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Running head: DNP THE FUTURE OF NURSING AND HEALTHCARE 1

Is the DNP the Future of Nursing and Healthcare?

Mallory M. Miner

Idaho State University
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Is the DNP the Future of Nursing and Healthcare?

Yes, the Doctorate of Nursing Practice (DNP) is the future of nursing and healthcare. In

this paper, I will discuss what role the DNP will play. Throughout this course, we have learned

about the development of the DNP as well as the eight DNP essentials, the scope of practice of

the DNP and interprofessional collaboration, clinical scholarship, evidenced based practice, and

technology. All of these help to give an idea of the active role that DNP’s will need to play.

Furthermore, a DNP or PhD is worth pursuing. Where the advanced practice role fits and the

DNP’s leadership and clinical scholarship within the current healthcare issues will also be

discussed. By the end of this paper, my hope is that the reader will know more about DNP

programs and their role in the future of nursing and healthcare.

New DNP Programs and the Changing Demands of Health Care

In 2010, the Institute of Medicine’s (IOM) released a report where they named nurses to

be the ones to improve the health care system. IOM released its report The Future of Nursing:

Leading Change, Advancing Health, which talked about how more education is needed for

nurses. There are many new and existing pathways, not only associate and bachelor level nurses,

but also DNP’s. The goal is to have a more educated workforce. The report talked about how the

future needs more nurses with masters and doctorates. If we don’t improve our educational

preparation, there will be no one who is qualified to teach in the university/academia world.

The Institute of Medicine, in the 1999 report To err is human: Building a safer health

system, talked about how the culture of safety needs to be developed in health care organizations.

The healthcare system needs more educated employees to improve the reliability and safety for

patients. In order to improve, we need to apply evidence to health care delivery, use information

technology, align payment policies with quality improvement and prepare the workforce. By
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having the DNP, we are helping to reinvent the nation’s health care delivery system. In order to

meet the health care needs of all Americans, we need DNP’s.

DNP’s will have a role in improving the health care system, but first, look at the newness

of the DNP degree. According to Nichols (2013) in January 2013, the American Association of

Colleges of Nursing (AACN) reported 221 current colleges and universities across the United

States offering DNP degrees with more than 100 programs in the planning stages. I am currently

a student in the DNP program at Idaho State University, which is a new program. I am in the

second cohort. I was unaware of the new program, until I was applying for the Masters of

Nursing Science (MSN) and one of my professors convinced me to just go ahead and apply for

the DNP program.

Nichols (2013) goes on to say that there will need to be future studies where, how, to

what degree, and in what capacity DNP’s are being employed (Nichols, 2013). I have seen

DNP’s in the clinical setting, the educational setting, and the research setting. This goes without

saying that as new DNP graduates enter the work force they will be in both the clinical, research

and academic settings (Ahmed, Andrist, Davis & Fuller, 2013). One of the many benefits of the

DNP include the many possibilities and facets of a nursing career. I agree with Nichols (2013) in

that because the DNP is a relatively new degree, it will take some time before the DNP is the

future of nursing and healthcare. Change always takes time. With the healthcare reform or the

Affordable Care Act, there has already been so much change. First people need to know what

DNP’s are, the eight essentials offer a great start.

Eight Essentials

The eight essentials of the DNP will help explain what the DNP is and how DNP’s will

play a large part of the future of nursing and healthcare. The first essential is “Scientific
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Underpinnings for Practice” (American Association of Colleges of Nursing [AACN], 2006).

This will be important for DNP’s because we need to first have a solid foundation in science so

that we are competent DNP's. The second essential is “Organizational and Systems Leadership

for Quality Improvement and Systems Thinking” (AACN, 2006). Mahatma Gandhi says

something along the lines of be the change you wish to see in the world. As DNP’s, we can

improve our various situations and become leaders. The third essential is “Clinical Scholarship

and Analytical Methods for Evidence-Based Practice” (AACN, 2006). Clinical scholarship is

how DNP’s move forward. The next essential is “Information Systems/Technology and Patient

Care Technology for the Improvement and Transformation of Health Care” (AACN, 2006).

DNP’s are going to be dealing with issues and policies dealing with information systems and

technology.

The fifth essential is “Health Care Policy for Advocacy in Health Care” (AACN, 2006).

DNP’s will need to be advocates for patients in settings where there may be healthcare issues

dealing with technology or policy. Another essential is “Interprofessional Collaboration for

Improving Patient and Population Health Outcomes” (AACN, 2006). DNP’s will need to

integrate DNP leadership skills into our interprofessional practice. The penultimate essential is

“Clinical Prevention and Population Health for Improving the Nation’s Health” (AACN, 2006).

