Spotlight on Nursing

In the health care environment of today, clinical skills alone do not suffice for health care providers to deliver quality care and value to their employers. While health care costs continue to surge and patients evolve in their approach to their own health, hospitals and health system leaders have been challenged to not only care for patients as they traditionally have, but also to increase access to care, address social determinants of health, engage in innovative care delivery strategies, provide affordability and value for patients, and partner with patient consumers.¹

Historically, nurses have prepared for practice by focusing on clinical skills. Terminal degrees in nursing were limited to the research-focused doctorate programs, Doctor of Philosophy (PhD) or Doctor of Nursing Science (DNS).² However, this education has proven to be insufficient to adequately prepare nurses to serve in leadership roles and to contribute in the organizational, delivery, and policy settings related to care. In 2010, the Institute of Medicine, now known as the National Academy of Medicine, called for reconceptualizing educational programs that prepare today's nursing professionals.³ Until recently, only a small number of nurses completed graduate education. In recognition of the increasing complexity of health care, the profession has reformed its pathways to support completion of doctoral education. This led to elevating the educational options for nurses with the establishment of a practice doctorate: The Doctor of Nursing Practice (DNP) designed to “inform science, enhance clinical practice, influence policy, and impact best practices for educating nurses as clinicians, scholars, and leaders.”⁴

In earlier times, a master's degree was the accepted preparation for advanced practice nursing (APRN) defined as the categories of nurse practitioner (NP), clinical nurse specialist (CNS), certified nurse midwife (CNM), and certified registered nurse anesthetist (CRNA). While certified APRNs are grandfathered in at the master's level, the preferred degree is the DNP. The DNP degree represents the highest level of preparation in nursing practice for nurses seeking a focus on the scholarship of clinical practice, application of clinical skills, and the integration of the two.⁴ Hallmarks of the APRN DNP graduate go beyond clinical competency to include evidence-based practice, quality improvement, and systems leadership.³ DNP programs focus on innovative, evidence-based practice that reflects the application of credible research findings.⁴

In contrast to research-focused doctoral programs, which may prepare graduates to generate knowledge through research and statistical methodologies, practice-focused doctoral programs such as the DNP teach graduates to generate knowledge through innovation of practice change, the translation of evidence, and the implementation of quality improvement processes in specific practice settings, systems, or with specific populations to improve health or health outcomes.⁵

Since its inception, the DNP credential has expanded dramatically as it recognizes that nurses are lifelong learners who enter and grow within their discipline to improve access to and quality of care. Schools nationwide that have implemented DNP programs have reported sizable enrollment.⁶ According to the Hawai?i State Center for Nursing 2019 Workforce Supply Report, 84% of master's prepared APRNs continuing their education are working toward the DNP.⁷ The remaining are seeking degrees in business, education, and other fields.

After graduation, employers recognize the unique contributions of DNP-prepared nurses, and the demand for nurses with the DNP will continue to grow.³ Almost universally, nurse educators agree upon the value of the DNP in preparing individuals for advanced nursing practice.⁶

In Hawai‘i, nurses continue to move into executive positions as DNP-prepared nurses assume roles focused on leadership, health informatics, public health, knowledge translation, quality improvement, and applications of implementation and improvement science.⁴ DNPs fill roles such as chief nurse executive (CNE), director of quality improvement, director of evidence-based practice, and chief information officer.⁴

UH Mānoa Nursing began its DNP program in 2014 and is accredited by the Commission of Colleges of Nursing Education (CCNE). In 2015, the school transitioned from a post-master's degree and enrolled its first class of Family and Adult-Gerontology Nurse Practitioners into the DNP. In 2019, there were 101 students enrolled in the DNP program offerings, including 25 who graduated that year. These APRNs are working throughout the islands in all health care settings improving access to health care.

In the ever-changing landscape of health care, patients will benefit from having those in the most trusted workforce not only in direct-care roles but also advocating for them at all levels of decision-making and policy setting.