The History and Evolution of the Practice Focused Doctorate Degree in Nursing

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In the early years of nursing, doctorate-level study degrees were first offered in 1924 as an EdD (Doctor of Nursing Education), focusing on developing highly educated nursing faculty (Chism, 2012, pp. 3-13). By 1967 some colleges also offered nursing degrees as Ph.D.(Doctor of Nursing Philosophy) or DNS (Doctor of nursing science DNS), both of these degrees focus on developing nurse researchers (Chism, 2012, pp. 3-13). None of these early doctorate-level degrees addressed the need for highly educated clinically-focused nurse leaders.

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The first clinically-focused nursing doctorate was offered in 1979 through Case Western Reserve University as an ND (Nursing Doctorate) degree, and by 2001 the first DNP (Doctor of Nursing Practice) program was started in Kentucky (Patzek, 2017; Chism, 2012, pp. 3-13). In 2004 the American Association of Colleges of Nursing, also known as the AACN, released a position statement supporting DNP level education as a practice requirement for advanced nurse practitioners (American Association of Colleges of Nursing, 2020). Initially, AACN recommended universities develop plans to implement the requirement by 2015 (Chism, 2012). However, this recommendation was not readily received by professional practice groups resulting in no universally adopted timeline for implementation.

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As DNP degree availability expanded, AACN initially provided no clear guidance for program format or curriculum structure in DNP programs (Ketefian & Redman, 2015). This lack of uniformity continued until 2006 with the development and release of the current AACN DNP program requirements, which outline eight DNP knowledge essentials as required educational constructs (American Association of Colleges of Nursing, 2006). These essentials are intended to provide fundamental core competencies for all DNP-prepared nurses.

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Unlike Ph.D. nursing programs that focus heavily on teaching nurses research methodology and discovering new knowledge through original research, the DNP degree is focused on practice implementation science that brings knowledge discovered by original research into practice. DNP programs emphasize evidence-based practice (EBP) concepts and research methods that address testing the application of EBP to quality improvement processes (Chism, 2012; Ketefian & Redman, 2015). The DNP also expands the nurse leader's focus to a global health management perspective incorporating concepts of theory-guided practice, finance, economics, epidemiology, preventative healthcare, healthcare policy, and information technology to lead systems-based healthcare improvement (American Association of Colleges of Nursing, 2006).  Mastery of the eight DNP essentials allows advanced practice nurses to apply these concepts to both systems-based leadership and clinical-based practice to improve healthcare quality.

What follows is my personal DNP essentials application to practice statement and a review of each of the eight DNP essentials that showcase my study, mastery, and application of each DNP practice essential.