Practice Doctorate Resource
Center
Frequently Asked Questions
Submit your questions about the Practice Doctorate, and NONPF will seek to provide you answers. Please submit questions to NONPF. Check back for FAQ answer postings.
See below for the most recent summary of common questions about the practice doctorate with responses prepared by the NONPF Practice Doctorate Task Force. To access a PDF file of the questions, click here.
Frequently Asked Questions About Practice Doctorates
Developed by the NONPF Practice Doctorate Task Force*
August 2006
NONPF’s Involvement with Practice Doctorate Degree Movement
Doctoral degree programs for nurse practitioners and other advanced practice nurses that are focused on practice are being developed across the country. In keeping with NONPF’s mission to promote the highest quality in nurse practitioner education, NONPF has actively engaged in discussions about the practice doctorate since 2000. NONPF continues to advocate for the highest standards in nurse practitioner education and work with others to support the education of nurses in all advanced practice roles.
As a leader in the development of competencies for nurse practitioner practice and standards for graduate education, NONPF has participated on task forces with other professional organizations, co-sponsored national forums for dialogue on the practice doctorate, held sessions on this topic at NONPF’s annual conferences and hosted a national teleweb discussion on the practice doctorate. Dialogue generated through these venues led to the creation of a national task force to develop competencies for nurse practitioners who pursue a practice doctorate. In addition NONPF leaders published three landmark articles on the practice doctorate (Marion et al., 2003; Marion et al., 2005; O’Sullivan et al., 2005; see http://www.nonpf.org/NONPF2005/PracticeDoctorateResourceCenter/PDresource.htm to access articles). NONPF continues to work collaboratively to ensure that practice focused doctoral degrees meet the highest standards for nurse practitioner education.
In an effort to promote clarity and improve understanding of the practice doctorate, NONPF has developed responses to frequently asked questions. We invite our members and others interested in the development of the degree to continue this dialogue.
What are practice doctorates?
Practice doctorates are doctoral degree programs that focus on practice within a professional discipline. The idea of a practice doctorate is not new. Practice doctorates are awarded in many fields such as education, law, medicine, dentistry, nursing, pharmacy, physical therapy, occupational therapy and audiology. The practice doctorate in nursing is a degree reflecting the highest level of educational preparation for nurse practitioners and other advanced practice nurses.
Is there a need for practice doctorates in nursing?
Society needs expert nurse practitioners and other types of advanced practice nurses who can work collaboratively to shape the health care system and improve nursing care outcomes. The increasingly complex health care environment necessitates that nurse practitioners are prepared with the highest level of scientific knowledge and practice expertise possible. The scientific knowledge explosion requires additional preparation in how to translate research into practice. The practice doctorate prepares nurse practitioners and other advanced practice nurses to provide this level of care.
Why is parity with colleagues from other disciplines important?
Advanced practice nurses need educational parity with other disciplines to secure a place at the table and participate fully in decision making with their professional colleagues. Opportunities to participate equitably with other disciplines are more abundant when nurse practitioners are prepared at the doctoral level. Parity with other health professionals facilitates representation of nursing on policy making bodies and greater opportunity for nursing’s voice to be heard. Educational parity enhances nursing’s influence and collaboration when formulating policy and practice guidelines, developing new care delivery models, and designing and evaluating mechanisms for quality improvement and determining future directions.
How does the practice doctorate affect currently practicing NPs?
Nurse practitioners who wish to expand their sphere of influence while remaining focused on practice can now choose a practice doctorate degree. They may choose this degree to deepen their practice expertise, translate research into quality care to improve patient outcomes and provide leadership to address key health care system issues. By expanding their expertise, these nurse practitioners are able to position themselves for their career ahead. Some may choose the practice doctorate as a means of securing a new place for themselves as clinically focused teachers of nurse practitioners and use their clinical expertise to prepare the next generation of nurse practitioners while continuing their own practice.
What are the expected competencies for NPs who complete a practice doctorate program?
In collaboration with a national task force, NONPF has developed competencies for doctorally-prepared nurse practitioners which are posted on the NONPF website (see http://www.nonpf.org/NONPF2005/PracticeDoctorateResourceCenter/PDresource.htm). These competencies build on the NONPF core competencies for all master’s prepared nurse practitioners and the competencies developed for each specialty with national stakeholders.
Why would an NP with a master’s degree choose to enroll in a practice doctorate program?
