Heard on an in-patient unit in a fictional hospital: “Hello, I’m Dr. Smith. I’ll be your nurse today.” If you were a patient and heard that statement, you would a) get your hearing checked, b) make sure you’re not in the psychiatric ward, and/or c) assume it was the drugs talking. And in most cases, you would be right. But it turns out there is a significant push within national nursing leadership for a clinical doctorate in nursing.
A doctorate in any field is supposed to be as far as you can go, educationally. A person who holds a PhD in, say, history, is understood to know pretty much everything there is to know about history, or rather as much as one person can know about a specific area of history. That person is expected to be an expert in that field. In the world of academia, where the idea of the doctorate comes from, the job of the PhD is to advance the field he or she is expert in and to educate others. It has basically always been true that to be top in academics, you have to have a doctorate.
In what we call “the professions,” ie, the group of vocations that require specialized training and specific educational and certification requirements to provide a service (to severely paraphrase Wikipedia), the doctoral tradition is much more recent. None of the original 3 “learned professions,” divinity, medicine, and law, started out as academic pursuits. Local ministers in the Middle Ages were barely more educated than their flocks. Medicine was taught, when it was taught at all, by apprenticeship, as was law. The development of the modern doctorate as the entry point in medicine and law didn’t start until expanding bodies of knowledge and regulatory requirements started to require it. Nursing, now widely acknowledged as a profession in its own right, started out as in-hospital, nondegree, nonacademic training programs and, as such, got into the academic realm even later.
The requirements for professional doctorates are much different than PhDs as well. A typical PhD today has a bachelor’s, a master’s, 1 to 2 years of post-master’s class work, and has spent years on a piece of original research that had to be defended in front of a faculty during PhD candidacy.. A doctor of jurisprudence has to do 3 years of law school after college—no dissertation or post-master’s work required. A doctor of medicine requires a bachelor’s but no master’s, and the dissertation portion is in effect replaced by a 3- to 10-year residency. Dentists, pharmacists, veterinarians, optometrists, and podiatrists now must have their fields’ equivalent of a doctorate. The regulatory bodies of all these professions have agreed to call their penultimate degrees “doctorates,” although the requirements vary widely.
Enter nursing. Here’s Michael Carter, dean emeritus of the College of Nursing, University of Tennessee Memphis, and himself the holder of a doctorate of nursing science, writing in the second edition of Advanced Practice Nursing (2013):
“One of the most important aspects of any profession is the appropriate educational preparation of the leaders of the discipline. Almost without exception, the professions require that their leaders must hold doctoral degrees. The broad purposes of doctoral educational programs are to provide preparation that leads to careers in government, business, and industry, as well as academia.”
Well, no, that’s not actually true. The doctorate is the entry-level degree for some professions. In nursing, the goals of the doctoral degree seem to be focused on leadership and policy in government, business, and industry. That is, the goal of the clinical doctorate, the doctorate of nursing practice, is aimed in that direction. Academic nursing has granted a research-based PhD or equivalent DNSc (doctor of nursing science) for many years.
So what is a person with a DNP prepared to do? The American Academy Colleges of Nursing (AACN) Task Force on the Practice Doctorate in Nursing has made curricular recommendations for the DNP called DNP Essentials. They include:
- Scientific Underpinnings for Practice
- Organizational and Systems Leadership for Quality Improvement and Systems Thinking
- Clinical Scholarship and Analytical Methods for Evidenced-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 and Population Health Outcomes
- Clinical Prevention and Population Health for Improving the Nation’s Health
- Advanced Nursing Practice
How do nursing programs provide training in these areas? It varies by school, but DNP programs generally require more clinical hours than the NP and more extensive policy and leadership training. Some require a master’s as a prerequisite, but not all. Many programs, in place of the traditional dissertation, require a project that involves a significant policy change initiative.
No one is quite sure what the clinical doctoral-level nursing role will look like yet. It is safe to say the nurse bringing you your first postappendectomy meal or fetching you Percocet won’t be trained to the doctoral level. But that nurse’s practice will likely someday be defined and regulated by nurses who are.