Discussion using a APA7 format and scholarly references no older than 5 years.

For each course, you will be required a reflective discussion on how the course outcomes, the program outcomes, and the DNP Essentials were achieved throughout the course. Please familiarize yourself with each essential.

Select two essentials and explain how you will be incorporating them into your practicum project as a DNP student. In Addition, select three leadership role-specific competencies from the AONL packet and explain how you will be achieving those during the DNP journey.

COMMUNICATION

KNOWLEDGE

LEADERSHIP

PROFESSIONALISM

BUSINESS SKILLS

Nurse Executive
Competencies

Suggested APA Citation: AONE, AONL. (2015).

AONL Nurse Executive Competencies

. Chicago, IL: AONE, AONL.

Accessed at: www.aonl.org

Accessible at: www.aonl.org/competencies

Contact: aonl@aha.org or (312) 422-2800

© 2015 American Organization of Nurse Executives (AONE), American Organization for Nursing Leadership (AONL). All materials contained in
this publication are available to anyone for download on www.aonl.org, for personal, non-commercial use only. No part of this publication may
be reproduced and distributed in any form without permission of AONL, except in the case of brief quotations followed by the above suggested
citation. To request permission to reproduce this material, please email aonl@aha.org.

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http://www.aonl.org/competencies

mailto:aonl%40aha.org?subject=

http://www.aonl.org

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Nurse Leaders in executive practice set

the vision for nursing practice in the

delivery of safe, timely, efficient, equitable

and patient-centered care. Working within

a collaborative and interprofessional

environment, the nurse in executive

practice is influential in improving the

patient experience of care (including quality

and satisfaction), improving the health of

populations and reducing the per capita cost

of health care.

The AONL Nurse Executive Competencies

detail the skills knowledge and abilities that

guide the practice of nurse leaders in executive

practice regardless of their educational

level, title or setting. The competencies are

captured in a model developed in 2004 by the

Healthcare Leadership Alliance1 that identify

the common core set of competency domains

for health care leadership: communication

and relationship management; knowledge

of the health care environment; leadership;

professionalism; business skills and principles.

OVERVIEW

1 Members include the American Organization for Nursing Leadership, The American College of Healthcare Executives, American Association for
Physician Leadership, Healthcare Financial Management Association, Healthcare Information and Management Systems Society, and Medical
Group Management Association.

Reliability and validity for the AONL Nurse Executive Competencies is established by periodic job analysis/role delineation studies. These
competencies are based on A National Practice Analysis Study of the Nurse Executive (2014).

A. EFFECTIVE COMMUNICATION

� Make oral presentations to diverse
audiences on:

» Nursing

» Health care topics

» Organizational issues

� Produce written materials for diverse
audiences on:

» Nursing

» Health care topics

» Organizational issues

� Facilitate group discussions

� Demonstrate skill in interpersonal
communication

B. RELATIONSHIP MANAGEMENT

� Build collaborative relationships

� Exhibit effective conflict resolution skills

� Create a trusting environment by:

» Following through on promises and
concerns

» Establishing mechanisms to follow-up on
commitments

» Balancing the concerns of individuals with
organizational goals and objectives

» Engaging staff and others in decision-
making

» Communicating in a way as to maintain
credibility and relationships

C. INFLUENCING BEHAVIORS

� Assert views in non-threatening, non-
judgmental ways

� Create a shared vision

� Facilitate consensus building

� Inspire desired behaviors and manage
undesired behaviors

� Achieve outcomes through engagement of
stakeholders

� Promote decisions that are patient-centered

� Apply situational leadership skills

D. DIVERSITY

� Establish an environment that values
diversity (e.g. age, gender, race, religion,
ethnicity, sexual orientation, culture)

� Establish cultural competency in the
workforce

� Incorporate cultural beliefs into care delivery

� Provide an environment conducive to
opinion sharing, exploration of ideas and
achievement of outcomes

E. COMMUNITY INVOLVEMENT

� Represent the organization to non-health
care constituents within the community

� Serve as a resource to community and
business leaders regarding nursing and
health care

� Represent the community perspective in
the decision-making process within the
organization/system

� Represent nursing to the media

� Serve on community-based boards, advisory
groups, and task forces

F. MEDICAL/STAFF RELATIONSHIPS

� Build credibility with physicians as a
champion for patient care, quality and the
professional practice of nursing

� Confront and address inappropriate or
disruptive behavior towards patients
and staff

� Represent nursing at medical executive
committee and other department/medical
staff committees

COMMUNICATION AND
RELATIONSHIP BUILDING1

� Collaborate with medical staff leaders and
other disciplines in determining needed
patient care service lines

� Collaborate with physicians and other
disciplines to develop patient care protocols,
policies and procedures

� Collaborate to determine patient care
equipment and facility needs

� Use medical staff mechanisms to address
physician clinical performance issues

� Address and model appropriate conflict
resolution

� Create opportunities for physicians and
nurses to engage in professional dialogue

G. ACADEMIC RELATIONSHIPS

� Determine current and future supply and
demand for nurses to meet the care delivery
needs

� Identify educational needs of existing and
potential nursing staff

� Collaborate with nursing programs to
provide required resources

� Collaborate with nursing programs in
evaluating quality of graduating clinicians
and develop mechanisms to enhance this
quality

� Serve on academic advisory councils

� Collaborate in nursing research and translate
evidence into practice

� Collaborate to investigate care delivery
models across the continuum

� Create academic partnerships to ensure a
qualified workforce for the future

COMMUNICATION AND RELATIONSHIP BUILDING1

A. CLINICAL PRACTICE KNOWLEDGE

� Demonstrate knowledge of current nursing
practice and the roles and functions of
patient care team members

� Communicate patient care standards as
established by accreditation, regulatory and
quality agencies

� Ensure compliance with the State Nurse
Practice Act, State Board of Nursing
regulations, state and federal regulatory
agency standards, federal labor standards
and policies of the organization

� Adhere to professional association
standards of nursing practice

� Ensure that written organizational clinical
policies and procedures are reviewed and
updated in accordance with evidence-based
practice

� Integrate bioethical and legal dimensions
into clinical and management
decision-making

� Ensure protection of human subject rights
and safety in clinical research

B. DELIVERY MODELS / WORK DESIGN

� Demonstrate current knowledge of patient
care delivery systems across the continuum

� Describe various delivery systems and age-
appropriate patient care models and the
advantages/disadvantages of each

� Assess the effectiveness of delivery models

� Develop new delivery models

� Participate in the design of facilities

C. HEALTH CARE ECONOMICS AND POLICY

� Understand regulation and payment issues
that affect an organization’s finances

� Describe individual organization’s payer mix,
CMI and benchmark database

� Align care delivery models and staff
performance with key safety and economic
drivers (e.g., value-based purchasing,
bundled payment)

� Take action when opportunities exist to
adjust operations to respond effectively
to environmental changes in economic
elements

� Use knowledge of federal and state laws
and regulations that affect the provision of
patient care (e.g., tort reform, malpractice/
negligence, reimbursement)

� Participate in legislative process on health
care issues through such mechanisms as
membership in professional organization
and personal contact with officials

� Educate patient care team members on the
legislative process, the regulatory process
and methods for influencing both

� Interpret impact of legislation at the state
and federal level on nursing and health care
organizations

D. GOVERNANCE

� Use knowledge of the role of the governing
body of the organization in the following
areas:

» Fiduciary responsibilities

» Credentialing

» Performance management

� Represent patient care issues to the
governing body

� Participate in strategic planning and quality
initiatives with the governing body

� Interact with and educate the organization’s
board members regarding health care and
the value of nursing care

� Represent nursing at the organization’s
board meetings

� Represent other disciplines at the
organization’s board meetings

KNOWLEDGE OF THE HEALTH
CARE ENVIRONMENT2

E. EVIDENCE-BASED PRACTICE/OUTCOME
MEASUREMENT AND RESEARCH

� Use data and other sources of evidence to
inform decision making

� Use evidence for establishment of
standards, practices and patient care models
in the organization

� Design feedback mechanisms by which to
adapt practice based upon outcomes from
current processes

