A Doctor of Nursing Practice, or DNP nurse, is a nurse who has reached the pinnacle of the profession. There are several different levels of nursing qualification, the key ones are:
- Licensed Vocational Nurse/Licensed Practical Nurse
- Registered Nurse
- Advanced Practice Nurse
- Doctor of Nursing Practice
The LVN/LPN qualification (NCLEX-PN) is the shortest route into nursing, and a nurse who has earned that license has a relatively limited scope of practice, being responsible for day-to-day tasks such as checking vitals, inserting catheters, or giving injections.
Registered nurses are educated to either associate’s degree or bachelor’s degree level and must pass the more in-depth NCLEX-RN examination. These nurses can perform a wider variety of nursing tasks than an LPN or an LVN, and they may be found in clinics, emergency rooms, intensive care units, care homes, and other areas. Their broad education equips them to handle a variety of tasks in health care.
Advanced Practice Nurses are educated to the master’s degree level. These nurses have more freedom and autonomy in their clinical practice and have taken the time to specialize in a specific area of health care. You may sometimes see these nurses referred to as Advanced Practice Registered Nurses (APRNs). An APRN might focus on a specific field such as mental health, pediatrics, oncology, or emergency nursing.
The Doctor of Nursing Practice, or Nurse Practitioner, is trained to an even higher level. Some nurse practitioners who have been qualified for a long time were able to take their certification after earning a master’s degree, but today it’s far more common for a Nurse Practitioner to be a DNP graduate.
The DNP program is a doctoral-level program that requires extensive clinical experience, classroom education, and the completion of a DNP project or thesis. There are many DNP specializations. For example, a nurse anesthetist or midwife might hold a DNP.
Nurses who are qualified to this level have a lot of respect and autonomy. Within their scope of practice, they are permitted to work freely without requiring the direct supervision of a doctor or other medical professional.
The duties and responsibilities of a Doctor of Nursing Practice (DNP)
A DNP-prepared nurse has the opportunity to work in many different areas of nursing, depending on what they choose to specialize in during their DNP program. These highly-trained nurses have the chance to work in both clinical and non-clinical roles. This means nurses can focus on caring for a specific type of patient or move into broader managerial or even public health-related positions.
Where can a DNP work?
Nurses who wish to stay in healthcare after earning their DNP will often choose to serve as APRNs or clinical nurse specialists, providing direct care to patients in that way. Others might choose to become a nurse anesthetist or focus on another specialist area of health care.
A DNP prepared nurse could work in:
- Private practices
- Hospitals
- Ambulatory clinics
- Long-term care facilities
- Community clinics
- Educational settings
- Consulting for health-adjacent corporations
Nurses can specialize in a variety of areas including psychiatric-mental health, neonatal care, or family health.
What is a typical workday like for a DNP?
Because the job roles of DNP-level nurses and nurse practitioners can vary so much, there’s no such thing as a typical workday. A nurse who trained to become a clinical nurse specialist may still be very much on the frontlines and deeply involved with patient care. Other nurses could take a managerial role either leading a ward or working as a nurse executive at a higher level in a hospital, or move into academia where working routines are different again.
What are the most common roles a DNP can occupy within an organization?
There are four main roles under the category of Advanced Practice Registered Nurse:
- Certified Registered Nurse Anesthetist (CRNA)
- Certified Nurse-midwife (CNM)
- Clinical Nurse Specialist (CNS)
- Nurse Practitioner (NP)
There are some additional areas for specialization. For example, a clinical nurse specialist or a nurse practitioner may be able to focus on an area such as pediatric care or adult-gerontology. This gives nurses the opportunity to focus on the parts of patient care that interest them the most.
Not all nurses who earn a DNP stay in patient-facing roles, however. Many choose to move into consulting, management, leadership or other areas where they can use the skills and knowledge they have gained over the years to shape the future of health care.
This is particularly true of advanced practice nurses who earned a master’s degree and spent some time working in their specialization before they enrolled in a DNP program. These nurses may have already been working in the field for many years, and be looking to step off the wards and into an area with a more steady workload and predictable hours.
Educational requirements for becoming a DNP
The traditional route into nursing is to earn a Bachelor’s Degree and then take the NCLEX-RN. Some nurses take the Associate’s Degree route, earning the NCLEX-RN and the right to call them registered nurses in a shorter time than it takes to complete the bachelor’s degree, however, the BSN route is strongly encouraged by many hospitals.
