The DNP: Combining Leadership and Nursing

Dr. Kristen Williams works at Southern Health Associates as a family nurse practitioner in Troy, Alabama.

Dr. Kristen Williams works at Southern Health Associates as a family nurse practitioner in Troy, Alabama.

If there’s one thing the world became acutely aware of during the COVID-19 global pandemic, it’s the immeasurable value that nurses bring to any health care organization. But, even before the pandemic, the compassion, expertise and strength of nurses have been the drivers of quality care in hospitals, doctor’s offices, ambulatory care centers, and other health care settings.

For many nurses, finding ways to add even more value to their training is something they’re constantly looking to do. They might want to hone their clinical and soft skills, deepen their understanding of the business of health care, and/or navigate a path to an administrative role. Whatever their professional goals might be, earning a Doctor of Nursing Practice (DNP) degree is a path nurses can take to achieve them.  

Dr. Spurlock
Dr. Spurlock

What is a Doctor of Nursing Practice?

“A DNP is the highest clinical degree in nursing,” explains Amy Spurlock, Ph.D., coordinator and professor in Troy University’s Doctor of Nursing Practice program. For advanced practice nurses — such as nurse midwives, CRNAs, certified nurse practitioners, and certified clinical nurse specialists — a DNP is the pinnacle of their nursing education. These professionals have already completed master’s programs, have earned their certifications and are ready to take the next step in their education.

“We also have students who go straight from getting their Bachelor of Nursing degree to entering the DNP program — the BSN-to‑DNP,” says Dr. Spurlock. “However, because they’re not already advanced practice nurses, they have to choose a specific clinical track when they enter the program.”

DNP vs. Ph.D.: What’s the Difference?

So, why would a person choose to pursue a DNP rather than a Ph.D.? The answer lies in what a student’s professional goals are.

“A DNP program is more practice-based, while a Ph.D. program is more research-based,” explains Dr. Spurlock. “Unlike Ph.D. students, most of our students in the DNP program don’t have a goal of teaching in higher education. Instead, they want to earn the highest degree in nursing. A lot of nurses get into the profession because they want that practice piece. The DNP program provides that.”

For family nurse practitioner, Kristen Williams, the clinical emphasis of the DNP is exactly what she was looking for. Dr. Williams, who graduated from TROY with a DNP in 2017, knew which degree option she wanted to advance her nursing education. “Although I appreciate and use research and evidence-based practice daily in my current work environment, I chose the DNP over Ph.D. due to the clinical setting and patient interaction that comes along with this degree.”

Another factor that can influence the choice between DNP vs a Ph.D. in nursing is convenience. “A lot of Ph.D. programs require a face-to-face presence in the classroom,” says Dr. Spurlock. “For many of our students — particularly those who are working or who have families — that’s not possible. So, an online DNP program like the one at TROY is a better fit for them.”

For Dr. Williams, the kind of flexibility that the online program provided was critical. “The online experience made the balance of home, work, and school very manageable,” she adds. “I experienced two pregnancies throughout the program, and I am very thankful for the flexibility the online courses provided.” 

But as is usually the case when combining work, education and other responsibilities, adjustments are necessary to make it all work. “I strengthened my time management and organizational skills to help get lectures and assignments completed before deadlines. I also emailed my professors regularly since we did not meet in person.” 

The Advantages of Earning a DNP

Currently, a DNP isn’t required to practice as a family nurse practitioner (FNP) or for a nursing leadership role. However, that’s likely to change. “We think that a DNP will be required for advanced practice nursing in a few years,” says Dr. Spurlock. “So, our program here at TROY is already meeting that need. Also, some areas of the country already prefer DNP-prepared nurses.”

Students pursue the DNP degree for a variety of other reasons. “Some will do it for career advancement,” says Dr. Spurlock. “For example, they might want to move into an administrative role — such as chief of nursing or director of research. And others want to move into teaching and know that they’ll need a doctorate — like the DNP — if they’re going to be on a tenure track.” 

