Will Requiring the DNP Improve the Quality of Oncology Nursing?

Over the past decade, there has been increased advocacy on the part of many influential voices in our profession to require the Doctor of Nursing Practice (DNP) degree for entry-level nurse practitioner roles.

In 2004, the American Association of Colleges of Nursing endorsed the posi- tion of moving from master’s training to the doctorate as the level of preparation necessary for nurse practitioners by 2018.¹ In 2018, the National Organization of Nurse Practitioner Faculties changed the commitment to require the DNP as entry level for nurse practitioner practice by 2025.²

Although there is not currently a requirement for the DNP for nurse prac- titioners, in keeping with this goal, many programs have already made this transition and eliminated Master of Science in Nursing (MSN) as a degree offering for nurse practitioner specialties.

Origins of the DNP Degree

The DNP was first offered in 2001 by the University of Kentucky as a mechanism to equip nurse practitioners with expanded knowledge to help them navigate a rapidly changing and increasingly complex health care environment. Expanding from fewer than 50 programs in 2006 to 357 programs in 2020, the DNP has become a highly—but not universally—sought-after achievement in nurse practitioner education.³

Although the discussion on whether to require a doctorate for practitioners is not exclusive to our field, nursing is one of the few health care professions that do not require education at the doctoral level. Pharmacy, dentistry, optometry, psychology, physical therapy, occupational therapy, and audiology either require or offer doctoral-level education.

Key Points for and Against DNP Requirements

Both within and outside the profession of nursing, the calls for and against requiring a DNP have been increasingly prevalent over the past decade. Those who support the DNP for entry-level practice argue that it places nurse practitioners on education parity with other health professions. Advocates note that the DNP degree reflects the quality and rigor of education that nurse practitioners receive to provide health care.

The health care environment is more complicated than ever before and propo- nents of a DNP requirement stress the benefits additional education provides in key areas, such as evidence-based practice, quality improvement, health policy, interprofessional collaboration, and organizational leadership, better preparing nurse practitioners to practice and lead in the contemporary health care environment.

Those who oppose a mandate for the DNP argue that extant research demonstrates that nurse practitioners are contributing to effective patient care and positive clinical outcomes without a broad doctoral requirement. Research has shown that nurse practitioners are already providing high-quality care with no statistically significant difference in outcomes compared with physicians. Evidence also shows that patients cared for by nurse practitioners are more likely to receive education on health promotion and to report higher satisfaction with their care.^4,5

Opponents also cite a lack of differentia- tion between MSN- and DNP-prepared nurse practitioners, as they have the same scope of practice. Some physician organizations have noted that confusion could result for patients in clinical settings when multiple care providers, physicians and nonphysicians, identify themselves as a “doctor,” which is a concern that has been widely dismissed, as no 1 profession owns exclusive rights to the title.⁶

Considerations for Oncology Nursing

It remains to be seen whether the goal of requiring a DNP by 2025 will come to fruition. However, as more nurse practitioners attain the DNP, research is needed to assess the impact of enhanced education on clinical and health system outcomes. Does the DNP make a difference in care? We can’t answer that yet.

As a senior nursing administrator for a comprehensive cancer center, I think doctoral education provides benefits that are particularly relevant and useful for nurse practitioners working with oncology populations. The number and complexity of treatment regimens today and the constant introduction of entirely novel treatment approaches, including next-generation immunotherapies and cellular therapies such as CAR T, underscore the importance of outstanding and consistent education for nurse practitioners.

Few can argue that more education for nurse practitioners would not help
to drive further improvements in health care outcomes, especially for patients with cancer—who are a vulnerable population, requiring highly complex and well-coordinated care. I have also seen nurse practioners play a critical role in targeting and successfully addressing ineq- uities in care and care access in rural and underrepresented communities, driving meaningful progress toward one of the most critical goals for the oncology field.

Personal Perspective

I was one of the first 300 people to earn a DNP when I earned my doctorate in 2008. Over the years, I have observed that DNP education has made me a more effective practitioner and team member.

My education helped me to better navigate the challenges and opportunities of modern oncology nursing, particularly in areas such as leading interprofessional teams, coordinating complex care, using informatics to transform health care, and advocating for equitable health policy. It helped make me a more confident and broadly informed nurse and manager. Knowing how to obtain, analyze, and integrate information is just as important for today’s nurses as professional knowledge itself.

I believe the DNP is an investment in education that gives one a foundation to provide even better care for patients, and I would recommend the doctorate for any nursing professional seeking greater professional opportunities.

Andrew Storer, PhD, DNP, RN, NP, FAANP, is vice president of nursing and deputy chief nursing officer at Roswell Park Comprehensive Cancer Center.

References

1. AACN position statement on the practice doctorate in nursing. American Association of Colleges of Nursing. October 2004. Accessed February 22, 2022. https://bit.ly/3h8m2i6

2. The Doctor of Nursing Practice degree: entry to nurse prac- titioner practice by 2025. National Organization of Nurse Practitioner Faculties. May 2018. Accessed February 22, 2022. https://bit.ly/3h93e28

3. DNP fact sheet. American Association of Colleges of Nursing. Updated October 2020. Accessed February 22, 2022. https://bit.ly/35iyI34

4. Kurtzman ET, Barnow BS. A comparison of nurse prac- titioners, physician assistants, and primary care physi- cians’ patterns of practice and quality of care in health centers. Med Care. 2017;55(6):615-622. doi:10.1097/ MLR.0000000000000689

5. Newhouse RP, Stanik-Hutt J, White KM, et al. Advanced prac- tice nurse outcomes 1990-2008: a systematic review. Nurs Econ. 2011;29(5):230-251.

6. Crausman RS, McIntyre B. Use of the doctor title in clinical settings. J Med Regul. 2009;95(2):4-5. doi:10.30770/2572-1852-95.2.4