� Design and interpret outcome measures

� Disseminate research findings to patient
care team members

� Allocate nursing resources based on
measurement of patient acuity/care needed

� Monitor and address nurse sensitive
outcomes and satisfaction indicators

F. PATIENT SAFETY

� Support the development of an
organization-wide patient safety program

� Use knowledge of patient safety science
(e.g., human factors, complex adaptive
systems, LEAN and Six Sigma)

� Monitor clinical activities to identify both
expected and unexpected risks

� Support a Just Culture (non-punitive)
reporting environment, supporting a reward
system for identifying unsafe practices

� Support safety surveys, responding and
acting on safety recommendations

� Lead/facilitate performance improvement
teams to improve systems/processes that
enhance patient safety

G. PERFORMANCE IMPROVEMENT/METRICS

� Articulate the organization’s performance
improvement program and goals

� Use evidence-based metrics to align patient
outcomes with the organization’s goals and
objectives

� Apply high reliability concepts for the
organization

� Establish quality metrics by

» Identifying the problem/process

» Measuring success at improving specific
areas of patient care

» Analyzing the root causes or variation
from quality standards

» Improving the process with the evidence

» Controlling solutions and sustaining
success

H. RISK MANAGEMENT

� Identify areas of risk/liability

� Facilitate staff education on risk
management and compliance issues

� Develop systems that result in prompt
reporting of potential liability by staff at all
levels

� Identify early warning predictability
indications for errors

� Correct areas of potential liability

� Ensure compliance by staff with all required
standards

KNOWLEDGE OF THE HEALTH CARE ENVIRONMENT2

A. FOUNDATIONAL THINKING SKILLS

� Address ideas, beliefs or viewpoints that
should be given serious consideration

� Recognize one’s own method of decision
making and the role of beliefs, values and
inferences

� Apply critical analysis to organizational
issues after a review of the evidence

� Maintain curiosity and an eagerness to
explore new knowledge and ideas

� Promote nursing leadership as both a
science and an art

� Demonstrate reflective practice and an
understanding that all leadership begins
from within

� Provide visionary thinking on issues that
impact the health care organization

B. PERSONAL JOURNEY DISCIPLINES

� Learn from setbacks and failures as well
as successes

C. SYSTEMS THINKING

� Use knowledge of classic and contemporary
systems thinking in problem solving and
decision making

� Provide visionary thinking on issues that
impact the healthcare organization

� Recognize the contribution of mental
models on behavior

� Promote systems thinking as an expectation
of leaders and staff

� Consider the impact of nursing decisions on
the healthcare organization as a whole

� Use resources from other paradigms

D. SUCCESSION PLANNING

� Develop a leadership succession plan

� Promote nursing leadership as a desirable
specialty

� Mentor current and future nurse leaders

� Establish mechanisms that provide for early
identification and mentoring of staff with
leadership potential

� Develop a workforce analysis plan and
implement strategies to ensure an adequate
and qualified workforce

E. CHANGE MANAGEMENT

� Adapt leadership style to situation needs

� Use change theory to implement change

� Serve as a change leader

LEADERSHIP3

A. PERSONAL AND PROFESSIONAL
ACCOUNTABILITY

� Hold self and others accountable for mutual
professional expectations and outcomes

� Contribute to the advancement of the
profession

� Participate in and contribute to professional
organizations

� Demonstrate and promote leader and staff
participation in professional organizations

� Promote leader and staff participation
in lifelong learning and educational
achievement

� Achieve and maintain professional
certification for self

� Promote professional certification for staff

� Role model standards of professional
practice (clinical, educational and leadership)
for colleagues and constituents

B. CAREER PLANNING

� Coach others in developing their own career
plans

� Seek input and mentorship from others in
career planning and development

� Develop a personal and professional career
plan and measure progress

� Solicit feedback about personal strengths
and weaknesses

� Act on feedback about personal strengths
and weaknesses

C. ETHICS

� Uphold ethical principles and corporate
compliance standards

� Hold self and staff accountable to comply
with ethical standards of practice

� Discuss, resolve and learn from ethical
dilemmas

D. ADVOCACY

� Promote clinical perspective in
organizational decisions

� Involve nurses and other staff in decisions
that affect their practice

� Represent the perspective of patients and
families

� Advocate for optimal health care in the
community

PROFESSIONALISM4

A. FINANCIAL MANAGEMENT

� Develop and manage an annual operating
budget and long-term capital expenditure
plan

� Use business models for health care
organizations and apply fundamental
concepts of economics

� Interpret financial statements

� Manage financial resources

� Ensure the use of accurate charging
mechanisms

� Educate patient care team members
on financial implications of patient care
decisions

� Participate in the negotiation and monitoring
of contract compliance (e.g., physicians,
service providers)

B. HUMAN RESOURCE MANAGEMENT

� Ensure development of educational
programs to foster workforce competencies
and development goals

� Participate in workforce planning and
employment decisions

� Use corrective discipline to mitigate
workplace behavior problems

� Evaluate the results of employee
satisfaction/quality of work environment
surveys

� Support reward and recognition programs to
enhance performance

� Formulate programs to enhance work-life
balance

� Interpret and ensure compliance with legal
and regulatory guidelines

� Provide education regarding components of
collective bargaining

� Promote healthful work environments

� Address sexual harassment, workplace

violence, verbal and physical abuse

� Implement ergonomically sound work
environments to prevent worker injury and
fatigue

� Develop and implement emergency
preparedness plans

� Analyze market data in relation to supply
and demand

� Contribute to the development of
compensation programs

� Develop and evaluate recruitment,
onboarding, and retention strategies

� Develop and implement an outcome-based
performance management program

� Develop and implement programs to re-
educate the workforce for new roles

C. STRATEGIC MANAGEMENT

� Create the operational objectives, goals and
specific strategies required to achieve the
strategic outcome

� Conduct SWOT and Gap analyses

� Defend the business case for nursing

� Utilize the balanced scorecard analysis to
manage change

� Evaluate achievement of operational
objectives and goals

� Identify marketing opportunities

� Develop marketing strategies in
collaboration with marketing experts

� Promote the image of nursing and the
organization through effective media
relations

BUSINESS SKILLS5

D. INFORMATION MANAGEMENT
AND TECHNOLOGY

� Use technology to support improvement of
clinical and financial performance

� Collaborate to prioritize for the
establishment of information technology
resources

� Participate in evaluation of enabling
technology in practice settings

� Use data management systems for decision
making

� Identify technological trends, issues and
new developments as they apply to
patient care

� Demonstrate skills in assessing data
integrity and quality

� Provide leadership for the adoption and
implementation of information systems

BUSINESS SKILLS5

Overview
1. Communication
2. Knowledge
3. Leadership
4. Professionalism
5. Business Skills

The Essentials of Doctoral Education
for Advanced Nursing Practice

October 2006

TABLE OF CONTENTS

Page
Introduction

Background 3
Comparison Between Research-Focused and Practice-Focused

Doctoral Education 3
AACN Task Force on the Practice Doctorate in Nursing 4

Context of Graduate Education in Nursing 5
Relationships of Master’s, Practice Doctorate, and Research
Doctorate Programs 6

DNP Graduates and Academic Roles 7

The Essentials of Doctoral Education for Advanced Nursing Practice 8
I. Scientific Underpinnings for Practice 8

II. Organizational and Systems Leadership for Quality
Improvement and Systems Thinking 9

III. Clinical Scholarship and Analytical Methods
for Evidence-Based Practice 11

IV. Information Systems/Technology and Patient Care Technology
for the Improvement and Transformation of Health Care 12

V. Health Care Policy for Advocacy in Health Care 13

VI. Interprofessional Collaboration for Improving Patient
and Population Health Outcomes 14

VII. Clinical Prevention and Population Health for Improving
the Nation’s Health 15

VIII. Advanced Nursing Practice 16

Incorporation of Specialty-Focused Competencies into DNP Curricula 17
Advanced Practice Nursing Focus 17
Aggregate/Systems/Organizational Focus 18

ADVANCING HIGHER EDUCATION IN NURSING

One Dupont Circle NW, Suite 530 · Washington, DC 20036 · 202-463-6930 tel · 202-785-8320 fax · www.aacn.nche.edu

Curricular Elements and Structure 18
Program Length 18
Practice Experiences in the Curriculum 19
Final DNP Project 19

DNP Programs in the Academic Environment: Indicators of Quality
in Doctor of Nursing Practice Programs 20
Faculty Characteristics 20
The Faculty and Practice 20
Practice Resources and Clinical Environment Resources 21
Academic Infrastructure 21

Appendix A

Advanced Health/Physical Assessment 23
Advanced Physiology and Pathophysiology 23
Advanced Pharmacology 24

Appendix B
DNP Essentials Task Force 25

References 27

Introduction

Background

Doctoral programs in nursing fall into two principal types: research-focused and practice-
focused. Most research-focused programs grant the Doctor of Philosophy degree (PhD),
while a small percentage offers the Doctor of Nursing Science degree (DNS, DSN, or
DNSc). Designed to prepare nurse scientists and scholars, these programs focus heavily
on scientific content and research methodology; and all require an original research
project and the completion and defense of a dissertation or linked research papers.
Practice-focused doctoral programs are designed to prepare experts in specialized
advanced nursing practice. They focus heavily on practice that is innovative and
evidence-based, reflecting the application of credible research findings. The two types of
doctoral programs differ in their goals and the competencies of their graduates. They
represent complementary, alternative approaches to the highest level of educational
preparation in nursing.

