ Medical Service, Veterans Affairs Boston Healthcare System, Boston, MA 3 William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 2
179
Editorial
References American Association of Colleges of Nursing (AACN). (2006). DNP Roadmap Task Force Report, 2014. Retrieved from http://www.aacn.nche.edu/dnp/ roadmapreport.pdf American Association of Colleges of Nursing (AACN). (2012). Doctorate of nurse practice: Frequently asked questions, 2014. Retrieved from http://www.aacn.nche.edu/dnp/about/frequently-asked-questions American Association of Colleges of Nursing (AACN). (2014). 2013–2014 Enrollment and graduations in baccalaureate and graduate programs in nursing. Washington, DC: Author. Brar, K., Boschma, G., & McCuaig, F. (2010). The development of nurse practitioner preparation beyond the master’s level: What is the debate about? International Journal of Nursing Education Scholarship, 7, Article 9. doi:10.2202/1548-923X.1928
180
K. Wysocki et al.
Broome, M. E. (2012). Doubling the number of doctorally prepared nurses. Nursing Outlook, 60(3), 111–113, 113 e111. doi:10.1016/j.outlook.2012.04.001 Buchholz, S. W., Budd, G. M., Courtney, M. R., Neiheisel, M. B., Hammersla, M., & Carlson, E. D. (2013). Preparing practice scholars: Teaching knowledge application in the Doctor of Nursing Practice curriculum. Journal of the American Association of Nurse Practitioners, 25(9), 473–480. doi:10.1002/2327-6924.12050 Kirschling, J. M. (2014). Reflections on the future of doctoral programs in nursing, 2014. Retrieved from http://www.aacn.nche.edu/dnp/JK-2014-DNP. pdf Loomis, J. A., Willard, B., & Cohen, J. (2007). Difficult professional choices: Deciding between the PhD and the DNP in nursing. Online Journal of Issues in Nursing, 12(1), 6.
Copyright of Journal of the American Association of Nurse Practitioners is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
An essential piece of nursing’s future: The continued development of the nurse practitioner as expert clinician and scientist As one of the largest groups in the healthcare industry, nurse practitioners (NPs) are in a unique position to improve the translation of clinical research into evidencebased practice; yet, unfortunately, few NPs work in clinical research settings. We believe that a variety of issues are contributing to the small number of NPs in both academic and nonacademic healthcare research positions. First, disagreements regarding the best educational trajectory for NPs interested in pursuing doctoral education has potentially contributed to the small number of PhD-prepared NPs (Brar, Boschma, & McCuaig, 2010; Loomis, Willard, & Cohen, 2007). Second, many bright motivated students fail to pursue a combined degree as an NP and clinical researcher (PhD/NP or PhD/doctorate of nursing practice [DNP]) as evidenced by the low enrollment in these programs (Broome, 2012). The goals of this editorial are to (a) highlight the advantages of the NP-scientist’s role in the current healthcare industry, and (b) outline potential strategies to encourage more nursing professionals to pursue degrees in advanced clinical practice (NP) and clinical research (PhD). We argue that nurses trained as both a PhD-prepared clinical scientist and either MSN-NP or DNP-NP are essential to successfully generate and translate nursing research into improved clinical practice.
