Doctoral Education In Nursing Discipline Development of the Doctoral Discipline of Nursing
Doctoral education in nursing has a rich and evolving history that reflects the growing recognition of nursing as a distinct and vital discipline within the healthcare system. The origins of doctoral education for nurses can be traced back to the early 20th century, marking a significant shift from basic clinical training to advanced scholarly and research-focused education. This section explores the historical development, the evolution of doctoral programs, and the contemporary landscape of doctoral education in nursing.
Early Development
The journey toward doctoral education for nurses began in the 1920s when the first doctoral program was established at Teachers College, Columbia University. This pioneering program offered an educational doctorate (EdD), which was designed for nurses seeking advanced knowledge in education and administration. At that time, the nursing profession had not yet developed its own doctoral programs, and nurses had to pursue advanced degrees through programs that were more accessible to women and offered part-time study options (Bullough & Bullough, 1984).
The EdD programs were instrumental in preparing nurses for leadership roles in teaching and administration. However, these programs were not tailored specifically to the nursing discipline and did not provide the rigorous research and theoretical training that would later become a hallmark of doctoral education in nursing. It was not until the latter half of the 20th century that doctoral programs specifically designed for nurses began to emerge, driven by the need for a robust research and theoretical foundation within the nursing field.
Evolution of Doctoral Programs
The latter part of the 20th century witnessed significant advancements in doctoral education for nurses. The development of doctoral programs in nursing was driven by the recognition that the nursing profession needed its own research-based and theoretical framework. As a result, doctoral programs in nursing expanded rapidly, providing nurses with opportunities to engage in research and contribute to the development of nursing theory.
The introduction of the Doctor of Philosophy (PhD) in nursing marked a critical milestone in the evolution of doctoral education. The PhD in nursing is often regarded as the “gold standard” for doctoral preparation, emphasizing research competence and the development of nursing knowledge and theory (Kirkman, Thompson, Watson, & Stewart, 2007). This program aimed to produce nurse researchers capable of advancing the scientific foundation of nursing practice.
In the 1960s, Boston University introduced the Doctor of Nursing Science (DNSc), also known as the clinical doctorate. This program was designed to prepare nurses for doctoral-level work in clinical practice rather than focusing solely on research and theory (Loomis, Willard, & Cohen, 2007). The DNSc aimed to bridge the gap between clinical practice and academic research, offering a pathway for nurses to engage in advanced clinical roles while contributing to the development of nursing science.
The PhD and DNSc
Over time, the DNSc and PhD programs have evolved, and studies have shown that the DNSc is often considered equivalent to the PhD in many respects (Loomis et al., 2007). Both degrees provide advanced education and training for nurses, but they differ in their emphasis. The PhD focuses primarily on research and theory, while the DNSc integrates clinical practice with research and theoretical development.
In the 1970s, Margaret Newman of New York University advocated for the development of the Nursing Doctorate (ND) program. The ND program was intended to prepare nurses for basic licensure as registered nurses while also providing advanced education in clinical practice. Newman envisioned the ND as a parallel to medical schools’ preparation of physicians, aiming to equip nurses with advanced clinical knowledge and skills (Newman, 1979). The first ND program was established at Case Western Reserve University in Cleveland, Ohio, in 1979, further diversifying the pathways for doctoral education in nursing.
The Doctor of Nursing Practice (DNP)
The introduction of the Doctor of Nursing Practice (DNP) represents a significant development in doctoral education for nurses. Proposed by the American Association of Colleges of Nursing (AACN) in 2007, the DNP was envisioned as the terminal degree for advanced practice nursing by 2015 (AACN, 2007a). The DNP focuses on advanced preparation in clinical practice, aiming to provide nurses with a comprehensive understanding of healthcare delivery, evidence-based practice, leadership, and healthcare policy.
The DNP is comparable to practice doctorates in other fields, such as pharmacy and physical therapy, and is designed to prepare nurses for roles that require advanced clinical expertise and leadership skills (AACN, 2006c). The DNP program includes coursework in scientific foundations of nursing practice, healthcare technologies, clinical prevention, and interprofessional collaboration. It aims to equip nurses with the knowledge and skills needed to address complex healthcare challenges and improve patient outcomes.
