VIEWPOINT
By Karen Roush, PhD, RN, FNP
Whatever Happened to the Clinical DNP? Are current doctor of nursing practice programs a good fit for NPs in direct patient care?
W
hen we were about to graduate from our to ensure that patients benefit from the latest innoNP program at Columbia University back vations in care delivery.” A doctorate focused on in 1996, we were asked in a survey how improving outcomes and quality of care through many of us would return to school to complete a translating evidence into practice fits well within these clinical doctorate if one were available. We were roles—it’s what these advanced practice nurses do— told that the purpose of such a doctorate would be and it has the potential to improve their practice. to improve our clinical skills in diagnosis and manBut does it really improve the practice of the NP? agement of patients in preparation for practicing The roles of NPs are grounded in nursing, but independently— essentially, it would be an intenthey are expressed in activities that were once assosive clinical internship. ciated only with medical docWithin a few years, Columbia tors. Yes, as nurses NPs practice Let’s provide was among the first schools to wellness care and treat patients offer a doctor of nursing pracholistically and tend to be very a doctorate tice (DNP) program. Some of good at listening to and treatmy colleagues who enrolled deing patients within the contexts that’s relevant scribed to me the residencies of their lives. But the practice to what most they completed to earn their of most NPs is not focused on degree. Arranged by students quality improvement at the sysNPs do. through their own contacts, the tems level. Their practice is eviinternships were usually condence based, but it is focused ducted under the supervision of physicians and in on doing histories and physical exams—with the health care settings where the students were already purpose of diagnosis and management of acute and employed. As in any such placement, some had great chronic illnesses, ordering tests, interpreting test reexperiences that they felt made them better clinicians, sults, and prescribing medications and other therapies. while others did not. Many have admitting privileges and some perform DNP programs are proliferating at a rapid rate; minor surgical procedures, or suturing and fracture there are currently 241 and another 59 in the works, repair. according to the American Association of Colleges So, if NPs want to increase their clinical expertise, of Nursing (AACN). But many don’t resemble the especially in a specialty area, what educational route clinical doctorate I first heard described. Now the is available when few DNP programs offer an intenprimary focus seems to be on translating evidence sive clinical placement? If they want a credential that into practice. In order to graduate, the NP must do indicates clinical education at the doctoral level—what a capstone project, which is usually an educational credential says that? intervention with staff or a quality improvement If all NPs are going to be required to have a docproject. torate by 2015 for entry into practice, then we need Translation of evidence into practice is an importo provide one that is relevant to what many, if not tant skill. But why are DNP programs making it a most, NPs actually do. I’m not arguing for a new primary focus for NPs, who have been educated to doctoral-level degree or, for that matter, for any new diagnose and manage health problems? As currently degree. We are already overrun with degrees and realized, the DNP is an appropriate and valuable specializations and certifications. I’m arguing for a program for a clinical nurse specialist (CNS) or a rigorous clinical practice DNP track that provides clinical nurse leader (CNL). According to the NaNPs with the opportunity to hone their diagnostic tional Association of Clinical Nurse Specialists, the and clinical skills under the tutelage of expert diagrole of the CNS is to “influence care outcomes by nosticians and clinicians, whether they are medical providing expert consultation for nursing staffs and or nursing doctors. ▼ by implementing improvements in health care deKaren Roush is AJN’s clinical managing editor. Contact author: livery systems”; the AACN describes the role of the [email protected]. The author has disclosed no poCNL as putting “evidence-based practice into action tential conflicts of interest, financial or otherwise. [email protected]
AJN ▼ June 2014
▼
Vol. 114, No. 6
11
By Karen Roush, PhD, RN, FNP
Whatever Happened to the Clinical DNP? Are current doctor of nursing practice programs a good fit for NPs in direct patient care?
W
hen we were about to graduate from our to ensure that patients benefit from the latest innoNP program at Columbia University back vations in care delivery.” A doctorate focused on in 1996, we were asked in a survey how improving outcomes and quality of care through many of us would return to school to complete a translating evidence into practice fits well within these clinical doctorate if one were available. We were roles—it’s what these advanced practice nurses do— told that the purpose of such a doctorate would be and it has the potential to improve their practice. to improve our clinical skills in diagnosis and manBut does it really improve the practice of the NP? agement of patients in preparation for practicing The roles of NPs are grounded in nursing, but independently— essentially, it would be an intenthey are expressed in activities that were once assosive clinical internship. ciated only with medical docWithin a few years, Columbia tors. Yes, as nurses NPs practice Let’s provide was among the first schools to wellness care and treat patients offer a doctor of nursing pracholistically and tend to be very a doctorate tice (DNP) program. Some of good at listening to and treatmy colleagues who enrolled deing patients within the contexts that’s relevant scribed to me the residencies of their lives. But the practice to what most they completed to earn their of most NPs is not focused on degree. Arranged by students quality improvement at the sysNPs do. through their own contacts, the tems level. Their practice is eviinternships were usually condence based, but it is focused ducted under the supervision of physicians and in on doing histories and physical exams—with the health care settings where the students were already purpose of diagnosis and management of acute and employed. As in any such placement, some had great chronic illnesses, ordering tests, interpreting test reexperiences that they felt made them better clinicians, sults, and prescribing medications and other therapies. while others did not. Many have admitting privileges and some perform DNP programs are proliferating at a rapid rate; minor surgical procedures, or suturing and fracture there are currently 241 and another 59 in the works, repair. according to the American Association of Colleges So, if NPs want to increase their clinical expertise, of Nursing (AACN). But many don’t resemble the especially in a specialty area, what educational route clinical doctorate I first heard described. Now the is available when few DNP programs offer an intenprimary focus seems to be on translating evidence sive clinical placement? If they want a credential that into practice. In order to graduate, the NP must do indicates clinical education at the doctoral level—what a capstone project, which is usually an educational credential says that? intervention with staff or a quality improvement If all NPs are going to be required to have a docproject. torate by 2015 for entry into practice, then we need Translation of evidence into practice is an importo provide one that is relevant to what many, if not tant skill. But why are DNP programs making it a most, NPs actually do. I’m not arguing for a new primary focus for NPs, who have been educated to doctoral-level degree or, for that matter, for any new diagnose and manage health problems? As currently degree. We are already overrun with degrees and realized, the DNP is an appropriate and valuable specializations and certifications. I’m arguing for a program for a clinical nurse specialist (CNS) or a rigorous clinical practice DNP track that provides clinical nurse leader (CNL). According to the NaNPs with the opportunity to hone their diagnostic tional Association of Clinical Nurse Specialists, the and clinical skills under the tutelage of expert diagrole of the CNS is to “influence care outcomes by nosticians and clinicians, whether they are medical providing expert consultation for nursing staffs and or nursing doctors. ▼ by implementing improvements in health care deKaren Roush is AJN’s clinical managing editor. Contact author: livery systems”; the AACN describes the role of the [email protected]. The author has disclosed no poCNL as putting “evidence-based practice into action tential conflicts of interest, financial or otherwise. [email protected]
AJN ▼ June 2014
▼
Vol. 114, No. 6
11
