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Doctor of Nursing Practice | Context - Context
Doctor of Nursing Practice
Doctor of Nursing Practice In Context

The Doctor of Nursing Practice is the highest degree available for clinical nursing education. It is used by degree holders to progress their clinical careers, move into advanced practice nursing, or enter roles in leadership, administration and policy-making.

In a 2004 statement, the American Association of Colleges of Nursing (AACN) declared the DNP as the preferred terminal degree for clinical nursing education. [1] It supplants the Master of Science in Nursing (MSN) as the primary desired graduate degree for entry into advanced practice nursing.

The push came amid calls to increase the profile of the degree: Research from the Institute of Medicine in 2011 showed that, while 13% of nurses held a graduate degree, less than 1% held a doctoral degree. [2] By 2015, an AACN survey found enrollment in practice-focused doctoral programs had increased 26.2%. [3] In the same survey, the AACN found 269 schools offered a DNP program in 2014, an increase from 247 the year before.

Exploring the Doctor of Nursing Practice

The Doctor of Nursing Practice is one of two terminal degrees attainable in the nursing field, the other being the Doctor of Philosophy of Nursing. The main difference between the two is where the degree can be applied. The DNP, for instance, is geared toward practical use in the clinical side of nursing, whereas the Ph.D. is used for research and teaching.

While all programs vary in terms of hours needed, most programs require students entering with an MSN to complete around 30-40 credit hours. Additionally, while programs have latitude in how their curricula are developed, the AACN maintains a set of core competencies and outcomes each enrollee should master upon completion, including: [5]

  1. Integrating nursing science with ethical, psychological, analytical, and organizational knowledge
  2. Developing and evaluating care delivery and cost-effectiveness of initiatives, while also applying principles of budgeting and finance
  3. Using information technology to inform quality of care improvements and further tracking, analyzation and interpretation of data and outcome results
  • Designing and maintaining systems of evaluation that monitor everything from care outcomes to how patients engage with consumer materials and technology
  • Grasping policy formulation and dissemination, as well acting as an advocate and providing leadership to all levels
  • Ensuring effective communication and collaboration between departments
  • Analyzing epidemiological, cultural diversity, environmental, and biostatistical records as a function of managing population health
  • Consistently demonstrating advanced knowledge of clinical judgment, accountability, evaluation and improving patient outcomes
Who might choose to earn a DNP?

Being the terminal degree for advanced nursing practice, the DNP is designed for those with clinical career ambitions that stretch beyond general administration of patient care and organization into specialized responsibilities like high-level accounting for outcomes, policy-making, advocacy, and spearheading improvement initiatives across the practice.

The DNP is for nurses who want to pursue the most advanced positions of clinical practice. They often have the highest aspirations for C-suite execution of policy, leadership responsibilities, care improvement, outcome analyzation, and critical thinking to pace the profession with the needs of the patient population.

A Doctor of Nursing Practice can be applied in a host of settings, including:

  • Hospital
  • Ambulatory care
  • Home health
  • Community health
  • Academia
  • Pediatrics
  • Neonatal
  • Adult care

The degree is most often pursued by master’s holders, but opportunities in baccalaureate-to-doctoral tracks do exist. The DNP, as the terminal degree, requires extensive coursework and clinical hours, but it can lead to great opportunities at all levels of nursing and can serve as a pathway toward the profession’s highest echelons.

DNP in the world

  • How do I earn a DNP?Completion of a baccalaureate and master’s degree is required for entry into a DNP program. Most programs prefer candidates to hold a nursing degree, but candidates from other fields are often adjudged on an individual basis.
  • How long does it take?DNP programs entered after earning a master’s degree often take two years, while it might take three to four years for students who jump in straight from their bachelor’s. A 2016 AACN survey found DNP programs typically take 2.6 years on average. [4] Additionally, other programs offer advanced tracks from a lesser degree to a higher one that can be completed in condensed time.
Why earn a DNP?
Students may pursue a DNP degree for any number of reasons, including career ambitions, lifelong love of learning, desire to care for others, and financial gain:

Earning potential

As the DNP is the highest degree possible for clinical-focused nurses, pay for advanced nurse practitioners with the degree tends to be the highest in the nursing profession. The U.S. Bureau of Labor Statistics reported median annual pay for advanced practice registered nurses [APRN] in nurse practitioner, anesthetists and midwives roles in 2015 was $104,740, [6] while registered nurses (who commonly hold a bachelor’s or associate degree) made about $30,000 less. [7]

Licensure or certification

There are four APRN positions with specialty certifications to which a DNP can be applied: Nurse Practitioner, Certified Nurse Midwife, Certified Registered Nurse Anesthetist and Clinical Nurse Specialist.

Career advancement

A DNP is often needed, or desired, for executive nursing positions. Further, the trend of upward enrollment and more programs offering the degree, as well as industry sentiment, could increasingly make the degree particularly attractive in APRN settings.

Career change

Holders of a DNP are supremely qualified for a variety of high-level nursing roles, and they often stand out from competing job applicants that do not possess the doctoral degree.

Job security

Nurse practitioner is ranked as the No. 2 best job for the future by Kiplinger. [8] An expected 25.7% increase in job openings from 2015-2025 make the degree an especially noteworthy asset for those looking to achieve high-level nursing careers.

Potential influence

Future policy-makers and shapers of the evolving world of health care and nursing will likely be holders of the terminal degree who studied the type of critical thinking and action planning needed to approach the problem.

