As the healthcare industry continues to expand and shift due to an aging U.S. population and increased technological innovation, with one article estimating that 4 million new jobs will be created by 2026, it’s becoming increasingly more important for the largest percentage of workers within the industry — our nurses — to keep pace with these exponential changes.


That’s why nurses within all area of practice, from women’s health to intensive care to public health are seriously considering going back to school to not only further their careers, but to better serve the patients whose lives depend on them. While not every nurse may feel the need to pursue more education, there is no doubt that the demand for more educated nurses will only continue to grow.

Barb Taylor, Ph.D., RN, the dean of PLNU’s School of Nursing echoes this demand for nurses with higher levels of education in our country.

“Back in 2004, the American Association of Critical-Care Nurses (AACN) said that entry into one of the four nursing roles for advanced practice, which includes certified nurse midwife, certified registered nurse anesthetist, certified nurse practitioner, and clinical nurse specialist, was going to require a doctorate for entry into practice by the year 2015,” Taylor said.

While the 2015 mark may have initially been too aggressive, and that goal has been pushed to 2025, the takeaway remains: nurses who want to get into advanced practice will eventually need to have a graduate degree at the doctorate level. It’s in response to this need that spurred PLNU to launch its Doctorate of Nursing Practice (DNP) program in 2017.

“This is why we started that journey of developing our DNP, which is modeled after other clinical practice doctorates, like the medical doctorate (MD), occupational therapy doctorate (OTD), pharmacy doctorate (Pharm.D.), and so on,” Taylor said. “This doctorate of nursing practice follows the same model as those in that it’s focused on clinical practice rather than research.”

Nurses who want to get into advanced practice will eventually need to have a graduate degree at the doctorate level.

While nurses can and still do enter the four roles of advanced practice without a doctorate, they each still require a master’s degree and sizeable amount of education. Additionally, even for those nurses who don’t want to continue into advanced practice but only have an associate’s degree (ADN), there is a push for more education in the healthcare industry at this level as well, with the goal of having 80 percent of all nurses with a BSN by 2020.

Taylor acknowledged that this means nurses will have a lot of competition as the industry continues to demand more education from them.

“Nursing is changing a lot,” Taylor said. “The idea of a nurse being at the bedside for thirty years really doesn’t happen very much anymore. And from a national perspective, there’s research that shows the higher degree of your nursing staff in your hospital the decrease there is in negative outcomes.

Michelle Riingen, DNP, RN, CNS-BC, the associate dean and director of PLNU’s RN to BSN adult degree completion program, agrees with this push for more education in nursing.

With nurses being the largest population within the healthcare team, nurses need to maintain lifelong learning to better provide care in dynamic environments,” Riingen said.

In light of all this, if you’re a nurse with a BSN and are thinking about going to graduate school, it’s probably a good idea. Still, what if you don’t know exactly what type of program to enroll in based on your passions and skills? Keep reading to learn more about the four advanced practice roles in nursing as well as about the two available terminal degrees in nursing, the DNP and Ph.D.

 

The 4 Advanced Practice Roles in Nursing

When considering working toward an advanced practice role in nursing, it’s important to ask yourself certain questions. What is it about nursing that you’re passionate about? Do you like the idea of remaining on a hospital floor and being at the bedside? Do you want to assess, diagnose, and treat patients alongside a doctor or physician’s assistant? Are you motivated to help patients on issues related to women’s health? Your answers to these questions and many others will help dictate what type of program you should pursue. It’s also worth noting that you can only begin to pursue one of these four tracks if you already have a BSN. Nurses interested in these tracks without a BSN should look into RN to BSN or RN to MSN programs as an immediate next step.

There are four types of advanced practice nurses: clinical nurse specialists, certified registered nurse anesthetist, certified nurse practitioners, and certified nurse midwives. All of these roles require a master’s degree in addition to appropriate certification and licensing. Different universities offer different types of master’s programs that prepare nurses for these four main tracks, and so it’s important to ensure the master’s program you’re considering fits with the advanced practice role you want to pursue. For example, at the master’s level, PLNU offers a master’s of science in nursing (MSN) with a certification track to prepare nurses to assume the role of a clinical nurse specialist. Additionally, for nurses who already have an MSN, PLNU offers a post-MSN CNS certification program to prepare nurses for clinical nurse specialist roles as well. Further, at least some experience within your nursing field of interest is usually required in order to be accepted into a master’s program that prepares nurses for one of the four advanced practice roles. This means that if you wanted to acquire an MSN along with the post-MSN CNS certification and work in, say, the adult/gerontology area, you would need to have some basic experience working within the adult/gerontology setting before applying.

