Choosing a career as a Doctor of Nursing Practice, DNP, can lead you in many directions but it is the end of the road in terms of academics. It is a ‘terminal’ degree in nursing, and one held in high esteem. With that said, you may be wondering if there is a difference between NPs and DNPs.
The answer to that isn’t quite as simple as you would think it should be. Unfortunately, it’s a complex issue in that both are the same in many respects, but a DNP has greater career opportunities open to them. Therefore, it is important to understand just how a DNP differs from an NP with a master’s degree.
Both can function as Nurse Practitioners, but only DNPs are qualified to take on certain administerial roles. With that in mind, let’s start with the broad scope of nurse practitioners, and then we’ll be ready to move on to the various career paths a DNP can pursue.
All Nurse Practitioners Can Follow 4 Distinct Paths
It doesn’t matter whether you hold an MSN (Master of Science in Nursing) or a DNP (Doctor of Nursing Practice) because both can work as nurse practitioners, functioning in much the same way as doctors do. Some states grant autonomy to NPs while other states require nurse practitioners to work under the auspices of an MD.
Those who hold a DNP can work autonomously in all states except Florida, California, and Georgia, where they are granted restricted autonomy. However, there is one new exception to that as well in that in 2020, Governor Newsome signed into state law that after 3 years of working under the supervision of an MD, nurse practitioners can work autonomously.
As you can see, the difference between NPs and DNPs isn’t so much about how they can practice but rather the levels at which they can practice. In addition, there are four specialties both NPs and DNPs can follow. These include:
• Family Practice – all ages from birth to death
• Clinical Nurse Specialists – i.e., PHMNP (Psychiatric Mental Health NP)
• Certified Registered Nurse Anesthetists
• Certified Nurse-Midwives
In all of these roles, nurse practitioners with either a Master of Science in Nursing or a DNP degree can function in the same capacity. However, here is where the roles diverge. In practice, they are almost parallel but beyond that, typically only DNPs are considered for positions in administration or within bodies that set policy in healthcare. That’s a very basic explanation, but the point is, that both can practice at much the same levels, but it takes a DNP to go beyond patient care.
What You Can Do With A DNP – Outcomes
Here is where the excitement begins! You have studied an additional 2 years, or about 5 semesters after your MSN to achieve the level of a Doctor of Nursing Practice. That’s 2.5 years for the MSN and another 2 for the DNP, a total of 4.5 postgraduate years on top of the four years for the BSN. Doesn’t that sound equivalent to the amount of time an MD spends in school?
Let’s digress for just a moment at this point. Within the past few years, there has been a movement within the medical community in which some groups are challenging a nurse’s ‘right’ to function in a capacity like MDs and DOs. Once more, look at the length of time it takes a DNP to achieve that level of degree in healthcare and compare it to a doctor who spends about four years in grad school. Do you see a difference in the length of time?
With that said, that is why the nursing community and other esteemed healthcare groups are fighting back. With such a crisis-level shortage of doctors, there is a need for what NPs have to offer and perhaps it should be said here that they have spent a far greater amount of time with patients as well. Now you will understand just how important these advanced roles within healthcare are in terms of what DNPs are able to do.
Here is a sampling of career paths a DNP can follow. Bear in mind this is not a comprehensive list but a sampling of how the path of a DNP diverges from that of an NP.
1. Clinical Education
It is often thought that university professors in nursing hold a PhD., but that isn’t always the case. DNPs also teach at the university level, but their area of specialization is in the clinical applications of nursing whereas a professor with a Ph.D. has expertise in research. That’s the difference right there! Both teach at the college level, but a DNP works in the clinical area of nursing whereas a Ph.D. in nursing focuses on research.
2. Patient Care At Higher Levels Within Specializations
DNPs are often specialists within the discipline of nurse practitioners. Therefore, a DNP would most likely be a Certified Registered Nurse Anesthetist or a Certified Nurse Midwife. Both of these specializations take a high level of knowledge and experience and are something that requires all 4.5 of those post-graduate years of study.
3. Leadership In Healthcare Reform
Quite often the future of healthcare is in the hands of a DNP. These professionals are about the most well-versed individuals in healthcare because they’ve spent the majority of their career thus far on the front lines. Nurses have about the best vantage point to know what is working and what healthcare lacks in terms of patient care.
This was especially evident during the SARS-CoV-2 pandemic in which nurses stood by as patients succumbed to the virus because necessary equipment, medication, and personnel were lacking. No one foresaw a pandemic of these proportions, but it was the nursing staff who were most vocal about what was needed and should have been a top priority but wasn’t. these are the leaders of the future in terms of healthcare reform and why much will be on their plate in the coming years.