New York now requires nurses who went the ADN route to earn their BSN within ten years of licensure, because of the higher quality of patient care BSN-prepared nurses have been found to provide and the better patient outcomes that result from this. Once a nurse has a BSN, the next step is a master’s degree (MSN). There are some institutions that offer ADN to MSN programs for those who have extensive clinical experience. The DNP is the next step after a master’s degree.
What are the admission requirements for a typical DNP program?
Entry into a DNP program is far more competitive than for some of the lower-level nursing qualifications. DNP graduates are expected to be highly specialized in their fields and to have an in-depth understanding of the subject they have focused on. The programs are academically rigorous and require more work and independent study than undergraduate programs.
Each university sets its own criteria for postgraduate admissions, but example entry requirements might be:
- A BSN-level qualification plus valid RN licensure
- A Master’s Degree or better in a field related to the desired DNP specialization
- In some cases, Advanced Practice Licensure
- Extensive clinical experience
- Letters of recommendation
- Transcripts showing a 3.5GPA or better for graduate work
Applicants will be expected to provide evidence of their experience, write an essay or Statement of Purpose and go through an interview process before admission.
Those who came into a nursing background from a less-traditional background may still be able to gain admission onto a DNP program but they will still need to have a Master’s Degree first of all. If a would-be DNP student’s GPA was not sufficient, they may need to retake some graduate-level classes to improve their grades and provide an explanation for their prior difficulties in their Statement of Purpose.
Some institutions allow BSN holders to enroll in their MSN program with the goal of seamlessly moving from the MSN to DNP upon competition of the master’s degree. A BSN to DNP program will usually cover between 65 and 95 academic credits and also include 1,000 hours of clinical experience.
What are the typical requirements for graduating with a DNP?
It’s possible to study a DNP full-time, but a lot of nurses study part-time, allowing them to gain clinical experience while they study, and also earn some money to support themselves. This is important because tuition fees for DNP programs can be costly.
A BSN to DNP program would take three to four years if studied full-time, with a part-time doctoral program taking between four and seven hours depending on the specialization and how much time the learner is able to commit to it. Upon enrolling in the program, the nurse must hold a valid RN license with no restrictions and must maintain that license throughout their studies.
Someone who already has a Master of Science in Nursing should be able to complete a DNP program more quickly and graduate within three years. The total study requirements for an MSN to BSN program are usually around 40 credits and a total of 1,000 clinical practice hours completed post-BSN. If a learner has already completed some clinical practice time in the process of earning a Master’s degree, they’ll usually be able to count those hours towards their DNP requirement.
The exact requirements of a DNP depend on the specialization the nurse is studying for. All nurses who are aiming to become APRNs are expected to understand the concepts covered in the American Association of Colleges of Nursing’s eight core competencies for advanced nursing practice.
Those core competencies are:
- Scientific underpinnings for practice
- Organizational and systems leadership
- Clinical scholarship and analytical methods for evidence-based practice
- Information systems/technology and patient care technology for improving patient care
- Health care policies and advocacy
- Interprofessional collaboration
- Clinical prevention and population health for the improvement of public health
- Advanced nursing practice
Nurses who wish to earn both a DNP and an APRN specialty may find themselves having to complete a mixture of doctoral-level and master’s level courses in order to earn the APRN certification they’re aiming for. This may make their DNP program take slightly longer than average to complete, especially if this is their first APRN specialization.
However, if the nurse has already completed one APRN specialization they won’t need to re-take the core master’s level courses, which reduces the length of the program compared to a first-time APRN student. A would-be DNP student can discuss their study plan during the graduate admission process to find out how long it will take for them to complete their studies.
A DNP student will be expected to complete a final project to show that they have mastered the skills required for their area of nursing practice. That project could include:
- Consulting
- A pilot study
- Quality improvement
- Research utilization
- A practice portfolio
- Program evaluations
The DNP is a postgraduate qualification, not a certification, meaning it will not lapse or expire. Any advanced practice nursing certifications the nurse takes alongside their DNP, however, may have continuing education or ongoing practice requirements attached to them. Most certifications in nursing have a validity period of five years.
