The Doctor of Nursing Practice (DNP) degree is gaining more prominence within the nursing profession.
Steps are being taken to transition to the DNP as the standard for advanced practice registered nurses. While the profession is not quite there yet, the DNP is a terminal degree that prepares the nurses for leadership, given the constantly changing demands of a complex U.S. healthcare system.
How to become a DNP nurse
Nurses have many points of entry into the nursing profession -- and, ultimately, to a Doctor of Nursing Practice, including entering as licensed practical nurses (LPN) or licensed vocational nurses (LVN). Registered nurses often seek licensure after completing a diploma program or earning an Associate Degree in Nursing(ADN) or a Bachelor of Science in Nursing (BSN), according to Angela Renee Stewart, DNP, APRN, ACNP-BC, AOCNP, TTS, Clinical Assistant Professor at Baylor University, Louise Herrington School of Nursing.
"The LPN and LVN nurses can complete an associate degree or diploma program to become an RN and then would have to complete a BSN program prior to entering graduate school," she said. "After obtaining the BSN, they could then apply and complete the BSN-DNP program. The ADN or diploma nurse would need to complete an RN-to-BSN program first, and then apply to a BSN-to-DNP program."
AN RN with a Master of Science in Nursing degree (MSN), who is seeking a DNP, would need to apply to a DNP program and complete the course requirements to earn the terminal degree, according to Stewart. Programs like Baylor University's Online DNP Programs can offer clinical placement support, as well as access to world-class faculty and networking.
Unlike the research-focused PhD in nursing degrees, the DNP has more of a clinical focus. The DNP curricula, according to the AACN, "build on traditional master's programs by providing content in evidence-based practice, quality improvement, systems, leadership, among other key areas."
DNP nurses study the most up-to-date technologies in clinical medicine and can apply those technologies to solve problems. They have a population health perspective, which allows them to collect, analyze, and report on epidemiological data. They also can specialize in providing care for specific populations, from birth to geriatrics. Their education prepares them not only to make a difference at the bedside but also in systems of care, according to a paper in Nursing Outlook.
Completing a DNP degree can take from two years for a master's prepared nurse to five years for those with an Associate Degree in Nursing (ADN).
DNP nursing roles
DNP nurses work in clinical practice in inpatient and outpatient settings and specialize in particular areas, such as family practice, adult acute care, pediatrics, nurse-midwifery, and nurse anesthesia, according to Stewart. These nurses practice at hospitals, as well as private practices, including family, internal medicine, or specialty practice, such as cardiology and oncology. Some practice in the emergency room, at community clinics, free clinics, surgery centers, schools, and other settings.
"DNPs must practice within the scope of practice of their specialty training, and their practice is regulated at the state level," Stewart said. "Some states allow DNPs to own their own practice without an attending physician, and some are semi-independent requiring a physician to be available for consultation. "The institutions will usually have bylaws that must be followed in addition to the state nurse practice act and the scope of practice for the specialty in which the DNP is certified."
DNP nurses also can join the ranks of much-needed nurse faculty. A 2019 survey of 892 nursing schools with baccalaureate and/or graduate degree programs uncovered 1,637 faculty vacancies, according to AACN's Special Survey on Vacant Faculty Positions.
"The data show a national nurse faculty vacancy rate of 7.2%. Most of the vacancies (89.7%) were faculty positions requiring or preferring a doctoral degree," according to AACN.
Some choose to become nurse leaders, including nursing administrators or chief executive officers, while others prefer careers in information technology and analytics.
While a doctorate in nursing may not be required for all of these positions, it can improve a nurse's chances of moving into leadership or management roles, according to Nurse.com's Higher Education Guide.
DNP job outlook
The market for DNP nurses is strong, and schools nationwide are reporting considerable and competitive student enrollment, according to Stewart. "Employers are recognizing the contribution of DNPs as expert nurses in the practice arena creating demand for DNP-prepared nurses as it continues to grow," Stewart said.
There are several options for nurses seeking a Doctor of Nursing Practice degree, according to Stewart.