The concept of a practice doctorate in nursing is not new. However, this course of study
has evolved considerably over the 20 years since the first practice-focused nursing
doctorate, the Doctor of Nursing (ND), was initiated as an entry-level degree. Because
research- and practice-focused programs are distinctly different, the current position of
the American Association of Colleges of Nursing (AACN, 2004) [detailed in the Position
Statement on the Practice Doctorate in Nursing] is that: “The two types of doctorates,
research-focused and practice-focused, may coexist within the same education unit” and
that the practice-focused degree should be the Doctor of Nursing Practice (DNP).
Recognizing the need for consistency in the degrees required for advanced nursing
practice, all existing ND programs have transitioned to the DNP.

Comparison Between Research-Focused and Practice-Focused Doctoral Education

Research- and practice-focused doctoral programs in nursing share rigorous and
demanding expectations: a scholarly approach to the discipline, and a commitment to the
advancement of the profession. Both are terminal degrees in the discipline, one in
practice and one in research. However, there are distinct differences between the two
degree programs. For example, practice-focused programs understandably place greater
emphasis on practice, and less emphasis on theory, meta-theory, research methodology,
and statistics than is apparent in research-focused programs. Whereas all research-
focused programs require an extensive research study that is reported in a dissertation or
through the development of linked research papers, practice-focused doctoral programs
generally include integrative practice experiences and an intense practice immersion
experience. Rather than a knowledge-generating research effort, the student in a practice-
focused program generally carries out a practice application-oriented “final DNP
project,” which is an integral part of the integrative practice experience.

AACN Task Force on the Practice Doctorate in Nursing

The AACN Task Force to Revise Quality Indicators for Doctoral Education found that
the Indicators of Quality in Research-Focused Doctoral Programs in Nursing are
applicable to doctoral programs leading to a PhD or a DNS degree (AACN, 2001b, p. 1).
Therefore, practice-focused doctoral programs will need to be examined separately from
research-focused programs. This finding coupled with the growing interest in practice
doctorates prompted the establishment of the AACN Task Force on the Practice
Doctorate in Nursing in 2002. This task force was convened to examine trends in
practice-focused doctoral education and make recommendations about the need for and
nature of such programs in nursing. Task force members included representatives from
universities that already offered or were planning to offer the practice doctorate, from
universities that offered only the research doctorate in nursing, from a specialty
professional organization, and from nursing service administration. The task force was
charged to describe patterns in existing practice-focused doctoral programs; clarify the
purpose of the practice doctorate, particularly as differentiated from the research
doctorate; identify preferred goals, titles, and tracks; and identify and make
recommendations about key issues. Over a two-year period, this task force adopted an
inclusive approach that included: 1) securing information from multiple sources about
existing programs, trends and potential benefits of a practice doctorate; 2) providing
multiple opportunities for open discussion of related issues at AACN and other
professional meetings; and 3) subjecting draft recommendations to discussion and input
from multiple stakeholder groups. The final position statement was approved by the
AACN Board of Directors in March 2004 and subsequently adopted by the membership.

The 2004 DNP position statement calls for a transformational change in the education
required for professional nurses who will practice at the most advanced level of nursing.
The recommendation that nurses practicing at the highest level should receive doctoral
level preparation emerged from multiple factors including the expansion of scientific
knowledge required for safe nursing practice and growing concerns regarding the quality
of patient care delivery and outcomes. Practice demands associated with an increasingly
complex health care system created a mandate for reassessing the education for clinical
practice for all health professionals, including nurses.

A significant component of the work by the task force that developed the 2004 position
statement was the development of a definition that described the scope of advanced
nursing practice. Advanced nursing practice is broadly defined by AACN (2004) as:

any form of nursing intervention that influences health care outcomes for
individuals or populations, including the direct care of individual patients,
management of care for individuals and populations, administration of
nursing and health care organizations, and the development and
implementation of health policy. (p. 2)

Furthermore, the DNP position statement (AACN, 2004, p. 4) identifies the benefits of
practice focused doctoral programs as:

• development of needed advanced competencies for increasingly complex practice,
faculty, and leadership roles;

• enhanced knowledge to improve nursing practice and patient outcomes;
• enhanced leadership skills to strengthen practice and health care delivery;
• better match of program requirements and credits and time with the credential

earned;
• provision of an advanced educational credential for those who require advanced

practice knowledge but do not need or want a strong research focus (e.g., practice
faculty);

• enhanced ability to attract individuals to nursing from non-nursing backgrounds;
and

• increased supply of faculty for practice instruction.

As a result of the membership vote to adopt the recommendation that the nursing
profession establish the DNP as its highest practice degree, the AACN Board of
Directors, in January 2005, created the Task Force on the Essentials of Nursing
Education for the Doctorate of Nursing Practice and charged this task force with
development of the curricular expectations that will guide and shape DNP education.

The DNP Essentials Task Force is comprised of individuals representing multiple
constituencies in advanced nursing practice (see Appendix B). The task force conducted
regional hearings from September 2005 to January 2006 to provide opportunities for
feedback from a diverse group of stakeholders. These hearings were designed using an
iterative process to develop this document. In total, 620 participants representing 231
educational institutions and a wide variety of professional organizations participated in
the regional meetings. Additionally, a national stakeholders’ conference was held in
October 2005 in which 65 leaders from 45 professional organizations participated.

Context of Graduate Education in Nursing

Graduate education in nursing occurs within the context of societal demands and needs as
well as the interprofessional work environment. The Institute of Medicine (IOM, 2003)
and the National Research Council of the National Academies (2005, p. 74) have called
for nursing education that prepares individuals for practice with interdisciplinary,
information systems, quality improvement, and patient safety expertise.

In hallmark reports, the IOM (1999, 2001, 2003) has focused attention on the state of
health care delivery, patient safety issues, health professions education, and leadership for
nursing practice. These reports highlight the human errors and financial burden caused
by fragmentation and system failures in health care. In addition, the IOM calls for
dramatic restructuring of all health professionals’ education. Among the
recommendations resulting from these reports are that health care organizations and

groups promote health care that is safe, effective, client-centered, timely, efficient, and
equitable; that health professionals should be educated to deliver patient-centered care as
members of an interdisciplinary team, emphasizing evidence-based practice, quality
improvement, and informatics; and, that the best prepared senior level nurses should be in
key leadership positions and participating in executive decisions.

Since AACN published The Essentials of Master’s Education for Advanced Practice
Nursing in 1996 and the first set of indicators for quality doctoral nursing education in
1986, several trends in health professional education and health care delivery have
emerged. Over the past two decades, graduate programs in nursing have expanded from
220 institutions offering 39 doctoral programs and 180 master’s programs in 1986 to 518
institutions offering 101 doctoral programs and 417 master’s programs in 2006.
Increasing numbers of these programs offer preparation for certification in advanced
practice specialty roles such as nurse practitioners, nurse midwives, nurse anesthetists,
and clinical nurse specialists. Specialization is also a trend in other health professional
education. During this same time period, the explosion in information, technology, and
new scientific evidence to guide practice has extended the length of educational programs
in nursing and the other health professions. In response to these trends, several other
health professions such as pharmacy, physical therapy, occupational therapy, and
audiology have moved to the professional or practice doctorate for entry into these
respective professions.

