Nurses who want to further their educations and increase their leadership skills now have another avenue they can travel — the Doctor of Nursing Practice (DNP or DrNP) degree program. Since this degree is not as well-known as the PhD, some may wonder why a nurse would elect to pursue a DNP instead of a PhD. The DNP focuses upon leadership and management skills and the knowledge needed to facilitate change. The PhD and DNSc degrees are directed toward careers that emphasize research and do not necessarily focus on day-to-day operations in healthcare delivery.

With the DNP's 2004 endorsement by the American Association of Colleges of Nursing (AACN) and the plan to move the level of preparation necessary for advanced practice from a master's degree to the doctorate level by 2015, nursing programs across the nation are developing DNP programs and admitting students. The AACN's website and allnursingschools.com list the current DNP programs and link visitors to the programs' websites. Visiting the websites is a good way to learn the different requirements of each program and sort through different educational approaches. Anyone considering a DNP program can preview the course titles and coursework for each program online.

Many DNP programs differ in their admission requirements. The majority of DNP programs are post-master's degree programs. Some programs accept students with BSNs but add master's degree credit hours to the credit hours required for the DNP, while others accept students with bachelor's degrees in non-nursing disciplines. Programs may offer the ability to use distance learning for coursework, including courses offered via interactive television and videocassette.

Each DNP program is unique in the particular coursework offered, but a look at the courses comprising the Rush University College of Nursing DNP program offers a general idea. At Rush, the courses include leadership, organizational analysis and evaluation, financial and business planning using data in decision-making, outcomes management, politics and policy, ethics, and human resource management.

Students must also plan and implement a system-wide change at their workplaces, including making plans to sustain the projects after they have completed their degree work. Student projects have already been implemented in state health departments, major medical centers, academic institutions, the military, professional groups, and for-profit companies. At Rush, students learn to involve all levels of stakeholders and negotiate for needed resources.

DNP graduates can work in many different settings. Memorial Hermann-Texas Medical Center, for instance, recently named Elizabeth Fuselier, DNP, to the newly created position of chief of advanced practice. This position was established to indicate a joint focus on the highest level of nursing care and to create a learning environment for advanced practice nurses.

Michelle Stephenson, RN, DNP, a graduate of the Rush University program, is chief nurse executive at Children's Memorial Hospital in Chicago. Stephenson elected to earn a DNP as a way to enhance her current role. The coursework and project she completed in the program gave her an organized, systematized approach to work she was already doing.

"I believe my completion of the doctoral program has provided authenticity to me in my role as a chief nursing officer," she says.

Stephenson's DNP project was to pilot an acuity-adaptable pulmonary unit in a pediatric hospital as a precursor to the design of a new hospital. Since no other pediatric unit had used the acuity-adaptable approach, Stephenson had no model to refer to while designing the new facility. She says her project gave her the opportunity to approach health care in a more open-minded and creative manner.

The medical staff and hospital board members were supportive of Stephenson as she progressed through the program and helped celebrate the completion of her degree.

"I took acknowledgement and support as a visible sign of how obtaining the DNP has made a difference in how I and nursing are perceived in the organization," Stephenson says.

Stephenson hopes to serve as an example of the value of advanced education to nurses at all levels in her organization. She says the key to selecting the correct program depends on an individual's goals and career plans. Completing the necessary background work may be difficult, but it is doable and the benefits outweigh any associated inconvenience.