1. Fitzpatrick, Joyce J. PhD, MBA, RN, FAAN

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Yes, the DNP is the appropriate degree not only for nurses in advanced practice, but also for clinical teaching positions at the basic and advanced practice levels, clinical leadership positions such as nursing administration in healthcare systems, and information technology management and nurse entrepreneurs. The academic preparation and skill sets included in DNP programs, delineated in the American Association of Colleges of Nursing (AACN) Essentials document (AACN, 2006), provide core content necessary for the practice environment in which most nurse leaders work.


Although nursing needs clinical leaders prepared at the DNP level, this does not negate the need for some nurses to be prepared with research degrees (PhD or Doctor of Nursing Science). As an applied health discipline, nursing needs far fewer research prepared nurses and far more nurses prepared at the highest level of clinical practice and leadership: these nurses would receive the DNP. My own belief is that the balance in nursing should be similar to what is present in the medical discipline; only a small percentage of physicians are prepared at the MD/PhD level and therefore have a primary emphasis on basic research. All physicians, however, are prepared at the professional doctorate level, the MD. In nursing, we should also reserve the PhD in nursing as the preparation for basic science research.


There are other reasons why the DNP is the appropriate degree for clinical leadership in practice, education, and applied research. The current emphasis on master's level education for nurse leaders in clinical settings does not provide either the breadth or depth of knowledge and experiences in leadership, health systems design and evaluation, evidence-based practice, health policy, or applied research. DNP programs, on the other hand, are designed to broaden the knowledge base of the advanced practice clinician and provide the skills to participate as an equal member of the healthcare team. Some may argue that nurses are as well prepared as physicians and other healthcare professionals for healthcare team leadership, but these arguments fall short when educational preparation is compared. As leaders within the largest workforce in healthcare, nurses prepared at the DNP level will be in an ideal position to initiate efforts to improve the health of the nation at local clinical levels and within the health policy arenas. There has been support within the nursing leadership literature for the professional doctorate as entry level for practice for many years (Christman, 1980; Fitzpatrick, 1989). The current movement for the DNP for advanced nursing avoids the entry-level debate, but some of the same arguments for parity with other healthcare professionals and better educational preparation for leadership and scholarship remain.


One of the most critical reasons for advancing the DNP degree in nursing is to provide nurse leaders with knowledge and skills to question current practices and change future practice (Magyary, Whitney, & Brown, 2006). Questions related to healthcare delivery and costs, clinical interventions for improved patient care, and more effective use of staff are ideal issues for inquiry of those prepared at the DNP level.


I have argued elsewhere that it is unethical for schools of nursing to prepare nurses at the PhD level when those nurses have no intent to focus their careers in research (Fitzpatrick, 2003). The resources required to prepare PhD graduates are tremendous, and many graduates never pursue research beyond the dissertation. The DNP focus on applied research addresses the need within the discipline for integration of scholarship and practice and ultimately bridges the gap between academic and practice-based nursing.




AACN. (2006). The essentials of doctoral education for advanced nursing practice. Retrieved March 24, 2007, from[Context Link]


Christman, L. (1980). Leadership in practice. Image: Journal of Nursing Scholarship, 12, 31-33. [Context Link]


Fitzpatrick, J. J. (1989). The professional doctorate as an entry level into clinical practice. In Perspectives in nursing, 1987-1989, (pp. 53-56). New York: National League for Nursing. [Context Link]


Fitzpatrick, J. J. (2003). The case for the clinical doctorate in nursing. Reflections on Nursing Leadership, 29(1), 8-9, 37. [Context Link]


Magyary, D., Whitney, J. D., & Brown, M. A. (2006). Advancing practice inquiry: Research foundations of the practice doctorate in nursing. Nursing Outlook, 54, 139-151. [Context Link]