How do I choose a DNP program?
As with any education decision, there are a multitude of considerations to be aware of in choosing a DNP program. Besides standard factors like program quality and geography, it's important you keep in mind your ability to earn more, as well as particular opportunities for specialization and personal growth:

Accreditation

The American Association of Colleges of Nursing (AANC) operates as the primary accrediting entity through the Commission on Collegiate Nursing Education (CCNE), which grants accreditation to satisfactory programs.

Faculty

DNP faculty should have extensive education and practice backgrounds and should be proficient in any specialty you are interested in. If you choose to study online, be sure to research what lines of communication exist between students and faculty.

Delivery method

DNP programs can be taken online, on campus, or in a hybrid structure that blends the two. Be sure that the program’s offerings will be conducive to your best learning environment and work status.

Program length

DNP students often study on a part-time basis to make room for clinical hours, which are necessary for earning a DNP. However, if you intend to study full-time, be prepared for it to take longer. AACN statistics show part-time students average 2.8 years in completion time, while full-time students average 2.4. [4]

Cost

When considering cost of the program, always be sure to balance tuition with personal financial contributions, grants, scholarships, and student debt.

Curriculum and specialization

Vet each program’s curriculum to ensure it aligns with your interests and desired end product. Also keep in mind particular specialties to which a DNP can be applied. AACN enrollment statistics from the 2015-16 academic year point to popular specialties outside Nurse Practitioner include: [9]

  • Midwifery
  • Anesthesia
  • Leadership
  • Administration/Management
  • Informatics
  • Community Health/Public Health

Success of previous students

Most programs use statistics on graduation and employment of graduates as marketing material, so public information on job placement is often readily available.

Rankings

While rankings aren’t the most important metric to consider, they’re worth keeping in mind as you search for a DNP program. Consult program rankings, often issued yearly by credible organizations, to identify regional and national leaders.

Doctor of Nursing Practice Career Advancement
The United States has faced a nursing shortage in recent years, spurred by retirements, greater patient loads, and increased need for specialization. The financial crisis of 2008 also compounded the negative factors. [33] However, the market for nursing jobs is in much better condition now than most vocations. Bureau of Labor Statistics data forecast employment of nurse practitioners, anesthetists, and midwives to grow 31% between 2014 and 2024 [6], compared to the 7% average for all occupations. Consider also the demand for Advanced Practice Registered Nurses (APRN) with a Doctor of Nursing Practice (DNP), and steady job market gains paired with the value seen in a DNP by employers make the degree an attractive investment for those with the highest ambitions. A 2014 study published in the Journal of Nursing Administration found that, of responding chief nurse officers in Michigan hospitals: [34]
  • 41% employed DNP-level APRNs
  • 50% were either "extremely" or "somewhat" likely to hire more DNP-prepared APRNs

Even though a Doctor of Nursing Practice can lead to a higher salary, interest in the degree is mainly driven by the increased amount of education that opens access to high-level positions. 64% of nurses in a survey of NPs — presented at the 2015 conference of American Association of Nurse Practitioners by Ann Kriebel-Gasparro, an assistant professor at Temple University — said earning a DNP led them to secure a position of leadership. [36]

The study from Journal of Nursing Administration found that positions CNOs would consider a DNP-level nurse practitioner for include: [34]

  • Vice president for patient care (75%)
  • Vice president for clinical service (66.7%)
  • Program director (66.7%)
  • Quality improvement director (58.3%)
  • Director of clinical services (50%)
  • Clinical information technology specialist (50%)
  • Direct care clinician (41.7%)
  • Chief executive officer (25%)
  • Faculty member (25%)

Salaries for DNP holders tend to measure higher than those at the master’s level: A 2009 survey on nurse practitioner compensation from the journal Advance for Nurse Practitioners and Physician Assistants found DNP-level NPs made $7,688 more on average than master’s graduates. [35]

Potential settings and specializations to which a DNP can be applied include:

  • Hospital settings that are suited to critical care, trauma and ER/OR specialization
  • Administrative roles at care providers or institutions
    Family care, from pediatrics to adult/gerontology
  • Telehealth, a field particularly ripe for innovation
  • Women’s health-related fields like OB-GYN, neonatal and midwifery
  • Leadership roles that may translate to an executive position or a board seat
  • Education — the DNP can prepare a nurse for faculty roles if supported by other coursework
  • Anesthesia, which can become a considerably profitable specialization
  • Community and population health, where policy-making and advocacy are important
  • IT and systems specialization, encompassing data extraction and insight generation
Doctor of Nursing Practice Curriculum

Until recently, the Master of Science in Nursing (MSN) was often the highest degree targeted by Advanced Practice Registered Nurses (APRNs). However, despite just 1% of the current nursing population holding a doctoral degree [2], the shift toward the Doctor of Nursing Practice (DNP) has resulted in considerably fast-paced growth for DNP programs:

  • American Association of Colleges of Nursing statistics from 2016 show that there are 289 DNP programs currently open across 48 states and District of Columbia. [15]
  • Enrollment increased by 3,000 students from 2014 to 2015, while graduation increased by more than 1,000 in the same timespan.

To put this into context, a Georgetown University report from 2015 showed there were only 391 DNP graduates in 1998 and still just 512 by 2006. Georgetown recorded 2011 graduation numbers as high as 2,000. [16] This exponential growth is the clearest demonstration of the swelling demand for the degree, thanks to the emphasis placed on it by nursing advocacy groups and higher education at large.