Career options for a DNP
DNPs who are looking to stay actively involved in the patient-facing side of health care have several options, including:
- Nurse practitioner
- Certified nurse midwife
- Certified registered nurse anesthetist
- Clinical nurse specialist
In addition to these patient-facing specializations, a DNP has the choice of moving into a more organizational or systems role, for example focusing on:
- Informatics
- Health policy
- Management
- Organizational or professional leadership
This means DNP-prepared nurses can work in academia, corporate settings, private health care, or in managerial or educator roles in health care settings. They benefit from having a huge level of freedom compared to nurses who are only qualified to the BSN level.
Nurses who have extensive experience in wards, emergency rooms, or other clinical settings will find it easier to get a job in a leadership role at a hospital since they can combine the classroom learning of their postgraduate education with an understanding of what happens in the real world. Nurse leaders and educators working in hospitals are expected to be in touch with what the nurses they’re supporting are doing, be good communicators and have a robust understanding of how nursing care works at a larger scale.
What can a DNP do that an NP cannot?
It’s important to understand that Doctor of Nursing Practice (DNP) refers to a qualification, whereas Nurse Practitioner (NP) refers to a specific job title within the field of nursing. The acronyms can be confusing, and since there’s significant overlap between them it’s important to use them properly.
In most cases, a Nurse Practitioner (NP) is someone who has earned their RN license and then completed a Master’s of Science in Nursing. This means most people who go on to earn a DNP are already NPs.
Not all DNPs are NPs, however, since it is possible to study DNP programs at some institutions without holding an MSN.
Nurse Practitioners are respected nurses who deliver primary and specialized health care to their patients. They can diagnose patients and offer health advice. In some states, NPs are also allowed to prescribe medication. They can do this, within their scope of practice, without needing the approval of a physician. There are several specializations for NPs, and each specialization has extensive licensing requirements.
A Doctor of Nursing Practice is a doctoral-level qualification that is aimed at nurses who wish to continue practicing. Nurses who wish to move into academia have the option of studying a different doctoral level program, the Doctor of Nursing Philosophy, or PhD in Nursing.
The main difference between DNPs and NPs is the extra level of education that a DNP graduate has. This gives DNPs a significant advantage when it comes to applying for leadership positions and jobs where they’ll be making decisions at a policy level.
What can you do with a DNP that is outside the field of nursing?
Nurses who wish to move out of a hospital setting and work in other fields may find a DNP useful if they can combine it with some Master’s level education in other areas such as public health, business, or informatics. This gives nurses the chance to work in education, consult or move into technical support, data analysis, or even programming for health care systems, or work with local authorities and governments to improve health outcomes at a population level.
Those who want to pursue a career in research usually choose the Ph.D. rather than the DNP, because the Ph.D. has a more academic focus. However, any doctoral-level qualification will put you in a strong position when it comes to applying for positions in academia and will lay the groundwork for any future qualifications you wish to pursue.
DNP salary and benefits
According to the Bureau of Labor Statistics, the average salary of a Registered Nurse is $73,300. This statistic includes both ADN and BSN-prepared nurses, and in most cases, it’s likely ADN-prepared nurses will earn less than their BSN-holding counterparts due to lower seniority, less experienced, and weaker qualifications.
As nurses invest in their education, they’ll see an increase in their pay. Nurses with a postgraduate qualification (whether that’s an MSN or a DNP) can expect to earn around $115,800 per year.
The exact salary enjoyed by a DNP graduate depends on the job they pursue post-graduation. Since DNP is not a job title, salaries can vary dramatically. A nurse who opts to stay in a general family nurse practitioner role after earning a DNP may earn far less than a Certified Registered Nurse Anesthetist, for example.
What are some of the highest-paying roles a DNP can hold?
A nurse who pursues a DNP with the hope of increasing their salary in the long term would do well to choose an advanced practice specialization. Some of the highest-paying job titles available to DNP graduates include:
- Certified Registered Nurse Anesthetist
- Nurse Practitioner
- Certified Nurse Midwife
Certified Registered Nurse Anesthetist (CRNA)
The median annual salary for a Certified Registered Nurse Anesthetist (CRNA) is $174,790. This is more than double the average salary of a Registered Nurse. CRNAs specialize in administering anesthetics, preparing patients for anesthesia, monitoring them during procedures, and are in charge of post-procedure recovery too.