In some cases, earning a DNP can result in a salary increase, particularly when the degree allows a nurse to move into a higher-level position. However, that’s not the primary reason most nurses decide to pursue the degree. “Our students aren’t expecting a pay bump,” says Dr. Spurlock. “Instead, they’ve come into the program because they want to make a difference for their patients and communities. Many of them work in health professional shortage areas and medically underserved areas. So, the knowledge and experience they gain through the DNP program can be taken back to those communities and put into practice with the patients.”

Community practice and career flexibility are two reasons that spurred Dr. Williams to pursue her DNP. “I chose to begin the program so that I could further my education and begin a role as a health care provider to serve our community. Having this degree also gives me the option to teach in nursing programs,” she adds. 

Developing and Enhancing the Skills Needed for Excellence

While heightening clinical skills is a major focus of the DNP program, it isn’t the only priority. “Students also learn how to conduct studies and implement evidence into practice,” explains Dr. Spurlock. “They become good consumers of research and learn how to read and apply peer-reviewed research. By understanding how to read and understand journal articles, they’re able to continually improve their own practice.”

Other non-clinical skills students learn include those related to written and oral communication. “These skills become highly developed during the program,” says Dr. Spurlock. “Anyone earning a DNP is preparing to be a nurse leader. So, having the ability to communicate with the public and your peers in a manner that will allow people to understand what you’re saying is crucial. Excellent communication skills are also extremely important in helping patients develop their health literacy.” 

For most doctor of nursing practice students, the program is another step in achieving their goals. That was the case for Dr. Williams, who advises, “Consider how it fits into your personal and professional goals. It is a great way to strengthen knowledge of incorporating evidence-based practice into your organization to improve health outcomes. It has taught me to make evidence-based decisions when it comes to my patients’ health care.”

Earning a Doctor of Nursing Practice Degree at TROY

The DNP program at TROY, which launched in 2009, was the second one approved by the state of Alabama. “We’ve been doing this for quite a while and have a lot of experience in delivering a great learning experience for our students,” says Dr. Spurlock.

The program has very good outcomes, with 70-90+% of students finishing it. “We try to recruit students who will be successful,” says Dr. Spurlock. In addition to the excellent graduation rate, students from the school also have a good passing rate for certifications.

Small groups — typically consisting of 35 to 38 students — are admitted to the program each year. “We like that number because we can devote time and attention to each student’s success,” says Dr. Spurlock. Students can be admitted in August, January and May.

Students enrolled in the DNP program at TROY complete their studies entirely online with only a few exceptions. The only time all students are required to physically come to campus is for orientation in August. During this three-day immersive event, students can meet one another and walk around the campus. “The students enjoy getting to know each other and having a chance to interact in person with faculty,” says Dr. Spurlock. “Also, they like knowing that we’re a brick-and-mortar university.”

Students in TROY’s DNP program choose one of two tracks of study — nurse leader or family nurse practitioner. All students in the program take a set of core courses, which include topics such as applied biostatistics, evidence-based practice, leadership, health care policy, informatics, and health disparities. In addition to the coursework, 1,000 clinical hours beyond those earned for a BSN are also required.

Family nurse practitioner students are required to come to campus at the beginning of their first FNP course and at the end of their last FNP clinical course to demonstrate specific clinical skills, such as health assessments and suturing.

The family nurse practitioner track was in place at the beginning of TROY’s DNP program. It is currently the most popular track — particularly for those who enjoy practicing in a clinical setting and want to enhance their practical skills. However, the nurse leader track — which was added more recently — is also attracting interest from those wanting to pursue leadership roles.

For post-master’s students, it typically takes two years to complete the program if they’re taking a full-time class load. However, there is also the option to complete the program on a part-time basis. A full-time schedule consists of three to four classes per semester and one to two classes during the summer. For part-time students, two to three classes per semester is the norm.

Students in the BSN-to-DNP program can complete their studies in three years. “It’s designed to be full-time,” says Dr. Spurlock. “We want all of the knowledge they have to be fresh in their minds so they can pass the certification exams.”

Every student is assigned an individual degree planner to help them map out the best path to completion of their DNP. “We keep it very flexible,” says Dr. Spurlock. “Their plan is looked at every semester and changes can be made if needed.”

Implementing Evidence into Practice

“The hallmark of our DNP program is a doctoral synthesis project,” says Dr. Spurlock. “It provides students opportunities to implement evidence into practice.” Students work on their projects over four semesters. They’re required to identify, develop, implement and evaluate evidence that they’ve put into practice themselves.

