DIFFICULT PROFESSIONAL CHOICES: DECIDING BETWEEN THE PhD AND THE DNP IN NURSING

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1 NursingWorld OJIN: Difficult Professional Choices: Deciding Between the PhD and the... Page 1 of 16 Loomis, J., Willard, B., Cohen, J., (December 22, 2006) "Difficult Professional Choices: Deciding Between the PhD and the DNP in Nursing" OJIN: The Online Journal of Issues in Nursing. Available: OJIN: The Online Journal of Issues in Nursing Article published December 22, 2006 DIFFICULT PROFESSIONAL CHOICES: DECIDING BETWEEN THE PhD AND THE DNP IN NURSING Jo A. Loomis, MS, FNP-C Barbara Willard, ND, RN Jayne Cohen, DNSc, RNC ABSTRACT Although the PhD has been the traditional doctoral degree in nursing, nurses now have a choice between that degree and the Doctor of Nursing Practice (DNP) degree. An Internet-based exploratory survey of DNP students (n= 69) investigated the motivation of nurses to pursue doctoral education, factors that influenced the decision between the two degrees, rationale for choosing the DNP program, and career plans after graduation. A majority reported considering the PhD but decided the DNP would be more appropriate for their professional and personal goals. Nursing education was ranked as an important career intention for 55% of respondents, dispelling the concern that the DNP will increase the shortage of nursing faculty. The results indicate that the DNP degree is a desirable option for clinically oriented nurses considering doctoral education and provides nurses with a choice of educational pathways for their professional careers. Key words: PhD in nursing, research doctorate, Doctor of Nursing Practice, DNP, practice doctorate in nursing, clinical nursing practice, nursing faculty shortage, advanced practice nurses, nursing education For the past several decades, doctoral education in nursing has centered on the Doctor of Philosophy (PhD) degree and the Doctor of Nursing Science (DNSc) degree. More recently, a newer, terminal degree, the Doctor of Nursing Practice (DNP), has come into the spotlight. As of this writing more than ten DNP programs are in operation at university settings around the country, and more than 190 programs are under consideration or development (American Association of Colleges of Nursing [AACN], 2004, 2005; National Organization of Nurse Practitioner Faculties [NONPF], 2004). This article reports a study which sought to clarify what has motivated nurses to pursue a DNP instead of a PhD program. Understanding the rationale for this decision may help to clarify some of the issues and concerns currently influencing the development of the DNP degree. This article will first review the literature related to the introduction of the DNP degree. Then the survey itself along with the study findings will be reported, followed by a discussion of the findings and recommendations for future research.

2 NursingWorld OJIN: Difficult Professional Choices: Deciding Between the PhD and the... Page 2 of 16 Review of the Literature The practice doctorate, also called a clinical doctorate or a professional doctorate, was created to focus on clinical practice, rather than on nursing research (AACN, 2004; Henry, 1997; Lenz, 2005; O Sullivan, Carter, Marion, Pohl & Werner, 2005; Veeser, Stegbauer & Russell, 1999). However, its development has been controversial, and its possible effects on advanced practice nursing in particular, and on the profession as a whole are still widely debated as this article is written. This section will address the history of the practice doctorate in nursing, review concerns which have been expressed regarding the DNP, discuss the relationship between the DNP and the Boyer Model of Scholarship, and assess the influence the DNP may have on nursing faculty tenure decisions. The practice doctorate...was created to focus on clinical practice rather than on nursing research. History of the Practice Doctorate in Nursing McEwen and Bechtel (2000) in discussing the history of nursing doctorates pointed to a tremendous growth in the number of doctoral programs in the last few decades. They called for an examination of doctoral education programs in light of this rapid growth and the increasing knowledge base that is foundational to nursing philosophy and practice. Starck, Duffy, and Vogler (1993) predicted a shortage of clinically prepared leaders and called for the increase of doctorally prepared nursing faculty, who would also be expert clinicians. They argued that this type of nursing faculty, scholar as well as expert clinician, would be needed to educate the clinical leaders of the future. Thus the concept of a practice doctorate is not new (AACN, 2004; Lenz, 2005; Sperhac & Clinton, 2004). An earlier response to the need for clinical and scholastic excellence was the DNSc degree, also called the clinical doctorate, which was initiated by Boston University in 1960 (Veeser, et al.,1999). This degree originally was touted as the advanced clinical alternative to the researchoriented PhD degree (Robb, 2005). However, the AACN and others have found little difference between the preparation of the PhD and the DNSc graduate, labeling them both research-oriented terminal degree programs (AACN, 2004; Marion et al, Viens, O Sullivan, Crabtree, Fontana & Price., 2003; McEwen & Bechtel, 2000; McKenna, 2005). In 1975 Margaret Newman (1997) of New York University, called for a practice doctorate to elevate the level of professional nursing, stating, "Nursing lacks both recognition for what it has to offer and authority for putting that knowledge into practice" (p. 362). The Nursing Doctorate (ND) degree was developed to be a professional degree equal to professional degrees in other fields, such as medicine, dentistry, optometry, and veterinary medicine (O Sullivan et al., 2005). Case Western Reserve University s Francis Payne Bolton School of Nursing has had a ND degree program since 1979 and is now offering a ND to DNP conversion program. The University of Colorado at Denver and Health Sciences Center is phasing out their ND program as the school converts to the DNP model. At the October, 2004 general meeting of the American Association of Colleges of Nurses (AACN), a majority of the deans and directors of the member institutions present voted to move advanced practice nurse preparation from the master s level to the doctoral level by This new AACN policy will make the DNP the standard for APN education (AACN, 2004). Educational institutions as well as nurses themselves are discussing the impact of this process and what it will mean to