Further, support for doctoral education for nursing practice was found in a review of
current master’s level nursing programs (AACN, 2004, p. 4). This review indicated that
many programs already have expanded significantly in response to the above concerns,
creating curricula that exceed the usual credit load and duration for a typical master’s
degree. The expansion of credit requirements in these programs beyond the norm for a
master’s degree raises additional concerns that professional nurse graduates are not
receiving the appropriate degree for a very complex and demanding academic experience.
Many of these programs, in reality, require a program of study closer to the curricular
expectations for other professional doctoral programs rather than for master’s level study.

Relationships of Master’s, Practice Doctorate, and Research Doctorate Programs

The master’s degree (MSN) historically has been the degree for specialized advanced
nursing practice. With development of DNP programs, this new degree will become the
preferred preparation for specialty nursing practice. As educational institutions transition
from the master’s to DNP degree for advanced practice specialty preparation, a variety of
program articulations and pathways are planned. One constant is true for all of these
models. The DNP is a graduate degree and is built upon the generalist foundation
acquired through a baccalaureate or advanced generalist master’s in nursing. The
Essentials of Baccalaureate Education (AACN, 1998) summarizes the core knowledge
and competencies of the baccalaureate prepared nurse. Building on this foundation, the
DNP core competencies establish a base for advanced nursing practice in an area of
specialization. Ultimately, the terminal degree options in nursing will fall into two

primary education pathways: professional entry degree (baccalaureate or master’s) to
DNP degree or professional entry degree (baccalaureate or master’s) to PhD degree. As
in other disciplines with practice doctorates, some individuals may choose to combine a
DNP with a PhD.

Regardless of the entry point, DNP curricula are designed so that all students attain DNP
end-of-program competencies. Because different entry points exist, the curricula must be
individualized for candidates based on their prior education and experience. For
example, early in the transition period, many students entering DNP programs will have a
master’s degree that has been built on AACN’s Master’s Essentials. Graduates of such
programs would already have attained many of the competencies defined in the DNP
Essentials. Therefore, their program will be designed to provide those DNP
competencies not previously attained. If a candidate is entering the program with a non-
nursing baccalaureate degree, his/her program of study likely will be longer than a
candidate entering the program with a baccalaureate or master’s in nursing. While
specialty advanced nursing education will be provided at the doctoral level in DNP
programs, new options for advanced generalist master’s education are being developed.

DNP Graduates and Academic Roles

Nursing as a practice profession requires both practice experts and nurse scientists to
expand the scientific basis for patient care. Doctoral education in nursing is designed to
prepare nurses for the highest level of leadership in practice and scientific inquiry. The
DNP is a degree designed specifically to prepare individuals for specialized nursing
practice, and The Essentials of Doctoral Education for Advanced Nursing Practice
articulates the competencies for all nurses practicing at this level.

In some instances, individuals who acquire the DNP will seek to fill roles as educators
and will use their considerable practice expertise to educate the next generation of nurses.
As in other disciplines (e.g., engineering, business, law), the major focus of the
educational program must be on the area of practice specialization within the discipline,
not the process of teaching. However, individuals who desire a role as an educator,
whether that role is operationalized in a practice environment or the academy, should
have additional preparation in the science of pedagogy to augment their ability to
transmit the science of the profession they practice and teach. This additional preparation
may occur in formal course work during the DNP program.

Some teaching strategies and learning principles will be incorporated into the DNP
curriculum as it relates to patient education. However, the basic DNP curriculum does
not prepare the graduate for a faculty teaching role any more than the PhD curriculum
does. Graduates of either program planning a faculty career will need preparation in
teaching methodologies, curriculum design and development, and program evaluation.
This preparation is in addition to that required for their area of specialized nursing
practice or research in the case of the PhD graduate.

The Essentials of Doctoral Education for Advanced Nursing Practice

The following DNP Essentials outline the curricular elements and competencies that
must be present in programs conferring the Doctor of Nursing Practice degree. The DNP
is a degree title, like the PhD or MSN, and does not designate in what specialty a
graduate is prepared. DNP graduates will be prepared for a variety of nursing practice
roles. The DNP Essentials delineated here address the foundational competencies that are
core to all advanced nursing practice roles. However, the depth and focus of the core
competencies will vary based on the particular role for which the student is preparing.
For example, students preparing for organizational leadership or administrative roles will
have increased depth in organizational and systems’ leadership; those preparing for
policy roles will have increased depth in health care policy; and those preparing for APN
roles (nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse
midwives) will have more specialized content in an area of advanced practice nursing.

Additionally, it is important to understand that the delineation of these competencies
should not be interpreted to mean that a separate course for each of the DNP Essentials
should be offered. Curricula will differ in emphases based on the particular specialties
for which students are being prepared.

The DNP curriculum is conceptualized as having two components:

1. DNP Essentials 1 through 8 are the foundational outcome competencies deemed
essential for all graduates of a DNP program regardless of specialty or functional
focus.

2. Specialty competencies/content prepare the DNP graduate for those practice and

didactic learning experiences for a particular specialty. Competencies, content,
and practica experiences needed for specific roles in specialty areas are
delineated by national specialty nursing organizations.

The DNP Essentials document outlines and defines the eight foundational Essentials and
provides some introductory comments on specialty competencies/content. The
specialized content, as defined by specialty organizations, complements the areas of core
content defined by the DNP Essentials and constitutes the major component of DNP
programs. DNP curricula should include these two components as appropriate to the
specific advanced nursing practice specialist being prepared. Additionally, the faculty of
each DNP program has the academic freedom to create innovative and integrated
curricula to meet the competencies outlined in the Essentials document.

Essential I: Scientific Underpinnings for Practice

The practice doctorate in nursing provides the terminal academic preparation for nursing
practice. The scientific underpinnings of this education reflect the complexity of practice

at the doctoral level and the rich heritage that is the conceptual foundation of nursing.
The discipline of nursing is focused on:

• The principles and laws that govern the life-process, well-being, and optimal
function of human beings, sick or well;

• The patterning of human behavior in interaction with the environment in normal
life events and critical life situations;

• The nursing actions or processes by which positive changes in health status are
affected; and

• The wholeness or health of human beings recognizing that they are in continuous
interaction with their environments (Donaldson & Crowley, 1978; Fawcett, 2005;
Gortner, 1980).

DNP graduates possess a wide array of knowledge gleaned from the sciences and have
the ability to translate that knowledge quickly and effectively to benefit patients in the
daily demands of practice environments (Porter-O’Grady, 2003). Preparation to address
current and future practice issues requires a strong scientific foundation for practice. The
scientific foundation of nursing practice has expanded and includes a focus on both the
natural and social sciences. These sciences that provide a foundation for nursing practice
include human biology, genomics, the science of therapeutics, the psychosocial sciences,
as well as the science of complex organizational structures. In addition, philosophical,
ethical, and historical issues inherent in the development of science create a context for
the application of the natural and social sciences. Nursing science also has created a
significant body of knowledge to guide nursing practice and has expanded the scientific
underpinnings of the discipline. Nursing science frames the development of middle
range theories and concepts to guide nursing practice. Advances in the foundational and
nursing sciences will occur continuously and nursing curricula must remain sensitive to
emerging and new scientific findings to prepare the DNP for evolving practice realities.

The DNP program prepares the graduate to:

1. Integrate nursing science with knowledge from ethics, the biophysical,
psychosocial, analytical, and organizational sciences as the basis for the highest
level of nursing practice.

2. Use science-based theories and concepts to:
• determine the nature and significance of health and health care delivery

phenomena;
• describe the actions and advanced strategies to enhance, alleviate, and

ameliorate health and health care delivery phenomena as appropriate; and
• evaluate outcomes.

3. Develop and evaluate new practice approaches based on nursing theories and
theories from other disciplines.

Essential II: Organizational and Systems Leadership for Quality Improvement and
Systems Thinking

Organizational and systems leadership are critical for DNP graduates to improve patient
and healthcare outcomes. Doctoral level knowledge and skills in these areas are
consistent with nursing and health care goals to eliminate health disparities and to
promote patient safety and excellence in practice.