Perspectives on doctoral education Historically, the role of the PhD-prepared nurse was to generate relevant scientific knowledge for application by the expert clinical nurse (Buchholz et al., 2013). The impetus for the DNP originated in the American Association of Colleges of Nursing’s (AACN) 2004 goal suggesting advanced practice nursing specialization preparation should be moved to the doctoral level, and the National Research Council’s 2005 report encouraging the nursing profession to develop a nonresearch, practice-based doctorate for expert practitioners who could also serve in clinical faculty roles (AACN, 2006). Since that time, increasing numbers of schools have developed post-MSN and/or post-BSN DNP programs for nurses wishing to pursue advanced clinical knowledge and/or NP certification. Following the 2004 AACN policy statement and the accreditation of DNP programs in 2008, the AACN has remained supportive of nurses pursuing a DNP, while simultaneously supporting and expanding the pipeline of PhD-prepared nurse 178
scientists who are “a critical resource for supplying the evidence base for nursing practice” (AACN, 2012). In 2008, enrollment in DNP and PhD programs were equally matched at approximately 4000 students; however, by 2012, DNP enrollments had more than doubled in comparison to PhD enrollments (14,699 DNP vs. 5110 PhD; Kirschling, 2014). As of September 2013, there were 243 DNP programs in the United States, with plans for an additional 59 programs in development; meanwhile, there were only 132 programs offering a PhD in nursing (AACN, 2014). Important to note, these numbers reflect only schools that are AACN members and do not represent the complete number of nursing DNP and PhD programs in the United States. Nationally, the number of DNP programs continues to outweigh the number of nursing PhD programs, suggesting the problem is actually greater than these numbers reflect.
Advantages of combined clinician/researcher Those trained as both clinicians and researchers will be the true leaders of clinical translational research with the ability to understand the most pertinent healthcare issues and design effective, scientifically appropriate programs of research to evaluate and implement best nursing practice. Few current NPs have the education background to develop researchable questions, design effective studies, and generate fundable grant proposals. Furthermore, those nurses with primary research training and limited clinical experience may not have the expertise to ask the most pertinent questions or design feasible interventions regarding the most pressing problems in today’s ever changing healthcare system. Only those with expertise in both clinical practice and research will be able to lead and interact with other scientists to successfully design and translate empirical research into improved patient care.
Problems with current NP-PhD programs A potential contributor to the small numbers of dually prepared DNP-PhD NPs may be the belief that the two roles need to be separate. Focusing on the differences between these two options fails to emphasize the usefulness of combined education and training. While some suggest a choice should be made between the two degrees, our position is that in order to develop and implement pertinent research in a timely manner, nurses trained Journal of the American Association of Nurse Practitioners 27 (2015) 178–180 C 2015 American Association of Nurse Practitioners
Editorial
K. Wysocki et al.
in both advanced clinical care and research methods are essential to positively impact clinical practice.
Strategies to improve combined PhD/DNP programs We believe that the lack of nurses pursuing joint degrees is multifactorial and includes an increased emphasis on the DNP pathway in order to quickly generate a large number of doctoral-prepared nurses, a reduced focus on the research doctorate, the length of time required to complete a dual degree program (i.e., MSN-NP/DNP-PhD), the cost of dual degree programs, the income differential between clinically prepared NPs and research-prepared doctoral candidates, and the lack of perceived significance that a dually prepared DNP-PhD would bring to the academic or nonacademic setting. Information on the number of nurses with both a DNP and PhD has not been reported; however, because very few programs provide both degrees and are only recently developed, it is unlikely that they will create the number of well-trained individuals needed. To promote the dual PhD-DNP role, academic programs need to continue to provide education in research methods, find supportive environments for the dual degree role in academia, clinical settings, and other related healthcare venues, ensure adequate funding (i.e., state and national government sources), develop and disseminate empirical data regarding the advantages of nurses prepared with dual degrees, and refine dual degree programs in order to maximize learning opportunities without burdening the student with tremendous cost. The program length for NPs pursuing a research doctorate may be too long. Suggestions to address this issue would include providing an efficient educational method that insures students have time for clinical practice, establishing clinical and research mentorship programs, and keeping the dual degree under 5 years. Additional solutions may include providing advanced clinical training, statistics, and research design courses at the undergraduate level, which would benefit both students pursuing an advanced degree as well as those preparing to work at the bedside. Another significant barrier is the potentially prohibitive cost of a dual degree. With the added course work and time spent in academic settings comes the cost incurred for credit hours, loss of salary, and social costs. We suggest increased parity with medical school programs in government funding to additionally support both DNP and PhD programs. Additional funding would allow universities to provide the needed financial incentive for qualified nursing educators, enhanced educational programing, and the ability to provide the advanced practice nursing
student with the needed support throughout his or her academic journey. Additionally, income disparity between types of doctoral preparation may steer nurses in one direction over another. PhD-prepared nurses pursuing academic faculty or administrative positions find average salaries to be somewhat lower than those seen in clinical practice depending on the size and location of the program. The NP in a blended role (i.e., clinical, academic, and/or research) may find starting salaries, which meet or exceed the average starting salary for the DNP-only prepared NP. Either way, the point is economics. Nurses considering alternate career paths will factor in salary at graduation and salary trajectory when making academic career choices.