At the beginning of their program of study, students are matched with a member of the graduate nursing faculty — who serves as the chair of their doctoral committee — and another faculty member or outside mentor with a doctorate. These individuals guide the student through the project courses.

“Students have to put together a proposal for a study they want to conduct for their project, show a need for that study, develop a methodology for it, get it approved, and then implement and evaluate their findings,” explains Dr. Spurlock. “It’s not a dissertation because it’s not original research. Instead, they’re looking at research that’s already been conducted and then implement it within the practice where they’re working.”

Students can focus on any clinical area they prefer for their doctoral synthesis project. Once they’ve decided what that area is, they choose a preceptor. This is someone the student wants to learn from, who they will work with to do hands-on clinical hours, and who will provide guidance regarding the project. “For students who are interested in studying a drug protocol, a Pharm.D. might be their preceptor,” says Dr. Spurlock. “If a student’s interest is in health care policies and resulting implications, they might work with a hospital CEO.” Students can work with multiple preceptors during their time in the DNP program.

During their last semester in the program, students submit their projects to the graduate school and send an abstract to a professional conference. “Almost all of our students get accepted to present at a national conference,” says Dr. Spurlock.

Students share their projects during a 30-minute presentation before graduating and then develop a manuscript that’s submitted to a peer-reviewed journal for potential publication. “Many of the students are published,” says Dr. Spurlock. “Recent student articles that have appeared in journals have covered topics such as medications used to treat stroke patients in the ER. Another project focused on the implementation of a depression screening tool in a rural practice in Mississippi. There were a lot of health disparities in that area and there was a stigma within the population regarding depression. Our student implemented a depression screening at the practice for every patient who came in — no matter what the reason. It resulted in a practice change because the screening improved outcomes and helped remove the bias against treatment for depression.”

The doctoral synthesis projects students complete are having a positive impact on communities throughout the country. “The work they do on their projects has a lasting effect on public health,” says Dr. Spurlock. “Our students are very successful at that.”

What is Leadership in Nursing?

Many of the students in TROY’s DNP program choose the family nurse practitioner track because their interest is in serving as a primary care provider. However, others are more interested in moving into nursing leadership roles, such as a chief nursing officer or director of outpatient care services. For these students, the nurse leader track is an ideal choice.

“Our nurse leader students learn about health care administration, informatics, management information systems and other topics that will help them take on more formalized management roles,” explains Dr. Spurlock. “Because they’ll be overseeing other employees and units, they have to have an understanding of policy, have a certain level of comfort with informatics, and know what it takes to be an effective manager.”

Many of those who choose the nurse leader track are already serving in management roles, such as nurse supervisors, where they work. For their doctoral synthesis project, a popular topic area is quality improvement. “One example of this is exploring the use of skin bundles to prevent pressure injuries,” says Dr. Spurlock.

The DNP Springboard

“As a faculty member in the DNP program, one of the most rewarding things for me is watching our students grow,” says Dr. Spurlock. “Many of them never thought they’d get a doctoral degree. But, two or three years after they enter the program, they’re presenting their doctoral synthesis project and sharing their fabulous evidence.”

Another effect of the DNP program that Dr. Spurlock sees is how it opens options for graduates that they wouldn’t have had otherwise. “The DNP is like a springboard,” she says. “It allows them to go in so many different directions. I’m constantly receiving calls from graduates who tell me they’ve gotten published, or they just received a promotion, or that they’re now teaching.”

Family nurse practitioner Dr. Williams recommends the program enthusiastically. “I got my BSN from TROY, so I knew how dedicated their faculty and staff were to helping their students succeed. I would recommend the TROY DNP program to others. They are committed to helping their students succeed both personally and professionally. Their curriculum is well-organized and the faculty and staff are very knowledgeable and helpful.” 

Since the DNP program at TROY began, 163 students have graduated from it. “I love seeing them go out and make a difference,” says Dr. Spurlock. “The work they’re doing multiplies the impact they have on their patients.”  

You can explore TROY’S Doctor of Nursing Practice online program on our website and request more information.