There was a time not so very long ago that the only degree in nursing beyond a master’s in science was the PhD in Nursing. More recently, the DNP, Doctor in Nursing Practice, came into being and although they are both doctoral degrees, they each follow very different career paths. Even though both degrees now have a solid history, there is still some amount of confusion as to what can be done with each degree. That is to say, how exactly do they differ?
The short answer is simply this. A nurse holding a PhD in Nursing is best suited for research and/or education. A nurse with a DNP is most likely going to opt for the clinical side of nursing practice.
A Closer Look at the Functions of a DNP
While that is an over-simplified definition, the point is that a DNP is primarily trained in patient care and is able to function in the same ways as doctors. They can diagnose, treat, and prescribe medications. They can function autonomously in 23 states. This means they do not need to work under the supervision of a medical doctor. In the other 27 states they either have limited autonomy or must be directly under a doctor. With that said, some states are currently looking at granting autonomy, but no changes in legislation have been finalized yet.
Nurses who hold a DNP are also likely to hold positions on the clinical side of nursing such as:
- CNO – Chief Nursing Officer within a healthcare institution
- CEO – Chief Executive Officer within a healthcare institution
- University professor
- The field of healthcare policy research and advisor
Along with other jobs that are geared toward the clinical side of patient care.
What Can PhD Level Nurses Do?
Here is where it gets a bit confusing. Even though the length of time it takes to earn a PhD in Nursing is longer than it takes to earn a Doctor in Nursing Practice, a PhD nurse can only function in the same capacity of an RN. This means they cannot diagnose, treat, or prescribe medication.
A PhD in Nursing such as the degree program offered at Wilkes University prepares the graduate for work in the field of research and also in education. To put it simply, you will not find a nurse practitioner with a PhD in Nursing unless they followed an NP track in a master’s program. If they continue to work as a nurse in a hospital, for example, without the Master’s in Nursing Practice, they will function as an RN, only.
Why Do We Hear More About DNPs Than PhDs in Nursing?
Even though a PhD in Nursing is still considered to be the gold standard in the field, fewer and fewer students are pursuing this degree. The only real evidence-based reason for this is because of what they can do with the degree.
Bear in mind that a Doctor of Philosophy in Nursing is focused on research and/or education. While there are many jobs open in those types of positions, there are infinitely more jobs available for DNPs who can function in much the same way as doctors. In fact, in those 29 states mentioned above, they do exactly the same thing as doctors do! They are autonomous and are not reliant on working under a doctor. In the remaining states, although they can do all the same things, everything they do is open to scrutiny by the doctor under which they are working.
Why Are There More Jobs Available for DNPs?
The answer to this should come as no surprise. There has been a severe shortage of doctors in literally every country on earth. Many people believe it is the cost of medical school that is the ultimate reason for a shortage in MDs, but that isn’t the only reason.
Consider for just a moment how long it takes before a doctor can practice. They must be through med school before they can even become an intern or resident doctor. A DNP, however, can begin practicing nursing even with only an associate degree. That would be after two years of education.
While they couldn’t practice as a nurse practitioner, it is possible to begin working in the field after a short period of time. They can then go on to study for the next degree which would happen to be a Bachelor of Science in Nursing. From there they can go on to a master’s program or an accelerated DNP program but always while working in the field if they so desire. This is not the case with doctors and one of the reasons so many people believe there is a shortage of doctors. The cost and length of an education make it impossible to pursue that career.
Unfortunately, that is not the only reason the shortage of medical doctors has grown. We need to remember that for more than two years, there was a global pandemic. Some doctors succumbed to the virus and others reached their level of burnout. In a career in which there was already a shortage, a huge increase in the number of patients that needed to be seen was unrealistic. It just couldn’t be done. This prompted a growing number of nurses to begin working toward a DNP.
This cannot be said of nurses with a PhD in Nursing. Since they cannot function as a doctor, there was no need to work toward narrowing the gap between patients served and doctors serving them. More and more nurses picked up the mantle, so to speak, in order to begin preparing for a degree that would enable them to treat patients. Now, at this point in history, fewer students than ever before are pursuing a PhD because the need is not as great.