Nurse practitioners have much wisdom to share but they tend to focus on direct care delivery for their patients. They need a stronger voice to advocate for populations of patients. NPs who want to develop their leadership skills and acquire positions with expanded responsibility and authority to improve outcomes of care will pursue practice doctorates. Master’s prepared faculty will need this preparation to advance in their careers.
How does the practice doctorate differ from the PhD degree?
The practice doctorate is a degree focused on practice while the PhD is focused on research. Practice doctorate programs typically incorporate a component on specialty practice for nurse practitioner preparation or for other advanced practice nursing roles. The PhD programs are designed to teach methods for generating new knowledge and build nursing science on which practice is based. The majority of the 101 doctoral programs offered in nursing (AACN, 2006) are PhD programs that focus on research. Past president of NONPF, Dr. Ann L. Sullivan, discussed the distinctions between the practice doctorate and the PhD in a newsletter column (The Mentor, Vol 16, #1) and noted that “the number of people seeking a PhD may decline as people seeking additional skill and knowledge in the clinical arena opt instead for the practice doctorate; however, this shift will preserve the integrity of the PhD as it remains only for those interested in a research career” (p.2). Those who were not attracted to a research oriented doctoral degree may choose a practice doctorate instead, increasing the total number of applicants to doctoral study.
Which doctoral degrees awarded in nursing are practice doctorates?
Several types of doctoral degrees have been awarded in the past including the Doctor of Philosophy (PhD), the Doctor of Education (EdD), the Doctor of Nursing Science (DNS, DNSc.) and Nursing Doctorate (ND) degrees. The title of the degree is approved by the university system in which the degree is granted. The curriculum determines the type of doctoral study. Of these degrees, the PhD was devoted to research. However, some of the DNS and DNSc degree programs were research oriented while others were focused on practice. All the ND programs were focused on practice. The newest title for a practice doctorate is the Doctor of Nursing Practice (DNP) degree recommended by the American Association of Colleges of Nursing (AACN) as the preferred title for programs offering practice doctorates. The AACN has recommended that graduate education for nurse practitioners and other advanced practice nurses occur in Doctor of Nursing Practice degree programs by 2015. For a complete description of the DNP and the eight essential components of the curriculum visit their website (http://www.aacn.nche.edu/DNP).
Is there much difference in practice doctorate programs in nursing nationwide?
There are variations in the practice doctorate programs that students should consider carefully before application to ensure their career goals can be met. Some programs are built on expanding the master’s specialty preparation while offering minimal new content beyond the NP clinical coursework. Others are revamping their entire curricula to incorporate new technologies, new scientific knowledge, additional inquiry skills and leadership skills. Not all practice doctoral programs offer nurse practitioner education; some focus on other advanced practice roles, administration or informatics.
Who accredits practice doctorate programs in nursing?
The Commission on Collegiate Nursing Education (CCNE) has announced plans to initiate a process for accreditation of DNP programs, expanding their scope of operation. The National League for Nursing Accrediting Commission (NLNAC) indicates on its Web site that the NLNAC accreditation process will continue to focus on advanced practice competencies, curricular content, and learning outcomes and, as advanced practice nursing moves in new directions, will accredit the nursing practice doctorates regardless of the title of the degree. It is important to note that nurse practitioner programs are generally not specifically accredited today; instead, they are reviewed currently as part of the broader accreditation process of the master’s program. In the future, one could expect that the nurse practitioner program could be evaluated as part of the accreditation process for the doctoral program. The Criteria for Evaluation of Nurse Practitioner Programs (National Task Force on Quality Nurse Practitioner Education, 2002) will remain a guiding framework for the evaluation of NP programs within the accreditation process. Applicants to practice doctorate programs should ask if the practice doctorate program meets nationally-recommended professional standards and is within an accredited graduate program.
How will nurse practitioners with practice doctorates be licensed as nurse practitioners? Will additional national certification be required?
Since each state regulates nursing practice within its borders, graduates must apply for licensure as nurse practitioners to the state in which they wish to practice. Licensure for advanced practice nurses is granted according to the state’s rules and regulations. These rules and regulations usually include graduation from an accredited nursing program in a specialty recognized by the state after completion of coursework in that specialty. Most states require national certification in an advanced practice specialty for licensure as do most employers. Medicare rules and regulations require master’s education and national certification in a nursing specialty for reimbursement.
A national task force is working with regulators to chart the course for addressing regulatory and certification issues uniformly. State boards of nursing are examining the need for changes in the regulation of advanced practice nurses also. Generally public forums are held to hear from stakeholders such as educators, employers, health consumers and graduates before revising rules and regulations. Advance notice is given before action is taken as well.
