In 1979, Case Western Reserve University’s (CWRU) Francis Payne Bolton School of Nursing created the first practice doctorate in nursing (CWRU, 2023). Since then, the need for Doctor of Nursing Practice (DNP)-prepared nurses has significantly increased. In 2004, the American Association of Colleges of Nursing (AACN) Position Statement on the Practice Doctorate in Nursing outlined the need for more nurses with advanced practice nursing degrees. The contributions of a DNP-prepared nurse can be summarized in the AACN’s (2004) definition of nursing practice:
…any nursing intervention that influences healthcare outcomes for individuals or populations, including the direct care of individual patients, management of care for individuals and populations, administration of nursing and healthcare organizations, and the development and implementation of health policy. Preparation at the practice doctorate level includes advanced preparation in nursing based on nursing science and is at the highest level of nursing practice (p.3).
During an interview in October of 2023, Mary Beth Modic, DNP, APRN-CNS, CDCES, FAAN., describes the journey of becoming a DNP-prepared nurse, how it has contributed to a nursing career, and how a DNP can impact patient outcomes.
Leadership can be described as the ability of a person to influence others toward a goal (Northouse, 2021). DNP-prepared nurses are leaders within the healthcare team by influencing patient outcomes and how nurses practice. Doctorally-prepared leaders in nursing are important for implementing high-quality, evidence-based healthcare as they bring unique expertise in research, innovative educational approaches, patient management knowledge, theoretical and statistical expertise, and political awareness (Broome, 2012). When describing her inspiration to pursue a DNP, Dr. Modic mentions a specific event when a nursing leader influenced her to merge clinical practice, evidence, and leadership to improve patient outcomes and nursing practice.
One of the first leadership courses I took was was taught by Dr. Joyce Fitzpatrick from Case Western Reserve University Francis Paine Bolton School of Nursing. This course just captivated me. As a result of taking her course, I went to my leaders at the organization where I work and said: “I want to bring this leadership course to the diabetes mentors.” I wanted them to be exposed to this important information. So my organization’s nursing leader said: “All right, we will make it happen.” For six months, diabetes mentors went on an unbelievable educational ride with Joyce. The stars lined up where I could connect people. It was Joyce who lit up the fire under my bottom. (M. Modic, personal communication, October 27, 2023)
The impact of professional organizations within nursing can be seen throughout the profession’s evolution. In 1896, nurses gathered to form a national organization meant to advance standards of nursing education, establish a code of ethics, and promote the nursing profession (Matthews, 2012). This assembly of nurses, originally known as the Associated Alumnae of Trained Nurses of the United States and Canada, was renamed the American Nurses Association (ANA) in 1911 (ANA, n.d.). The ANA is just one of many professional nursing organizations that impact the nursing profession. Dr. Modic describes several organizations that have influenced her pursuit of a DNP:
I have been an active member of the American Diabetes Association, the National Association of Clinical Nurse Specialists, and others. I was a member of the Academy of Medical-Surgical Nurses for a while as well. I was the president of our local Clinical Nurse Specialist chapter. These achievements were prior to entering graduate school. So, I always felt the importance of being professionally minded. I have been involved in professional organizations that, I felt, I could contribute to and would expand my knowledge. (M. Modic, personal communication, October 27, 2023)
Active involvement in professional nursing organizations not only impacts an individual nurse’s practice but the collective advancement of the nursing profession.
Throughout a person’s professional career, individuals may pursue many different positions. Various roles in nursing may have greater influence in shaping your path, while others are a smaller stepping stone in your career.. According to Brown and Lent (2013), a career refers to a collection of work positions held throughout one’s work history, suggesting that each job contributes to building a career, significant or not to an individual. However, how a career is developed can be described as a personalized process of moments rather than a collection of jobs. Career development includes placing an individual at the center of their career, including their roles, career choices, and relevant events that occur throughout their journey (Patton & McMahon, 2014; Brown & Lent, 2013). Career development can include receiving a promotion, completing a degree, or achieving years of service within an organization. Dr. Modic describes how being a DNP-prepared nurse has impacted her development and contributed to critical moments in her career:
“I am working part-time; I have worked part-time since I had my first child. So, I have been at my hospital for 47 years. My clinical specialty is diabetes, and that is what I do. My professor, Dr. Joyce Fitzpatrick, has helped me develop this clinical empowerment experience program; it is now ten years old. It has been replicated and modified for others in my hospital organization. The program unites nurses from different clinical areas and hospitals, and focuses on fostering connections, setting a sense of belonging, and making people feel welcome. It helps nurses develop strategies to distribute nursing inter-professional knowledge and influence others. This program supports the power of nursing leadership and the image of a nurse. This program teaches how to nurture other people’s practices as well as our own. It supports using person-centered language to connect through empathetic communication and appreciation. It teaches implementing the concept of appreciative inquiry into the practice and transforming healthcare. Over the last ten years, this program has been provided to over 800 nurses. The retention of the individuals who completed this program has been impressive. Many who completed this program became nurse managers, directors, innovators, and advanced practice nurses. So yes, it is exciting and imposing for an organization to invest in the future of nurses. After many years in my nursing career, I am happy and feeling up to the challenge, as I continue to contribute.” (M. Modic, Personal Communication, October 27, 2023)
The description of her career development shared by Dr. Modic is consistent with DNP-prepared nurses’ career opportunities. An integrated review by van Dongen et al. (2023) concluded that many doctoral-prepared nurses develop their careers in education or research. Additionally, the literature suggests that career opportunities for these nurses have expanded to areas of clinical practice, policy development, and process improvement (Broome & Fairman, 2018). Because nurse can contribute in many ways, doctorly-prepared nurses can have multiple and overlapping positions, including research, clinical, educational, and administrative responsibilities (Chavez et al., 2021).
The number of DNP educational programs continues to increase. Enrollment in DNP programs has increased over the last 20 years, from 70 students in 2003 to 41,021 students in 2022. DNP programs are offered at 426 nursing schools (McElroy, 2023). For those considering obtaining a DNP degree, Dr. Modic provides advice for choosing a program for beginning the journey:
“All programs are not created equally. I always use this example for people who will continue their education. I do not say: “going back to school.” I say: “going forward to school” because you are never going backward. One can find an advertisement: “Get your degree in 18 months!” However, it does not say to learn anything. When you commit to an educational experience, you invest the time and the money. Ensure you get what you need from it, particularly the quality. Look for a school that would truly invest in you as a person, a professional, and a leader who can shape the profession. All those things should be integral when you are looking at a program. Some questions you should ask are: Who are the faculty who are moving nursing forward? Who are the faculty that have changed nursing practice? These qualities are tangible. You can see it; you can read it. Thus, this is my recommendation. Do not pick out the cheapest program; pick the one that gives you the most stellar faculty and is committed to you evolving into your best professional self. (M. Modic, Personal Communication, October 27, 2023)
The DNP-prepared nurse has been recognized as a vital component of the nursing profession. Their diverse knowledge and advanced understanding of nursing practice helps advance patient outcomes and the nursing profession. The ANA offers a position statement regarding DNP nurses that is available to ANA members at https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/doctor-of-nursing-practice-advancing-nursing-profession/.
