DNP Reflection

History and Purpose
Current DNP programs began in 2004 when the American Association of Colleges of
Nursing (AACN) proposed that all nursing schools should change from a master’s level
preparation for advanced practice registered nurses (APRN) to a Doctor of Nursing practice
(DNP) preparation by the year 2015 (McCauley et al., 2020). At the master’s level the
educational focus is on building advanced clinical capability while at the doctorate level the
educational focus is broader and includes the development of scholarship, leadership, and
systems knowledge (Cashin, 2018). In addition, around the same time, the focus in healthcare
was shifting toward more interprofessional, evidence-based care to ensure healthcare providers
had the tools necessary to address the growing complexity of healthcare (McCauley et al.,
2020). Other disciplines, including physical therapy and pharmacy, also started to implement an
educational change to require a doctorate level degree for entry into practice (McCauley et al.,
2020).
Current State of DNP
In 2004 there was widespread support for the proposed change from master’s level
education to a doctorate level of education for an APRN to gain entry to practice. However, as
of today, the Master of Science in nursing is the primary entry point into APRN practice. The
goal of moving fully to doctoral education by 2015 has not been fully achieved but good
progress has been made. In 2018, there were 457 existing or planned DNP programs in the US
in all 50 states and the District of Columbia (AACN, 2020). Lack of clear roles and contributions
of DNP educated advance practitioners has led to the slow transition to requiring a doctorate
level of education (Mancuso et al., 2016).
Future State of DNP
The increasing complexity of healthcare requires the highest level of scientific
knowledge and healthcare practice expertise to assure high quality and safe patient outcomes
(AACN, 2018). Several factors driving the future need for re-emphasized change to DNP level of
education include the expanded knowledge needed for healthcare, the increasing complexity of
patient needs, national concerns about the quality of care and patient safety, critical shortages
of nursing staff which demands better prepared leaders, and increasing educational
expectations of all members of the healthcare team (AACN, 2018). There are barriers in the
push for doctorate level of education including insufficient faculty for the various DNP programs
and limited numbers of clinical sites (Terhaar et al., 2016). Studies to assess the impact of DNP
graduates on health outcomes and healthcare costs will provide much needed information for
employers to acknowledge the benefits of hiring DNP prepared nurses (Terhaar et al., 2016).
DNP Transforming Healthcare and Solving Complex Health Problems
DNP prepared nurses transform patient care by integrating evidence-based practice and
relevant disease-specific clinical practice guidelines into patient care. DNP education assists in
gaining the insight, skills, and knowledge to build leadership qualities. These qualities help drive
the development of strategies to improve patient care and drive change in the clinical
environment through application of evidence-based interventions. A DNP-prepared leader
understands the organizational and policy implications of patient care models and changes to
those models from an institutional standpoint. Most importantly, a doctorate level education
assists in developing the knowledge and experience in redesigning, evaluating, and sharing the
results of quality improvement projects to better provide safe, cost-effective, and efficient
patient-centered care (Sherrod & Goda, 2016).
Advantages of Having the DNP
The DNP is instrumental in equipping nurses with the relevant knowledge, skills and
experiences required to handle complex issues in the health care system and initiate needed
changes and reforms for quality patient care (Beeber et al., 2019). Having a DNP allows for
expanded opportunities in nursing leadership, including increased involvement in policy
development, promotes nurses use of evidence-based practice in clinical and community settings,
and increases utilization of advanced technologies in healthcare systems (Beeber et al., 2019). The
competencies gained by pursing a DNP degree are essential in policy formulation and
implementation which has a direct impact on an institution’s delivery of healthcare services
(Sherrod & Goda, 2016).
References:
American Association of Colleges of Nursing [AACN]. (2018). Fact Sheet: The Doctor of
Nursing Practice (DNP). https://www.aacnnursing.org/Portals/42/News/Factsheets/DNP-
Factsheet-2018.pdf
Beeber, A., Palmer, C., Waldrop, J., Lynn, M., & Jones, C. (2019). The role of doctor of nursing
practice-prepared nurses in practice settings. Nursing Outlook, 67(4), 354–364.
https://doi.org/10.1016/j.outlook.2019.02.006
Cashin, A. (2018). A scoping review of the progress of the evolution of the doctor of nursing
practice in the USA to inform consideration of future transformation of nurse practitioner
education in Australia. Collegian, 25(1), 141–146.
https://doi.org/10.1016/j.colegn.2017.05.001‌
Mancuso, J., Udlis, K., & Anbari, A. (2016). Comments surrounding the doctor of nursing
practice (DNP): Stress, ambiguity, and strain. Journal of Nursing Education and
Practice, 7(4). https://doi.org/10.5430/jnep.v7n4p76
McCauley, L., Broome, M., Frazier, L., Hayes, R., Kurth, A., Musil, C., Norman, L., Rideout, K.
H., & Villarruel, A. (2020). Doctor of nursing practice (DNP) degree in the United States:
Reflecting, readjusting, and getting back on track. Nursing Outlook, 68(4), 494–503.
https://doi.org/10.1016/j.outlook.2020.03.008
Sherrod, B., & Goda, T. (2016). DNP-prepared leaders guide healthcare system change.
Nursing Management (Springhouse), 47(9), 13–16.
https://doi.org/10.1097/01.numa.0000491133.06473.92
Terhaar, M., Taylor, L., & Sylvia, M. (2016). The doctor of nursing practice: From start-up to
impact. Nursing Education Perspectives, 37(1), 3–9. https://doi.org/10.5480/14-1519

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History and Purpose

Current State of DNP

level of education (Mancuso et al., 2016).

Future State of DNP

The increasing complexity of healthcare requires the highest level of scientific

DNP Transforming Healthcare and Solving Complex Health Problems

environment through application of evidence-based interventions. A DNP-prepared leader

patient-centered care (Sherrod & Goda, 2016).

Advantages of Having the DNP

expanded opportunities in nursing leadership, including increased involvement in policy

implementation which has a direct impact on an institution’s delivery of healthcare services

(Sherrod & Goda, 2016).

Nursing Practice (DNP). https://www.aacnnursing.org/Portals/42/News/Factsheets/DNP-

practice-prepared nurses in practice settings. Nursing Outlook, 67(4), 354–364.

practice in the USA to inform consideration of future transformation of nurse practitioner

education in Australia. Collegian, 25(1), 141–146.

Practice, 7(4). https://doi.org/10.5430/jnep.v7n4p76

Nursing Management (Springhouse), 47(9), 13–16.

impact. Nursing Education Perspectives, 37(1), 3–9. https://doi.org/10.5480/14-1519

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