DNP’s will be able to improve the nation's health by healthcare policy.

The last essential is “Advanced Nursing Practice” (AACN, 2006). DNP’s will deal with

complex areas of practice, with an increased growth of specialization. Because DNP’s may also

be teaching the nurses of tomorrow, it is then the DNP’s responsibility to continue to contribute

to society and the field of nursing, whether it is in academia, clinically, or research. These eight
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essentials not only outline what and how the DNP works but also help define the scope of

practice of the DNP.

The scope of practice of the DNP

To fill the void in primary care, many new DNP programs were created Nichols (2013).

There is also a need for healthcare quality and access. According to Lathrop (2014), nurses will

need to be full partners with physicians and other healthcare professionals. The practice context

is the emphasis of the DNP in order to have clinical practice expertise with patient care in order

to improve patient outcomes Lathrop (2014). Interprofessional conflict is not new. One of the

concerns is that the prefix “Doctor” used towards those with a DNP may cause confusion and

misconceptions among patients. Collaboration will need to take place to address issues such as

these Lathrop (2014).

The authors of our textbook, Ahmed, Andrist, Davis & Fuller (2013) believes that, with

the leadership reflected in the DNP curriculum, the DNP nurse will be prepared to lead the

initiatives needed. Regarding curriculum, Swanson (2013) agrees that the DNP will be

appropriate in areas of advanced practice specialties and nursing leadership. Some have

embraced the DNP as the final or terminal degree for non- research focused nurses Swanson

(2013). According to Bednash (2014), leading authorities are calling for a rapid increase in the

number of nurses to hold doctoral degrees. With more nurses who are prepared at the doctoral

level, there will be more Advanced Practice Registered Nurses (APRN). This would also be an

answer to the faculty shortage and enable those who wish to embark on research careers, and

pursue top leadership positions Bednash (2014).

The future of the DNP, with regards to nursing, is innovative and controversial (Ahmed

et. al, 2013). The DNP will bring research and policy into the clinical realm and provide
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leadership roles including nursing executives, quality managers, clinical program directors, and

nursing faculty (Ahmed et. al, 2013). With the health care reform, DNP’s will be under pressure

to impact the health care delivery, design, and policy and continue to be an advocate.

The universal health care focus is on the cost of providing car and provider’s

reimbursement (Ahmed et. al, 2013). Some of the barriers advanced practice nurses have dealt

with in the past include outdated state statutes and regulations and insurer policies regarding

reimbursement of nursing practice. Even though there are millions of dollars being spent and the

federal government is near bankruptcy, there are still poor clinical outcomes. The Affordable

Care Act was passed in 2010 to provide insurance. Nurses have the potential to advance their

practice in order to coordinate care, provide patient education, prevention and self-management

of chronic disease (Ahmed et. al, 2013). With this scope of practice, the DNP is a part of the

future of nursing and healthcare.

Why the DNP?

Nursing’s history has contributed to the development of the DNP by having the first

doctoral degrees outside nursing, in areas such as education and the sciences. Nurses are

teachers, researchers and clinicians. There were many PhD programs that started in the 1970’s in

nursing and then the nursing doctorate, ND came but it lacked uniformity. I agree with the

article, titled “Doctor of Philosophy and Doctor of Nursing Practice as a complementary

degrees” the article goes on to talk about how the two degrees support one another and together

can help with the progression and creation of knowledge into the practice of the discipline

(Edwardson, 2010). It’s true, the PhD nurse is more prepared for research and scholarship while

the DNP is more focused on delivering services, and as long as both programs are held to the

same standards, then I believe they will complement each other.
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Bednash (2014) would argue that nursing students who are trying to decide whether or

not to choose a DNP versus a PhD program should explore the differences in these degree

options, find what the expectations for students enrolled in these programs are, and the career

choices available to doctoral-prepared nurses, including faculty positions Bednash (2014).

Regardless of whether one chooses the DNP or PhD option there is a need of both. There will

need to be collaboration between the two degrees as well (Florczak, Poradzisz & Kostovich,

2014).

The future is bright for the DNP even with the obstacles and barriers due to growth.

Ahmed et. al (2013) goes on to say that the rate of DNP graduations has exceeded the rate of

PhD nursing students. The purpose of a PhD program is to gain new knowledge in the discipline,

conduct scientific inquiries and generate research Bednash (2014). So where does all of this fit

into the future of nursing? Well, according to Swanson, the future of nursing depends on nurse

leaders who work with the education, practice and research of the field Swanson (2013). Another

aspect Betenacourt, Beiter & Landry (2013) brings up is that of the future of healthcare is

ensuring that there continues to be a compelling interest in the medical field.

