Is the Doctor of Nursing Practice (DNP) the new entry-level degree for advanced nursing practice?

DNP with a patient
DNP with a patient

The nation is at a critical turning point in healthcare delivery, with the nursing profession at the center of its changes. The aging baby boomer population, COVID-19 pandemic, and complex health disparities are just a few of the factors shaping the increasingly complex landscape of healthcare.

Nurses with a Doctorate of Nursing Practice (DNP) degree navigate healthcare complexities with an advanced level of knowledge and leadership skills beyond what is obtained with a master's degree in nursing (MSN). For these reasons, the DNP degree is becoming the requirement for entry-level advanced nursing practice.

Why Doctorally-prepared NPs?

According to the American Association of Colleges of Nursing (AACN), the DNP serves as an alternative to research-based doctoral programs (Ph.D.) with an advanced curriculum in evidence-based practice, quality improvement measures, and systems leadership. This educational foundation prepares nurses to deliver high-quality patient outcomes by applying the highest level of scientific knowledge and practice expertise.

Doctorally-prepared NPs practice at senior levels within the healthcare team, utilizing advanced education and training to interpret complex data for vital decisions about healthcare management. DNP-prepared nurses continue to positively impact the nursing profession as faculty and leaders of health-related research. They are also using advanced critical thinking skills learned in these higher degree programs to manage increasingly complex clinical situations and healthcare systems. 

Doctorally-prepared NPs are desired for their knowledge and expertise, therefore positively impacting healthcare delivery as nurse executives, political leaders, advanced clinical practitioners, and within academic settings.

Do NPs need doctoral education?

Recent conversations about the nursing profession have many questioning, “do NPs need to be doctorally-prepared?”

A master's degree in nursing (MSN) has long been considered the next best step after a bachelor of science in nursing (BSN) on the nursing education ladder. As the highest achievable nursing degree, a doctorate was historically reserved for those interested in research and faculty positions. 

In 2004, the American Association of Colleges of Nursing (AACN) endorsed the advanced nursing practice preparation level from the master’s degree to the doctorate level by 2015. AACN found this initial push to be largely unsuccessful because the shorter and less expensive MSN degree continued to be an acceptable educational path for employers and accreditation agencies.

In 2012, AACN published this statement, reinforcing the organization’s position from 2004 that NPs need a doctorate. The AACN recognizes the value of preparing the next generation of advanced practice nurses with a DNP degree. They cite clinical, organizational, economic, and leadership skills learned through these programs as valuable attributes of a DNP, correlating to positive outcomes within all areas of the healthcare landscape.

The future of DNP and the NP role

The National Organization of Nurse Practitioner Faculties (NONPF) is committed to transition entry-level nurse practitioner (NP) education to the DNP degree by 2025. As a leader in quality NP education, NONPF recognizes the intricacies of the current healthcare delivery system and how NP education must evolve to meet its expanding role.

A doctorally-prepared NP is well-equipped to help fill clinical vacancies caused by physician shortages and is ready to meet the various health needs of the nation’s communities. Employers also recognize a difference in DNP-prepared NPs, who are cited to have a greater understanding of evidence-based clinical guidelines and application into practice. They are also noted to have a stronger knowledge of health policy over those with an MSN degree, according to a recent study. This evidence speaks to the growing valuation of NPs and NPs with this advanced degree in the future.

When will the DNP degree be required for NPs?

While state laws continue to allow NPs to practice with a master's degree, there is a growing emphasis on transitioning these roles to a DNP at the entry-level. The National Organization for Nurse Practitioner Faculties (NONPF) has also committed to move all entry-level NP education to the DNP degree by 2025, as of 2018. 

In addition, while the AACN has not formally clarified their position on the DNP for entry-level nurse practitioners since their position statement in 2004, recently updated online information indicates they continue to support this change. The time is nearing when the DNP may be the required entry-level degree for nurse practitioners.

Who decides if a DNP is required for entry into the NP role?

The Commission on Collegiate Nursing Education (CCNE), an entity of the AACN, is the organization that accredits nursing education programs. Recommendations for foundational education may come from national organizations such as the NONPF and AACN, but the CCNE is responsible for the accreditation of nursing degree programs. 