A typical online DNP program will require between 28 and 42 credit hours to complete. However, it’s important to keep in mind that there’s more to the DNP than coursework. Other curriculum considerations include:

  • Clinical practice hours, which can range from a few hundred to more than 1,000
  • Availability of required courses and desired electives
  • Mandatory in-person campus appearances
  • Whether your desired program has a capstone requirement.

These considerations can dramatically affect the length of your program, as well as what you get out of the program. Be sure to choose a DNP program that aligns with your schedule and your goals.

Standard coursework refers to the classes that constitute the bulk of DNP foundational learning, often present across all programs in some form. Electives will help you hone your abilities and education in the specialization of your choice, or they might supplement your knowledge in tracks that interest you but are outside your specialization.

Standard courses, as outlined by the National Organization of Nurse Practitioner Facilities, include those focused on: [17]

  • Scientific foundation:

    Critical analysis of practice data, drawing from basic scientific nursing underpinnings, as well as other areas of knowledge.

  • Leadership:

    Taking on increasingly complex roles of leadership that teach reflective thinking and interprofessional collaboration.

  • Independent practice:

    For advanced practice, nurses must take on full accountability, which is covered in courses of this nature.

  • Health delivery systems:

    Builds on the framework of organization to affect consensus building, partnership crafting, risk management, and facility and delivery system development.

  • Practice inquiry:

    Evaluating and investigating outcomes, then designing initiatives based on evidence and analysis.

  • Policy:

    These courses scrutinize the factors that lead to development, dissemination, and advocacy of health policies. They also touch on ethics.

As for elective courses, they are much more likely to vary institution to institution, but are generally offered, and encouraged, across the country. Many programs will require the completion of a small number of credit hours in electives.

What’s the importance of experiential learning?

Having firsthand experience with real-world applications of studies is integral to a complete education and is particularly essential for nurses seeking a Doctor of Nursing Practice (DNP). This quality is important for responsibilities in advanced practice beyond care administration, like policy-making, informatics, and systems evaluation, because of the implications for patient, nurse, and provider that exist along the spectrum.

When it comes to nursing, students engage in experiential learning through two main channels:

  • Clinical hours: Each DNP program requires that students log a set number of hours in clinical practice to satisfy certain degree requirements, often upward of 1,000 hours. The definition of clinical practice experience according to the Commission on Collegiate Nursing Education (CCNE) is broad, but generally refers to supervised, hands-on learning and demonstration of core competencies. [20]
  • Residency: For some programs, there is no clear line of demarcation between clinical hours and a residency, especially those programs whose final project is a residency. Residencies are set apart by their longer duration of time, their focus or subspecialty, and an expectation that the student will demonstrate their proficiency in each competency required for a DNP.

Considerations when Choosing a Residency

Just as with your vetting of DNP programs, there are particular points to consider when selecting a residency program:

  • Help from the school: Programs will typically advise students on opportunities, as well as alert them to new ones. While the residency takes place outside of the classroom, each placement needs final approval from the program to ensure it meets standards and program-specific needs.
  • Credit for licenses/certifications: According to the CCNE, any previously earned licenses or certifications cannot be put toward credit hours in a residency program. [20]
  • Specialty: Students often participate in residencies that include experiential learning within their subsection, whereas clinical practice hours may be more generally focused.

The first thing you should looking for when comparing DNP programs is quality or school caliber. But the considerations do not end there. While there are certain foundational courses and topics of study that exist in each course (in compliance with standards set by the Commission on Collegiate Nursing Education), each program is unique. There is a lot to keep in mind when assessing curricula, whether that relates to:

  • Core competencies and specializations
  • Academic infrastructure, including facilities and resources
  • Faculty experience
  • Breadth of coursework
  • Alignment with your professional goals
  • Practice experiences

Course delivery

While there are two central modes of course delivery — online and on-campus — many programs blend elements of both to come up with a hybrid construct that allows for flexibility while also providing necessary mentorship.

For example, in Texas, which is a leading state in awarding nursing degrees [16], 16% of DNP programs surveyed in 2015 offered their entire course catalog online, 46% offered partial curricula, and 65% offered a hybrid of web-enhanced materials. [18]

There are several core learning objectives inherent in each DNP program, coming from the AACN, that prepare graduates to: [5]

  • Conduct a comprehensive and systematic assessment of health and illness parameters in complex situations, incorporating diverse and culturally sensitive approaches.
  • Design, implement, and evaluate therapeutic interventions based on nursing science and other sciences.
  • Develop and sustain therapeutic relationships and partnerships with patients (individual, family, or group) and other professionals to facilitate optimal care and patient outcomes.
  • Demonstrate advanced levels of clinical judgment, systems thinking, and accountability in designing, delivering, and evaluating evidence-based care to improve patient outcomes.
  • Guide, mentor, and support other nurses to achieve excellence in nursing practice.
  • Educate and guide individuals and groups through complex health and situational transitions.
  • Use conceptual and analytical skills in evaluating the links among practice, organizational, population, fiscal, and policy issues.

For an advanced degree like a DNP, completing coursework and accruing clinical hours are not the only requirements for conferral. Nearly every program ends with a high-level, scholarly project that encompasses and demonstrates not only all the competencies APRNs learn in the program, but also often relates to a personal subject of interest within their specialization.