 

Certified Nurse Practitioner (CNP)

Certified nurse practitioners work alongside a supervising physician in order to assist and treat patients. They can prescribe medication, examine patients, and diagnose certain illnesses, giving them responsibilities that are similar to that of doctors, though their exact responsibilities will depend on the state where they’re administering care. There are several areas of expertise that you can work within as a certified nurse practitioner, such as acute care, family practice, gerontology, neonatal, pediatric, psychiatric/mental health, and women’s health.

“A nurse practitioner is going to focus on providing primary care. They will work on par with a physician’s assistant (PA). The PA will an education focused on a medical approach and the NP will have an advanced education in nursing,” Taylor said. “The NP will have the consultative supervision of an MD to administer healthcare and assess, diagnose, and treat patients. From a healthcare perspective in the United States, nurse practitioners are an excellent addition to meeting the needs of the healthcare of the nation.

From a healthcare perspective in the United States, nurse practitioners are an excellent addition to meeting the needs of the healthcare of the nation.

As a nurse, if you find yourself drawn to work that is similar to that of a primary care physician — meeting with patients whom you might become familiar with overtime to assess, diagnose, and treat a host of symptoms related to health and wellness, managing chronic conditions, and working toward disease prevention — then this might be the right track for you.

Prerequisites for Role: Relevant nursing experience, master’s degree and specialized graduate preparation, and state licensing and certification

Average Salary: $105,361 (salary varies based on experience, area of specialty, state of practice, etc.)

 

Clinical Nurse Specialist (CNS)

A clinical nurse specialist works within a hospital or other clinical setting and applies evidence-based practices to assist patients, nurses, and the healthcare organization overall. They are often in leadership, administrative, or educational roles within clinical settings. In addition to having an area of speciality, they are trained in physiology, pharmacology, and physical assessment.

A clinical nurse specialist involves applying research and providing clinical expertise as well as having communication and leadership abilities,” Taylor said. Taylor pointed to a CNS working on a stroke unit to provide an example. “A CNS working on a stroke unit would manage the stroke patient from an inpatient prospective, working to facilitate stroke victims’ transition to home and providing continuous resources for the patient [and their family] after they leave the hospital.”

Taylor also gave the example of a CNS working with patients of congestive heart failure. In this case, once the patient has been allowed to return home, the CNS would continue to speak with the patient over the phone, monitoring symptoms by asking questions and addressing issues that might come up in order to keep the patient trending toward recovery.

But this is only one of the many areas where a CNS might work, as they can be found in one of the three main healthcare spheres: the patient, nurse, or organization sphere. So, a CNS working for the organization in, say, acute care, could be involved with helping the hospital develop better practices for treating patients in that unit on an organizational level. For a CNS working with the nurses, they might be in charge of teaching, training, and managing them to be more proficient healthcare practitioners. And another CNS might be working specifically with the patients, similar to what Taylor mentioned above with patients suffering from a stroke or congestive heart failure.

If you find that you like to be involved with several activities while remaining within the clinical setting, be that as not only an educator or a leader, but also as someone who continues to work with the patients, then a clinical nurse specialist might be the right track for you.

Prerequisites for Role: Relevant nursing experience, master’s degree and specialized graduate preparation, and state licensing and certification

Average Salary: $103,032 (salary varies based on experience, area of specialty, state of practice, etc.)

 

Certified Registered Nurse Anesthetist (CRNA)

A certified registered nurse anesthetist helps administer anesthesia in different medical settings. They work with surgeons, anesthesiologists, dentists, and other healthcare professionals to ensure patients throughout the process of surgery are taken care of, which includes managing patients’ pain, making sure patients are stabilized, and tending to patients’ post-operation recovery.

Becoming a certified nurse anesthetists requires advanced training due to the expertise needed to help administer serious surgeries and other medical procedures. If you feel drawn to the surgical side of medicine and to helping patients in recovery, then the certified registered nurse anesthetists might be the right track for you.

Prerequisites for Role: Relevant nursing experience, master’s degree and specialized graduate preparation, and state licensing and certification

Average Salary: $179,349 (salary varies based on experience, area of specialty, state of practice, etc.)

 

Certified Nurse Midwife (CNM)

Similar to the certified registered nurse anesthetists, certified nurse midwives entail a more specific set of roles and responsibilities, which relate to treating women with childbirth and reproductive health. They help with childbirths, provide counseling to women, write prescriptions, and assist patients throughout the pregnancy process. They can be found in hospitals, private practices, and other types of clinics.

Do you feel drawn to women’s health and childbirth? If you feel that offering nursing healthcare in these capacities inspires you then this might be the right track for you.

Prerequisites for Role: Relevant nursing experience, master’s degree and specialized graduate preparation, and state licensing and certification

Average Salary: $106,383 (salary varies based on experience, area of specialty, state of practice, etc.)