Controversies and Challenges
The development of the DNP has been met with both support and controversy. Proponents argue that the DNP provides improved formal preparation for advanced practice roles that go beyond what is covered in a master’s degree in nursing (Hathaway, Jacob, Stegbauer, Thompson, & Graff, 2006). They believe that the DNP enhances clinical expertise, leadership capabilities, and the ability to shape healthcare policy.
However, opponents of the DNP raise several concerns. Some argue that the DNP adds to the complexity of the nursing profession and may confuse the public about the roles and functions of different nursing degrees (Chase & Pruitt, 2006). Additionally, there are concerns about the potential shortage of advanced practice nurses who may not be able to afford the additional coursework required for the DNP. Critics also argue that the DNP may exclude schools of nursing that lack the resources to develop and offer DNP programs.
Evolving Doctoral Programs in Nursing Education
The Role of Doctoral Programs in Nursing
Doctoral programs play a crucial role in advancing the nursing profession by preparing nurse scholars, researchers, and leaders. The evolution of doctoral education reflects the growing complexity of healthcare and the increasing need for advanced expertise in nursing practice. These programs aim to address various aspects of nursing practice, including research, clinical expertise, leadership, and policy development.
The development of doctoral programs in nursing has been driven by several factors, including the need for evidence-based practice, the demand for advanced clinical roles, and the recognition of nursing as a distinct academic discipline. Doctoral programs provide nurses with the opportunity to engage in advanced research, contribute to the development of nursing theory, and influence healthcare policy and practice.
The Impact of Doctoral Programs on Nursing Practice
Doctoral education has a significant impact on nursing practice by advancing knowledge, improving patient outcomes, and shaping healthcare policy. Nurse researchers with doctoral degrees contribute to the development of evidence-based practice by conducting studies that inform clinical guidelines and interventions. They also play a key role in developing and testing new theories that advance the understanding of nursing practice.
Doctoral-prepared nurses are also instrumental in shaping healthcare policy and improving healthcare delivery. They engage in policy analysis, advocate for changes in healthcare systems, and work to address disparities in healthcare access and outcomes. By leveraging their advanced education and expertise, doctoral-prepared nurses contribute to the development of innovative solutions to complex healthcare challenges.
The Future of Doctoral Education in Nursing
As the healthcare landscape continues to evolve, the role of doctoral education in nursing will become increasingly important. The demand for advanced practice nurses, nurse educators, and researchers is expected to grow, necessitating the development of robust doctoral programs that prepare nurses for these roles. The future of doctoral education in nursing will likely involve continued refinement of existing programs, the introduction of new educational pathways, and ongoing dialogue about the best approaches to doctoral preparation.
Understanding Doctoral Preparation in Nursing Education
The Doctoral Journey
Doctoral preparation in nursing involves a rigorous and comprehensive educational journey that includes coursework, research, and practical experience. Doctoral students engage in advanced study of nursing theory, research methodologies, and clinical practice. They also conduct original research that contributes to the advancement of nursing knowledge and practice.
The doctoral journey typically begins with the completion of core coursework in areas such as research methods, theoretical foundations, and healthcare policy. Students then progress to the development and execution of a research project or dissertation that addresses a significant issue within the field of nursing. This research component is a critical aspect of doctoral education, as it allows students to contribute new knowledge to the field and demonstrate their expertise.
The Importance of Research and Theory
Research and theory are central to doctoral education in nursing. Doctoral programs emphasize the importance of generating new knowledge through research and developing theoretical frameworks that inform nursing practice. Research conducted by doctoral students and faculty contributes to the evidence base for nursing practice and helps to address pressing healthcare challenges.
Theoretical development is also a key component of doctoral education. Nursing theories provide a framework for understanding and improving patient care, guiding practice, and informing research. Doctoral students are expected to engage with existing theories, contribute to their development, and apply them to clinical and research settings.
The DNP as a Practice Doctorate
The Doctor of Nursing Practice (DNP) represents a significant shift in doctoral education, focusing on advanced clinical practice rather than research and theory. The DNP program is designed to prepare nurses for leadership roles in clinical settings, emphasizing the application of evidence-based practice, healthcare technologies, and policy development.
The DNP program includes coursework in areas such as advanced clinical practice, healthcare systems management, and interprofessional collaboration. Students also complete a capstone project that demonstrates their ability to apply advanced knowledge to real-world clinical challenges. The DNP is intended to enhance the skills and expertise of nurses working in advanced practice roles, such as nurse practitioners, clinical nurse specialists, and nurse anesthetists.
