Doctor Nurse? Read on to see if the new DNP degree is right for you

From The Floor

Doctor Nurse? Read on to see if the new DNP degree is right for you

As the profession evolves, so do the letters after our names

By Genevieve M. Clavreul, RN, Ph.D.
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While I waited at a local eatery before a doctor’s appointment, I noticed a small group of nursing students engaged in a boisterous and animated discussion. They talked about an upcoming exam, their instructors’ differing teaching styles, and so forth, but what really caught my attention was the comment of one student regarding the new degree, the ‘Doctor Nurse’ — and had they ever heard of anything so silly?  

‘Doctor Nurse’ does sound silly and contradictory, but there is indeed a whole new practice doctorate available for nurses, bringing us up to degree parity with other healthcare disciplines like audiology, dentistry, pharmacology, physical therapy and psychology.  

The Nursing Doctorate: A Short History

In the early 1900s, the Doctor of Education (Ed.D.) degree was created to prepare nursing leaders to become educators and specialists in curricular change.  

In the 1970s, the nursing world saw the rise of the Doctor in Philosophy (Ph.D.). The Ph.D. in Nursing was designed to advance the science of the discipline through research, and continues to be recognized as the highest level in scholarly achievement. If a nurse wants to pursue a research career at an esteemed university or the National Institutes of Health, a Ph.D. will open the door.

Also around this time, there was a proliferation of advanced degrees with a practice emphasis, namely the Doctor of Nursing Science (DNSc, DNS or DSN), which emphasized clinical proficiency, although students were still required to perform scholarly research. A splinter of this degree was the Doctor of Nursing (ND), aimed at preparing for clinical leadership.

Since nursing appears to always be in search of the next best way to define itself, leaders and opinion makers didn’t stop there. Most recently we’ve seen the rise of the Doctorate of Nursing Practice (DNP), which focuses on research utilization for improved delivery of care, patient outcomes and clinical systems management, or to prepare the nurse for a leadership role in nursing management and healthcare administration.

With all these choices available, it didn’t take long for the academics to realize that some streamlining needed to occur. So today’s terminal degree in nursing is moving towards only two arms of study: Ph.D., the academic and research- oriented degree (phasing out the DNSc, DNS and DSN), and DNP, the practice-oriented or professional terminal degree (replacing the ND).  

Resistance from Physicians

The DNP is generating some controversy, especially with nursing’s primary partner in healthcare: physicians.

Advanced practice nurses are no stranger to resistance from various state and national physicians groups. For example, in February, the California Medical Association and the California Society of Anesthesiologists sued the State of California over recently passed regulation that would allow Certified Registered Nurse Anesthetists (CRNA) to administer anesthesia without the supervision of a physician.      

So it wasn’t surprising when the Congress of Delegates from the American Academy of Family Physicians (AAFP) at their September meeting requested the AAFP fund a study comparing the practices of primary care physicians and nurse practitioners (NP).                  

Their request focused on the very specific goal of evaluating the quality of existing studies that compare the two groups of healthcare providers, in terms of patient outcomes and cost effectiveness. Ironically, during testimony, Delegate Jack Chou, MD, president of the California AFP, cautioned the group that the evaluation could produce results that the members might not like.

Alternate delegate William Thrift, MD, of Prescott, Arizona, argued that further analysis was necessary. He went on to state that NPs in Arizona need only 600 hours of clinical practice to practice independently compared to 12,000 hours for primary care physicians. “Yet in Arizona,” he said, “they can do the same work.”  

The results of such a study will no doubt generate a great deal of discussion among not only nurses and physicians, but the general public as well.

The Profession Evolves

The point is that as nursing practice evolves, it will bump up against the job responsibilities of physicians and other medical professionals, and the boundaries will begin to blur.

Even though nursing can trace its roots back to Catholic monks who provided care to the sick during the Dark Ages, as a profession in America it can be considered rather young. The first nursing licensure law was passed by North Carolina in 1903, making nursing just a little over 100 years old. So historically nursing is a relatively new field and as such, goes through spurts of growing pains as it moves towards a platform of maturity.  
Career Options

If you choose to follow the conventional path of associate or bachelor to RN, and then onto a Masters of Nursing, you will have a plethora of choices for career advancement. Do you remain at the bedside or venture into management and administration? Do you become an advance practice nurse or nurse practitioner? Or do you educate the next generation of nursing students?  

In order to make the right educational choice to maximize your career goals, keep in mind that the most basic difference between the Ph.D. and DNP is as simple as scholarly research vs. clinical practice.

If you dream of making a groundbreaking advancement in nursing research at a university such as John Hopkins, University of Pennsylvania, or UCLA, then only a Ph.D. in nursing will do; if you want to pursue a more independent practice or make a mark on nursing administration and leadership, then it’s the DNP you need. Either way, you’ll be a Doctor Nurse!    

Geneviève M. Clavreul RN, Ph.D., is a healthcare management consultant who has experience as a director of nursing and as a lecturer of hospital and nursing management. She can be reached at

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