The ABCs of DNPs

Doctor of nursing practice graduates focus on the clinical aspects of the field

Since the American Association of Colleges of Nursing recommended that advanced practice nurses be prepared at the doctoral level in 2004, the number of doctorate of nursing practice degree programs has skyrocketed.

In 2006, 20 schools in the United States offered DNP programs. By 2011, that number had grown to 184, with another 101 programs currently in the planning stages, according to AACN data. In 2011, 1,595 nurses graduated from DNP programs in the United States, an increase of about 24 percent from 2010.

While interest is mounting, not all nurse practitioners and clinical nurse specialists see the need to return to the classroom. Renice Washington, FNP-C, a nurse practitioner who works in gynecology and oncology at Northside Hospital, was one of those — until recently.

“I graduated with my FNP degree in 1998 and considered myself a very competent nurse practitioner,” Washington said. “I attended all the national conferences and although they’ve been talking about the DNP for 10 years or more, I had no intention of wasting my time. But then about five years ago, some of my colleagues who were in DNP programs started to tell me how life-changing it was, and I started to listen.”

Today, Washington is  18 months into the DNP program at Georgia Baptist College of Nursing of Mercer University. Between her work with uterine, cervical and ovarian cancer patients at Northside  Hospital and her service in the U.S. Navy Reserve, Washington is going to school part time. She aims to graduate in May 2014.

In a recent class presentation, Washington  talked about the seasons in her life and how she had been stuck in the “winter” of her career.

“I had gone to sleep and was hibernating. The DNP woke me up,” she said. “I had the clinical part of my job down — the diagnosing and implementation of a care plan — but was I really trying to take new research and make it work at the bedside? Was I thinking about my own research or publications? No.

“This degree has inspired me to be more creative and given me the opportunity to grow and apply new research that is coming along.”

After taking a course in academic research and grant writing, Washington  started a study on compassion fatigue in her workplace. She knows from experience that people in “helping” professions can get exhausted emotionally. She’s read the literature, but now she wants to look at symptoms and interventions that can help her co-workers.

“This degree really gets your juices going,” Washington said. “It gives you an opportunity to learn and grow. You can be a great nurse practitioner and not take a DNP program, but I think you can be an even better nurse practitioner with it.”

Mercer’s 'early adopters’

Georgia Baptist College of Nursing of Mercer University launched its doctorate of nursing practice degree in 2010, and graduated its first class in May 2012. Susan Bulfin, associate clinical professor and DNP advisor, calls her students “early adopters” of the trend of nurses seeking higher levels of education to meet their growing and more complex roles.

“Mercer already had a Ph.D. program in nursing which focuses on research and academics,” said Bulfin, RN, FNP-BC, DNP. “With the DNP, we are equipping advanced practice nurses to translate the growing body of nursing research into practice. It is becoming more challenging to sift through all the information that is out there and implement what is valuable.”

She believes the degree will help nurses meet the growing health care provider shortage due to more doctors choosing specialty fields rather than general practice. It also can ease the nursing faculty shortfall. That was one of the reasons  Bulfin decided to earn a DNP — she wanted to transition into teaching.

“If you want to teach at the university level, a doctoral degree is preferred,” she said.

In the clinical setting, Bulfin believes it puts nurses on par with co-workers who are also educated  at the doctoral level such as physical therapists and pharmacists. The degree’s business courses in finance, resource management and health systems analysis also prepare graduates  for health care administration roles.

But will the market be willing to pay for advanced practice nurses trained at the doctoral level? Washington believes  they will be in time — as soon as the market  needs them. She also believes her pursuit of the  degree was largely responsible for her recent promotion to captain in the U.S. Navy Reserve.

“So many people are going back for their doctorates in the Navy and it is having an impact on promotions and pay,” she said.

Bulfin believes  having more doctoral-prepared nurses is good for the profession. But having several different education paths and degrees has caused controversy and confusion among some nurses.

“Some nursing schools have wondered if they should close their master’s-level nurse practitioner programs in light of the mandate, but are reluctant to do so, knowing that not every student is ready to pursue a doctorate,” Bulfin said. “Other schools have started BSN-to-Ph.D. or BSN-to-DNP programs.”

“The focus of the Ph.D. degree is research and the DNP degree is translating that research into evidence-based practice,” Bulfin said. “I think we need both in nursing and that the DNP degree is here to stay.”

Great preparation

Sandra Lamb, a graduate of Mercer’s first DNP class, chose the degree because it would prepare her for different roles.

“I love clinical practice, but I had also thought about teaching, and I’d like to pursue my own research into preventive measures for osteoporosis. I can do so many things with this degree. Nursing is such a broad-spectrum field and ever-changing. I wanted to keep learning and be better at everything I do,” said Lamb, FNP-C, MSN, DNP.

Just learning the new technology used in online classes was a jolt for Lamb, a grandmother of three.

“I was proud that I could keep up, and the synchronous classes with the video cams felt like being in a real class. That connection to other nurses was a wonderful experience,” she said.

Having worked in family practice in physician’s offices for 20 years, Lamb hoped the degree would bring more career opportunities and she wasn’t disappointed. Lamb is teaching part time in a new health care administration program that she helped develop at Reinhardt University  in Waleska.

She also practices part time and serves on the Board of Directors of Bethesda Community Clinic in Holly Springs, which  serves uninsured and underinsured patients . Her newly acquired business knowledge was useful immediately.

“In one of my courses, I had to write a business plan for my dream business. I wrote a plan for starting a clinic for the underserved, and I’ve seen that paper project become a reality,” she said. “It was challenging, but I’m glad I did it. The DNP is such a diverse degree and I’m benefiting from that diversity.”