3 NursingWorld OJIN: Difficult Professional Choices: Deciding Between the PhD and the... Page 3 of 16 advanced practice nursing, to the institutions that prepare nurses for practice, and to the profession as a whole. Concerns Expressed Regarding the DNP The development of the DNP has not been without controversy. The development of the DNP has not been without controversy. One objection is that another degree will confuse the public, those within the profession of nursing, and other health professionals regarding the scope of practice and role of the advanced practice nurse (Gennaro, 2004; Meleis & Dracup, 2005). Another concern is the difference in degree title nomenclature currently existing among schools conferring the Doctor of Nursing Practice degree. Using such designations as ND, DNP, or DrNP leads to title and role confusion and leaves room for misunderstanding (Dracup, Cronenwett, Meleis, & Benner, 2005). A further concern is whether offering a DNP degree will decrease the number of nursing faculty in the years ahead. It has been theorized that DNP programs may cause PhD enrollments to dwindle, resulting in a smaller pool of potential nursing faculty members (Fulton & Lyon, 2005; Meleis & Dracup, 2005). The PhD in nursing, as well as in education, public health, and other fields, is considered the standard preparation for tenure-track nursing faculty positions. Some fear the DNP may decrease the nursing faculty pool because DNP-prepared nurses who seek faculty positions may face academic marginalization if the PhD is the only accepted doctoral requirement for eligibility for tenure. Meleis and Dracup ( 2005) concluded that lack of degree acceptance will preclude nurses who chose the DNP instead of the PhD from a presence at the academic table. With the current critical nursing faculty shortages, especially of doctorally prepared faculty candidates (Anderson, 2002), some fear that dividing the potential pool of doctorally prepared nurses between those with a PhD and those with the DNP might reduce the number of candidates eligible for nursing faculty. This could eventually threaten the future of the nursing profession as schools struggle to find faculty to handle the demand for educating nurses at the baccalaureate and master s levels. But proponents of the DNP have a different perspective. Patricia L. Starck, Dean of the University of Texas (UT) School of Nursing, as of this writing, the newest DNP program, stated on the UT website, "We foresee that many (DNP graduates) will seek careers that combine teaching with practice" (University of Texas, 2006). UT plans to give priority admission to current faculty who are advanced practice nurses. Starck strengthened her position by stating, "It is my belief that graduates with the DNP degree may be eligible for tenure if they are productive clinical scholars meeting the criteria established by a given university. Our Medical School several years ago revised its criteria to provide two pathways to tenure--the Educator/ Scientist and the Educator/Clinician" (P. L. Starck, personal communication, August 21, 2006). Additionally Sterling and McNally (1999), Sperhac and Clinton (2004), and Lenz (2005) found that a doctoral degree enhances the status and image of the nurse practitioner, as well as increasing credibility and respect within the health care community. Status and parity with other health professionals may be a beginning to foster equality at the academic level. Relationship Between the Boyer Model and the DNP For more than a decade, the academy has been considering a model for scholarship presented by Boyer (1990) that redefined scholastic excellence from a narrow focus on research to a broader focus that views teaching as a practice-based process involving classroom teaching and also