Based on a 2013 study from the Doctors of Nursing Practice, final projects can come in a few different forms that are all generally related: [19]

Capstone

71.4% of nurses who earned a DNP ended their program with a capstone project. There is considerable latitude in what qualifies as a capstone, but such projects are generally long-term investigations of a question. These courses involve recording and analyzing that particular subject, topic, phenomena, or specialty, and then synthesizing research and experiences into mastery of practical application.

Residency/clinic

While clinical hours or residencies may occur outside of a final project, 31.4% of DNP graduates indicated their end product included hours of practice in a residency.

Article for publication

For 25.1% of nurses, their final project was to write a scholarly article for publication.

Thesis/dissertation

Just 14.9% APRNs with a DNP said a thesis or dissertation was their final project, though the report noted an upward trend in this area.

Regarding residencies, such placements as part of a final DNP project usually cover some 400-600 hours in a clinical setting. These hours can then be applied toward the overall requirement of hours students must complete. Besides practice learning, these residencies are designed to promote engagement with current leaders while also further refining critical thinking and scholarly synthesis within a nurse’s professed special interest.

Doctor of Nursing Practice Program Length

The length of an online master’s degree program can depend on a number of variables, perhaps the most prominent of which is the pace at which you choose to study. You can finish a typical master’s degree program in about two to three years if you choose to study full-time, although some accelerated programs may be able to help you finish more quickly.

Online master’s degree programs tend to offer flexibility suitable for students who choose to study part-time. This option will likely extend your time to completion, but it can allow you to study while fulfilling your familial, social, and professional obligations.

You can find more information on this topic at our program length overview page.

Doctor of Nursing Practice Admissions Requirements
While each program will set its admissions requirements based on its own criteria, many requirements are universal across all programs. No matter where you apply, you can expect to provide items like transcripts from previous degrees or coursework; standardized test scores; a personal statement or essay; letters of recommendation; and an overview of relevant work experience. In certain cases, some of these requirements may be waived. For more information about admissions, please visit our admissions requirements page.

Core Requirements

While each set of applicant criteria will be different everywhere you look, schools will generally require that students have:

  • A Master of Science in Nursing from an institution accredited by a recognized authority
  • A cumulative grade point average of at least 3.0 on a 4.0 scale
  • Registered Nurse or Advanced Registered Nurse Practitioner licensure within the U.S.
  • Completion of at least one undergraduate statistics or biostatistics course

Auxiliary requirements that may be asked of applicant nurses may include:

  • Background and drug screening
  • A specialty advanced practice licensure (like midwife or anesthetist) attached to Master of Science in Nursing (MSN)
  • A set number of clinical practice hours already completed
  • Current, valid scores from the Graduate Records Examination
Doctor of Nursing Practice Alternative Degrees
There are a number of degrees available in nursing education at the baccalaureate, graduate and doctoral level. [12] There is also a list of different licensures and certifications, some that can be awarded with associate degrees.

39% of nurses responding to an AMN Healthcare survey in 2015 stated an associate degree was their highest level of education. [13]. These conferrals — including the Registered Nurse (RN) diploma and the Associate Degree in Nursing (ADN) — are often used as a career starter or stepping stone to four-year (and more) programs.

38% of nurses in the AMN Healthcare survey said their highest degree was a bachelor’s. The most common degree for undergraduates is the Bachelor of Science in Nursing (BSN), but other options include accelerated tracks for those with non-nursing degrees.

10% of nurses held a master’s in the AMN survey. Aside from post-master’s DNP programs, many “bridge” programs exist that place students on an accelerated track from this degree to a doctorate.

1% of AMN respondents said they held a doctoral degree. The terminal degree is the endpoint of nursing education and can either be achieved as a practice-focused DNP or research-heavy Doctor of Philosophy in Nursing (Ph.D.).

Similar fields of study

If you are pursuing a Doctor of Nursing Practice (DNP), then it’s likely you have been in nursing for a while and wish to continue progressing toward its highest levels. The DNP is, after all, the terminal degree of nursing practice education. In a University of Tennessee survey of nurses who had completed their DNP, the average length of tenure in the profession upon entering the program was 20 years. [40]

Still, there are other degrees at the doctorate level you may investigate pursuing:

Doctor of Philosophy of Nursing Practice (Ph.D.)

: This terminal degree branches off from the DNP in that nurses use the Ph.D. in research-focused, academic roles, rather than clinical practice.

Doctor of Nursing Science (DNS)

: While also a terminal degree used in research-heavy positions in education, the DNS has been declining in popularity in favor of the Ph.D.

Doctor of Nursing Practice Accreditation
Regional accreditation is the most prestigious type of accreditation that an online or traditional college or university can receive. It is granted only after careful consideration by private, not-for-profit organizations tasked with evaluating educational quality. Regional accreditation is particularly important if you anticipate that you might want to transfer credits from one online degree program to another or use those credits to pursue another degree. Most regionally accredited schools will only accept credits from other regionally accredited institutions of higher learning. You can learn more on this topic at our regional accreditation page..

What to Look For in DNP Accreditation

Doctor of Nursing Practice (DNP) programs anywhere in the country must conform to a specific set of nationally set standards and codes that govern how programs operate, what they teach students, and what outcomes students can expect in recognized competencies.
There are two main agencies in the United States that account for almost all accrediting of domestic DNP programs:

  • The Commission on Collegiate Nursing Education (CCNE)
  • The Accrediting Commission for Education in Nursing (ACEN)

The CCNE is the primary accreditor of DNP programs. While it operates as an autonomous entity, the CCNE is an arm of the American Association of Colleges of Nursing. It has currently accredited 274 DNP programs across the country. The ACEN, by comparison, has accredited 13 DNP programs.

