NU703 Unit 5 Literature Synthesis, DNP Role Use Example

The Degree Is Used Where It Is Understood: A Literature Synthesis of Seven Sources on Why Employers' Understanding of the DNP, More Than Graduates' Preparation, Shapes Whether It Gets Used

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Purdue University Global

NU703: Professional Role Development of the DNP-Prepared Nurse

Unit 5 Literature Synthesis

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[Date]

The claim and synthesis are the author's; every source is real and cited as published.

The Claim and Its Limits

Graduates of Doctor of Nursing Practice programs generally report that the degree strengthened their skills in quality improvement, evidence-based practice and leadership, yet the use of those skills in practice varies widely. The literature suggests that the main reason lies less in how graduates are prepared than in whether employers understand what the degree is for. This claim rests largely on surveys and interviews, not on outcome studies, and it should be read with that limit in mind.

Graduates Report Gains, but Roles Vary

Graduates describe real gains, but the settings they work in determine how those gains are used. In a survey of 1,308 DNP-prepared members of three professional nursing organizations, more than 70% reported substantial improvements in quality improvement, evidence-based practice and leadership abilities, yet only 22% said the degree was required by their employer, most of them in educational positions, and participation in activities associated with DNP education varied by position title (Minnick et al., 2019). In other words, the preparation appears to have taken hold, while the jobs that would call on it are uneven. An earlier overview of DNP programs and graduate placement in one state reached a similar point from the program side, asking whether the profession's directions would let graduates shape health care systems as intended or whether course corrections were needed (Dunbar-Jacob et al., 2013). Read together, these sources describe prepared graduates entering roles that do not consistently ask for what they learned.

Employers Often Cannot Say What the Degree Adds

The employer side of the evidence is thinner but consistent. When chief nursing officers leading public and teaching hospital systems in Michigan were surveyed, few employed DNP-prepared nurses, and most reported gaps in their knowledge of the role's expectations and projected outcomes (Nichols et al., 2014). Several years later, semistructured interviews with 23 employers in nonacademic settings concluded that the role of the DNP-prepared nurse in those settings remained unclear, with graduates typically working either as advanced practice nurses in clinical care or as system leaders, and with employers' comparisons to other advanced practice nurses and nurse leaders forming one of the study's main themes (Beeber et al., 2019). The two studies used different methods in different years, but both found that the people deciding how to use DNP-prepared nurses were unsure what distinguished them. If an employer cannot describe what the degree adds, it is hard to see how the employer could design a position that uses it.

The Profession's Own Messages Have Been Inconsistent

Employers' uncertainty did not arise from nowhere. In 2004, AACN called for advanced practice nursing education to shift from the master's to the doctoral level by 2015 (American Association of Colleges of Nursing, 2004). A later analysis by deans of leading nursing schools found that this universal standard had not been adopted, and traced the delay to a long history of inconsistency in messaging and curricula, along with certification, accreditation and cost barriers (McCauley et al., 2020). A survey of 340 nurses with various educational backgrounds found broad support for a DNP focused on improving outcomes through leadership, policy and translation of evidence, alongside confusion about the DNP-prepared nurse's role in academia, leadership and scholarship (Udlis & Mancuso, 2015). Taken together, these sources suggest that employers' confusion partly reflects the profession's: when nurses themselves disagree about what the degree is for, employers can hardly be expected to agree.

The evidence points less to a preparation problem than to a recognition problem: graduates report the skills, but the organizations they join are often unsure what to ask of them.

Counterevidence

Not all of the evidence supports placing the problem with employers. The same survey that found broad support for the DNP also found confusion among nurses, including those with doctoral preparation, about the degree's role in scholarship and leadership (Udlis & Mancuso, 2015). If graduates themselves are unsure how their role differs from that of master's-prepared colleagues, some of the underuse may begin with them rather than with employers. The variation that Minnick and colleagues found by position title and professional organization could also reflect differences in graduates' goals, not only in employers' understanding (Minnick et al., 2019). These findings qualify the claim: employer understanding appears to be the larger factor, but graduates' own clarity about their role contributes as well.

What the Evidence Cannot Yet Answer

None of the seven sources links DNP roles to patient or system outcomes. The employer interview study described the value DNP-prepared nurses bring to practice settings as largely unknown (Beeber et al., 2019), and the surveys report perceptions of improvement rather than measured results. This is the most important gap. Employers are unlikely to create positions for a degree whose effect on outcomes has not been shown, and the profession cannot show that effect without positions in which to measure it. Studies comparing units or organizations with and without DNP-prepared leaders, on outcomes such as quality measures or readmissions, would begin to fill it.

Conclusion

Across seven sources, the pattern is consistent. Graduates report gains in the skills the degree is meant to build; employers often cannot say what the degree adds; and the profession's own messages about the degree have been inconsistent. The literature supports the claim that understanding, more than preparation, shapes use, while noting that graduates' own role clarity also matters. For a DNP student, one practical lesson follows: part of the work after graduation is explaining the role to the organization, not only performing it.

Appendix: Synthesis Matrix

1. The AACN position statement of 2004: national; supports the history strand.

2. Beeber et al. (2019): program survey and employer interviews, 23 employers; nonacademic settings; supports the employer strand and the outcome gap.

3. Dunbar-Jacob et al. (2013): descriptive overview; one state; supports the graduate strand.

4. McCauley et al. (2020): expert analysis with unpublished AACN data; national; supports the history strand.

5. Minnick et al. (2019): survey of 1,308 DNP-prepared nurses; national; supports the graduate strand and the counterevidence.

6. Nichols et al. (2014): survey of chief nursing officers; one state's hospital systems; supports the employer strand.

7. Udlis and Mancuso (2015): survey of 340 nurses; mixed settings; supports the history strand and the counterevidence.

References

American Association of Colleges of Nursing. (2004). AACN position statement on the practice doctorate in nursing.

Beeber, A. S., Palmer, C., Waldrop, J., Lynn, M. R., & Jones, C. B. (2019). The role of Doctor of Nursing Practice-prepared nurses in practice settings. Nursing Outlook, 67(4), 354-364. https://doi.org/10.1016/j.outlook.2019.02.006

Dunbar-Jacob, J., Nativio, D. G., & Khalil, H. (2013). Impact of doctor of nursing practice education in shaping health care systems for the future. Journal of Nursing Education, 52(8), 423-427. https://doi.org/10.3928/01484834-20130719-03

McCauley, L. A., Broome, M. E., Frazier, L., Hayes, R., Kurth, A., Musil, C. M., Norman, L. D., Rideout, K. H., & Villarruel, A. M. (2020). Doctor of nursing practice (DNP) degree in the United States: Reflecting, readjusting, and getting back on track. Nursing Outlook, 68(4), 494-503. https://doi.org/10.1016/j.outlook.2020.03.008

Minnick, A. F., Kleinpell, R., & Allison, T. L. (2019). DNPs' labor participation, activities, and reports of degree contributions. Nursing Outlook, 67(1), 89-100. https://doi.org/10.1016/j.outlook.2018.10.008

Nichols, C., O'Connor, N., & Dunn, D. (2014). Exploring early and future use of DNP prepared nurses within healthcare organizations. Journal of Nursing Administration, 44(2), 74-78. https://doi.org/10.1097/NNA.0000000000000029

Udlis, K. A., & Mancuso, J. M. (2015). Perceptions of the role of the doctor of nursing practice-prepared nurse: Clarity or confusion. Journal of Professional Nursing, 31(4), 274-283. https://doi.org/10.1016/j.profnurs.2015.01.004