Summary In summary, we urge a transition in the current conversation. The national dialogue continues to focus on the differences between the DNP and PhD degrees and it needs to move to the benefits of combining the two degrees in order to provide an effective and efficient model for developing advanced practice NP clinical scientists (NP/PhD). Although the National Academy of Sciences has called for a nonresearch clinical doctorate to help bridge the nursing faculty shortage, this does not call for abandoning the idea of the combined PhD-DNP approach. Some universities have initiated dual degree PhD-DNP academic tracks. By design, the PhD-prepared NP, who is engaged in diagnosing and treating patients as well as the research process, will be able to decrease the time needed to translate science from the bench to the bedside and from the bedside back to the bench. We encourage our colleagues and leaders in the AACN, American Association of NPs (AANPs), National Organization of NP Faculties (NONPF), National Association of Pediatric NPs (NAPNAPs), as well as research institutes such as the National Institute of Nursing Research (NINR), Centers for Disease Control (CDC), Department of Defense (DOD) to continue the dialogue regarding the importance of encouraging NPs to pursue a research doctoral degree (PhD). In order to meet the need for PhD-prepared NPs in clinical, academic, research, there must be ongoing and continued discussion regarding the barriers to these programs as well as a broader look at the nursing educational traditions that do not serve the profession well. Kenneth Wysocki, PhD, FNP-BC, RN, FAANP1 , Patricia C. Underwood, PhD, FNP-BC, RN2 , & Susan Kelly-Weeder, PhD, FNP-BC, RN3 1
Matrix Medical Network, Scottsdale, AZ Medical Service, Veterans Affairs Boston Healthcare System, Boston, MA 3 William F. Connell School of Nursing, Boston College, Chestnut Hill, MA 2
179
Editorial
References American Association of Colleges of Nursing (AACN). (2006). DNP Roadmap Task Force Report, 2014. Retrieved from http://www.aacn.nche.edu/dnp/ roadmapreport.pdf American Association of Colleges of Nursing (AACN). (2012). Doctorate of nurse practice: Frequently asked questions, 2014. Retrieved from http://www.aacn.nche.edu/dnp/about/frequently-asked-questions American Association of Colleges of Nursing (AACN). (2014). 2013–2014 Enrollment and graduations in baccalaureate and graduate programs in nursing. Washington, DC: Author. Brar, K., Boschma, G., & McCuaig, F. (2010). The development of nurse practitioner preparation beyond the master’s level: What is the debate about? International Journal of Nursing Education Scholarship, 7, Article 9. doi:10.2202/1548-923X.1928
180
K. Wysocki et al.
Broome, M. E. (2012). Doubling the number of doctorally prepared nurses. Nursing Outlook, 60(3), 111–113, 113 e111. doi:10.1016/j.outlook.2012.04.001 Buchholz, S. W., Budd, G. M., Courtney, M. R., Neiheisel, M. B., Hammersla, M., & Carlson, E. D. (2013). Preparing practice scholars: Teaching knowledge application in the Doctor of Nursing Practice curriculum. Journal of the American Association of Nurse Practitioners, 25(9), 473–480. doi:10.1002/2327-6924.12050 Kirschling, J. M. (2014). Reflections on the future of doctoral programs in nursing, 2014. Retrieved from http://www.aacn.nche.edu/dnp/JK-2014-DNP. pdf Loomis, J. A., Willard, B., & Cohen, J. (2007). Difficult professional choices: Deciding between the PhD and the DNP in nursing. Online Journal of Issues in Nursing, 12(1), 6.
Copyright of Journal of the American Association of Nurse Practitioners is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
