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On October 25, 2004, the members of the AACN endorsed the Position Statement on the Practice Doctorate in Nursing. AACN member institutions voted to move the current level of preparation necessary for advanced nursing practice from the master's degree to the doctorate level.
Doctoral programs in nursing fall into two principal types: research-focused and practice- focused. Most research-focused programs grant the Doctor of Philosophy degree (PhD), while a small percentage offers the Doctor of Nursing Science degree (DNS). Designed to prepare nurse scientists and scholars, these programs focus heavily on scientific content and research methodology; and all require an original research project and the completion and defense of a dissertation or linked research papers. Practice-focused doctoral programs are designed to prepare experts in specialized advanced nursing practice. They focus heavily on practice that is innovative and evidence-based, reflecting the application of credible research findings. The two types of doctoral programs differ in their goals and the competencies of their graduates. They represent complementary, alternative approaches to the highest level of educational preparation in nursing.
The concept of a practice doctorate in nursing is not new. However, this course of study has evolved considerably over the 40 years since the first practice-focused nursing doctorate, the Doctor of Nursing (ND), was initiated as an entry-level degree. Because research- and practice-focused programs are distinctly different, the current AACN position is that: “The two types of doctorates, research-focused and practice-focused, may coexist within the same education unit” and that the practice-focused degree should be the Doctor of Nursing Practice (DNP). Recognizing the need for consistency in the degrees required for advanced nursing practice, all former ND programs have transitioned to the DNP.
Preparation for Specific Nursing Roles
Nurses with graduate degrees serve in a variety of direct and indirect care roles in wide range of practice arenas. Below is a sampling of career options for doctoral program graduates based on data collected by AACN on the most common majors available at U.S. nursing schools. This is by no means an exhaustive list, and there on no limits on where your graduate nursing education can take you.
Advanced Practice Registered Nurses (APRNs) provide primary, preventative, and specialty care in a variety of roles in acute and ambulatory care settings. According to the Health Resources and Services Administration (HRSA), “APRNs are RNs who have received advanced education to develop knowledge and skills in areas not usual for RNs, such as diagnosing and managing common acute and chronic diseases, ordering diagnostic tests, prescribing medications, and performing minor procedures.” Those considering a career as an APRN may choose from one of four recognized roles:
- Nurse Practitioners (NP), the largest segment of the APRN workforce, are essential providers of primary and acute care, and are particularly important to providing access to quality health care in underserved areas. NPs provide initial, ongoing, and comprehensive care, which includes taking comprehensive histories; providing physical examinations and other health assessment; and diagnosing, treating, and managing patients with acute and chronic conditions. This care encompasses health promotion, disease prevention, health education, and counseling as well as disease management. NPs practice autonomously in areas as diverse as family practice, pediatrics, geriatrics, psychiatric/mental health, and women’s health care.
- Clinical Nurse Specialists (CNS) specialize in areas of nursing practice that are often defined by a population, setting, or disease type. The CNS is responsible and accountable for diagnosis and treatment of health/illness states, disease management, health promotion, and prevention of illness and risk behaviors among individuals, families, groups, and communities. With a focus on continuous, evidence-based improvement of patient outcomes and nursing care, CNSs clearly demonstrate that their practice reduces healthcare costs among other quality factors. These providers specialize in a number of areas, such as adult health, acute and critical care, and community health among others.
- Certified Registered Nurse Anesthetists (CRNAs) provide the full spectrum of anesthesia care for individuals across the lifespan. CRNAs provide more than 30 million anesthetics in the U.S. annually and are the sole anesthesia providers in nearly all rural hospitals, affording patients access to trauma stabilization, pain care, and surgical services.
- Certified Nurse-Midwives (CNMs) provide a full range of primary healthcare services, including gynecologic care, childbirth, and care of the newborn. Ninety percent of visits to CNMs are for primary and preventive care, which may include addressing reproductive health issues and treating sexually transmitted diseases. This care is provided in diverse settings, including private homes, hospitals, birthing centers, and ambulatory care settings (e.g., private offices, community and public health clinics).
To become an APRN, students must complete an accredited graduate program, pass a national certification examination, and obtain a license to practice in one of the four APRN roles. Programs focus heavily on advanced clinical knowledge and skills that prepare nurses to provide expert patient care in a number of specialty areas. While master’s level programs are still available, the doctoral degree (DNP) is quickly becoming the standard for preparing APRNs for contemporary nursing practice. To date, more than two-thirds of nursing schools offering APRN programs either offer or are planning to offer the post-baccalaureate DNP program, while most currently have a post-master’s degree DNP option.