4 NursingWorld OJIN: Difficult Professional Choices: Deciding Between the PhD and the... Page 4 of 16 research and application. Traditionally, scholarship has been defined according to what Boyer called the "discovery" and "integration" of knowledge, in other words "knowledge generation." In contrast Boyer suggested the scholarly process is also advanced through the socially responsible application of that knowledge which Boyer called "application" and nursing calls "the scholarship of practice" (AACN, 2006). Society is served through this scholarship of practice as community needs for expert nursing care are met by nurses who directly give, evaluate, and constantly improve evidence-based nursing care. DNP proponents maintain that nursing scholarship is being advanced and enhanced through DNP programs, in keeping with Boyer s Model of scholarship, as expert clinicians both teach and practice in the community (AACN, 2006; Cartwright & Reed, 2005). More recent work by Boyer (1996) suggested that clinically expert nurses, practicing and teaching at the doctoral level, will raise advanced nursing practice to new levels in another newly recognized form of scholarship, namely the "scholarship of engagement" (AACN, 2006, p. 5). This will occur as theory and research findings are applied in practice settings, tested there, revised, and expanded. Research and practice both benefit from clinically expert nurses practicing and teaching at the doctoral level, and scholarship in both arenas is enhanced. Tenure Decisions and the DNP The growing interest in a broader definition of scholarship has resulted in questioning the traditional function of the professoriate (Boyer, 1996; Cartwright & Reed, 2005). Fitzpatrick (2003) challenged schools preparing advanced practice nurses to utilize expert clinicians who maintain active nursing practice as educators for their students. Ever expanding clinical practice opportunities will enable nurse educators both to teach and to keep abreast of advances in nursing practice. In discussing their research regarding student perceptions of nursing doctorates Hudacek and Carpenter (1998) commented that education in nursing research alone does not necessarily provide the competencies necessary for a nurse to be an educator, practitioner, or administrator of nursing. They stated, "Perhaps role preparation needs to be given more attention at the doctoral level in recognition that diversity in talents and career goals will add to the professional contributions made by these individuals" (p. 19). Tenure guidelines may change to accommodate the broadening scope of scholastic excellence, thus including clinically focused doctoral graduates in addition to PhD-prepared nurse researchers. Often the attraction to the PhD is recognition, acceptability, parity with other professions, and eligibility for tenure and changes in the university structure may be necessary. Although they may not not happen quickly, they may be on the horizon. Cartwright and Reed (2005) predicted that as the DNP becomes more readily available, there will be a greater acceptance of DNP-prepared faculty who are engaged in diverse facets of scholarship in all areas of clinical practice. They called this "expanding the pipeline to the doctorate" (p. 4) and suggested that in light of this expanded view of scholarship, candidates with DNP preparation may be accepted by "much of the higher education community" (p.5). The Research Survey Ever expanding clinical practice opportunities will enable nurse educators both to teach and to keep abreast of advances in nursing practice. An Internet-based, exploratory survey, approved through the university s Institutional Review Board (IRB), was sent to the ten universities that offered a DNP or DrNP degree program at the time of the study. The following paragraphs will describe the conduct and findings of this survey as

5 NursingWorld OJIN: Difficult Professional Choices: Deciding Between the PhD and the... Page 5 of 16 well as the limitations of this study. Sample A faculty contact person was identified at each of the ten universities. These contacts were asked to forward a second attached letter to their DNP student body, inviting students currently enrolled in the program to participate. The invitational letter, addressed to the students, contained the Internet address for the survey. A consent form explained the parameters of the survey; and participants gave implied consent by proceeding to respond to the survey questionnaire, which was conducted and maintained on a secure web server. The target population included the students currently enrolled in one of ten schools of nursing that offered a practice doctorate at the time of the survey. However, this request to participate resulted in reaching students in only five of the ten schools. A convenience sample (n = 69) consisting of those students who completed the survey, was obtained. Those five schools in which students were reached together reported current DNP enrollment at 384 students, yielding an 18% response rate. Students ranged from those newly graduated nurses from baccalaureate degree programs or even those holding a baccalaureate degree in another field, to those who have been practicing nurses, and for some advanced practice nurses, for many years. Some of the programs had an accelerated pre-licensure component for baccalaureate-prepared students. Instrument The instrument, designed specifically for this study by the researcher (first author), was a short questionnaire in two parts, consisting of multiple choice questions and short essay-type responses (Table 1). Initially a draft of the survey was ed to colleagues seeking suggestions for strengthening the survey. Based on this feedback, slight adjustments were made to the survey format. The first part contained 15 demographic and background items. The second part contained 10 open-ended or multiple-choice questions that addressed: a) factors that influenced the students to seek a doctorate, b) factors that influenced their decision to attend the DNP program instead of a PhD or DNSc degree program, c) factors that influenced the choice of the particular school, and d) career intentions after graduation. Procedure The instrument took minutes to complete, depending on the time spent answering the essay questions. To protect the subjects confidentiality, no information that could link a student to his or her responses was collected. Rather students were given a random two-word code that allowed them to re-enter the survey Internet site to add more information if they desired. Research Findings Profile of respondents. The age of the respondents clustered around the five-year period of years of age (Table 2). Three out of 69 respondents identified themselves as male; and the majority (84%) identified themselves as Caucasian (Table 3). Ninety-two percent of the sample reported they held a master s degree in nursing and the majority (70%) were nurse practitioners. Advantages of the different degrees. Respondents were asked what advantages they perceived from attaining a doctorate in nursing (PhD or DNSc) degree and what advantages they perceived from