DNP graduates’ practice includes not only direct care but also a focus on the needs of a
panel of patients, a target population, a set of populations, or a broad community. These
graduates are distinguished by their abilities to conceptualize new care delivery models
that are based in contemporary nursing science and that are feasible within current
organizational, political, cultural, and economic perspectives.

Graduates must be skilled in working within organizational and policy arenas and in the
actual provision of patient care by themselves and/or others. For example, DNP
graduates must understand principles of practice management, including conceptual and
practical strategies for balancing productivity with quality of care. They must be able to
assess the impact of practice policies and procedures on meeting the health needs of the
patient populations with whom they practice. DNP graduates must be proficient in
quality improvement strategies and in creating and sustaining changes at the
organizational and policy levels. Improvements in practice are neither sustainable nor
measurable without corresponding changes in organizational arrangements,
organizational and professional culture, and the financial structures to support practice.
DNP graduates have the ability to evaluate the cost effectiveness of care and use
principles of economics and finance to redesign effective and realistic care delivery
strategies. In addition, DNP graduates have the ability to organize care to address
emerging practice problems and the ethical dilemmas that emerge as new diagnostic and
therapeutic technologies evolve. Accordingly, DNP graduates are able to assess risk and
collaborate with others to manage risks ethically, based on professional standards.

Thus, advanced nursing practice includes an organizational and systems leadership
component that emphasizes practice, ongoing improvement of health outcomes, and
ensuring patient safety. In each case, nurses should be prepared with sophisticated
expertise in assessing organizations, identifying systems’ issues, and facilitating
organization-wide changes in practice delivery. In addition, advanced nursing practice
requires political skills, systems thinking, and the business and financial acumen needed
for the analysis of practice quality and costs.

The DNP program prepares the graduate to:
1. Develop and evaluate care delivery approaches that meet current and future needs of

patient populations based on scientific findings in nursing and other clinical sciences,
as well as organizational, political, and economic sciences.

2. Ensure accountability for quality of health care and patient safety for populations with
whom they work.

a. Use advanced communication skills/processes to lead quality improvement
and patient safety initiatives in health care systems.

b. Employ principles of business, finance, economics, and health policy to
develop and implement effective plans for practice-level and/or system-wide
practice initiatives that will improve the quality of care delivery.

c. Develop and/or monitor budgets for practice initiatives.
d. Analyze the cost-effectiveness of practice initiatives accounting for risk and

improvement of health care outcomes.
e. Demonstrate sensitivity to diverse organizational cultures and populations,

including patients and providers.
3. Develop and/or evaluate effective strategies for managing the ethical dilemmas

inherent in patient care, the health care organization, and research.

Essential III: Clinical Scholarship and Analytical Methods for Evidence-Based
Practice

Scholarship and research are the hallmarks of doctoral education. Although basic
research has been viewed as the first and most essential form of scholarly activity, an
enlarged perspective of scholarship has emerged through alternative paradigms that
involve more than discovery of new knowledge (Boyer, 1990). These paradigms
recognize that (1) the scholarship of discovery and integration “reflects the investigative
and synthesizing traditions of academic life” (Boyer, p. 21); (2) scholars give meaning to
isolated facts and make connections across disciplines through the scholarship of
integration; and (3) the scholar applies knowledge to solve a problem via the scholarship
of application (referred to as the scholarship of practice in nursing). This application
involves the translation of research into practice and the dissemination and integration of
new knowledge, which are key activities of DNP graduates. The scholarship of
application expands the realm of knowledge beyond mere discovery and directs it toward
humane ends. Nursing practice epitomizes the scholarship of application through its
position where the sciences, human caring, and human needs meet and new
understandings emerge.

Nurses have long recognized that scholarly nursing practice is characterized by the
discovery of new phenomena and the application of new discoveries in increasingly
complex practice situations. The integration of knowledge from diverse sources and
across disciplines, and the application of knowledge to solve practice problems and
improve health outcomes are only two of the many ways new phenomena and knowledge
are generated other than through research (AACN, 1999; Diers, 1995; Palmer, 1986;
Sigma Theta Tau International, 1999). Research-focused doctoral programs in nursing
are designed to prepare graduates with the research skills necessary for discovering new
knowledge in the discipline. In contrast, DNP graduates engage in advanced nursing
practice and provide leadership for evidence-based practice. This requires competence in
knowledge application activities: the translation of research in practice, the evaluation of
practice, improvement of the reliability of health care practice and outcomes, and
participation in collaborative research (DePalma & McGuire, 2005). Therefore, DNP

programs focus on the translation of new science, its application and evaluation. In
addition, DNP graduates generate evidence through their practice to guide improvements
in practice and outcomes of care.

The DNP program prepares the graduate to:

1. Use analytic methods to critically appraise existing literature and other evidence
to determine and implement the best evidence for practice.

2. Design and implement processes to evaluate outcomes of practice, practice
patterns, and systems of care within a practice setting, health care organization, or
community against national benchmarks to determine variances in practice
outcomes and population trends.

3. Design, direct, and evaluate quality improvement methodologies to promote safe,
timely, effective, efficient, equitable, and patient-centered care.

4. Apply relevant findings to develop practice guidelines and improve practice and
the practice environment.

5. Use information technology and research methods appropriately to:
• collect appropriate and accurate data to generate evidence for nursing

practice
• inform and guide the design of databases that generate meaningful

evidence for nursing practice
• analyze data from practice
• design evidence-based interventions
• predict and analyze outcomes
• examine patterns of behavior and outcomes
• identify gaps in evidence for practice

6. Function as a practice specialist/consultant in collaborative knowledge-generating
research.

7. Disseminate findings from evidence-based practice and research to improve
healthcare outcomes

Essential IV: Information Systems/Technology and Patient Care Technology for the
Improvement and Transformation of Health Care

DNP graduates are distinguished by their abilities to use information systems/technology
to support and improve patient care and healthcare systems, and provide leadership
within healthcare systems and/or academic settings. Knowledge and skills related to
information systems/technology and patient care technology prepare the DNP graduate to
apply new knowledge, manage individual and aggregate level information, and assess the
efficacy of patient care technology appropriate to a specialized area of practice. DNP
graduates also design, select, and use information systems/technology to evaluate
programs of care, outcomes of care, and care systems. Information systems/technology
provide a mechanism to apply budget and productivity tools, practice information
systems and decision supports, and web-based learning or intervention tools to support
and improve patient care.

DNP graduates must also be proficient in the use of information systems/technology
resources to implement quality improvement initiatives and support practice and
administrative decision-making. Graduates must demonstrate knowledge of standards and
principles for selecting and evaluating information systems and patient care technology,
and related ethical, regulatory, and legal issues.

The DNP program prepares the graduate to:

1. Design, select, use, and evaluate programs that evaluate and monitor outcomes
of care, care systems, and quality improvement including consumer use of
health care information systems.

2. Analyze and communicate critical elements necessary to the selection, use
and evaluation of health care information systems and patient care technology.

3. Demonstrate the conceptual ability and technical skills to develop and execute
an evaluation plan involving data extraction from practice information
systems and databases.

4. Provide leadership in the evaluation and resolution of ethical and legal issues
within healthcare systems relating to the use of information, information
technology, communication networks, and patient care technology.

5. Evaluate consumer health information sources for accuracy, timeliness, and
appropriateness.

Essential V: Health Care Policy for Advocacy in Health Care

Health care policy–whether it is created through governmental actions, institutional
decision making, or organizational standards–creates a framework that can facilitate or
impede the delivery of health care services or the ability of the provider to engage in
practice to address health care needs. Thus, engagement in the process of policy
development is central to creating a health care system that meets the needs of its
constituents. Political activism and a commitment to policy development are central
elements of professional nursing practice, and the DNP graduate has the ability to assume
a broad leadership role on behalf of the public as well as the nursing profession
(Ehrenreich, 2002). Health policy influences multiple care delivery issues, including
health disparities, cultural sensitivity, ethics, the internationalization of health care
concerns, access to care, quality of care, health care financing, and issues of equity and
social justice in the delivery of health care.

DNP graduates are prepared to design, influence, and implement health care policies that
frame health care financing, practice regulation, access, safety, quality, and efficacy
(IOM, 2001). Moreover, the DNP graduate is able to design, implement and advocate for
health care policy that addresses issues of social justice and equity in health care. The
powerful practice experiences of the DNP graduate can become potent influencers in
policy formation. Additionally, the DNP graduate integrates these practice experiences
with two additional skill sets: the ability to analyze the policy process and the ability to
engage in politically competent action (O’Grady, 2004).

