To provide expert evidence-based nursing care across diverse settings and systems, the Doctor of Nursing Practice, or DNP, has become more popular among nurses in New York and New Jersey. The practice-focused degree appeals to nurses because it prepares them to take on the ever-changing face of the healthcare system.
Since the Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland, Ohio, created the practice doctorate more than 30 years ago, close to 100 schools of nursing around the country have begun to offer the program, including eight in New York and New Jersey.
In response to the growing regional trend, the University of Medicine and Dentistry of New Jersey School of Nursing in Newark offered the first DNP program in New Jersey in 2006. The UMDNJ program faculty wanted to meet the demands of a growing number of nurses who wanted to excel in practice and [who] were interested in advanced study regarding practice, says Cheryl Holly, RN, EdD, associate professor and director of the DNP program for the school of nursing. [UMDNJs] curriculum provides a systematic integration of advanced clinical and advanced leadership content with a focus on evidence-based, quality care and cultural competency skills.
In 2002, to better define the consistency of DNP programs the American Association of Colleges of Nursing formed a task force to research the variations between the different models of nursing programs to help determine future program development, according to its Position Statement on the Practice of Doctorate in Nursing in October 2004. The following recommendations came out of that research: the term practice doctorate be used instead of a clinical doctorate; the practice-focused doctoral program be a distinct model of doctoral education that provides an additional option for attaining a terminal degree in the discipline; and that practice-focused doctoral programs prepare graduates for the highest level of nursing practice beyond initial preparation in the discipline.
Our program is primarily a traditional, classroom program where students can interact with each other and faculty face-to-face, Holly says. Our students tend to be older than the traditional PhD student, as they have been waiting for years for a doctoral degree to be offered that was related to practice rather than research.
UMDNJs program offers two tracks to the DNP degree direct care and indirect care. The direct track is for nurse practitioners, clinical specialists, CRNAs, and CNMs, Holly says. The indirect track is for those who are in mid-level to senior leadership [who manage nurses at the bedside].
The program is very competitive. Although the GPA for admission is 3.4, the average DNP student has a 3.8 GPA, Holly says. Many have two masters degrees or post-masters certificates. Increasingly, we are receiving applications from nurses who have doctorates in other fields, such as psychology, economics, law, and urban health, who are in practice positions and want to advance their knowledge in a practice discipline and want to focus on practice excellence. About 90 students will make up the programs eighth class in January.
THE LURE OF CASE WESTERNCheryl Holly, RN
Although not a local program, Case Westerns DNP program is appealing to many New York and New Jersey nurses because of its accessibility. For Lisa Kosits, RN-BC, DNP, CCRN, CEN, CPEN, clinical faculty in the ED at Montefiore Medical Center in the Bronx, N.Y., Case Western was the ideal choice because it provided an option she didnt find in New York. Most of the local programs are for nurse practitioners, she says. My graduate degree was as a clinical nurse specialist.
Although the school requires six credits be earned on campus in Ohio, enrolled students dont have to travel there to attend regular classes and are not locked into Monday through Friday schedules that may interfere with work and family life. This was a selling point with Kosits. Case was offering the program in Connecticut on the weekends. This really fit well with my work schedule, she says.
Because the DNP focuses on practice, its the optimal choice for any nurse leader. You must have your finger on the pulse of the clinical care as well as the staff and environment that care is provided in, says Carol Porter, RN, DNP, chief nursing officer/senior vice president of New York Citys Mount Sinai Medical Center, who also is a Case Western graduate. Porter believes nursing leadership should be focused on outcomes (quality patient care, positive work environment, and institutional integrity), and financial and operational performance. To do that, she says, nurse leaders must be close to the bedside, comfortable in the boardroom, and focused on the RN workforce as they provide patient care.
Porter says Mount Sinai encourages its clinical nursing staff and nursing leaders to pursue higher education, and several RNs have chosen the DNP.
CHALLENGING COURSEWORKLisa Kosits, RN
Although offered by different schools in different ways, one thing is consistent with the DNP degree: the coursework is challenging. As convenient as the programs may be, some personal sacrifices are necessary during the pursuit of a degree.
Our class time was intense, Kosits says. Courses took place over a Friday, Saturday, and Sunday for two weekends. In between, we had assignments to complete for class the following weekend. When class was over, there were other assignments due during the semester. Kosits is an active member of the Emergency Nurses Association and serves as secretary of its Bronx/Manhattan chapter. Because of school, she didnt attend the associations annual conference for two years. Overall, I would say that 65% of my free time was spent on school work, she says.
Students in the UMDNJ program complete an intensive capstone project as a requirement for graduation. Representative of the issues and challenges found in nursing practice, the projects are designed to make a contribution to practice situations or provide a resolution or greater understanding of a particular issue, Holly says. The intent of these projects is to find, appraise, and translate existing knowledge and research to practice situations or to evaluate the impact of new programs on quality and outcomes and systems, she says. Examples of projects include childhood obesity, falls, pressure ulcers, teen pregnancy, risky sexual behavior, installation of new computer systems for medication administration, and electronic medical records, among others.
NURSE LEADERS CHOOSE DNPCarol Porter, RN
As a chief nurse who has obtained a DNP, Porter is in good company. UMDNJs first graduating class boasts four members who were either chief nurses or senior vice presidents of nursing at their facilities. Holly notes the DNPs focus on practice is what draws nurse leadership to the degree, in lieu of other types of doctorates. The DNP is designed for nurses directly involved in clinical practice or in areas that support clinical practice such as management, education, informatics, and policymaking, Holly says. [UMDNJs program focuses] on those areas that are important to practice, such as economics and finance, epidemiology, cultural responsiveness, and health disparities.