Righting a Wrong Largely Caused by the Pandemic
It can be said that the loss of so many doctors due to Covid-19 and the already critical shortage of physicians led to a boom in students pursuing a DNP, enabling them to go into practice relatively quickly. With that said, let’s look at some sobering statistics about nursing in general so that you can see why we need to right that wrong, i.e., why we need to reemphasize the need for PhDs in the nursing field.
Let’s start with some statistics. Currently, the shortage of nurses has grown as well for several reasons related to the pandemic. Many left due to burnout. Others succumbed to the virus and others still left the profession due to mandates in vaccinations.
With more and more nurses focusing on filling the void in physicians, there are fewer nurses entering the side of the profession that focuses largely on research and education at a graduate level in leading universities.
Having said that, consider for just a moment how new nurses will be educated if fewer nurses are going into the educational side of nursing. According to current numbers, only 13% of nurses in this country alone have graduate degrees in the profession. This means that only that many nurses are even eligible to become teachers even at lower levels of education. The rule of thumb is that a college or university professor needs to hold a degree at least on level above the class they are teaching.
So, of those 13% of eligible teachers, only 1% hold a degree high enough to teach graduate students of the highest level. Sadly, this equates to fewer RNs, fewer NPs, fewer DNPs and fewer PhDs in Nursing. That could have a huge impact on nursing going forward, resulting in an even greater shortage than we already have.
With that being the case, we now need more nurses on a PhD level who can inspire future generations of nurses with the research they have conducted. We need more PhD level nurses to lead teams of researchers and developers. With fewer educators out there, who will prepare nurses to take on leadership roles that will continue to shape the landscape of healthcare?
The Need to Keep Up with Advances in Research
Another point which should be emphasized is the fact that the tools for conducting research are advancing along with technology. No matter what type of research a PhD is conducting, it is all going to be impacted by Big Data. This is a relatively new area within research and one that can offer amazing strides in healthcare.
It’s all about evidence-based findings and what better way is there to document evidence than in numbers that are provided in real time? Whereas DNPs focus on clinical-based evidence, PhDs focus on research which is often conducted in non-clinical approaches. As vague as that may sound, the point is that PhDs are being educated in methods of research pertinent to education whereas DNPs are being educated to be leaders in clinical applications.
Where Nurses with a PhD Are Likely to Be Employed
It seems as if we keep returning to the same point. There is an extreme shortage of nurses and so the obvious place of employment for Nurses with a PhD degree would most likely be as educators on a university level.
Nurses with a PhD would also likely find employment in research. Often this is funded through grants to a university, but other healthcare related industries also seek researchers well-versed in scientific inquiry. To put it rather bluntly, a nurse with a PhD in Nursing is likely to find employment with a hospital, a teaching hospital, or a university, each of which depends on research to shape policy and guidelines within the field of nursing.
Which Is Better for You?
The only way to really determine which career path is better for you is to first look at what you want to do with your career. Do you want to continue working with patients, generally or within a specialty, or are you better suited to being more isolated in a laboratory type setting?
DNPs can work in private practice, hospitals, universities and as contractors who are sent to various areas of the nation that are extremely underserved. Some hospitals employ temporary DNPs to help work through months of backlogs in patient care.
PhDs, on the other hand, are often employed in research that is on the cutting edge of healthcare reform and policy. You would rarely interact with patients unless you continued to serve in the capacity of an RN. If you thrive better in areas where you can pursue finding answers to questions, then you would definitely want a Doctor of Philosophy in Nursing.
On the other hand, if you want to specialize in a specific area of nursing, then you would work toward an APRN, Advanced Practice Registered Nurse. Here it is good to note that all Registered Nurses are not APRNs, but all Advanced Practice Registered Nurses are just that. They are all registered nurses.
Looking back again at a PhD in Nursing, this degree would give you the tools you need to conduct research that will advance the field of nursing. As an educator you will stimulate the minds of the next generation of nurses. While a DNP can teach at a college level, most prefer to work a patient-facing side to healthcare. They may do research, but only evidence-based research that can help design hospital policies for nurses and their roles within an institution.
Fortunately, both DNPs and PhDs are in great demand and both degrees have their place in the future of nursing here at home as well as around the world. The only suggestion you can be left with is that it’s time to do a bit of introspection. Some nurses want to work one on one with patients while others would rather look at patient care as a whole. They would rather research better and more effective ways of serving patients while DNPs would rather take those advances into practice. Which is better for you? Only you know where you want to be in another decade, so that is how you should make your decision today.
