Answer: Nurse practitioners (NPs) are specialized health care providers who administer direct patient care in clinical settings, and have received the graduate-level training to diagnose medical issues, develop patient care plans, perform certain advanced procedures, and prescribe medications. As one type of advanced practice registered nurse (APRN), NPs must earn either a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP) in order to become certified as a nurse practitioner, and gain the title of NP. The DNP is one of two terminal doctoral degrees in the field of nursing. Those who earn a DNP have completed the highest level of training in nursing practice.
The main distinction between the terms NP and DNP is that nurse practitioner is a career or job title, while the Doctor of Nursing Practice is a graduate degree. It is common to see nurse practitioners include MSN or DNP in their professional title, as a way to disclose their level of educational attainment. Along with this, they will often have the acronym for their particular nursing specialty (e.g. FNP if they are certified as a family nurse practitioner, or NNP if they are a neonatal nurse practitioner).
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Traditionally, APRNs (of which NPs are a subsection) have been required to earn at least an MSN in order to qualify for national certification and state licensure in their specialization. However, there has been a push in recent years to raise this entry-level requirement to a doctorate, making the DNP the new standard for certification and licensure. In October 2004, the American Association of Colleges of Nursing (AACN) and its member schools voted to endorse the AACN Position Statement on the Practice Doctorate in Nursing, which recommended raising the prerequisite for APRN certification from a master’s degree to a DNP by the year 2015. While this goal has not yet been attained, more nursing schools are beginning to offer DNP programs, and it is expected that the DNP will eventually become the preferred preparation for advanced nursing practice. As of 2017, either an MSN or DNP will qualify registered nurses (RNs) to sit for the national certification exam in their APRN specialization and become a licensed NP. To learn more about nurse practitioners and the Doctor of Nursing Practice degree, check out the brief summaries below.
What is a Nurse Practitioner (NP)?
Nurse practitioners are licensed clinicians who provide direct care to specific patient populations. Working in a wide range of hospitals, clinics, and other medical facilities, they tend to specialize in either primary or acute care, as well as a particular demographic, such as children and adolescents, women, or the family unit. While RNs primarily provide support services, monitoring patients’ health and administering medications under the supervision of a physician or APRN, NPs have the advanced training to develop patient care plans, supervise other medical staff, and treat certain illnesses and injuries on their own. However, it is important to note that an NP’s practice authority, the ability to practice independently of physician oversite, varies by state.
Along with certified nurse midwives, certified registered nurse anesthetists, and clinical nurse specialists, NPs are a type of APRN, meaning they have earned at least an MSN. APRNs must also pass a national certification exam in their specialty, which, in the case of NPs, is typically administered through either the American Nurses Credentialing Center (ANCC) or the American Academy of Nurse Practitioners Certification Board (AANPCB). Within the category of nurse practitioner, there are eight main specializations based on population focus:
- Adult-Gerontology Acute Care Nurse Practitioner
- Adult-Gerontology Primary Care Nurse Practitioner
- Family Nurse Practitioner
- Neonatal Nurse Practitioner
- Pediatric Acute Care Nurse Practitioner
- Pediatric Primary Care Nurse Practitioner
- Psychiatric-Mental Health Nurse Practitioner
- Women’s Health Nurse Practitioner
The duties of an NP will depend largely on their particular specialty, as well as the state in which they practice. In many ways, they function in the same way physicians do: overseeing all aspects of care for their patients, and directing RNs or other medical assistants to best carry out care plans. An NP’s responsibilities typically include taking patient’s medical histories; assessing their current health status; diagnosing any issues; developing a personalized care strategy; coordinating care with other health professionals; treating acute, chronic, or behavioral conditions through procedures or medication as necessary; and educating patients about preventative health or how to best manage ongoing issues. In some states, NPs even have full practice authority, meaning they are able to prescribe medicine and practice completely independent of a physician.
What is a Doctor of Nursing Practice (DNP)?
The DNP is a practice-based doctorate in nursing, and one of two terminal degrees in the field. While its counterpart, the PhD, is more research-oriented, and intended for students who want to work as nurse scientists or scholars, the DNP is designed for those interested in working in direct patient care or leading teams in a clinical setting. Students can earn their DNP in a general leadership or administration focus, or pursue their doctorate along with an APRN specialty, such as one of the nurse practitioner concentrations listed above.
There are several different paths RNs can take to earn a DNP, depending on their current level of education, and the particular nursing focus they want to specialize in. In general, DNP programs fall under one of three categories:
- BSN to DNP Programs: This path is for RNs who possess a Bachelor of Science in Nursing, and want to pursue their DNP without first completing a separate MSN program. A full-time BSN to DNP program typically takes three to four years to complete, while a part-time program may take anywhere from four to six years.
- MSN to DNP Programs: This type of DNP program is the most common of the three mentioned here, and designed for RNs who already hold a Master of Science in Nursing. A post-master’s DNP program generally takes one to two years of full-time study to complete, or two to three years of part-time study.
- RN to DNP Programs: This degree path is for RNs with an Associate Degree in Nursing (ADN) who want to pursue their DNP without first completing a separate BSN or MSN program. RN to DNP programs are not very common, and some even require students to possess a non-nursing bachelor’s degree in addition to their ADN. Full-time students can expect to complete the program in four years of study, while part-time options may take as many as six years.
The primary difference between an MSN and a DNP is the specific set of doctoral-level coursework required in all DNP programs, as outlined by the AACN in The Essentials of Doctoral Education for Advanced Nursing Practice. According to the AACN, DNP programs must contain courses designed to prepare students in eight key competencies that are fundamental to all advanced nursing practice roles. These include organizational and systems leadership, health care information systems/technology, interprofessional collaboration, health care policy, and evidence-based practice. In addition to the DNP curriculum and any MSN-level coursework they must complete as part of their particular program, all DNP students are required to fulfill 1,000 post-BSN clinical practice hours. A portion of clinical hours earned during an MSN program typically count towards this minimum.
At the DNP level, clinical hours are usually completed in conjunction with a student’s DNP capstone project, an original work that is developed and implemented over several semesters and practicum courses. This project is meant to demonstrate students’ mastery of the theories and practices learned throughout the DNP program, by giving them the chance apply these concepts and skills toward improving a certain aspect of the current health care system.