The DNP graduate has the capacity to engage proactively in the development and
implementation of health policy at all levels, including institutional, local, state, regional,
federal, and international levels. DNP graduates as leaders in the practice arena provide a
critical interface between practice, research, and policy. Preparing graduates with the
essential competencies to assume a leadership role in the development of health policy
requires that students have opportunities to contrast the major contextual factors and
policy triggers that influence health policy-making at the various levels.
The DNP program prepares the graduate to:

1. Critically analyze health policy proposals, health policies, and related issues from
the perspective of consumers, nursing, other health professions, and other
stakeholders in policy and public forums.

2. Demonstrate leadership in the development and implementation of institutional,
local, state, federal, and/or international health policy.

3. Influence policy makers through active participation on committees, boards, or
task forces at the institutional, local, state, regional, national, and/or international
levels to improve health care delivery and outcomes.

4. Educate others, including policy makers at all levels, regarding nursing, health
policy, and patient care outcomes.

5. Advocate for the nursing profession within the policy and healthcare
communities.

6. Develop, evaluate, and provide leadership for health care policy that shapes health
care financing, regulation, and delivery.

7. Advocate for social justice, equity, and ethical policies within all healthcare
arenas.

Essential VI: Interprofessional Collaboration for Improving Patient and Population
Health Outcomes1

Today’s complex, multi-tiered health care environment depends on the contributions of
highly skilled and knowledgeable individuals from multiple professions. In order to
accomplish the IOM mandate for safe, timely, effective, efficient, equitable, and patient-
centered care in a complex environment, healthcare professionals must function as highly
collaborative teams (AACN, 2004; IOM, 2003; O’Neil, 1998). DNP members of these
teams have advanced preparation in the interprofessional dimension of health care that
enable them to facilitate collaborative team functioning and overcome impediments to
interprofessional practice. Because effective interprofessional teams function in a highly
collaborative fashion and are fluid depending upon the patients’ needs, leadership of high
performance teams changes. Therefore, DNP graduates have preparation in methods of
effective team leadership and are prepared to play a central role in establishing
interprofessional teams, participating in the work of the team, and assuming leadership of
the team when appropriate.

1 The use of the term “collaboration” is not meant to imply any legal or regulatory requirements or
implications.

The DNP program prepares the graduate to:
1. Employ effective communication and collaborative skills in the development and

implementation of practice models, peer review, practice guidelines, health
policy, standards of care, and/or other scholarly products.

2. Lead interprofessional teams in the analysis of complex practice and
organizational issues.

3. Employ consultative and leadership skills with intraprofessional and
interprofessional teams to create change in health care and complex healthcare
delivery systems.

Essential VII: Clinical Prevention and Population Health for Improving the Nation’s
Health

Clinical prevention is defined as health promotion and risk reduction/illness prevention
for individuals and families. Population health is defined to include aggregate,
community, environmental/occupational, and cultural/socioeconomic dimensions of
health. Aggregates are groups of individuals defined by a shared characteristic such as
gender, diagnosis, or age. These framing definitions are endorsed by representatives of
multiple disciplines including nursing (Allan et al., 2004).

The implementation of clinical prevention and population health activities is central to
achieving the national goal of improving the health status of the population of the United
States. Unhealthy lifestyle behaviors account for over 50 percent of preventable deaths in
the U.S., yet prevention interventions are underutilized in health care settings. In an
effort to address this national goal, Healthy People 2010 supported the transformation of
clinical education by creating an objective to increase the proportion of schools of
medicine, nursing, and other health professionals that have a basic curriculum that
includes the core competencies in health promotion and disease prevention (Allan et al.,
2004; USHHS, 2000). DNP graduates engage in leadership to integrate and
institutionalize evidence-based clinical prevention and population health services for
individuals, aggregates, and populations.

Consistent with these national calls for action and with the longstanding focus on health
promotion and disease prevention in nursing curricula and roles, the DNP graduate has a
foundation in clinical prevention and population health. This foundation will enable
DNP graduates to analyze epidemiological, biostatistical, occupational, and
environmental data in the development, implementation, and evaluation of clinical
prevention and population health. Current concepts of public health, health promotion,
evidence-based recommendations, determinants of health, environmental/occupational
health, and cultural diversity and sensitivity guide the practice of DNP graduates. In
addition emerging knowledge regarding infectious diseases, emergency/disaster
preparedness, and intervention frame DNP graduates’ knowledge of clinical prevention
and population health.

The DNP program prepares the graduate to:
1. Analyze epidemiological, biostatistical, environmental, and other appropriate

scientific data related to individual, aggregate, and population health.
2. Synthesize concepts, including psychosocial dimensions and cultural diversity,

related to clinical prevention and population health in developing, implementing,
and evaluating interventions to address health promotion/disease prevention
efforts, improve health status/access patterns, and/or address gaps in care of
individuals, aggregates, or populations.

3. Evaluate care delivery models and/or strategies using concepts related to
community, environmental and occupational health, and cultural and
socioeconomic dimensions of health.

Essential VIII: Advanced Nursing Practice

The increased knowledge and sophistication of healthcare has resulted in the growth of
specialization in nursing in order to ensure competence in these highly complex areas of
practice. The reality of the growth of specialization in nursing practice is that no
individual can master all advanced roles and the requisite knowledge for enacting these
roles. DNP programs provide preparation within distinct specialties that require expertise,
advanced knowledge, and mastery in one area of nursing practice. A DNP graduate is
prepared to practice in an area of specialization within the larger domain of nursing.
Indeed, this distinctive specialization is a hallmark of the DNP.

Essential VIII specifies the foundational practice competencies that cut across specialties
and are seen as requisite for DNP practice. All DNP graduates are expected to
demonstrate refined assessment skills and base practice on the application of biophysical,
psychosocial, behavioral, sociopolitical, cultural, economic, and nursing science as
appropriate in their area of specialization.

DNP programs provide learning experiences that are based in a variety of patient care
settings, such as hospitals, long-term care settings, home health, and/or community
settings. These learning experiences should be integrated throughout the DNP program
of study, to provide additional practice experiences beyond those acquired in a
baccalaureate nursing program. These experiential opportunities should be sufficient to
inform practice decisions and understand the patient care consequences of decisions.
Because a variety of differentiated roles and positions may be held by the DNP graduate,
role preparation for specialty nursing practice, including legal and regulatory issues, is
part of every DNP program’s curricula.

The DNP program prepares the graduate to:

1. Conduct a comprehensive and systematic assessment of health and illness
parameters in complex situations, incorporating diverse and culturally sensitive
approaches.

2. Design, implement, and evaluate therapeutic interventions based on nursing
science and other sciences.

3. Develop and sustain therapeutic relationships and partnerships with patients
(individual, family or group) and other professionals to facilitate optimal care
and patient outcomes.

4. Demonstrate advanced levels of clinical judgment, systems thinking, and
accountability in designing, delivering, and evaluating evidence-based care to
improve patient outcomes.

5. Guide, mentor, and support other nurses to achieve excellence in nursing
practice.

6. Educate and guide individuals and groups through complex health and
situational transitions.

7. Use conceptual and analytical skills in evaluating the links among practice,
organizational, population, fiscal, and policy issues.

Incorporation of Specialty-Focused Competencies into DNP Curricula

DNP education is by definition specialized, and DNP graduates assume a variety of
differing roles upon graduation. Consequently, a major component of DNP curricula
focuses on providing the requisite specialty knowledge for graduates to enact particular
roles in the larger healthcare system. While all graduates demonstrate the competencies
delineated in DNP Essentials 1 through 8, further DNP preparation falls into two general
categories: roles that specialize as an advanced practice nurse (APN) with a focus on
care of individuals, and roles that specialize in practice at an aggregate, systems, or
organizational level. This distinction is important as APNs face different licensure,
regulatory, credentialing, liability, and reimbursement issues than those who practice at
an aggregate, systems, or organizational level. As a result, the specialty content preparing
DNP graduates for various practices will differ substantially.

