The Nursing PhD and DNP, What's the Difference?

Joyce Zurmehly PhD, DNP, RN

NEA-BC

Goal of Today’s Presentation

At the end of this presentation, the learner will be able to:

•Discuss and identify the differences in the DNP degree and the PhD.

• Articulate advantages of clinical and research doctorates in nursing.

•Describe programs of study leading to achieving a DNP or PhD in nursing degrees

Reports on the State of the Healthcare System

• AHA In Our Hands, 2002

• JCAHO Health Care at the Crossroads, 2002 –Sentinel events – 25% nurse related

• IOM To Err is Human, 2000

Reports Cite Need for Better & Differently Educated Workforce

• PEW Competencies for the 21st Century, 1998

• IOM Crossing the Quality Chasm, 2001

• IOM Health Professions Education:

A Bridge to Quality, 2003

• RWJ Health Care’s Human Crisis, 2002

IOM Core Competencies for all Health Professionals in the 21st Century

• Provide patient-centered care

• Work in interdisciplinary teams

• Employ evidence-based practice

• Apply quality improvement

• Utilize informatics

IOM (2003) Health Professional Education A Bridge to Quality.

Confusing & Complex

• PhD First pure nursing doctorate NYU in 1934

• Since then, DNS, DNSc, DSN , the ND, the DrNP

• 2006 AACN divided two research and practice doctorates

• Research: DNSc,DNS,DSN, fused to one PhD

• Practice: ND , DrNP, fused to DNP

• Still in progress

• http://www.aacn.nche.edu

I Remember School Nurses…..

History & Evolution of the Practice

Doctorate in Nursing

1960—Boston University opens 1st clinical doctorate1979—Case Western Reserve opens 1st ND program 1999—UTHSC opens DNSc practice doctorate2001—University of Kentucky opens First DNP

Program2002—AACN forms Task Force on the Practice

Doctorate2003—Columbia University admits students2004—AACN members approve DNP Position

Statement & 2015 target implementation date

http://www.aacn.nche.edu

History of PracticeDoctorates

• DNS originally conceived as practice doctorates

• Over time these programs also focused upon development of researchers

• Nursing Doctorate programs (ND) originally focused on development of an entry-level generalist but over time changed dramatically with little congruence across the four ND programs that existed in 2004

Stakeholder Observations• Need to develop advanced competencies for

increasingly complex clinical, faculty and leadership roles;

• Need for enhanced knowledge to improve nursing practice and patient outcomes;

• System change requires enhanced leadership skills to strengthen practice and health care delivery;

• Credits and time invested in master’s programs not congruent with the credential earned;

FUTURE OF NURSING/IOM GOALS

Recommendation 5: Double the number of nurses with a doctorate by 2020.

– Schools of nursing, with support from private and public funders, academic administrators and university trustees, and accrediting bodies, should double the number of nurses with a doctorate by 2020 to add to the cadre of nurse faculty and researchers, with attention to increasing diversity.

Charge to the Task Force on the Practice

Doctorate – 2002• clarify the purpose of the professional clinical

doctorate, specifically core content and core competencies;

• describe trends over time in clinical doctoral education;

• assess the need for clinically focused doctoral programs;

• identify preferred goals, titles, outcomes, and resources;

Trends in

Nursing Education

• Credits required to complete the MSN are approaching the number of credits most

disciplines need for doctoral degree

• many 60+ hours and 3 years

• didactic and clinical increased by 72 and 36 hours respectively for NP programs

between 1995-2000 (AACN & NONPF 2002)

• Graduates and employers identify even more content is needed (e.g., information

and practice management, health policy, risk management, evaluation of evidence,

and advanced diagnosis and management, genomics)

(Bellack, Graber, O’Neil, Musham, & Lancaster, 1999; Lenz, Mundinger,

Hopkins, Clark, & Lin, 2002).

Sparked the current movement ?

What sparked the DNP movement?

• The focus on clinical practice vs. pure research

• Evidence-based practice – required research knowledge

• Other health professionals – Pharm. D., DPT

• Multiple nursing practice degree names and initials

What gives the DNP movement impetus?

• Supporting professional organizations & nursing agencies

• Institute of Medicine

• Magnet Status

• Health Care Reform

• Research Data

Key Points of the Doctor of Nursing

Practice (DNP)

• Practice doctorate – defined as any

form of nursing intervention (Advanced

Practice, Administration, Informatics)

• The DNP is the terminal practice degree

that prepares graduates for the highest

level of nursing practice

Key Points of the Doctor of Nursing

Practice (DNP)

• The DNP is not an entry-level degree.

• Typically, licensure would occur prior to entering the DNP program.