These nurses have a high level of autonomy and are able to administer anesthetics without requiring supervision from a doctor. They can work in clinics, emergency rooms, labor wards, or other settings where anesthesia is used on a regular basis. CRNAs are required to hold a valid certification from the National Board of Certification and Recertification for Nurse Anesthetists and go through regular continuing education.
Nurse practitioner
Nurse Practitioners can work in a variety of specializations and settings, such as psychiatric-mental health, pediatrics, or family nursing. The median salary for a nurse practitioner is $109,820. Nurse practitioners work in clinics, hospitals, and outreach centers. They may also be found in care homes or other long-term care facilities.
Nurse Practitioners can diagnose illnesses, provide counseling about general health issues and refer patients to other health professionals. Interdisciplinary collaboration is an important part of the work that a Nurse Practitioner does. In some states, nurse practitioners are able to prescribe medication without approval from a doctor.
Psychiatric-mental health Nurse Practitioners may take a psychopharmacological approach to treatment. They can offer medication and individual, family, or group therapy as a part of their practice.
Certified nurse midwife
Midwives are individuals who have trained to care for women and newborn babies. A Certified Nurse Midwife is someone who is a registered nurse and trained as a midwife. To become a Certified Nurse Midwife, a nurse must become certified via the Accreditation Commission for Midwifery Education. Certifications are valid for five years, and nurses are required to undergo continuing education in order to retain their qualifications.
The Bureau of Labor Statistics lists the average salary of a Certified Nurse Midwife as $105,030, putting it far ahead of that of a Registered Nurse. Because of the nature of the work they do, these advanced practitioners may be required to work nights, weekends, and public holidays, or be on-call for such occasions.
Other benefits of earning a DNP
One of the biggest benefits of earning a DNP degree, other than the potential salary increase that it offers, is the respect and autonomy that those holding specializations and Nurse Practitioner-level titles enjoy. Whether you choose to become a Family Nurse Practitioner, Psychiatric Nurse Practitioner, or a Nurse Anesthetist, within the scope of those fields you’ll have a lot of freedom to do your job without having to defer to doctors or other medical professionals.
Those who are looking to move out of patient-facing environments will find holding a high-level qualification opens many doors. Nurse educators have the option of working in a hospital environment or in a nursing college, for example. Informatics nurses can explore the areas of computing and information technology that appeal to them and use data science, analytics, and other skills to improve the efficiency of patient care.
DNP-prepared nurses are most definitely in-demand. The Bureau of Labor Statistics predicts that job openings for postgraduate-prepared nurses will increase by 45% between 2019 and 2029. This growth is in part because the current crop of advanced practice-level nurses is getting older and heading towards retirement, and also because the overall population in the United States is getting older.
An aging population brings with it new challenges and a significant number of people living with chronic or acute health conditions. Those patients need skilled medical care that only advanced practice nurses can provide.
Masters degrees vs the DNP – how nurses view them
In the nursing field, there’s some confusion about the difference between being a Master’s Degree holding APRN and a DNP graduate. The AACN states the intent of the DNP is to build on the skills learned in the Master’s qualification, adding quality improvement, evidence-based practice, and leadership skills.
In many parts of the country, there’s a shortage of doctors able to provide primary care. Nurse practitioners provide people living in those areas with access to basic health care, with nurse practitioners providing preliminary assessments, diagnosing and prescribing for those with minor ailments, and making referrals for those who need more specialist care.
Some older nurses who qualified as APRNs through the more traditional master’s degree route feel their qualifications are being drawn into question by the existence of the DNP, but this is not the case. Nurses who earned an MSN and are certified to practice in a specific area such as psychiatric mental health or anesthesia are fully qualified to do those jobs. The skills offered by a DNP are focused on advancing leadership, scholarship, and building on the knowledge base in nursing.
The DNP allows nurses to fill a gap in the health care sector, but the qualification is not designed to make nurses seem ‘like doctors’ or to make the MSN obsolete.
Nurses who are coming through the education system today have numerous options when it comes to choosing which pathway to follow. Whether you opt to go the traditional BSN to MSN, then take a DNP later, or enroll in a integrated course that takes you from your Bachelor’s to a DNP, you’ll have the option to earn clinical experience along the way and the end result will be that you’ll become a much better nurse, able to help your patients more effectively and provide a higher standard of care.