It is noteworthy that specialties evolve over time, and new specialties may emerge. It is
further recognized that APN and aggregate/systems/organizational foci are not rigid
demarcations. For example, the specialty of community health may have DNP graduates
who practice in APN roles providing direct care to individuals in communities; or,
community health DNP graduates may focus solely on programmatic development with
roles fitting more clearly into the aggregate focus.

The specialized competencies, defined by the specialty organizations, are a required and
major component of the DNP curriculum. Specialty organizations develop competency
expectations that build upon and complement DNP Essentials 1 though 8. All DNP
graduates, prepared as APNs, must be prepared to sit for national specialty APN
certification. However, all advanced nursing practice graduates of a DNP program
should be prepared and eligible for national, advanced specialty certification, when
available.

Advanced Practice Nursing Focus

The DNP graduate prepared for an APN role must demonstrate practice expertise,
specialized knowledge, and expanded responsibility and accountability in the care and
management of individuals and families. By virtue of this direct care focus, APNs
develop additional competencies in direct practice and in the guidance and coaching of
individuals and families through developmental, health-illness, and situational transitions
(Spross, 2005). The direct practice of APNs is characterized by the use of a holistic
perspective; the formation of therapeutic partnerships to facilitate informed decision-
making, positive lifestyle change, and appropriate self-care; advanced practice thinking,
judgment, and skillful performance; and use of diverse, evidence-based interventions in
health and illness management (Brown, 2005).

APNs assess, manage, and evaluate patients at the most independent level of clinical
nursing practice. They are expected to use advanced, highly refined assessment skills
and employ a thorough understanding of pathophysiology and pharmacotherapeutics in
making diagnostic and practice management decisions. To ensure sufficient depth and
focus, it is mandatory that a separate course be required for each of these three
content areas: advanced health/physical assessment, advanced physiology/
pathophysiology, and advanced pharmacology (see Appendix A). In addition to
direct care, DNP graduates emphasizing care of individuals should be able to use their
understanding of the practice context to document practice trends, identify potential
systemic changes, and make improvements in the care of their particular patient
populations in the systems within which they practice.

Aggregate/Systems/Organizational Focus

DNP graduates in administrative, healthcare policy, informatics, and population-based
specialties focus their practice on aggregates: populations, systems (including
information systems), organizations, and state or national policies. These specialties
generally do not have direct patient care responsibilities. However, DNP graduates
practicing at the aggregate/systems/organization level are still called upon to define
actual and emerging problems and design aggregate level health interventions. These
activities require that DNP graduates be competent in advanced organizational, systems,
or community assessment techniques, in combination with expert level understanding of
nursing and related biological and behavioral sciences. The DNP graduate preparing for
advanced specialty practice at the population/organizational/policy level demonstrates
competencies in conducting comprehensive organizational, systems, and/or community
assessments to identify aggregate health or system needs; working with diverse
stakeholders for inter- or intra-organizational achievement of health-related
organizational or public policy goals; and, designing patient-centered care delivery
systems or policy level delivery models.

Curricular Elements and Structure

Program Length

Institutional, state, and various accrediting bodies often have policies that dictate
minimum or maximum length and/or credit hours that accompany the awarding of
specific academic degrees. Recognizing these constraints, it is recommended that
programs, designed for individuals who have already acquired the competencies in The
Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 1998),
be three calendar years, or 36 months of full-time study including summers or four years
on a traditional academic calendar.

Post-master’s programs should be designed based on the DNP candidate’s prior
education, experience, and choice of specialization. Even though competencies for the
DNP build and expand upon those attained through master’s study, post-master’s and
post-baccalaureate students must achieve the same end-of-program competencies.
Therefore, it is anticipated that a minimum of 12 months of full-time, post-master’s study
will be necessary to acquire the additional doctoral level competencies. The task force
recommends that accrediting bodies should ensure that post-master’s DNP programs have
mechanisms in place to validate that students acquire all DNP end-of-program
competencies. DNP programs, particularly post-master’s options, should be efficient and
manageable with regard to the number of credit hours required, and avoid the
development of unnecessarily long, duplicative, and/or protracted programs of study.

Practice Experiences in the Curriculum

DNP programs provide rich and varied opportunities for practice experiences aimed at
helping graduates achieve the essential and specialty competencies upon completion of
the program. In order to achieve the DNP competencies, programs should provide a
minimum of 1,000 hours of practice post-baccalaureate as part of a supervised academic
program. Practice experiences should be designed to help students achieve specific
learning objectives related to the DNP Essentials and specialty competencies. These
experiences should be designed to provide systematic opportunities for feedback and
reflection. Experiences include in-depth work with experts from nursing as well as other
disciplines and provide opportunities for meaningful student engagement within practice
environments. Given the intense practice focus of DNP programs, practice experiences
are designed to help students build and assimilate knowledge for advanced specialty
practice at a high level of complexity. Therefore, end-of-program practice immersion
experiences should be required to provide an opportunity for further synthesis and
expansion of the learning developed to that point. These experiences also provide the
context within which the final DNP product is completed.

Practice immersion experiences afford the opportunity to integrate and synthesize the
essentials and specialty requirements necessary to demonstrate competency in an area of

specialized nursing practice. Proficiency may be acquired through a variety of methods,
such as, attaining case requirements, patient or practice contact hours, completing
specified procedures, demonstrating experiential competencies, or a combination of these
elements. Many specialty groups already extensively define various minimal experiences
and requirements.

Final DNP Project

Doctoral education, whether practice or research, is distinguished by the completion of a
specific project that demonstrates synthesis of the student’s work and lays the
groundwork for future scholarship. For practice doctorates, requiring a dissertation or
other original research is contrary to the intent of the DNP. The DNP primarily involves
mastery of an advanced specialty within nursing practice. Therefore, other methods must
be used to distinguish the achievement of that mastery. Unlike a dissertation, the work
may take a number of forms. One example of the final DNP product might be a practice
portfolio that includes the impact or outcomes due to practice and documents the final
practice synthesis and scholarship. Another example of a final DNP product is a practice
change initiative. This may be represented by a pilot study, a program evaluation, a
quality improvement project, an evaluation of a new practice model, a consulting project,
or an integrated critical literature review. Additional examples of a DNP final product
could include manuscripts submitted for publication, systematic review, research
utilization project, practice topic dissemination, substantive involvement in a larger
endeavor, or other practice project. The theme that links these forms of scholarly
experiences is the use of evidence to improve either practice or patient outcomes.

The final DNP project produces a tangible and deliverable academic product that is
derived from the practice immersion experience and is reviewed and evaluated by an
academic committee. The final DNP product documents outcomes of the student’s
educational experiences, provides a measurable medium for evaluating the immersion
experience, and summarizes the student’s growth in knowledge and expertise. The final
DNP product should be defined by the academic unit and utilize a form that best
incorporates the requirements of the specialty and the institution that is awarding the
degree. Whatever form the final DNP product takes, it will serve as a foundation for
future scholarly practice.

DNP Programs in the Academic Environment:
Indicators of Quality in Doctor of Nursing Practice Programs

Practice-focused doctorates are designed to prepare experts in nursing practice. The
academic environments in which these programs operate must provide substantial access
to nursing practice expertise and opportunities for students to work with and learn from a
variety of practice experts including advanced clinicians, nurse executives, informaticists,
or health policy makers. Thus, schools offering the DNP should have faculty members,
practice resources, and an academic infrastructure that support a high quality educational
program and provide students with the opportunities to develop expertise in nursing
practice. Similar to the need for PhD students to have access to strong research

environments, DNP students must have access to strong practice environments, including
faculty members who practice, environments characterized by continuous improvement,
and a culture of inquiry and practice scholarship.

Faculty Characteristics

Faculty members teaching in DNP programs should represent diverse backgrounds and
intellectual perspectives in the specialty areas for which their graduates are being
prepared. Faculty expertise needed in these programs is broad and includes a mix of
doctorally prepared research-focused and practice-focused faculty whose expertise will
support the educational program required for the DNP. In addition to faculty members
who are nurses, faculty members in a DNP program may be from other disciplines.

Initially, during the transition, some master’s-prepared faculty members may teach
content and provide practice supervision, particularly in early phases of post-
baccalaureate DNP curriculum. Once a larger pool of DNP graduates becomes available,
the faculty mix can be expected to shift toward predominately doctorally-prepared faculty
members.