In addition to accreditation by the nursing-specific agencies, there are certain accreditation agencies for specialties:

  • The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) will accredit Nurse Anesthetist tracks within DNP parameters
  • The American College of Nurse-Midwives (ACME) accredits midwifery tracks of DNP programs

Does your desired program comply with state authorizations?

While an advantage of learning online is being able to take classes from a reputable program states away, there are compliance considerations to take into account. You must ensure that the program you want to attend can legally permit you as a student. There are certain states from which programs cannot accept students.

It’s a good idea to consider the National Council for State Authorization Reciprocity Agreements (NC-SARA) when looking for an accredited program. States that participate in SARA agree to uniform standards the agency developed to ensure quality and consistency across interstate education.

Currently, all but six states have entered reciprocity agreements: California, New York, Florida, Massachusetts, Connecticut and New Jersey.

SARA maintains a resource library for students to verify their state’s participation, or lack thereof, that includes:

  • A list of institutions compliant with SARA.
  • A map depicting each state’s status.
Doctor of Nursing Practice Licensure and Certifications
According to Bureau of Health Workforce statistics, 2.9 million Registered Nurses (RN) were active in the workforce in 2012. [21] That number is expected to grow to 3.5 million by 2025. Licensure as an RN is a requirement for DNP programs. For some, an equivalent passing of the National Council Licensure Examination will satisfy requirements. Some states have also begun to license Advanced Practice Registered Nurses (APRN), who must meet requirements for education, clinical hours practiced, and certification in their specialty. [22] Knowledge from most DNP programs can be applied toward APRN positions with the following certifications: [23]

There are more than 220,000 CNPs nationwide, according to the American Association of Nurse Practitioners, 96.2% of whom have a graduate degree. [24] The overwhelming majority’s main focus is primary care (83.4%), but other areas of focus include family, adult, pediatric and women’s health.

According to the Bureau of Labor Statistics, there are 39,410 CRNAs in practice in the U.S. The median annual salary for this position is $157,140. [25]

The American College of Nurse-Midwives cited American Midwifery Certification Board numbers that showed 11,194 CNMs were in practice in 2015. [26] A Journal of Professional Nursing study found CNMs had the highest proportion of doctoral-level nurses of any APRN group. [27]

The CNS is similar to the NP, but can be further specialized in segments like pain type (wound, stress); type of care (rehabilitation, psychiatric); or setting (critical care, emergency room), according to the National Association of Clinical Nurse Specialists. [28] The NACNS found that, in 2014, only 5.9% of clinical nurse specialists held a DNP. [29]

While by definition these roles are certified, NPs and CNSs also can get certified in subspecialties. Since CNMs and CRNAs already are in subspecialties, they are unlikely to get further certification. A 2013 Utah Medical Education Council found popular subcertifications among state NPs were: [30]

  • Family Nurse Practitioner (FNP)
  • Neonatal Nurse Practitioner (NPN)
  • Pediatric Nurse Practitioner (PNP)
  • Acute Care Nurse Practitioner (ACNP)
  • Adult Nurse Practitioner (ANP)

Some nurses holding certifications choose to pursue a DNP to bolster their APRN credentials: A 2013 Michigan Center for Nursing survey found 5% of NPs, 4% of CNMs, and 2% of CRNAs were enrolled in a DNP program at the time. [31] Further reinforcing this trend is a 2010 California Board or Registered Nursing survey, which found 29% of NPs and CNMs who were enrolled in continuing education programs sought a DNP. [32]

The History of the Doctor of Nursing Practice (DNP) Degree

For nearly as long as humans have been around to catch diseases, injure themselves, or otherwise fail in faculties or abilities, there have been those caring for and mending them. But this care often was informal in nature, provided by family or religious groups. In fact, the nursing profession as we know it, despite the longevity of its concepts, has relatively modern roots.

It was not until Florence Nightingale, often hailed as the progenitor of modern nursing and avowed reformer, revolutionized the concept of professional nursing while caring for English casualties in the Crimean War (1853-1856) that professional nursing as we recognize it came into existence. [11] Besides instituting hygienic standards and improving care, which led to immediate decreases in mortality, Nightingale used her familiarity with statistics to evaluate outcomes, which then fueled her pursuit of further innovations.

It is this application of knowledge outside scientific medicine to direct care improvements and advocate for them that connects the birth of modern nursing to the DNP. Modern nursing was further transformed during the American Civil War and after, a time in which schools were founded and nurses became a recognized part of the workforce.

Doctor of Nursing Practice Tuition and Fees
There are a number of factors that can greatly affect how much your education will cost. These include whether you attend a public or private institution; whether you attend as an in-state or out-of-state student; and whether you qualify for financial aid like grants or scholarships. For a more detailed breakdown of tuition, fees, and other financial issues, please visit our tuition and fees page..