6 NursingWorld OJIN: Difficult Professional Choices: Deciding Between the PhD and the... Page 6 of 16 Sixty-six percent of respondents identified eligibility as nursing faculty as an advantage of a doctorate in nursing and almost 61% identified this eligibility as an advantage of a DNP degree. attaining a DNP degree (Tables 5 and 6). Subjects were allowed to indicate an unlimited number of advantages. Increased intellectual knowledge and career advancement ranked first and second among the advantages of all programs. Sixty-six percent of respondents identified eligibility as nursing faculty as an advantage of a doctorate in nursing and almost 61% identified this eligibility as an advantage of a DNP degree (Table 6). Rationale for choosing the degree. Of primary interest was the rationale for choosing the DNP degree instead of the PhD or DNSc degree. Respondents were asked to respond with either "yes" or "no" to the question "Did you consider pursuing a PhD or DSNc degree?" In a separate, open-ended question, they were asked to explain why or why not they considered pursuing one of these degrees. The majority of respondents (55%) reported they had considered the option, and some had begun a course of study and then stopped or transferred to a DNP program. The rationales given for this choice centered on their career focus. The most common reason for not considering the PhD was that the student was not interested in a researchintensive degree or a research-focused career; rather students reported that their primary interest was excellence in clinical practice. Some respondents commented about the length of time required for the PhD and were not willing to dedicate that amount of time. Others added that their (older) age was a contributing factor to their choice of the DNP, suggesting they wanted a shorter doctoral program for more productive years with the degree. One respondent stated, "The PhD is more respected in nursing circles," but this respondent did not share the rationale for switching to the DNP. One student commented, "I left the PhD program because the faculty seemed inflexible. They had been in the ivory tower for too long and did not have a grasp of what nurses in all roles face in today s health care environment." One person mentioned having been accepted into a PhD program, but switching because teaching in an Advanced Practice Nursing (APN) program was a priority, believing the DNP would better prepare this subject for that role. Rationale for program choice. The most frequent answers regarding the factors that influenced their choice to attend a specific DNP/DrNP program were: (a) the curriculum was compatible with interests and goals, (b) location of the school, and (c) the capability for distance learning (Table 4). Intentions after graduation. Students were asked "What are your intentions after graduation from the DNP program?" The respondents were requested to identify all choices that applied. The most common response (55%) indicated interest in participating in nursing education, followed by interest in primary care clinical practice (39.1%) (Table 8). Limitations Several study limitations should be noted: (a) ed surveys have not only advantages but also disadvantages (described below), (b) all subjects had made the choice of the DNP and were currently enrolled in DNP programs, (c) there was no control group, i.e., a matched group of students enrolled in either a PhD or DNSc program to serve as a comparison group, (d) there were no schools located on the West Coast of the US, and (e) the response rate was low (18%). Several factors contributed to the low response rate: (a) direct access to potential subjects was not