Requirement of Nurses with DNP
Enhancing Clinical Expertise
Nurses who complete the DNP degree often report improvements in their clinical expertise and the ability to shape healthcare policy. The advanced preparation provided by the DNP program equips nurses with the skills needed to address complex patient needs, implement evidence-based interventions, and lead quality improvement initiatives.
The DNP also provides nurses with a deeper understanding of healthcare systems, allowing them to influence policy and practice at the organizational and systemic levels. DNP-prepared nurses are well-positioned to contribute to efforts aimed at improving patient outcomes, reducing healthcare costs, and enhancing the overall quality of care.
Addressing Concerns and Challenges
Despite the benefits of the DNP, there are concerns about its impact on the nursing profession. Some critics argue that the DNP may create confusion about the roles and functions of different nursing degrees. There are also concerns about the potential for shortages of advanced practice nurses who may be unable to afford the additional coursework required for the DNP (Chase & Pruitt, 2006).
Another concern is the potential impact of the DNP on the preparation of nurse educators. The DNP program does not typically include formal preparation for teaching, which may affect the ability of DNP-prepared nurses to assume roles as nurse educators. Addressing these concerns will require careful consideration of the resources needed to support DNP programs and the development of strategies to ensure that DNP-prepared nurses can effectively contribute to the nursing profession.
DNP Programs in Nursing
Current Status and Trends
As of recent reports, there are 46 DNP programs in the United States, with an additional 140 nursing schools considering the introduction of DNP programs (AACN, 2007c). The growth of DNP programs reflects the increasing demand for advanced practice nurses and the recognition of the DNP as a valuable credential for clinical leadership.
DNP programs vary in their focus and structure, but they generally include coursework in advanced clinical practice, healthcare systems management, and leadership. Students also complete a capstone project that demonstrates their ability to apply advanced knowledge to clinical practice. The expansion of DNP programs is expected to continue as the demand for advanced practice nurses grows.
Evaluating Outcomes and Impact
As DNP-prepared nurses begin to enter the workforce, it will be important to evaluate the impact of the DNP on healthcare outcomes and the nursing profession. Outcome studies that assess the contributions of DNP-prepared nurses to patient care, healthcare systems, and policy development will be essential for documenting the value of the DNP.
Research on the effectiveness of DNP programs and the impact of DNP-prepared nurses on healthcare delivery will provide valuable insights into the benefits and challenges of the DNP. This research will help to inform future developments in doctoral education and ensure that DNP programs continue to meet the needs of the nursing profession and the healthcare system.
DNP and Nurse Educator
Role of DNP-Prepared Nurses as Educators
In response to the shortage of nurse faculty, many DNP-prepared nurses are likely to find roles as nurse educators in schools of nursing. However, there are concerns about whether DNP-prepared nurses will be adequately prepared for teaching roles, given that the DNP program does not typically include formal education training.
DNP-prepared nurses who assume educator roles may need additional support and resources to develop their teaching skills and adapt to the academic environment. Schools of nursing may need to provide professional development opportunities and mentorship for DNP-prepared nurses transitioning into teaching roles.
Addressing Resource Needs
The development of DNP programs and the increasing number of DNP-prepared nurses entering the workforce highlight the need for resources to support the growth of these programs. Schools of nursing will need to invest in faculty development, curriculum design, and program administration to ensure the success of DNP programs and the preparation of advanced practice nurses.
In addition to supporting the development of DNP programs, it is important to address the needs of diverse educational missions within schools of nursing. Ensuring that DNP programs are accessible and inclusive will be critical for producing the number of advanced practice nurses needed to address the healthcare needs of the United States.
Conclusion
The development of doctoral education in nursing has been a dynamic and transformative process, reflecting the growing complexity of healthcare and the evolving needs of the nursing profession. From the early days of educational doctorates to the introduction of the DNP, doctoral programs have played a crucial role in advancing nursing knowledge, improving patient care, and shaping healthcare policy.
As the field of nursing continues to evolve, doctoral education will remain a vital component of the profession’s advancement. The ongoing development of doctoral programs, the evaluation of their impact, and the support for DNP-prepared nurses in various roles will be essential for ensuring that the nursing profession continues to thrive and meet the needs of patients and healthcare systems. By addressing the challenges and leveraging the opportunities presented by doctoral education, the nursing profession can continue to make meaningful contributions to healthcare and improve the lives of individuals and communities.