• Terminal degree in nursing

• Represents the highest level of practice in the discipline

Key Points of the Doctor of

Philosophy (Ph.D.)

• The PhD degree is the research

focused terminal degree

• Prepares the individual to conduct

independent research

• Designed to prepare nurse scientists

and scholars

Contrast of Key Differences

DNP

Prepares for the highest

level of practice

Commitment to practice

career

Oriented toward improving

outcomes of care

• Practice Intensive

PhD /DNS/ DNSc

Prepares for the highest

level of research

Commitment to research

career

Oriented toward developing

new knowledge

• Research Intensive

Doctor of Nursing Practice

PRACTICE

EDUCATION RESEARCH

The Focus of the DNP

• Clinical decision making

• Evidence based research

• Research utilization in clinical practice

• Organizational and systems leadership

• Information systems and technology

• Health care policy

• Clinical prevention and population health

Focus of the PhD

• Acquiring the tools to do research

• Research Design

• Statistics

• Developing an area of specialization

• Education

• Practice

• Research

Doctor of Philosophy (Ph.D.)

RESEARCH

EDUCATION PRACTICE

DNP or PhD?

• Both programs require rigorous plan of

study

• Terminal degree

• Prepare leaders in the field of nursing

• Both prepare nurse educators

PhD DNP• Requires a rigorous,scholarly

approach to the discipline

• Commitment to advancement of

the profession

• Emphasizes theory, meta- theory,

research methodology and

statistics

• Completion and defense of an

original research project

• Requires a rigorous,scholarly

approach to the discipline

• Commitment to advancement of

the profession

• Emphasizes practice

• Requires an integrative practice

experience and an intense practice

immersion

• Carries out a practice application

oriented Final Capstone project which

is an integral part of the integrative

practice experience

CAREER TRAJECTORIES

• Typically, the PhD is one that remains in Academia and conducts research/education. However, many practice settings are seeing PhD graduates in administrative positions as well.

• DNP graduates are

intended to be “practice”

nurses.Advanced practice

positions, administrative

positions, educational

positions, etc. – in the

operational/organizationals

etting. However, many DNP

grads are choosing

academia as a career

choice.

HOW DOES FOCUS OF DNP DIFFER FROM PHD?

• Eating during labor

• Identify the problem

• Find the evidence

• Appraise the evidence

• Integrate evidence with clinical expertise, patient values

• Evaluate outcomes

• Disseminate

• Eating during labor

• Explore, compare cultural differences

• Compare differences in practice by geographic region, type of hospital, birth center

• Physiologic effects of restriction

DNP: Experts in EBPPhD: Experts in Research

QI Versus RESEARCH• Intervention may be

multifactorial represents best practices

• No risk to patients

• Audience is organization

• Data source: organization

• Rapid improvement cycles

• Design - no controls

• Not GeneralizableNational Organization of Nurse Practitioner Faculties (NONPF)

• Untried intervention being tested

• Risk may be present

• Complex protocol

• Audience is scientific community

• Data source –randomized population, multiple sites

• Design – focus on controls

• Generalizable

RESEARCH: WHEN EVIDENCE IS NOT THERE/NOT

SUFFICIENT

• Conduct a research study to determine the “what is it we want to know”

• Nature of the question will determine the level of the research study

1 - What is the nature of the phenomenon?

2 - Who, what, how many, how much?

3 - What are the relationships among the variables?

4 - Does one variable cause the other?

SO MANY QUESTIONS . . . Evidence-Based Practice (EBP): What is the best

approach for managing neuropathic pain in the terminally ill patient?

What research has been done that could provide clinical practice guidelines?

Quality Improvement (QI): Are we doing the right things to appropriately manage patients’neuropathic pain?

How do we know? How are we measuring patient outcomes?

Research (R): What is it like to live with neuropathic pain?Does drug “A” work better than drug “B?”

What’s been studied? Where are the gaps?

Considering Doctoral Education?

Essential Characteristics of Doctoral Candidates

Vision

Passion

Focus

Persistence

Resourceful

WHY PURSUE A DOCTORATE DEGREE?

• Increase in intellectual knowledge

• Career advancement

• Evidence-based practice

• Eligibility as nursing faculty

• Increase in income

• Improvement in clinical skills

• Improvement in communication skills

Loomis, J.,, Willard, B., Cohen, J., (December 22, 2006). Difficult Professional Choices: Deciding Between the PhD and the DNP in Nursing. OJIN: The Online Journal of Issues in Nursing. Vol. 12 No. 1.

DO I REALLY WANT TO DO

THIS AGAIN?