Scholarships and grants

A survey of new graduates from baccalaureate and associate nursing programs published by the National Student Nurses’ Association found 57% of students had between $5,000 and $60,000 in student debt, underscoring the cost of a nursing education. [37] As a means to pay for tuition, 68% of all respondents turned to financial aid/loans, while 43% applied for scholarships.
A list of potential scholarships and grants students can use to fund DNP program enrollment includes:

  • American Nurse Practitioners Foundation Scholarship
  • Oncology Nursing Society Foundation scholarships
  • March of Dimes graduate nursing scholarships
  • American Cancer Society doctoral degree scholarships
  • National Health Service Corps scholarships
  • American Association of Nurse Practitioners grants

Loan forgiveness

  • One avenue of financial mitigation is loan forgiveness. While states and schools will operate their own loan forgiveness programs, the national Public Service Loan Forgiveness Program is open to nursing students. An American Association of Colleges of Nursing survey from 2016 found 22% of all graduate nursing students intend to make use of it to help pay off remaining balances from federal loans. [38]
Frequently Asked Questions (FAQs)

Not necessarily. Some DNP programs may admit applicants with a Bachelor of Science in Nursing (BSN) degree.

The main difference between a Ph.D. and a DNP program is the focus of the degrees. The main focus of a Ph.D. in Nursing program is research, while the focus of a DNP program is to prepare nurses for the highest level of practice so they are able care for patients and put evidence-based research into practice. [41]

The main difference between an MSN degree and a DNP degree is the length of the programs. Individuals pursuing their MSN typically earn a four-year nursing degree (BSN) followed by the two-year master’s degree (MSN). Those earning their DNP will earn a four-year nursing degree (BSN) followed by a three- or four-year doctorate degree (DNP) depending on the program and the specialization of their choosing. [42]

While the roles and responsibilities of these two job titles may vary depending on location and workplace, the main difference between these two titles is that NPs focus their efforts on advanced patient care, while DNPs typically apply their education to the application of research into nursing practice. In other words, while DNPs use their academic and/or scientific approach in their practices, NPs generally just focus on practice, without the research aspect. [42]

If you are planning to work through your degree program, it may be best to find a program that can be completed part-time so you can avoid feeling overwhelmed by the demands your career and furthering your education may hold. It’s best to understand the application requirements of each program, as they will be different for every school. Ask yourself the following questions to help guide you toward the DNP program that’s right for you:

  • Accreditation: Is the program accredited?
  • Flexibility: Is the program on campus or online?
  • Program Length: How long will it take to complete the degree?
  • Is the program accredited by the Commission on Collegiate Nursing Education (CCNE)? Many graduate nursing programs are accredited, but it’s always good to double check. If the program is not accredited by the proper accrediting bodies it may lead to credentialing issues after graduation.
  • What are the educational and work experience requirements of the program? Some programs may require a certain number of years or hours of experience before they admit you. Most, if not all, programs require students have at least a BSN degree from an accredited institution. And depending on the track you’re looking at, you may also be required to possess an MSN degree. You may also need to take an entrance exam, like the GRE, before you are considered for the program.
  • Is financial aid available? Although they provide a great means of furthering your career, graduate programs can be expensive. Explore the options that each university offers to students for financial aid. Other means, like scholarships and grants, may also be available.
  • What are the requirements for the clinical experience portion of the DNP program? Many DNP programs require students to partake in clinical experiences through the course of the program and curriculum. Look into the opportunities and support that the program offers students to ensure that it will align with your needs. [43]

The time it takes to earn your Doctor of Nursing Practice degree will depend on the level of experience and education you have when entering the program. Many universities offer a variety of different tracks that are tailored to the student’s specific educational level. A post-master’s DNP program (where students have an MSN degree) can usually take one to two years to complete if the student is pursuing the degree full-time. [42] A post-BSN degree program can take three to four years to complete if the student is pursuing the degree full-time. [44]

Many online DNP programs offer both full-time and part-time options to cater to nurses who may be working while completing their degree. Part-time options allow for more flexibility for those who continue to work, while full-time options allow students to complete the degree at an expedited pace. [42]

Depending on the university where you wish to pursue your DNP degree, the admissions requirements for clinical experience may vary. For some programs, no experience is necessary, while others may require two to five years of experience before applying.

Whether you will need to complete the GRE prior to applying for a program will largely depend on what school you have chosen. There are many programs that do not require a GRE. Check the admissions requirements for your school before applying.

Yes. Many universities now offer part-time online DNP programs so nurses can continue to work and gain the clinical experience they need, while also furthering their education and career opportunities.

In an academic setting, the title “doctor” is used for those who have earned their DNP. However, in order to avoid confusion with medical doctors, in a medical setting or when addressing patients, those with a DNP are not addressed as a doctor. [45] The title of “doctor” is common to many professions, and many nurses who earn their DNP degree still refer to themselves as a nurse practitioner or advanced nursing specialist. DNPs are expected to display their credentials clearly so patients understand they are a nursing provider and not a medical physician. [46]

The modality of an online DNP program will depend on the program you choose. Many programs offer 100% online courses, but campus visits may be required. These campus visits may be one time only, once a term, or even once a month. One thing that is consistent across most online DNP programs is that the clinical experience aspect of the coursework must be completed in person, in a clinical facility or setting. [44]

Online and on-campus degrees typically look identical. Most institutions do not indicate on the degree that it was earned online.

Yes, typically schools follow the same curriculum for their online programs as they do for their campus-based programs.

The admission requirements for different DNP programs will vary, but most if not all programs require students have a nursing degree prior to applying for their DNP. Whether you are in the BSN to DNP or MSN to DNP track will determine which degree you will need. GPA requirements (the average is around a 3.3), a resume, professional recommendations ,and current licensure are also common requirements for admission. Some programs may require previous experience in a clinical setting, with time spans ranging from one to three years.

