July/August 2013

The Move to DNP

By Bobbie Berkowitz, PhD, RN, FAAN

Dean, Columbia University School of Nursing

Alice with Patient

In just fifteen months, nursing will enter a new phase of its professional evolution. The year 2015 is the date – set back in 2004 -- when the American Association of Colleges of Nursing recommended that the preparation for advanced practice nursing move from the master’s degree to the doctor of nursing practice (DNP).

The concept of a clinical doctorate has been a long time coming. It has its roots here at Columbia Nursing, when in the late 1980s our faculty introduced the first practice initiative built on evidence-based interventions delivered by nurse practitioners. In the 1990s we expanded and broadened our nurse practitioner practice to include all care settings and a greater sophistication in diagnosis, treatment, prevention and care coordination. Collaboration with Columbia primary care physicians laid the groundwork for a landmark study which showed that, with additional skills and experience, nurse practitioners could provide care that was equivalent to that of primary care physicians in terms of quality and scope. The publication of this study greatly widened the horizons of advanced practice nursing.

Keeping on the path set more than thirty years ago, Columbia Nursing is on track to elevate all advanced practice specialties at the School to the DNP-degree educational level. The goal of developing an educational pathway for the DNP as the entry into advanced practice nursing was already identified as a priority emerging from the strategic planning process initiated when I arrived at Columbia. I am pleased to report that the curriculum for the new DNP program is nearly complete and will meet national standards as well as those set by the Council for the Advancement of Comprehensive Care for a DNP education.

Our new DNP program will move the professional nurse (with a baccalaureate or master degree) smoothly to the terminal degree for advanced practice. Our DNP students will learn advanced skills in diagnosis and treatment, as well as the use of informatics and decision-making technologies for enhanced evidence-based practice. Our specially-designed, portfolio-based approach for the completion of the degree will ensure that our students master an array of competencies in comprehensive care.

The changing demands of the healthcare system increasingly require advanced practice nurses who can apply the highest level of scientific knowledge and practice expertise. That’s why we at Columbia Nursing believe that the DNP is the right degree at the right time. So do the Institute of Medicine, the Robert Wood Johnson Foundation, and the Joint Commission, which have also endorsed the transition to the DNP. I remind students contemplating the move to the DNP that our curriculum will prepare them as highly-educated and qualified practitioners in their profession.

Associate Dean for Student Affairs Judith Honig, EdD, DNP, was part of the team that developed the DNP at Columbia Nursing and served on the AACN task forces that helped create the national movement toward a DNP degree. She often says, “Education is power.” The DNP degree will provide many advantages: A strong grounding in evidence-based practice that transfers new knowledge to the bedside; opportunities or leadership positions and teaching; and a stronger position in the job market. Between 2004 and 2012, the number of students enrolled in DNP programs increased from 170 to 11,575. Currently, there are 217 such programs across in the nation. There is a wide variation in the focus of DNP programs: Many focus on competencies other than advanced clinical practice such as leadership and management, community health, and education. We have worked hard to ensure that our own curriculum provides the most advanced preparation possible for nurse practitioner practice.

The future of advanced clinical practice has never been brighter. As the healthcare system continues to evolve, advanced practice nurses will assume greater authority and independence for providing a broader range of clinical care than ever before. Columbia Nursing’s move to the DNP as entry into advanced practice is in step with the national trend to empower nurses and advance the profession that we helped set into motion more than 30 years ago.