7 NursingWorld OJIN: Difficult Professional Choices: Deciding Between the PhD and the... Page 7 of 16 possible; access was available only through identified faculty representatives, (b) one school was unable to send out the questionnaire to their students based on school policy, (c) one (or possibly more) school s current students were adjourned for the semester and could not be reached, (d) the study was conducted late in the semester, usually a very busy time for students, (e) students were given only two weeks to respond, and (f) three other schools yielded no respondents. It is possible that these schools did not forward the survey to their students. If this was the case, students at five out of the 10 schools in the target population did not receive the invitation to participate. These factors together limit the ability to generalize the findings of this study. Discussion This section will discuss the implications of the survey findings presented above. The need for the DNP degree, the impact of the DNP on faculty availability, the impact of the DNP on advanced practice, and ethical considerations of the DNP will be addressed. Is There a Need for the DNP Degree? The results of this study suggest that students who undertake the DNP program believe their personal and professional goals would not be met by pursuing a PhD in Nursing. Seventy one percent of respondents commented that they were not interested in research and therefore did not choose to enroll in a PhD program. This is consistent with the literature, which affirms that the PhD degree is considered the research-oriented degree (AACN, 2004; Marion et al., 2003; McEwen & Bechtel, 2000; McKenna, 2005). The primary focus for these students was augmenting clinical expertise, and the respondents reported that the choice of the DNP would further their goals in this area. In this sample, the mind-set of the DNP-bound student seemed to be different from that of the PhD candidate in terms of professional and personal goals. These nurses, the majority with master s degrees in nursing, and already practicing as advanced practice nurses, indicated that to achieve expert status in their field, they needed the education and credibility the doctoral degree would afford them, but resisted the idea that the PhD in nursing should be the only terminal degree. One respondent put it this way, "It is unethical and a waste of resources to require people to study for a research degree if they do not want to become career researchers. We are diverse people with diverse goals, abilities, and career paths!" A surprising survey outcome...was that 29% of respondents indicated a personal intention after graduation for involvement with research. A surprising survey outcome, in light of the students previous responses about professional intentions after graduation, was that 29% of respondents indicated a personal intention after graduation for involvement with research. Some mentioned that they were interested in clinical research and evidence-based practice, but not a career focused solely on research. One interpretation might be that DNP candidates see one aspect of research as being the application of research findings in the clinical arena. This finding is consistent with the scholarship of application as described in the Boyer Model (1996). DNP Graduates as Nursing Faculty Another unexpected outcome was that almost 61% of respondents indicated that they considered

8 NursingWorld OJIN: Difficult Professional Choices: Deciding Between the PhD and the... Page 8 of 16 eligibility as nursing faculty as an advantage to achieving the DNP. When asked about professional intentions after graduation, 55% said nursing education was their goal. Twelve percent of respondents said they were already on the faculty at their school, and cited this employment as influencing their decision to attend that particular school. Reflecting on conflicting opinions regarding eligibility for nursing faculty positions, one student commented, "Some people do not think [the] DNP is really a qualification for nursing faculty, so [I] considered the PhD for credibility, but it is just ignorance about [the] DNP and I chose to go against the grain." This important finding highlights the sample s opinion that the DNP will not reduce the number of potential nursing faculty, but may in fact increase the faculty pool. Rather than magnifying the differences between academic and clinical nursing (Dracup & Bryan-Brown, 2005), these respondents indicated that they see a blending of the two areas of nursing; nursing education and nursing practice. Respondents' Perceptions of the Impact of the DNP on Advanced Practice One cannot lose sight of the fact that the AACN s mandate to move the current level of preparation necessary for advanced nursing practice from the master's degree to the doctoral level by the year 2015 is on the horizon. One respondent commented: Upon review of the literature/position papers and talking with my professors and colleagues, I strongly feel that this is where advance practice nursing needs to go and will go within my lifetime. I think in order to remain competitive and administer the care that needs to be given, advanced practice nurses need to have a doctoral degree at the entry level. The minimal requirements for advanced practice nurses are continually expanding and are stretching the limits of the MS in nursing programs. A doctoral program that specializes in practice, while incorporating research elements, will give APRN s the background they need for evidence-based practice in a variety of roles. Additionally, the expansion of the aging population and anticipated demographic shifts will increase the need for nurse practitioners, as well as their practice requirements, furthering the need for additional education. Another commented, "I was always interested in direct patient care. When I found this degree I was so excited because I saw a way to combine so many pertinent factors with patient care, specifically leadership in the community and evidenced-based practice. I thought it gave me the most of what I was interested in." Ethical Considerations Silva and Ludwick (2006) question the social responsibility of the development of the DNP. The nurses responding to this survey often indicated that their motivation for achieving excellence in patient care was to provide for the needs of a specific population. The subjects indicated that social applications of the clinical skills, health care policy, and nursing care are uppermost in their minds. These nurses expected to provide the highest level of clinical practice in the community and pass on their expertise to other nurses through a faculty role. Based on these research data both society and the nursing profession will be well served by nurses attaining the DNP degree. These nurses expected to provide the highest level of clinical practice...and pass on their expertise to other nurses through a faculty role.