Consistency Across DNPPrograms

• Essentials of the Doctoral Education for Advanced Practice Nursing

• DNP Essentials

• DNP tool box

• http://www.aacn.nche.edu

References: AACN - Comparison of DNP and PhD/DNSc/DNS Programs

AACN – The Essentials of Doctoral Education for Advanced Nursing Practice

DNP Essentials

• DNP Core: Outcome competencies deemed essential for all graduates

• Specialty Competencies/Content: Clinical and didactic learning experiences focused on preparing the DNP graduate for specialty which is defined by the specialty organizations

Eight Core Essentials

• Scientific underpinnings for practice

• Organizational and systems leadership for quality improvement and

systems thinking

• Clinical scholarship and analytical methods for evidence-based practice

• Information systems/technology and patient care technology for the

improvement and transformation of health care

• Health care policy for advocacy in health care

• Interprofessional collaboration for improving patient & population

health outcomes

• Clinical prevention and population health for improving the Nation’s

health

• Advanced nursing practice

Consistency Across PhD Programs

• All prepare graduates to do independent research

• Dissertations are evidence of capacity to develop, conduct and analyze complex nursing research problems

Roles of the PhD Graduates

• Independent Researcher

• Faculty positions

• Practice leadership roles

• High level executive positions

• Policy development

Roles of the DNP Graduate

• Practice leadership roles

• Faculty positions responsible for clinical program delivery

• High level executive positions

• Policy development in clinical practice

Resources Needed

DNP

Mentors in leadership

Access to diverse

practice settings

Financial aid

PhD/DNS/DNSc

Mentors in research

Access to active

programs of funded

research

Dissertation support

YOUR DNP PRACTICE INQUIRY PROJECTS

• What are your burning issues in health care, in your advanced nursing practice (why are you here)?

– Implement innovations

–Apply evidence-based interventions

–Propose changes to care delivery models

– Implement quality improvement projects

–Develop and implement health policy

Frequently Asked Questions

• Will the creation of DNP programs detract from nursing research?

• DNPs will serve as the natural allies of researchers for the full implementation of evidence for practice

• Discipline needs both researchers and high level clinicians to advance the profession and provide high quality care

(From the National Academy of Sciences Report (December 2005)

COMMONALITIES – IMPROVE CARE DELIVERY!

• Involve teamwork – not done in isolation• Call for critical thinking and creativity• Commitment to improve care • One informs the other

Nurses base their practice on emerging evidence from research (EBP)

Research starts in practice and ends in practice

Quality improvement evaluates and monitors care, and identifies opportunities to improve care as the processes and outcomes of care are measured, continuously evaluated and improved

COMMONALITIES – PROVIDE STRUCTURE!• Evidence-based practice (EBP) – utilizes the best clinical

evidence in making patient care decisions typically from research. EBP translates knowledge into practice

• Quality improvement (QI) - utilizes a system to monitor and evaluate the quality and appropriateness of care (outcomes) based on EBP and research

• Research (R) - applies a methodology whether quantitative or qualitative to develop, uncover, create, find, add new nursing knowledge

CONCLUSIONS• PhD Research and DNP quality improvement and evidence based practice are integral to the delivery of quality patient care

• Each informs the other and improves upon the other

• Each requires commitment, team work, vision, critical thinking, creativity, leadership, energy and endurance

• “Doing the right thing” in each of these areas contributes to an environment of excellence, quality patient care and clinician satisfaction…and sets you apart as a change agent!

Nursing PhD

PhD and DNP

Nurturing Excellence

Through

Nursing Research

and Practice

References

• American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. Washington, DC: Author. Retrieved from www.aacn.nche.edu/DNP/pdf/Essentials.pdf

• American Association of Colleges of Nursing. (April, 2013). DNP fact sheet. Retrieved from www.aacn.nche.edu/media-relations/fact-sheets/dnp

• Burns & Grove (2005). The Practice of Nursing Research (5th ed).St. Louis: Elsevier Saunders

• Clarification of the DNP and PhD/DNS. (2014). Nurse Educator, 39(6), 306. doi:10.1097/NNE.0000000000000085

• Melnyk & Fine-Overholt (2005). Evidence-Based Practice in Nursing & Health Care.

• Moore, K. (2014). How DNP and PhD nurses can collaborate to maximize patient care. American Nurse Today, 9(1), 48-49.

• Polit & Beck (2008). Nursing Research: Generating and Assessing Evidence for Nursing Practice. Philadelphia : Lippincott Williams & Wilkins.

• Roberts & Bourke (1989). Nursing Research: A Quantitative and Qualitative Approach. Boston: Jones & Bartlett.

• National Organization of Nurse Practitioner Faculties (NONPF)

REFERENCES

Questions? More Information?

Joyce Zurmehly PhD, DNP, RN, NEA-BC