The American Nurses Credentialing Center (ANCC), a subsidiary of the American Nurses Association (ANA), as well as The American Association of Nurse Practitioners (AANP) must also agree on any changes to the entry-level degree for NPs. Requirement changes are additionally approved at the state board of nursing level.

Shifts in these requirements are dependent on the aforementioned school accreditation institutions and certification and licensing agencies but can be influenced by university program availability and employer requirements. If the DNP does become a requirement for all entry-level NPs, those who are currently licensed and certified will not be required to earn this degree level to continue practice.

Advantages of obtaining a DNP degree

Doctorally-prepared nurses have the necessary education and expertise to make complex decisions, lead healthcare teams, and make critical decisions about a patient’s plan of care. These qualities are becoming more essential for NPs to function in their increasingly complex roles. NPs may need a doctorate to stay competitive in the job market, distinguishing themselves from other applicants.

Other advantages include an increased salary potential, as well as job advancement opportunities. The ability to lead healthcare teams and contribute to high quality patient outcomes is becoming more complex. The NP role requires advanced knowledge and clinical expertise based on evidence allowing the DNP to meet current healthcare needs and anticipate future trends. 

According to the U.S. Bureau of Labor Statistics (BLS), employment for NPs is expected to grow over 46% from 2021-to 2031, with annual median pay of $117,670. A survey by Medscape found that 15% of the NP workforce held a doctorate, with a 4% higher average income than masters-prepared NPs.

DNP-prepared APRNs will continue to meet increasingly complex healthcare needs while establishing partnerships with other healthcare professionals. Nurse executive leaders such as chief nursing officers (CNO) and clinical leaders (CL) also benefit from the education received at the doctorate level. These roles are highly valued in the healthcare market today and can be well worth the time and effort of completing a DNP program. 

What are barriers to replacing an MSN with a DNP?

NPs are in high demand, especially as limited access to care remains a public concern. The extended curriculum of a DNP degree may be seen as a barrier to some nurses who are anxious to join a workforce desperate for their expertise.

An AACN survey showed that hospitals may also be hesitant to hire the more expensive doctorally-prepared practitioner as opposed to one who is master’s-prepared. While there is a significant difference between the salary of an NP and a physician, DNP-prepared advanced practice nurses may be more costly than an APRN prepared at the master’s degree level.

Barriers continue to exist for this change, as it did for the attempt to have all DNP-prepared advanced practice nurses in 2015. In the past, a lack of enforcement at the accreditation, licensure, and employer levels made the MSN much more favored by prospective students in terms of cost and time commitment. These barriers have not been completely resolved, and the current movement to reinforce this change by 2025 continues to be an important topic in the health care community.

Nursing associations, accreditation, and licensing agencies, employers, and universities are making more substantial changes to their programs and requirements to support the entry-level advanced practice nurse as a DNP. As more evidence builds to support this movement, barriers to replacing the MSN as the entry to advanced practice nursing will continue to lessen.

The future of DNPs

When it comes to making an impact in shaping the future of healthcare, the opportunities for DNPs are endless. The value of an APRN lies in impacting patient care, whether through individual relationships or at the organizational level. The future state of the DNP relies on nurses to play a critical role in advancing healthcare initiatives by providing leadership and clinical excellence to our communities and nation. 

Doctorally-prepared APRNs are:

  • Nurse administrators and executives who can design and assess healthcare systems
  • Nurse leaders who influence policy changes at local, state, national, and international levels
  • Advanced practitioners who improve access to and improve high-quality, cost-effective, patient-centered clinical care
  • Nursing scholars with roles as faculty, and who utilize clinical evidence to improve healthcare organizations and patient outcomes

How Baylor’s online DNP degree program will fit your goals

The faculty and advisors at Baylor University understand the commitment and dedication that are necessary for success as a DNP student. There is an abundance of resources that help online DNP students thrive in their programs. 

  • Clinical placement support from a Clinical Placement Coordinator
  • One-on-one clinical preceptor (as opposed to one preceptor for a group)
  • Dedicated academic advisor from your first class registration through graduation day and beyond

The flexible online DNP programs at Baylor University support your journey while you earn your DNP degree by providing you with the critical skills you need to pave a new path as an advanced practice nurse.

Check out Baylor’s program page and access the free program guide to request more information.