9 NursingWorld OJIN: Difficult Professional Choices: Deciding Between the PhD and the... Page 9 of 16 Recommendations for Future Research During the course of collecting and analyzing the data from this survey, several areas requiring further research were noted. Needed are a better understanding of both the age at which nurses are now entering doctoral programs as well as the goals and expectations of today s applicants to doctoral programs. Additionally, greater insight into the advantages and limitations of using the Internet to collect data will also benefit nursing research and hence nursing practice. These needs will be discussed below. Needed are a better understanding of both the age at which nurses are now entering doctoral programs as well as the goals and expectations of today's applicants to a doctoral program. Anderson (2000) as well as Dracup and Bryan-Brown (2005) report that nurses typically prepare for a doctorate later in life than students enrolled in other fields. Are DNP candidates entering doctoral education at a younger age? This survey showed that 27.5 % of respondents were 35 years of age or younger. Beginning doctoral education earlier in one s career could increase the number of productive years with the degree. Future research is needed to compare the age ranges of students enrolled in DNP programs with ages of nurses currently enrolled in PhD programs. Many of the studies of doctoral students are somewhat dated (Hudacek & Carpenter, 1998; McEwen & Bechtel, 2000). PhD students attitudes may have changed as nursing itself changes and looks toward the future. Comprehensive surveys of all doctoral programs and the goals and expectations of applicants and enrolled students themselves are needed to help to shape nursing education in the future. As computers become more commonplace for personal use in graduate education, surveys using will also become easier to use for research involving nursing doctoral studies. Surveys conducted over the Internet have the advantages of ease of delivery, access, and handling of the data. But they do require access to computers and a certain level of competence of use. With relatively older nurses entering doctoral studies, the nursing profession may lag behind other disciplines in the use of technology to facilitate its research, but with the demands for scholarly communication increasingly dependant on technology, this lag should be temporary at best. More research is needed regarding the advantages and limitations of collecting research data using the Internet....these students affirm that the DNP is a sound option...to obtain the education they desire...and make a positive contribution to the nursing profession. Conclusion Several of the respondents echoed the comment of this student, "I want to continue on the front lines of practice and act as a leader in clinical issues and policies." The proponents of the DNP degree development and the students who are pioneers in its programs see themselves as nursing leaders, forging a new frontier for the profession of nursing. Along with Lenz (2005), the AACN (2004, 2006), and Cartwright and Reed (2005), these students affirm that the DNP is a sound option for doctoral candidates in nursing, allowing them to obtain the education they desire to improve their clinical expertise, acquire the skills and abilities to shape policy in their communities, and make a positive contribution to the nursing profession. Table 1. Internet Survey Questions

10 NursingWorld OJIN: Difficult Professional Choices: Deciding Between the PhD and t... Page 10 of What school are you currently attending? 2. Are you currently enrolled in a Doctor of Nursing Practice degree program, either DNP or DrNP, through this school? 3. What year of the program are you enrolled in currently? 4. What is your planned year of completion? 5. How old are you? 6. What is your gender? 7. What is your race? 8. What is your home state? 9. What year did you complete your baccalaureate degree? 10. Was your baccalaureate degree in Nursing? 11. If your baccalaureate was not in Nursing, what was the field? 12. Year of Master's degree completion? 13. Was the Master's degree in Nursing? 14. If your Master's degree was in Nursing, what area of specialty? 15. If your Master's degree was not in Nursing, what was the field? 16. What factors influenced your choice to attend this specific DNP/DrNP program? Click on all that apply. 17. What other factors influenced your choice to attend this school? (open-ended question with short essay response) 18. What advantages do you perceive to you personally from completing a doctorate in nursing? Click on all that apply. 19. Please identify any additional advantages. 20. What advantages do you perceive to you personally from completing the DNP program? Click on all that apply. 21. Please identify any additional advantages. 22. Did you consider pursuing a PhD or DSNc degree? 23. Please explain why or why not?