The Faculty and Practice

Schools offering DNP programs should have a faculty cohort that is actively engaged in
practice as an integral part of their faculty role. Active practice programs provide the
same type of applied learning environment for DNP students as active research programs
provide for PhD students. Faculty should develop and implement programs of
scholarship that represent knowledge development from original research for some
faculty and application of research in practice for others. Faculty, through their practice,
provides a learning environment that exemplifies rapid translation of new knowledge into
practice and evaluation of practice-based models of care.

Indicators of productive programs of practice scholarship include extramural grants in
support of practice innovations; peer reviewed publications and presentations; practice-
oriented grant review activities; editorial review activities; state, regional, national, and
international professional activities related to one’s practice area; policy involvement;
and development and dissemination of practice improvement products such as reports,
guidelines, protocols, and toolkits.

Practice Resources and Clinical Environment Resources

Schools with DNP programs should develop, expand, sustain, and provide an
infrastructure for extensive collaborative relationships with practice systems or sites and
provide practice leadership in nursing and other fields. It is crucial for schools offering
the DNP to provide or have access to practice environments that exemplify or aspire to

the best in professional nursing practice, practice scholarship in nursing education, and
provide opportunities for interprofessional collaboration (AACN, 2001a). Strong and
explicit relationships need to exist with practice sites that support the practice and
scholarship needs of DNP students including access to relevant patient data and access to
patient populations (e.g., direct access to individuals, families, groups, and communities)
(AACN, 1999). Practice affiliations should be designed to benefit jointly the school and
the practice sites. Faculty practice plans should also be in place that encourage and
support faculty practice and scholarship as part of the faculty role.

Academic Infrastructure

The academic infrastructure is critical to the success of all DNP programs. Sufficient
financial, personnel, space, equipment, and other resources should be available to
accomplish attainment of DNP program goals and to promote practice and scholarship.
Administrative as well as infrastructure support should reflect the unique needs of a
practice-focused doctoral program. For example, this support would be evident in the
information technology, library holdings, clinical laboratories and equipment, and space
for academic and practice initiatives that are available for student learning experiences.

Academic environments must include a commitment to the practice mission. This
commitment will be manifest through processes and structures that reflect a re-
conceptualization of the faculty role whereby teaching, practice, and practice-focused
scholarship are integrated. This commitment is most apparent in systems that are
consistent with Boyer’s recommendations for broader conceptualization of scholarship
and institutional reward systems for faculty scholarship (Boyer, 1990). Whether or not
tenure is available for faculty with programs of scholarly practice, appropriate reward
systems should be in place that endorse and validate the importance of practice-based
faculty contributions. Formal faculty practice plans and faculty practice committees help
institutionalize scholarly practice as a component of the faculty role and provide support
for enhancing practice engagement. Faculty practice should be an essential and
integrated component of the faculty role.

Appendix A

I. Advanced Health/Physical Assessment

Advanced health/physical assessment includes the comprehensive history, physical, and
psychological assessment of signs and symptoms, pathophysiologic changes, and
psychosocial variations of the patient (individual, family, or community). If the patient is an
individual, the assessment should occur within the context of the family and community and
should incorporate cultural and developmental variations and needs of the patient. The
purpose of this comprehensive assessment is to develop a thorough understanding of the
patient in order to determine appropriate and effective health care including health promotion
strategies.

There is a core of general assessment content that every advanced practice nurse must have.
Specifics and additional assessment related to various specialties (e.g., women’s health,
mental health, anesthesiology, pediatrics) should be further addressed and refined in that
specialty’s course content within each program. Health/physical assessment must also be
used as a base and be reinforced in all clinical experiences and practicum courses.

Individuals entering an advanced practice nursing program are expected to possess effective
communication and patient teaching skills. Although these are basic to all professional
nursing practice, preparation in the advanced practice nursing role must include continued
refinement and strengthening of increasingly sophisticated communication and observational
skills. Health/physical assessment content must rely heavily on the development of sensitive
and skilled interviewing.

Course work should provide graduates with the knowledge and skills to:

1. demonstrate sound critical thinking and clinical decision making;
2. develop a comprehensive database, including complete functional assessment,

health history, physical examination, and appropriate diagnostic testing;
3. perform a risk assessment of the patient including the assessment of lifestyle and

other risk factors;
4. identify signs and symptoms of common emotional illnesses;
5. perform basic laboratory tests and interpret other laboratory and diagnostic data;
6. relate assessment findings to underlying pathology or physiologic changes;
7. establish a differential diagnosis based on the assessment data; and
8. develop an effective and appropriate plan of care for the patient that takes into

consideration life circumstance and cultural, ethnic, and developmental
variations.

II. Advanced Physiology/Pathophysiology

The advanced practice nurse should possess a well-grounded understanding of normal
physiologic and pathologic mechanisms of disease that serves as one primary component of
the foundation for clinical assessment, decision making, and management. The graduate
should be able to relate this knowledge “to interpreting changes in normal function that result
in symptoms indicative of illness” and in assessing an individual’s response to pharmacologic

management of illnesses (NONPF, 1995, p. 152). Every student in an advanced practice
nursing program should be taught a basic physiology/pathophysiology course. Additional
physiology and pathophysiology content relevant to the specialty area may be taught in the
specialty courses. In addition to the core course, content should be integrated throughout all
clinical and practicum courses and experiences. The course work should provide the
graduate with the knowledge and skills to:

1. compare and contrast physiologic changes over the life span;
2. analyze the relationship between normal physiology and pathological phenomena

produced by altered states across the life span;
3. synthesize and apply current research-based knowledge regarding pathological

changes in selected disease states;
4. describe the developmental physiology, normal etiology, pathogenesis, and

clinical manifestations of commonly found/seen altered health states; and
5. analyze physiologic responses to illness and treatment modalities.

III. Advanced Pharmacology

Every APN graduate should have a well-grounded understanding of basic pharmacologic
principles, which includes the cellular response level. This area of core content should
include both pharmacotherapeutics and pharmacokinetics of broad categories of
pharmacologic agents. Although taught in a separate or dedicated course, pharmacology
content should also be integrated into the content of Advanced Health/Physical Assessment
and Advanced Physiology and Pathophysiology courses. Additional application of this
content should also be presented within the specialty course content and clinical experiences
of the program in order to prepare the APN to practice within a specialty scope of practice.

As described above, the purpose of this content is to provide the graduate with the knowledge
and skills to assess, diagnose, and manage (including the prescription of pharmacologic
agents) a patient’s common health problems in a safe, high quality, cost-effective manner.
The course work should provide graduates with the knowledge and skills to:

1. comprehend the pharmacotherapeutics of broad categories of drugs;
2. analyze the relationship between pharmacologic agents and

physiologic/pathologic responses;
3. understand the pharmacokinetics and pharmacodynamics of broad categories of

drugs;
4. understand the motivations of patients in seeking prescriptions and the

willingness to adhere to prescribed regimens; and
5. safely and appropriately select pharmacologic agents for the management of

patient health problems based on patient variations, the problem being managed,
and cost effectiveness.

Appendix B

DNP Essentials Task Force

Donna Hathaway, PhD, Chair
Dean, College of Nursing
University of Tennessee Health Science Center

Janet Allan, PhD
Dean, School of Nursing
University of Maryland

Ann Hamric, PhD
Associate Professor, School of Nursing
University of Virginia

Judy Honig, EdD
Associate Dean, School of Nursing
Columbia University

Carol Howe, DNSc
Professor, School of Nursing
Oregon Health and Science University

Maureen Keefe, PhD
Dean, College of Nursing
University of Utah

Betty Lenz, PhD
Dean, College of Nursing
The Ohio State University

(Sr.) Mary Margaret Mooney, DNSc
Chair, Department of Nursing
North Dakota State University – Fargo

Julie Sebastian, PhD
Assistant Dean, College of Nursing
University of Kentucky

Heidi Taylor, PhD
Head, Division of Nursing
West Texas A&M University

Edward S. Thompson, PhD
Director, Anesthesia Nursing Program
University of Iowa

Polly Bednash, PhD (Staff Liaison)
Executive Director
AACN

Joan Stanley, PhD (Staff Liaison)
Senior Director, Education Policy
AACN

Kathy McGuinn, MSN (Staff Liaison)
Director, Special Projects
AACN

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