The future of healthcare should be targeted at high school or college students, by making

sure they are exposed to health careers and the possibilities of higher education. This will help

create future scientists and increase student interest and achievement. I would not be in this DNP

program if it were not from the promptings of my professors who encouraged me to apply and

move forward to graduate school. The future healthcare workforce should also reflect our

nation’s diverse populations in order to meet the goals of the healthcare and payment reform.

Which includes to deliver high quality care to all. Like Betenacourt, et. al (2013) says, the future

is now.
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Technology

Technology is also the future of healthcare. According to Thimbleby (2013) hospitals

started introducing computers that have made delivering healthcare more efficiently, they have

also changed how patient records are kept. Thimbleby (2013) also argues that the futures we

want to see should be a continual process as it is just an activity to check off and how everyday

there is a new future to plan, with new discoveries to be made. In order to be successful, we need

to know what we need. Advanced Practice Nurses are not the competitors, in talking about the

tension with professional practice boundaries. This issue is not limited to only physicians and

nurses but is also being seen in many other disciplines such as psychiatry, dentistry, and physical

therapy (Ahmed et. al, 2013). So what is the solution? We must collaborate and work across

teams and as a profession, nursing must be unified.

Conclusion

In conclusion, is the DNP the future of nursing and healthcare? Again I say yes. The

future of nursing and healthcare is however not just the DNP alone, it is everyone coming

together in order to ensure positive patient outcomes. The DNP is part of this movement but it is

not the future of nursing and healthcare alone. As I said before, the eight DNP essentials help to

give an idea of the active role that DNP’s will need to play. There will need to be many more

policies and reforms made in order to transform the Affordable Care Act into what it was meant

to be. The DNP as an advanced practice nurse will need to take an active role in order to fill the

void in primary care was well as work on an interprofessional team. With the DNP role, the

future of nursing and healthcare is bright.
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References

Ahmed, S., Andrist, L., Davis, S., Fuller, V. (2013). DNP Education, Practice, and Policy:

Redesigning Advanced Practice Roles for the 21st Century. New York: Springer Pub.

American Association of Colleges of Nursing. (2006). The essentials of doctoral education for

advanced nursing practice. Retrieved from

http://www.aacn.nche.edu/publications/position/DNPEssentials.pdf

Bednash, G., Breslin, E. T., Kirschling, J. M., & Rosseter, R. J. (2014). PhD or DNP: Planning

for Doctoral Nursing Education. Nursing Science Quarterly, 27(4), 296.

doi:10.1177/0894318414546415

Betancourt, J. R., Beiter, S., & Landry, A. (2013). Improving Quality, Achieving

Equity, and Increasing Diversity in Healthcare: The Future is Now. Journal Of Best

Practices In Health Professions Diversity: Education, Research & Policy, 6(1), 903-917.

Edwardson, S. R. (2010). Doctor of philosophy and doctor of nursing practice as complementary

degrees. Journal of Professional Nursing, 26(3), 137-140.

Florczak, K. L., Poradzisz, M., & Kostovich, C. (2014). Traditional or Translational Research for

Nursing: More PhDs Please. Nursing Science Quarterly, 27(3), 195.

doi:10.1177/0894318414534470

Institute of Medicine. (1999). To err is human: Building a safer health system. Washington, DC:

National Academy Press.

Institute of Medicine. (2010). The future of nursing: Leading change, advancing health.

Washington, DC: National Academies Press.

Lathrop, B., & Hodnicki, D. R. (2014). The Affordable Care Act: Primary Care and the Doctor
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of Nursing Practice Nurse. Online Journal Of Issues In Nursing, 19(2),

2.doi:10.3912/OJIN.Vol198No02PPT02

Nichols, C., O'Connor, N., & Dunn, D. (n.d). Exploring Early and Future Use of DNP Prepared

Nurses Within Healthcare Organizations. Journal Of Nursing Administration, 44(2), 74-

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Swanson, M. L., & Stanton, M. P. (2013). Chief Nursing Officers' Perceptions of the Doctorate

of Nursing Practice Degree. Nursing Forum, 48(1), 35-44. doi:10.1111/nuf.12003

Thimbleby, H. (2013). Technology and the future of healthcare. Journal Of Public Health

Research, 2(3), 160-167. doi:10.4081/jphr.2013.e28