11 NursingWorld OJIN: Difficult Professional Choices: Deciding Between the PhD and t... Page 11 of What are your professional intentions after graduation? 25. Do you have any additional comments that might clarify your choice of the DNP degree program? Note. Questions 16, 18, 20, 22, and 24 provided lists for respondents to choose all that applied. The specific choices for these tables are listed in Tables 4 through 8. Table 2. Demographics of the Sample: Age (Question #5, Table 1) Age in Years Number of Responses (n=69) % Table 3. Demographics of the Sample: Race (Question #7, Table 1) Race Number of Respondents (n=69) % White Black/African American Hispanic Asian American Indian/Alaskan Native 1 1.4

12 NursingWorld OJIN: Difficult Professional Choices: Deciding Between the PhD and t... Page 12 of 16 Table 4. Factors Influencing Choice to Attend a Specific School (Question # 16, Table 1) Factor % Curriculum Compatible With Interests and Goals 78.3 Location of School 53.6 Distance Education Possibilities 36.2 Attended This School for Undergrad/Grad Education 26.1 Faculty at This School 11.6 Family Ties to This School 4.3 Note. Percentages reflect number of times the factor was chosen and will not add up to 100 percent. Table 5. Advantages of Completing a Doctorate in Nursing (Question # 18, Table 1) Advantage % Increase in Intellectual Knowledge 88.4 Career Advancement 78.3 Evidence-Based Practice 68.1 Eligibility as Nursing Faculty 66.7 Increase in Income 55.1 Improvement in Clinical Skills 36.2 Improvement in Communication Skills 40.6 Note. Percentages reflect number of times that advantage was chosen and will not add up to 100 percent. Table 6. Advantages of Completing a DNP program (Question # 20, Table 1) Advantage % Increase in Intellectual Knowledge 91.3 Career Advancement 71

13 NursingWorld OJIN: Difficult Professional Choices: Deciding Between the PhD and t... Page 13 of 16 Evidence-Based Practice Eligibility as Nursing Faculty 60.9 Increase in Income 50.7 Improvement in Clinical Skills 43.5 Improvement in Communication Skills 50.7 Note. Percentages reflect number of times the advantage was chosen and will not add up to 100 percent. Dash indicates missing data. Table 7. Consideration of the PhD or the DNP (Question #22, Table 1) Response Number of Responses n= 67 % Yes No Table 8. Intentions After Graduation from the DNP Program (Question #24, Table 1) Career Choice % Nursing Education 55.1 Primary Care Clinical Practice 39.1 Nursing Research 29.0 Acute Care Clinical Practice 18.8 Administration 15.9 Women s Health Care Clinical Practice 11.6 Public Health Nursing 7.2 Forensic Nursing 2.9 Occupational/Business Health Management 1.4 Note. Percentages reflect number of times the intention was chosen and will not add up to 100 percent. AUTHORS

14 NursingWorld OJIN: Difficult Professional Choices: Deciding Between the PhD and t... Page 14 of 16 Jo A. Loomis, MS, FNP-C Jo Loomis received her BSN from the University of Missouri and submitted this research study in partial fulfillment of the requirements for the MS degree at the School of Nursing, San Jose State University in California. She is a family nurse practitioner and is certified by the North American Menopause Society as a menopause practitioner. Ms. Loomis has been accepted into a DNP program and will begin studies in January Barbara Willard, ND, RN bwillard@son.sjsu.edu Barbara Willard is an Assistant Professor of Pediatrics at San Jose State University School of Nursing in San Jose, California. Dr. Willard has her Nursing Doctorate degree from the University Of Colorado Health Science Center in Denver, Colorado, and a Master s degree in Nursing Education from Regis University School of Nursing also in Denver. Her specialty is in Pediatric Critical and Cardiac Intensive Care. Jayne Cohen, DNSc, RNC jcohen@son.sjsu.edu Jayne Cohen is the Director of the School of Nursing at San Jose State University in San Jose, California. Dr. Cohen received her Doctorate and Master s degrees in Nursing from the University of California, San Francisco. She is a nationally certified Women s Health Care Nurse Practitioner. REFERENCES American Association of Colleges of Nursing. (2004). Position statement on the practice doctorate in nursing. Retrieved October 26, 2005, from American Association of Colleges of Nursing. (2005). Frequently asked questions concerning the AACN position statement on the practice doctorate in nursing. Retrieved October 26, 2005, from American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice (Draft V). Retrieved May 15, 2006, from Anderson, C. (2000). Current strengths and limitations of doctoral education in nursing: Are we prepared for the future? Journal of Professional Nursing, 16, Boyer, E. (1990). Scholarship reconsidered: Priorities for the professoriate. Princeton, NJ: The Carnegie Foundation for the Advancement of Teaching. Boyer, E. (1996). Clinical practice as scholarship. Holistic Nursing Practice, 3, 1-6. Cartwright, C., & Reed, C. (2005). Policy & planning perspectives for the doctorate in nursing practice: An educational perspective. Online Journal of Issues in Nursing, 10, (3). Retrieved November 1, 2006, from:

