In support of diversity in doctoral nursing education

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Nursing is a relatively new profession throughout the world. In the United States (USA), the first Bachelor of Science in Nursing (BSN) degree was granted by Yale University in 1937, and it was not until the mid‐1950s that there were graduate degrees in nursing science. Thus, nursing education is uniquely positioned to be nimble and build an infrastructure appropriate to the complexity of contemporary and future healthcare challenges. In the USA, the profession has responded to this opportunity by recognizing the value of both Doctor of Philosophy (PhD)‐ and Doctor of Nursing Practice (DNP)‐prepared nurses, creating a model that is being emulated globally by other Schools of Nursing and across other health professions.
For too long, a gap has existed between knowledge discovery—seen as the domain of PhD scientists—and successful implementation of new knowledge. While there is increasing discussion of translational and implementation science, there are too few translators and models of successful implementation. It is estimated that a 17‐year lag exists from discovery to implementation of new science (Balas & Boren, 2000). We argue that DNP‐prepared nurses represent a critical link between knowledge discovery and successful clinical translation and implementation. At its core, the DNP preparation focuses on bringing science to practice and creating better healthcare outcomes through testing and implementing improved models of care. The DNP is prepared to impact health systems through bridging not one but two gaps; first between academic research and clinical implementation; and second between clinical implementation and policy translation. The role of the DNP has evolved synergistically with PhD preparation, and together they are mutually reinforcing.
Nursing has evolved rapidly over the last few decades, both in the USA and internationally. Today, the nurses comprise 80% of the global health workforce and we provide 90% of healthcare services worldwide (WHO, 2008), especially in the most marginalized communities, where nurses are often the sole source of primary care. The DNP education prepares and empowers nurses for their increasingly complex managerial and clinical roles, taking into account the ability to understand and assess the social determinants of health (SDH) while advocating for improvements across the full spectrum of factors that affect health outcomes of individuals and populations.
DNP‐prepared nurses are not only needed, they are urgently required in order to maximize the expansion of nurses' scope of practice, as we are called upon to practice independently, effectively and efficiently as the primary providers of health care to the majority of the world's population. The healthcare worker shortage is estimated to be 4.2 million healthcare workers (WHO, 2008), especially in rural areas. Expanding our clinical and managerial education to meet this gap is necessary, especially given that nurses are more likely than their physician counterparts to remain in rural and remote areas (Grobler et al., 2009; Laven & Wilkinson, 2003; Woloschuk & Tarrant, 2004).
While the DNP is important for enabling nurses to provide primary care, there are other equally compelling reasons to provide this educational option alongside the PhD. Practice‐oriented doctorates are available in every other health science, as it is increasingly recognized that novel science does not automatically translate into adoption and successful implementation. The management and leadership component of practice‐oriented doctorates, such as the DNP, ensures a full place at the decision‐making table at hospitals, clinics and other care sites where planning and allocation of resources are made. Nursing cannot truly fulfil its mission until we achieve clinical, political and institutional parity as decision makers, policy makers, advocates and educators.
In nursing and across health sciences, there is a certain amount of “degree snobbery” and hierarchal ranking by educational attainment.
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