Students
1. Are practice doctorate programs available for nurses who want to become nurse practitioners?
Yes, there are post-baccalaureate and post-master’s entry to programs offering the practice doctorate for nurse practitioners and more are being developed. Master’s prepared NPs or master’s prepared faculty who wish to pursue an academic career and teach advanced practice nurses in practice doctorate programs will need this preparation to advance in their teaching careers. Those who are already nurse practitioners with a long career ahead will want to return to school to expand their knowledge and to remain competitive with newer graduates.
2. What types of skills will be emphasized in practice doctorate programs?
Shaping the future of health care is a major responsibility that requires skills in collaboration, innovation and evaluation that are emphasized and practiced during the doctoral program. Assuming a leadership role requires being articulate about the complexities of health care finance, ethical decision making and policy as well as skills in negotiation and conflict resolution.
Accountability for advanced practice includes documenting the quality of practice, evaluating improvements and articulating these to the profession, professional colleagues and the public. Demonstration of care outcomes requires generating a database for evaluation of patient outcomes. Additional knowledge of design, data analysis and data interpretation are needed. Sophisticated skills needed to translate research into quality care are taught in the practice doctorate program.
3. How should students compare and choose among DNP programs?
Master’s prepared NPs will want to investigate programs offering post-master’s practice doctorate curriculum that grants some advanced standing based on graduate education and NP experience. University rules vary on the time elapsed for previous coursework to be applied to doctoral study to ensure currency of knowledge.
Those aspiring to become nurse practitioners should review programs that incorporate basic NP education into the practice doctoral program. Those programs with faculty actively engaged in advanced practice offer more excellent role models and provide insight about the current practice environment.
With clear goals in mind, prospective students can investigate the practice doctorate programs being offered to determine which best meets their needs. There is an updated list of schools offering this degree on the AACN Web site (http://www.aacn.nche.edu/DNP/index.htm). While there is a national curricular model recommended by AACN, practice doctorate programs vary in their emphases, specialties offered and available resources. Programs may offer different specialties in advanced practice that emphasize unique strengths available through their university partnerships and health care delivery settings. Visit the websites for these schools and obtain written descriptions of the goals and objectives of the programs, strengths of the faculty, their qualifications and credentials, and resources available for students. It is useful to speak with faculty about questions and unique interests after reviewing the specific requirements, eligibility criteria, and financial aid and other helpful information on the university’s website. Applicants may also be able to speak with or email recent graduates to ensure the knowledge and opportunities for acquiring clinical expertise in the specialty will meet the student’s needs.
4. Will there be financial aid to help with the cost of the doctoral program?
The additional coursework required in a doctoral program increases the cost of obtaining the degree. Talk with officials about scholarship, loan and other financial aid programs at schools under consideration.
Faculty
1. Will graduates of practice doctorate programs qualify for faculty promotion and tenure?
While universities set their own criteria for promotion and tenure, it is expected that graduates will be sought after by schools of nursing as clinically expert faculty to prepare the next generation of nurse practitioners. These doctorally-prepared individuals bring practice and leadership skills in evidence based practice, quality improvement and evaluation of patient outcomes as well as team building and collaborative practice. As clinical experts they also bring comprehension of the complexities involved in care delivery at the highest level. We anticipate that with an increase in faculty with professional doctorates versus the traditional research doctorates, institutions may need to address the issue of promotion and tenure for faculty whose terminal degree is a professional doctorate.
2. What kind of faculty teach in practice doctorate programs?
Faculty prepared at the doctoral level in nursing and in related fields teach in practice doctorate programs. Faculty with specialty certification as nurse practitioners also continue to teach specialty courses for development of clinical practice skills. Nurse practitioner preceptors and others with broader preparation and skills are also be needed to assist students with negotiation of the health care system and definition of clinical inquiry projects.
Curriculum and Teaching Strategies
1. What courses are offered in the practice doctoral program that are not already part of the master’s program for nurse practitioners?
In an effort to standardize the requirements and content for practice doctorates in nursing, the AACN held national forums and task force discussions to develop a model curriculum. NONPF participated in these forums and collaborated with AACN on its DNP Task Force providing input and feedback. The model curriculum proposed by AACN has eight essential components including a clinical practice requirement and a final scholarly clinical project. This model serves as a national guideline for comparing practice doctorate programs.
2. What are the expected competencies for NPs who complete the practice doctorate degree? Are they different from the master’s competencies?