Standards set by the American Association of Colleges of Nursing (AACN) require that before a DNP degree is completed, individuals must complete a total of 1,000 post-baccalaureate clinical hours. Some programs will forgo previous experience, but those students will have to complete those 1,000 hours during their program. Other programs require previous experience to decrease the number of clinical experience hours that students will have to complete while in the DNP program.

For post-baccalaureate DNP programs, credit hours can range from 70 to 90 credits depending on the specialty chosen. For post-master’s DNP programs, credit hours usually range from 30 to 40, which, like the post-baccalaureate programs, is dependent on the specialty of focus chosen.

While the curriculum may differ from program to program, all DNP programs, both on campus and online, must follow the Essentials of Doctoral Education of Advanced Nursing Practice, as outlined by the American Association of Colleges of Nursing (AACN). DNP curriculum is viewed as having two parts: DNP Essentials and specialty competencies. There are eight essentials that address the foundational information that is necessary for all advanced nursing careers. [44]
Those eight essentials are:

  1. Scientific Underpinnings for Practice
    Highlights the importance of evidence-based practices to improve patient care and clinical outcomes. DNPs should have a comprehensive understanding of nursing theory and how it relates to nursing practice.
  2. Organizational and Systems Leadership for Quality Improvement and Systems Thinking
    Emphasizes the need for key skills like understanding clinical guidelines, creating treatment plans for patients based on proven research, and evaluating the performance of patient and practice outcomes.
  3. Clinical Scholarship and Analytical Methods for Evidence-Based Practice
    Ensures that practitioners are accountable for patient care and safety. DNPs should know how to make informed decisions when it comes to organizational changes in health care delivery to patients as well as how to interact with government counterparts to shape health care policies.
  4. Information Systems/Technology and Patient Care Technology for the Improvement and Transformation in Health Care
    Understanding that technology is the future of health care is key for any DNP. Doctors of nursing practice should be able to participate in developing new health care technologies that ensure the safety and efficiency that is needed when caring for patients.
  5. Health Care Policy for Advocacy in Health Care
    DNPs should be able to identify problems within the health care system with regard to patient care, organizational procedures, and policies. Graduates must also be able to participate in legislation changes and the creation of new policies to improve these practical areas by acting as an advocate for patients and other nurses in the field.
  6. Interprofessional Collaboration for Improving Patient and Population Health Outcomes
    Acting as a leader is critical for the successful role as a DNP. Those in this role should be able to lead organizational change and collaborate with other nursing practitioners to develop and carry out different practice models and standards of care for patients.
  7. Clinical Prevention and Population Health for Improving the Nation’s Health
    Those with a DNP degree should possess the ability to understand “epidemiological, biostatistical, occupational, and environmental information” that affects both individual patients and larger communities. Nursing professionals should also be able to discern how social, economic, and cultural trends shape population health.
  8. Advanced Nursing Practice
    The main goal of a DNP should be to improve patient outcomes from any angle. The practitioner should have the ability to make informed decisions about patient care, understand complex health care systems, and mentor fellow nurses.

No. Although a DNP is a doctoral degree, DNP programs do not require a dissertation. Since this degree focuses on nursing practice as a result of research from others, clinical projects and experiences are necessary, but you will not have to research, write, or defend a dissertation or thesis. [41]

The purpose of a Doctor of Nursing Practice degree is to carry out research from others and put it into practice to see if it works. There’s low emphasis on research, instead working on the evaluation and utilization of specific research to solve practice and patient care. Faculty involved in many DNP programs will have more experience working in health care settings, like hospitals or offices, rather than in a lab or library doing research. It is important that DNP students and graduates understand how research is done, but they should have stronger experience in executing that research into practice. [49]

The AACN requires that each DNP program has three separate courses in advanced health/physical assessment, advanced physiology/pathophysiology, and advanced pharmacology to ensure that all DNP graduates have a “thorough understanding of pathophysiology and pharmacotherapeutics in making diagnostic and practice management decisions.” [44]
Some example course names that may be offered in DNP programs include:

  • Emerging Issues in Health Care
  • Leadership in Health Care
  • Data Driven Health Care
  • Health Care Policy and Advocacy

Asynchronous coursework can be completed on your own time — a big plus for many online graduate students who may be working around a busy work schedule or home life. Synchronous coursework has to be completed within a set timeframe. This is typically done for group projects, seminars, presentations, and other learning initiatives that require multiple attendees.

The elements of asynchronous and synchronous learning in your online program depend on the professor and the course. Once you enroll, reach out to teachers for specifics, but remember that the curriculum may be divided into these two subsets.

Different programs will offer different DNP specializations. Many specializations within DNP programs can fall under two categories: Advanced Practice Nursing focus or an organizational focus. [44]

The Advanced Practice Nursing (APN) focus relates to directly engaging with patients and their families. Nurses in the APN focus act as guides and coaches for the patients to understand their treatment options and the outcomes associated with their health. There are different types of APNs: Certified Nurse Practitioner, Certified Nurse Midwife, Certified Registered Nurse Anesthetist, and Clinical Nurse Specialist. It’s important to note that licensed APNs may either have an MSN or a doctorate (DNP). [50] It’s also critical to understand that all DNP graduates, prepared as APNs, must sit for national specialty APN certification. [44]

The aggregate/systems/organizational focus of DNP programs relates to the policy, administrative, and informatics side of clinical organizations. [44] These individuals focus more on organizational change, leadership, and health care policy, rather than direct patient care.