4. Chief Nursing Officer – CNO
This is a highly esteemed position within the field of nursing and one which takes a considerable amount of knowledge and experience in the clinical application of nursing. A CNO, Chief Nursing Officer, is responsible for hiring, training, scheduling, and all other areas of the field within a hospital or healthcare facility.
A CNO must stick to a strict budget as set by the Board of Directors and is thus responsible for ordering all equipment and items necessary within the department. Not only can it be difficult to stick to a strict budget, but the CNO will be answerable to the Board if there are any issues within the department. The CNO will make recommendations for future budgets and will work closely with leadership from all departments, on all levels.
5. CEO Of A Healthcare Facility Or Organization
This is one career path that is often best filled by a candidate with a Doctor of Nursing Practice degree. Some hospitals and healthcare organizations fill the role of CEO with a person who has a strong background in business, but in a hospital, business administration should always be secondary to patient care. Hospitals are in the business of saving lives in contrast to companies seeking to yield a profit. While hospitals need to stay within the confines of strict budgets, patient care must come first.
CEOs are responsible for overseeing literally every aspect of the healthcare organization which includes finances, staff, and strategic planning. The CEO works closely with members of the Board, community members, business leaders, and, of course, stakeholders, in an effort to get perspectives outside the facility. Even so, all decisions are ultimately in the hands of the CEO, so holding a high level of responsibility like this is quite an achievement from working just a few short years ago as an RN.
Among the skills needed would be strong leadership and interpersonal skills. While communication is vital, so too is an ability to foresee future needs for strategic planning. Much of this is covered within the scope of a DNP graduate program, but natural abilities are also at the heart of what makes a good leader.
6. Nursing Director
Sometimes referred to as the Director of Clinical Services, a Nursing Director is responsible for overseeing the entire nursing staff within a hospital or healthcare facility. The Nursing Director will also oversee other clinical and staff members. Among the responsibilities of a Director of Nursing Services (DONS) as a Nursing Director is also called would be:
• Continuing Ed
• Developing budgets
• Legal compliance
• Clinical services
The Nursing Director may also be responsible for one department as well. Among the skills a Director of Nursing Services should have would be such things as the ability to delegate, great communication skills, and a department or systems-level mindset.
7. Chief Registered Nurse Anesthetist
Quite often the Chief Registered Nurse Anesthetist works alongside an anesthesiologist and other members of a team. It is the CRNA’s job to do the health assessments and talk to the patient about what they can expect when the anesthesia is administered. They will often also explain what happens during a surgery or procedure as well, in terms of anesthesia and how they continually monitor your vitals so more can be administered if needed.
Among the skills needed for the job would be strong leadership skills because this is the person on the team that facilitates communication with other nurses working with the same patient. A CRNA is also responsible for coaching nurses in their charge on ethical concerns and also best practices.
Here again, a CRNA should have excellent communication skills and should be able to display sincere compassion. As one of the last faces a patient sees before being placed under, they are often fearful, and this is when they need reassurance almost more than any other time. Also, a CRNA should be able to handle a great deal of pressure.
8. Health Policy Analyst
Working as a Health Policy Analyst, a DNP typically heads a team that is responsible for addressing matters of setting policies going forward or amending those already established. Working together with a group of political activists within a community or other nonprofit organizations, data is gathered and analyzed so that the team addresses needs within various groups.
Demographics are a huge focus so that all groups, especially the marginalized, are getting healthcare treatment, regardless of their ability to pay.
A Health Policy Analyst also collects data to analyze current policies so that they can be replaced or modified as needed. There is a strong emphasis on seeking to ensure all groups are served equally well and if any current policies don’t address the needs of any group, or groups, they are simply rewritten to serve every group equally well. This has been an ongoing issue within medicine for many years and why the person named as the Chief Health Policy Analyst should be able to deal with high-stress situations.
Tensions can run high when certain groups are not being served equally. Equality and inclusion are vital within every aspect of healthcare, and this often places the analyst in the middle of warring factions. The bottom line is that all groups should be served equally well. There is no better way to improve patient outcomes across the board, and this is why this career is among the most exciting within the scope of positions held by a DNP.
Candidates for the job should be highly empathetic but with a strong background in administration. Exemplary research skills are imperative as are communication skills. Once you get involved in setting healthcare policy, you will always be on the cutting edge of community involvement. If you haven’t already, and this is the career path you intend to pursue, it may be time to brush up on your public speaking skills. You will definitely be using them often!
Taking the above career paths into account, which one do you think you would like to pursue once you have completed your DNP degree? They all sound exciting, but which path is right for you?