Working with stakeholders, NONPF has developed core and specialty competencies for nurse practitioners in seven specialties: acute care, adult, family, gerontological, pediatric, psychiatric-mental health and women’s health at entry to practice after completion of the master’s degree. These competencies form the foundation for the doctoral level core competencies for nurse practitioners similarly developed by a national NP task force. The 2006 NP doctoral level core competencies for nurse practitioners are published on the NONPF Web site (see http://www.nonpf.org/NONPF2005/PracticeDoctorateResourceCenter/PDresource.htm).
3. What is the clinical immersion component of the practice doctorate designed to accomplish?
Nurse practitioner students graduating from master’s programs are well prepared to deliver care to individuals but need to be better prepared to address the needs of communities and clinical populations and to use system wide approaches to ensure safe and effective health care. These additional skills can be taught through immersion in practice while gaining confidence in the NP role and refining practice skills. A recommendation by AACN for immersion is 1000 practice hours in the post-baccalaureate DNP program.
4. What is a practice inquiry project and why it is important?
Practice inquiry is a skill needed by nurse practitioners and other advanced practice nurses in order to take charge of their practice and implement improvements. Recognizing a practice problem exists and gathering data about it systematically are essential to defining it so that remedies can be developed. Without an inquiry approach, practice becomes static and eventually unsafe. If nurse practitioners do not analyze their own practice and improve it, others will collect their own data, develop their own interpretation and offer their own strategies for improvements. Relying on other disciplines to analyze nursing practice reduces our professional autonomy and independence. The hallmark characteristics of a true profession are its ability to be self-regulating while ensuring safe and effective care.
5. What is the recommended length of the practice doctorate program?
Program length varies by institutions, states and specialties and is influenced by accreditation criteria. The AACN’s DNP Roadmap Task Force recommends that post-baccalaureate programs be three calendar years in length or a minimum of 36 months of full-time study. Post-master’s programs that recognize coursework completed at the master’s level requires less time - a minimum of 12 months in the DNP program post-master’s.
6. Will students be able to continue to practice while enrolled in the practice doctorate program?
Universities may offer part-time study to encourage master’s prepared NPs in the doctoral program to continue to practice while in the program. In this way the students can further refine their clinical skills, be socialized into expanded responsibilities, avail themselves of opportunities to increase leadership and collaborative skills and develop their clinical scholarship skills by identifying a project in their advanced specialty.
7. Are there mechanisms for master’s prepared NPs to receive credit from their previous master’s program or experience as a practicing NP to apply toward the practice doctorate degree?
Universities have various mechanisms for evaluating and crediting prior graduate coursework and experience. There may be a ceiling on the number and type of courses that can be applied toward the doctoral degree in addition to time limits on transferring credit or applying previous coursework to the doctoral degree. Prior to enrolling in a practice doctorate program, one should inquire about the institution’s criteria for granting credit for previous work and experience. Some universities are examining the applicant’s professional portfolio to determine this.
8. How are courses likely to be offered in practice doctoral programs?
Coursework will be offered using traditional and non-traditional teaching methods and vary with each university according to its faculty’s philosophy and available resources. Some universities will continue to offer face to face seminars while others may be offered on-line. Web-enhanced courses may allow for interaction among faculty and students in their home communities and practice settings. Some courses may be offered as intensive 1-2 day long sessions once or twice a month. The structure for offering the program may also vary within a university and from course to course.
Employment
1. How will this additional educational preparation affect the salary of nurse practitioners?
Educational advancement and responsibilities go hand in hand. NPs taking on new responsibilities should receive pay commensurate with their expanded responsibilities. Practice doctoral program graduates who function effectively will raise the bar for others. Competition to hire these graduates may be keen as their ability to reduce costs, prevent hospitalization, reduce morbidity, disability, and mortality are documented and recognized by employers.
Expectations will rise as the graduates demonstrate their competence and expand their spheres of influence as leaders in health care delivery and education and bring greater negotiation skills.
2. Who will employ the graduates of practice doctorate programs?
Employers of NPs will seek graduates of practice doctorate programs to provide the expertise needed to care for patients as well as transform health care delivery. NPs will practice and collaborate with other disciplines within articulated health care systems. NPs currently practice in a wide variety of settings and will continue to practice in such settings but with greater responsibilities. However, the doctorally-prepared nurse practitioner will assume additional responsibilities and not be limited to direct care. Innovations in practice will be tested and evaluated and then disseminated to improve outcomes of care. Some graduates will work for schools of nursing as expert clinicians in academic managed nurse run clinics and teach in schools of nursing.