Nurse Educators combine clinical expertise with a passion for teaching. Responsible for preparing new nurses and advancing the development of practicing clinicians, nurse educators possess a solid clinical background, strong communication skills, and a high level of cultural competence. Educators must be flexible enough to adapt curriculum and teaching methods in response to innovations in nursing science and ongoing changes in the practice environment. Within this role, these professionals enjoy opportunities to conduct research, publish articles in scholarly journals, speak at nursing conferences, serve as consultants to education and healthcare institutions, write grant proposals, shape public policy, and engage in community service. Given the growing shortage of nurse faculty, the job outlook for those seeking careers in nursing education is bright with a growing demand for individuals needed to teach in schools of nursing, hospitals, public health agencies, and other settings.
Preparation for the nurse educator role varies by role and teaching site. Nurses seeking full-time faculty positions in four-year colleges and universities should pursue doctoral preparation. Future faculty pursuing a doctoral degree are advised to specialize in a clinical area or research within the discipline, not the process of teaching. Individuals pursuing full-time faculty roles should have additional preparation in the art and science of teaching (i.e., pedagogy, curriculum development, student assessment) to better convey their clinical mastery to nursing students. This additional preparation may occur in formal course work as part of a clinically-focused doctoral or master’s program, or completed separate from the graduate degree.
Nurse Administrators serve in a variety of managerial and leadership capacities in all practice environments. These nursing professionals facilitate and deliver quality patient care while coordinating actions in the workplace and managing a team of nurses. A nurse administrator may run a small team of nurses, several nursing units, an entire department, or an entire health system. These nurses are well-versed in nursing practice as well as in administrative procedures. Nurses drawn to this specialty typically aspire to be leaders in health care and often seek executive and policy making roles. Certification programs are available for graduates of nursing administration programs from the American Nurses Credentialing Center and the American Organization of Nurse Executives.
Public Health Nurses focus on preserving the health and well-being of the public. These specialists are licensed professional nurses who participate in activities related to population health, health promotion, disease prevention and control, and community education. Though their responsibilities vary by role and location, doctorally-prepared public health nurses often manage clinics in various state and community settings (e.g., immunizations, well-child, health screenings), investigate communicable disease cases to determine sources and implement action necessary to curtail the spread of disease; analyze data to identify needs and service gaps for individuals, families, and communities; provide education regarding disease control and prevention as well as general preventive health care to individuals and groups; and implement programs that address environmental and population health risks. These nurses work collaboratively with community leaders, government officials, teachers, parents, and other providers in areas related to community and population health.
Nurse Informaticists seek to improve information management and communications in nursing to maximize efficiency, reduce costs, and enhance the quality of patient care. The American Nurses Association defines nursing informatics as “a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice. Nursing informatics facilitates the integration of data, information and knowledge to support patients, nurses, and other providers in their decision-making in all roles and settings.” Informatics specialists must understand the nursing process, so they can design systems that will solve problems facing patient care. After completing a bachelor’s degree in nursing, many nurse informaticists obtain a master’s or doctoral degree in nursing depending upon their career aspirations.
Public Policy: Nurses in this arena work to shape public policy at the federal, state, and local levels. These professionals use their nursing knowledge to advise legislators on healthcare policy, develop legislation, and consult on nursing-related issues. Policy nurses provide expert analysis of the potential and current impact of government policies on healthcare concerns. These specialists work with government policy-making bodies, think tanks, nursing schools, national associations, special interest groups, and with other stakeholder organizations.
Nursing is an evolving profession that presents limitless career opportunities for nurses with doctoral degrees. Beyond the roles mentioned above, nurses are breaking fresh ground as specialists in forensics, case management, military nursing, school nursing, genetics/genomics, and others emerging practice areas. Today’s nurse experts are working as entrepreneurs, authors, consultants, attorneys, legislators, communicators, and in numerous other roles. For an extensive list of nursing specialties, including an overview of academic requirements, see www.nursing.jnj.com/specialty.
Choosing the Right Terminal Degree
Leading authorities like AACN, the National Academies of Medicine, and the Robert Wood Johnson Foundation are calling for a rapid increase in the number of nurses holding doctoral degrees to meet the nation’s demand for faculty, researchers, advanced clinicians, and leaders. Nurses wishing to pursue a terminal degree must decide if their professional interests are more inclined toward research or practice. To help you make this decision, AACN has developed the following grid to illustrate the difference in DNP and PhD preparation, practice, faculty expectations, expected program resources, and outcomes.