Among those: the Family Nurse Practitioner (FNP), Adult-Gerontology Acute Care Nurse Practitioner (AGACNP), Adult Gerontology Primary Care Nurse Practitioner (AGPCNP), Neonatal Nurse Practitioner (NNP), Pediatric Acute Care Nurse Practitioner (PNP-AC), Pediatric Primary Care Nurse Practitioner (PNP-PC), Psychiatric and Mental Health Nurse Practitioner (PMHNP), Women's Health Nurse Practitioner (WHNP), Clinical Nurse Specialist (CNS), Certified Nurse-Midwife (CNM), and Certified Registered Nurse Anesthetist (CRNA).
"The DNP also includes executive and director level roles dealing in decision-making and policy development," Stewart said. "The DNP degree offers APRNs and other nurses seeking top leadership and organizational roles the education and opportunity to implement evidence-based practice, quality improvement, and systems leadership where they practice."
Overall employment of nurse anesthetists, nurse midwives, and nurse practitioners is projected to grow 45% from 2020 to 2030, which is much faster than the average for all occupations, according to BLS.
DNPs, in particular, are in short supply, according to Stewart. They're needed in practice and educator roles.
"Many students do not have the opportunity to be precepted by a doctorally prepared nurse practitioner, and often must reach out to master's level NPs or physicians to serve as preceptors during their DNP program," Stewart said.
Another concern is that the nursing workforce is aging and retiring, creating shortages in practice, education, and leadership.
"We need more DNPs to ensure high quality health care in our complex healthcare system, and we need future educators and leaders in policy and management to continue to improve patient care and DNP job satisfaction," she said. "Many have left nursing due to the pandemic, and so we have a lot of work to do to ensure that we have the best leaders for tomorrow in practice, policy, education, and management."
Salary for DNP nurses
According to the U.S. Bureau of Labor Statistics (BLS), when it comes to nursing education, "The more they learn, the more they earn."
The salary potential for nurses with the Doctor of Nursing Practice degree vary by location and career choice. While BLS groups nurses with master's and higher degrees together, it reported in May 2021 that the median annual wage for nurse anesthetists, nurse midwives, and nurse practitioners was $123,780.
Nursing faculty at colleges, universities, and professional schools make an average income of $83,340, according to BLS. Nurse anesthetists command the highest annual salary at $195,610, followed by nurse practitioners at $120,680, and nurse midwives at an average $112,830.
A 2019 survey of nurse leaders conducted by the American Organization for Nursing Leadership found that most nursing leaders' annual salaries ranged from $90,000 to $169,000, with those at the top end of the pay scale earning more than $250,000 a year.
And salaries are an average $102,230 for informatics nurses in the U.S.
The push to move APRNs to a terminal degree
The American Association of Colleges of Nursing (AACN) endorsed a position statement on the DNP degree in 2004, declaring it the most appropriate entry-to-practice degree for APRNs in the U.S. AACN went so far as to set a goal that U.S. master's level nursing programs would change to DNP preparation by 2015, according to a paper published in Nursing Outlook in 2020.
This 2015 goal wasn't met, but DNP programs in the U.S. increased from about 50 in 2007 to about 357 in 2019, with an additional 106 post-baccalaureate and post-master's degree DNP programs being planned, according to the AACN Fact Sheet.
Stewart attributes the push to move APRNs to a terminal degree, such as the DNP, to several factors -- most notably, the rapid expansion of knowledge underlying practice, increased complexity of patient care in inpatient and outpatient settings, overall national concerns regarding quality of patient care and patient safety, and shortages in the nursing and medical professions requiring a higher level of preparation for nursing leaders who can plan and assess care.
While there are more than 36,000 students enrolled in DNP programs in the U.S., according to AACN, that's still a small percentage of nurses overall. For example, on average, only an estimated 17.8% of clinically practicing NPs indicate that they have doctoral degrees, according to The American Association of Nurse Practitioners.
Only 15% of the more than 7,400 nurses responding to the 2020 Nurse.com Nurse Salary Research Report indicated their highest level of education was the DNP, compared to 11% who were MSNs.
Stewart's advice to nurses is to get the terminal degree.
"Job opportunities are far greater, and it provides you with the knowledge and expertise to have a seat at the board table," Stewart said. "[Nurses] are the largest group of healthcare providers, and we need to ensure that our voice is heard, and that can only happen if we are educated and experienced just as our clinical partners at the highest level."
