2. Introduction
• The Doctor of Nursing Practice (DNP) is
recommended by the American Association of
Colleges of Nursing (AACN) as the terminal
practice-focused degree in nursing.
• The history of doctoral education is important to
understanding the DNP.
• Philosophical inquiry about the nature of nursing
discipline and science is key to DNP
competencies.
3. Overview of the DNP Degree
• The DNP is defined as a practice-focused terminal
degree in nursing practice.
• Focuses on population outcomes and nursing’s
impact on healthcare policy.
• Emphasizes practice, which separates it from theory-
and research-focused PhD degrees.
• Graduates must demonstrate scholarly activity via a
theory-driven research project demonstrating
research in practice.
4. • Doctoral education in nursing has seen its
greatest growth in the past 40 years.
• Due to the small number of nursing-related
doctorates available through the 1960s, most
nurses pursued doctorates in the basic
sciences or education.
• Nursing PhDs did not become popular until
the 1970s.
Historical Perspectives (1 of 4)
5. Historical Perspectives (2 of 4)
• Doctoral education in nursing developed in
three phases:
– Development of functional specialists—preparing
nurses as teachers and administrators
– Development of nurse scientists—questioning the
nature and knowledge base of nursing
– Development of doctorates “in and of nursing”—
utilizing answers about nature and knowledge
base to improve practice
6. • A fourth phase emphasizing nursing practice has
occurred recently with development of the
Doctor of Nursing Science (DNS) degree.
• The DNS was the first practice-focused doctorate
designed to focus on clinical expertise.
• Gradually acquired a theory focus and became
more like a traditional PhD, again creating the
need for a practice-based degree.
Historical Perspectives (3 of 4)
7. Historical Perspectives (4 of 4)
• The Doctorate of Nursing (ND) was introduced in
1979 to address several needs in nursing:
– Reorientation of care toward health status while
maintaining a detection and treatment focus
– Reorientation of the nursing community to promote
scholarship and autonomy
– Reorientation of professional preparation toward
independent, accountable nurse practitioners
• ND was not as popular or uniform as the DNS or
PhD, but needs are reflected in the DNP.
8. Development of the DNP Degree
• In 2002, the AACN create a task force to evaluate
the current status of practice doctorates in
nursing.
• The task force developed recommendations and
proposed curriculum models via the Position
Statement on the Practice Doctorate.
• Position Statement recommended DNP as the
terminal practice-focused degree.
• There are currently more than 100 DNP programs
in the United States.
9. DNP Competencies
• In 2006, the AACN developed the Essentials of
Doctoral Education for Advanced Nursing Practice
to address the competencies at the core of
advanced practice.
• The AACN also developed the Practice Doctorate
Nurse Practitioner Entry-Level Competencies.
• These two documents provide curriculum
standards for all DNP programs.
10. Essential I: Scientific Underpinnings for
Practice
• Essential I describes the scientific foundations
for nursing practice.
• Foundations are derived from both natural
and social sciences, including biology,
physiology, and psychology.
• Nursing science and middle-range nursing
theories are also part of the foundations.
11. Essential II: Organizational and Systems
Leadership for Quality Improvement and
Systems Thinking
• Essential II describes preparation in organization and
systems leadership that affects healthcare delivery
and outcomes.
• Emphasizes organizational assessments, systems
issues, and facilitation of organization-wide changes.
• Prepares graduates to assume leadership roles at
every level of an organization.
12. Essential III: Clinical Scholarship and
Analytical Methods for Evidence-
Based Practice
• Essential III describes competencies related to
evaluation, integration, translation, and application
of evidence-based practice.
• Addresses the unique perspective of graduates to
merge science and human elements and ask
practice-related questions.
• Emphasizes research partnerships, clinical research,
and guideline and method design.
13. Essential IV: Information
Systems/Technology and Patient Care
Technology for the Improvement and
Transformation of Healthcare
• Essential IV prepares graduates to use information
technologies to improve patient care outcomes.
• Emphasizes use of expertise to evaluate
documentation programs and the accuracy,
timeliness, and appropriateness of healthcare
consumer information.
14. Essential V: Healthcare Policy for
Advocacy in Health Care
• Essential V describes the importance of nurses’
involvement in policy and advocacy.
• Emphasizes the relationship of practice and
policy.
• Focuses on analysis of policies and proposals
from multiple viewpoints and participation on
boards and committees.
• Encourages advocacy through organizational
leadership.
15. Essential VI: Interprofessional Collaboration
for Improving Patient and Population Health
Outcomes
• Essential VI prepares graduates for interprofessional
collaboration within a multitiered healthcare
environment.
• Emphasizes collaboration with members of other
professions.
• Focuses on development of expertise necessary for
assuming leadership roles on collaborative teams.
16. Essential VII: Clinical Prevention and
Population Health for Improving the
Nation’s Health
• Essential VII prepares graduates to analyze
population data in order to develop and implement
prevention strategies and evaluate population
health.
• Emphasizes health promotion and risk reduction
from an advanced nursing practice perspective.
17. Essential VIII: Advanced Nursing Practice
• Essential VIII describes clinical specialization content
from a specific domain of advanced nursing practice.
• Prepares graduates to develop therapeutic
relationships with patients and other professionals to
improve patient outcomes.
• Encourages utilization of advanced clinical decision-
making skills, mentoring of others in the profession,
and patient education.
18. Focus on Essential I (1 of 3)
• Basic sciences: Hard and soft sciences that build a
scientific basis for practice.
• Discipline of Nursing: Body of knowledge concerned
with four aspects of care:
– Principles governing life processes and well-being
– Patterning of human behavior
– Processes by which positive changes are effected
– Wholeness of health of human beings as they interact with
the environment
19. • Nursing science: Methods of inquiry specific to the
discipline and their outcomes.
• Nursing Theory: Product of nursing science that
attempts to describe, predict, or explain phenomena
consistent with nursing’s perspective.
• Middle-range theory: Concrete, narrow areas of
nursing knowledge applicable to clinical practice that
help direct assessment.
Focus on Essential I (2 of 3)
20. Focus on Essential I (3 of 3)
DNP Graduates and Nursing Theory
• Theory-practice gap exists in nursing due to lack of
understanding and applicability of nursing theories.
• Middle-range theories are key to closing the gap due
to their narrow scope.
• DNP nurses are well-positioned to close the gap by
utilizing and explaining theory-guided practice.
21. DNP Graduates and Use of Theories
• Nursing theory is reflective of a broad range of
perspectives due to the many disciplines that
form the foundation of practice.
• The social component of nursing requires theory
selection based on the individual patient or
situation.
• DNP nurses must evaluate and apply theories
with an overarching goal of ensuring patient-
centered care.
22. Dilution of the Discipline: Philosophical
Considerations for DNP Graduates
• Application and integration of interdisciplinary
theories adds to the knowledge base, but may dilute
nursing as a unique discipline.
• It is essential, therefore, that DNP nurses develop a
good understanding of the profession, science, and
discipline of nursing.
• Understanding differentiates DNPs from other nurses
by promoting theory integration that aligns with
concerns of the discipline.
23. Summary
• The DNP is the AACN recommended terminal
practice-focused degree in nursing.
• This recommendation has implications for
nursing as a profession, science, and discipline.
• Understanding the scientific underpinnings of
practice and the profession itself are essential to
applying knowledge to patient care and bridging
the theory-practice gap.