15 NursingWorld OJIN: Difficult Professional Choices: Deciding Between the PhD and t... Page 15 of 16 Dracup, K., & Bryan-Brown, C.W. (2005). Doctor of nursing practice-mri or total body scan? American Journal of Critical Care, 14, Dracup, K., Cronenwett, L., Meleis, A.I., & Benner, P.E. (2005). Reflections on the doctorate of nursing practice. Nursing Outlook, 53,: Fitzpatrick, J. (2003). The case for the clinical doctorate in nursing. Reflections in Nursing Leadership. 8, 37. Fulton, J., & Lyon, B (2005). The need for some sense making: Doctor of nursing practice. Online Journal of Issues in Nursing, 10(3). Retrieved November 1, 2006 from: Gennaro, S. (2004). A rose by any other name? Journal of Professional Nursing, 20, Henry, B. (1997). Professional doctorates for professional practice. Image: Journal of Nursing Scholarship, 29, 102. Hudacek, S., & Carpenter, D. (1998). Student perceptions of nurse doctorates: Similarities and differences. Journal of Professional Nursing, 14, Lenz, E. (2005). The practice doctorate in nursing: An idea whose time has come. Online Journal of Issues in Nursing, 10, (3). Retrieved December 1, 2005, from Marion, L., Viens, D., O Sullivan, A., Crabtree, K., Fontana, S., & Price, M. (2003). The practice doctorate in nursing: Future or fringe? Topics in Advanced Practice Nursing ejournal. Retrieved September 14, 2005, from McEwen, M., & Bechtel, G. (2000). Characteristics of nursing doctoral programs in the United States. Journal of Professional Nursing, 16, McKenna, H. (2005). The mission and substance of doctoral education in nursing. Retrieved December 5, 2005, from Meleis, A., & Dracup, K. (2005). The case against the dnp: History, timing, substance, and marginalization. Online Journal of Issues in Nursing, 10 (3). Retrieved November 12, 2005 from National Organization of Nurse Practitioner Faculties. (2004). Recommendations for the practice doctorate. Retrieved October 26, 2005, from Newman, M. A. (1997). The professional doctorate in nursing: A position paper. Image: Journal of Nursing Scholarship, 29, O Sullivan, A., Carter, M., Marion, L., Pohl, J., & Werner, K. (2005). Moving forward together: The practice doctorate in nursing. Online Journal of Issues in Nursing, 10 (3). November 12, 2005, from

16 NursingWorld OJIN: Difficult Professional Choices: Deciding Between the PhD and t... Page 16 of 16 Robb, W. (2005). PhD, DNSc, ND: The abcs of nursing doctoral degrees. Dimensions of Critical Care Nursing, 24, Silva, M.C. & Ludwick, R. (2006). Ethics column: Is the doctor of nursing practice ethical? Online Journal of Issues in Nursing, 11(2). Retrieved May 11, 2006, from Sperhac, A., & Clinton, P. (2004). Facts and fallacies: The practice doctorate. Journal of Pediatric Health Care, 18, Starck, P. L., Duffy, M. E., & Vogler, R. (1993). Developing a nursing doctorate for the 21 st century. Journal of Professional Nursing 9, Sterling, Y., & McNally, J. (1999). Clinical practice of doctorally prepared nurses. Clinical Nurse Specialist, 13, Texas' first doctor of nursing practice degree. Newsroom. Retrieved May 12, 2006, from University of Texas School of Nursing. (2006). UT nursing school at Houston to offer Texas' first doctor of nursing practice degree. Newsroom. Retrieved May 12, 2006, from Veeser, P., Stegbauer, C., & Russell, C. (1999). Developing a clinical doctorate to prepare nurses for advanced practice at the University of Tennessee, Memphis. Image: Journal of Nursing Scholarship, 31, OJIN: The Online Journal of Issues in Nursing Article published December 22, 2006 Submit Letters to the Editor View Letters to the Editor Related Articles NursingWorld Home Front Page

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