Choosing a Nursing Doctorate

I remember when I started my master’s program at Vanderbilt. Just the idea of making it through the advanced classes and passing my boards—that was enough to keep me occupied. A doctorate degree? What are these people nuts? I just need to pass neuroscience, psychopharm, and theory of personality. I can’t even begin to think about a doctorate degree.

Well, I finally graduated, passed my boards, and started working. I was a psychiatric nurse practitioner working independently in a small clinic with a handful of counselors. Despite being exhausted, I felt the inner lifelong learner urging me to consider more schooling. The logical next step? Why, a nursing doctorate of course! But how to choose?

While the nursing profession is by no means perfect, one thing that makes it super awesome is its absolute determination to evolve in order to meet its #1 priority: the needs of our patients. Our history reveals groups of men and women determined to help, which means changing when things aren’t quite right. Nursing education is an example of this. Again, not perfect, but focused on the big picture: patient care.

There are a handful of different nursing doctorates, but essentially you need to decide between two types: a research doctorate or aprofessional doctorate.

1. A research doctorate focuses on generating new knowledge. The epitome of a a research doctorate is a Doctor of Philosophy (PhD). Nurses can purse all types of PhDs: PhD in Health Policy, PhD in Epidemiology, PhD in Information Systems, and of course, PhD in Nursing. 
2. A professional doctorate is the terminal degree for a practicing clinician. While the research doctorate generates new knowledge, the practice doctorate implements this knowledge (aka translational research).  A physician, for example, has a professional doctorate in medicine or osteopathy (MD & DO), a pharmacist has a professional doctorate in pharmacy (PharmD), and a physical therapist has a professional doctor in physical therapy (DPT).  In nursing, our professional doctorate is the Doctor of Nursing Practice (DNP)  

Struggling to decide between a DNP or PhD? These are the questions I would ask yourself

• Do I want to continue working clinically as an advanced practice nurse?
• Do I wish to be a tenured professor at a big university?
• Would I rather teach in a classroom or provide clinical education at the bed side?
• Is prestige important to me?
• Do I want to generate unique research that adds to the body of nursing literature?
• Do I want to implement other nurse’s research into the clinical setting?
• How long do I want to be in school?
• Do I want to continue working as an advanced practice nurse while earning my doctorate?

First, Some Fun Hypotheticals

As you ponder these questions, read the following scenarios, and pick which one sounds best to you:

#1: The Small Business Owner

You started your own business about 3 years ago and it has been an exhilarating experience. Not only are you making more money, but you’re able to run things your way. No more 15 minute medication appointments. You give all your patients at least 30 minutes. You even provide psychotherapy and have hired a massage therapist and a yoga instructor for a more holistic patient experience. 

#2: The Clinical Educator

Today you have patients in the morning and students in the afternoon: 1 new psychiatric evaluation, 5 follow-up medication appointments, lunch, and then you are heading over to the inpatient unit where you teach BSN-students in their psychiatric clinical rotation. While you love being a nurse practitioner, you also love teaching these novice nurses at the bedside. You couldn’t imagine a life without doing both. 

#3: The Tenured Professor

You have two classes to teach today: Theory of Personality at 10AM and Behavioral Neuroscience at 2PM. You hurry to update your PowerPoint with the latest neuroimaging research. The rest of the day is meetings and hopefully finding time to make headway on your new research. You are investigating compassion fatigue in front line mental health nurses. You recently applied for and received a grant from NIMH to conduct a qualitative study. Next year you hope to present your findings with a poster at the American Association of Nurse Practitioners conference. You are lucky because you are working closely with a PhD student who is helping with your research too. You are her mentor and have big hopes for her. 

#4: The Full-time Clinician

You have a fully booked schedule today: 3 new psychiatric evaluations, 10 follow-up medication appointments, and a meeting with your supervisor. You check your mailbox, review new patient lab work up, and sign off on some charts. You spot Dr. Smith at the coffee machine and quickly review a tough patient case with her. During a no-show, you pursue your online subscription of The Prescribers Letter to stay up to date on the newest advances in psychopharmacology. As the day comes to an end you meet up with your boss to discuss your idea of implementing a benzodiazepine contract into the standard clinic protocol. You explain that you conducted a literature review and found positive patient outcomes using this patient-provider contract. Your supervisor agrees and allows you to implement the contract and evaluate its usefulness. 

#5: The CNO

You work at a large hospital network as the Chief Nursing Officer. You do not provide any direct patient care, but instead you run the hospital and oversee all the nurses and advanced practice nurses. You were recently a big part of the hospital-wide EHR adoption strategy. You are involved in budgetary decisions, and are able to implement new research on a hospital wide scale.  Last year, you helped your hospital gain Magnet Recognition.

#6: The Lobbyist

You work full time as the president of your state nurse practitioner organization. You are an astute lobbyist fighting for the rights of nurse practitioners. You have organized successful campaigns in the past and as a result have increased access to care for patients in rural settings. 

Now, to answer the questions above: 

Do I want to continue working clinically as an advanced practice nurse?

A DNP and a PhD could both continue to work in a clinical setting. You make your own destiny! But, if you know in your heart of hearts that clinical is where you want to be, go DNP. 

Do I wish to be a tenured professor at a big university?

Again, both a DNP and PhD can be tenured at most universities. I did say most. Some universities do NOT allow DNPs to receive tenure, although this may be changing. If you see your self working at a big-wig university and you want to be tenure tracked, go PhD. 

Would I rather teach in a classroom or provide clinical education at the bed side? 

Did you answer classroom? Go PhD. Did you say clinical? Go DNP. 

Is prestige important to me? 

Both degrees are very important in their own way; however, there does exist some dissent. In my opinion, right now, a PhD is generally viewed as more prestigious. In the future this could change, but from my perspective, no matter what field you’re in, medicine, nursing, pharmacy, English, math, or computer science, a PhD is perceived as the apex of education. If prestige is something you are yearning, go PhD.

Do I want to generate unique research that adds to the body of nursing literature? 

PhD!

Do I want to implement other nurse’s research into the clinical setting?

DNP!

How long do I want to be in school?

Do you want to be in school <3 years? Go DNP. About 3-5 years? Go PhD.

Do I want to continue working as an advanced practice nurse while earning my doctorate?

If you would like to continue working as an advanced practice nurse while you receive your doctorate, you will want to go with a DNP. Some PhD programs allow you to work but it is generally less than 10 hours per week. As a PhD student, you will likely receive grant funding that covers tuition and a monthly stipend (usually <$20,000/year). You will be expected to work as a research and/or teaching assistant. You will be very busy, and continuing to work as an advanced practice nurse is highly unlikely. On the other hand, most DNP programs are designed to allow you to continue working on a full-time basis. You will likely NOT receive any grant funding for your DNP. 

As for the scenarios above: 

#1 The Small Business Owner — Go DNP, and consider a dual DNP/MBA program 

#2 The Clinical Educator— Go DNP, and consider a nurse educator certificate 

#3 The Tenured Professor— Go PhD

#4 The Full-time Clinician— Go DNP

#5 The CNO— Either DNP or PhD, but if I must pick, go DNP

#6 The Lobbyist— Either DNP or PhD, but if I must pick, go PhD, consider a PhD in Health Policy 

And, fun fact, I am about to finish my DNP, and I work at a super awesome health information technology company in downtown Seattle. DNP or PhD? Is there a wrong choice? We are nurse practitioners: the sky is the limit! 

**Again, please remember that I am making generalizations and there are always exceptions.**