The number of hours required for your clinical experience practicum will vary depending on the program you choose, as well as your education and experience level upon entering the program. The AACN requires that all DNP graduates clock a total of 1,000 post-baccalaureate hours. For example, if you have your MSN degree and are looking into a MSN to DNP program, that program may require at least 500 hours of post-baccalaureate experience upon admission, so it may require you complete another 500 hours during your clinical experience practicum (for a total of 1,000 hours) to complete the program successfully.

Regardless of how many hours of experience you have coming into the program, the AACN requires clinical experience as a portion of all accredited DNP programs. [51]

The answer to this question is program-specific. Some programs allow you to complete your clinical experience at your current place of work while others require you to gain experience in a new setting. If programs do allow you to complete your clinical experience hours at your current workplace, your experiences have to be tied to new experiences, not ones that you would engage in during your regular job responsibilities. So, you may need to move to a new department or be supervised by someone other than your usual direct supervisor. Regardless of the location, the experiences must be academically supervised. [51]

No, the AACN holds the same requirements for all DNP programs, regardless of the modality of the program. [51]

While previously earned supervised clinical hours may be applied to the clinical practice requirement (with proper notations), students in DNP programs must have exposure to clinical experiences that relate to the role and focus they are preparing for. [51]

There are no requirements for who decides the location in which clinical experience is completed. Some programs may require students to identify locations, while in others, the faculty may be more involved. Regardless of who decides, the location must give students the opportunity to integrate what they’re learning in their courses into practice. Faculty are responsible for assessing the appropriateness of the clinical location. [51]

Students earning their DNP must participate in a three-step process for full DNP certification. First, they must possess an active license as an advanced practice nurse. They then must successfully complete all requirements of their DNP program as set by the AACN. Lastly, they must pass the certification examination created by the Council for the Advancement of Comprehensive Care (CACC). [53]

The typical length for a BSN to DNP program is three years if courses are taken full time. The length can vary to four or more years if courses are completed part-time. [44]

Credit hours for BSN to DNP programs may vary from 70-90.

The typical MSN to DNP program has a minimum of 12 months of full-time study. Taking classes part-time can slow this process down, but allow the student to have a healthy work-life balance. [44]

Credit hours for MSN to DNP programs will vary depending on the program chosen, but the average ranges from 30-40.

Some programs may require applicants retake courses like statistics if it has been more than five years since they’ve completed their MSN degree.

When looking for DNP programs, you should consider the accreditation of the university, its nursing school, and the DNP degree program itself.

  • University Accreditation
    • Most universities are accredited by either a national or a regional institutional accrediting agency. For a list of those accrediting bodies, please visit the U.S. Department of Education website. [54]
  • Doctor of Nursing Practice Accreditation
    • The American Association of Colleges of Nursing (AACN) is the national accrediting body for DNP programs.

The Commission on Collegiate Nursing Education (CCNE) is the accrediting body for the American Association of Colleges of Nursing.

Accreditations are a strong indication of quality, but are also required for students who plan to apply for federal financial aid. Accreditation ensures that your degree is recognized by employers, professional associations, and other accredited institutions of higher education.

SARA (State Authorization Reciprocity Agreement) applies only to distance education programs in the United States that cross state lines. This agreement is made between member states and establishes comparable postsecondary national standards for distance education courses.

Not every state is a SARA member. Through SARA, member states only have to receive authorization in their home state. Without SARA, non-member states would have to receive authorization in their home state and the state of each of their online students. [47]

Every school has a department or team responsible for online education. This department will be able to answer questions regarding compliance for your home state. Additionally, you can locate the school through SARA (if it is a SARA institution) to confirm compliance.

While it’s hard to pinpoint just how much your career may grow after you earn a DNP degree, the U.S. Bureau of Labor Statistics projects that the job outlook for advanced practice nurses will grow by 31% from 2014 to 2024, which is much faster than the average growth rate among all professions. [55] As chronic conditions increase, demand grows for preventive care, and effects of health care legislation change the health care environment, the need for nurses, including those with advanced degrees, will continue to rise.

There are many different avenues in which your career could grow once you’ve earned your DNP.
Advanced Practice Nursing Focus:

  • Nurse Practitioner — Annual salary: $98,190 [56]
  • Nurse Anesthetist — Annual salary: $157,140 [57]
  • Advanced Practice Psychiatric Nurse — Annual salary: $67,490 [58]
  • Clinical Nurse Specialist — Annual salary: $67,490 [59]
  • Acute Care Nurse — Annual salary: $67,490 [60]
  • Nurse Midwife — Annual salary: $92,150 [61]

Organizational Focus:

  • Nursing Instructors, Postsecondary — Annual salary: $67,480 [62]
  • Informatics Nurse Specialists — Annual salary: $85,000 [63]
  • Medical and Health Services Manager — Annual salary: $94,500 [64]
  • Hospitalists — Annual salary: $187,200+ [65] (may require post-doctoral training)
  • Clinical Research Nurse Coordinator — Annual salary: $120,160 [66]

Career opportunities for those with a DNP not only vary by job title, but by location as well. The top five states with the highest employment of nurse practitioners are New York, California, Florida, Texas, and Ohio. The top five states where nurse practitioners had the highest mean salaries are California ($120,930), Alaska ($117,080), Hawaii ($114,220), Massachusetts ($112,860), and Oregon ($111,210). [52]

No, attaining management/senior positions is not guaranteed through the completion of a master’s degree. These positions often require many years of experience and a significant level of career achievement. However, an advanced degree can help you develop the necessary knowledge and skills required for these positions and also prove your dedication to the field.

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