Summary
The development of practice doctorate degree programs in nursing offers unique and exciting opportunities for nurse practitioners and other advanced practice nurses. The broad-based response to the work of national organizations and individual academic institutions indicates that there is a felt need for this innovation in nursing education to continue to successfully meet the needs of the society.
Advanced practice nurses require additional preparation because of the explosion of scientific knowledge, the evolving technology and multiple complexities of health care delivery. Nurse practitioners together with other advanced practice nurses must take the lead in helping to improve patient outcomes, to reduce health disparities, create new models of care and develop health policy.
References
American Association of Colleges of Nursing. (2006, August). Draft. DNP Roadmap Task Force Report. Available at: http://www.aacn.nche.edu/DNP/index
American Association of Colleges of Nursing (2006, August.) Draft. The Essentials of Doctoral Education for Advanced Nursing Practice. Available at: http://www.aacn.nche.edu/DNP/index
Boyer, EL (1990). Scholarship Reconsidered: Priorities of the Professoriate. Princeton, NJ: Carnegie Foundation.
Marion, L.N.,
O'Sullivan, A.L., Crabtree, M.K., Price, M., & Fontana, S.A. (2005).
Curriculum models for the practice doctorate in nursing. Topics in
Advanced Practice Nursing eJournal Medscape Nurses, 5(1).
Available at: http://www.medscape.com/viewarticle/50074.
Marion, L., Viens, D., O'Sullivan, A.L., Crabtree, K., Fontana, S., Price, M.M. (May 9, 2003). The practice doctorate in nursing: Future or fringe? Topics in Advanced Practice Nursing eJournal Medscape Nurses. Available at: http://www.medscape.com/viewarticle/453247
National Organization of Nurse Practitioner Faculties. (2006). Domains and core competencies of nurse practitioner practice. Washington, DC: Author. Available at: www.nonpf.org/NONPF2005/CoreCompsFINAL06.pdf
National Organization of Nurse Practitioner Faculties and The American Association of Colleges of Nursing (2002). Nurse Practitioner Primary Care Competencies in Specialty Areas: Adult, Family, Gerontological, Pediatric, and Women’s Health. Washington DC; HRSA 00-0532(P) Pp 1-51.
National Panel for Acute Care Nurse Practitioner Competencies. (2004). Acute care nurse practitioner competencies. Washington, DC: National Organization of Nurse Practitioner Faculties. Available at: www.nonpf.org/ACNPcompsfinal20041.pdf
National Panel for NP Practice Doctorate Competencies. (2006). Practice doctorate nurse practitioner entry-level competencies. Washington, DC: National Organization of Nurse Practitioner Faculties. Available at: www.nonpf.org/NONPF2005/PracticeDoctorateResourceCenter/CompetencyDraftFInalApril2006.pdf
National Panel for Psychiatric-Mental Health NP Competencies. (2003). Psychiatric-mental health nurse practitioner competencies. Washington, DC: National Organization of Nurse Practitioner Faculties. Available at: www.nonpf.org/finalcomps03.pdf
National Task Force on Quality Nurse Practitioner Education. (2002). Criteria for evaluation of nurse practitioner programs. Washington, DC: National Organization of Nurse Practitioner Faculties.
O’Sullivan, A.L., Carter, M., Marion, L., Pohl, J., & Werner, K.E. (September 30, 2005). Moving forward together. The practice doctorate in nursing. The Online Journal of Issues in Nursing. Available at: http://www.nursingworld.org/ojin/topic28/tpc28toc.htm.
* Members of the NONPF Practice Doctorate Task Force (2006):
M. Katherine Crabtree, DNSc, APRN, BC (Chair), Oregon Health & Science University
Marie-Annette Brown, PhD, ARNP, RN, FAAN, University of Washington
Susan Fontana, PhD, APRN, BC, University of Wisconsin, Milwaukee
Lucy Marion, PhD, APRN, FAAN, Medical College of Georgia
Donna Nativio, PhD, CRNP, FAAN, University of Pittsburgh
Ann O'Sullivan, PhD, CRNP, CPNP, FAAN, University of Pennsylvania
Joanne Pohl, PhD, APRN, BC, FAAN, University of Michigan
Marva Price, DrPH, FNP, CS, Duke University
You may wish also to check the FAQ postings on the AACN Web site - http//www.aacn.nche.edu/DNP/DNPFAQ.htm
National Organization of Nurse
Practitioner Faculties (NONPF)
1522 K Street, NW, Ste. 702
Washington, DC 20005
tel: (202) 289-8044 ● fax: (202) 289-8046
nonpf@nonpf.org
President: Joanne Pohl, PhD, APRN, BC, FAAN