 

The Terminal Nursing Degree: Ph.D. vs. DNP

While the four advanced clinical nursing roles don’t currently require a doctorate, as mentioned, that trend is changing. And the nurses who do have a doctorate will only continue to have an advantage in the healthcare setting. That’s why, whether you already have a master’s and are working in one of the four roles listed above or are considering enrolling in an master’s program, it’s worth thinking about whether a terminal degree makes sense to further your nursing career.

However, there are two doctorates that are available for nurses looking to earn an advanced terminal degree. A terminal degree refers to the highest academic credential for a given discipline.

The Ph.D. stands for a doctorate of philosophy, which is primarily a researching doctorate. You’re probably familiar with the Ph.D. because this is what most professors at four-year universities have. It’s a terminal degree for those focused on researching and adding new knowledge to a specific discipline. That discipline could be literature, biology, mathematics, or one of the many others within the higher education system. A Ph.D. in nursing is designed for those who want to research and find new knowledge within the field of nursing. It’s also for those who specifically want to teach at a major research university (although you can still teach with a DNP at some smaller universities).

For those with the DNP, they’re taking a look at a current problem and finding a way to solve that problem by applying knowledge that already exists.

As a Ph.D.-prepared nurse you’re gathering and creating new knowledge in your field,” Taylor said. “For those with the DNP, they’re taking a look at a current problem and finding a way to solve that problem by applying knowledge that already exists.

While you can find a full-time job teaching at a smaller university with a DNP, there are many universities that don’t offer tenure-track positions to nursing faculty unless they have a Ph.D. A tenure-track position within higher education is a position that, after a few years of being reviewed for research production and teaching competence, you are guaranteed a full-time job at the university until you retire.

“Universities have medical doctors and lawyers [who both have practice doctorates] in tenured teaching positions, but nursing isn’t there yet when it comes to having a doctorate in practice as opposed to a Ph.D.,” Taylor said. “So whenever I talk with potential students and they want to teach I say, ‘Where do you want to teach? What’s your goal?’ And if it’s at a large research school then I steer them toward a Ph.D. But if they’re willing to teach at a smaller school, or a community college, then I’ll say the DNP is still an option for you.”

If you’re considering a Ph.D. or DNP, it’s important to envision your end goal. If you love research and are committed to growing knowledge within the field of nursing, then the Ph.D. is probably the better choice. Additionally, if you’re committed to teaching at a larger school as well as doing research, then, again, the Ph.D. is going to be the better option for you.

Yet, the DNP is the better option if you see yourself staying within the clinical setting, even as an administrator one day. Taylor provided examples of two students who are currently in PLNU’s DNP program who are interested in staying on the clinical side.

“One student, a nurse anesthetist who works in an ambulatory surgery facility in the Los Angeles area is currently interested in research related to the protocol for administering anesthesia to obese persons,” Taylor said. “There are a lot of surgeries that are canceled because of the specific protocols for these types of patients, which affects the bottom dollar for the facility and the patient. This student wants to develop a protocol that would address this. Another student of mine is a nurse at UCSD and her father-in-law had a stroke. When they discharged him they told the family there’s a chance for depression for her father-in-law. The research shows that depression occurs pretty much 100 percent of the time. So this student is developing a protocol that will prepare families and patients who have suffered a stroke by providing depression screening tools and resources at discharge, rather than waiting for it to happen.”

I became a nurse because I wanted to provide care for patients. My heart has always been at the bedside, and I wanted to get my advanced degrees so I could be a better nurse as well as work with other nurses in taking care of their patients.

Both of these examples highlight the type of applied research that a DNP would do in a clinical setting. Whereas the Ph.D. would be the one focused on conducting comprehensive and original research for obese or stroke populations (e.g. the number of delayed surgeries for obese patients or the number of stroke victims that become depressed), it’s the DNPs who would take that research and figure out ways to apply it to the clinical setting to improve healthcare.

Riingen earned her DNP instead of a Ph.D. because she wanted to enhance her clinical expertise in nursing.

“I became a nurse because I wanted to provide care for patients. My heart has always been at the bedside, and I wanted to get my advanced degrees so I could be a better nurse as well as work with other nurses in taking care of their patients,” Riingen said.

PLNU alumni Lindsey Ryan (05, MSN 10), on the other hand, opted to go for a Ph.D. instead of a DNP.

“One of the things I really felt passionate about was generating new knowledge, and that was what the Ph.D. program was all about,” Ryan said. “The DNP-prepared nurses translate the evidence. The Ph.D.-prepared nurses are creating it. I felt very comfortable in my role with translating some of that research and implementing evidence-based practices, but I wasn’t knowledgeable about creating new evidence, and that seemed really exciting to me. I love innovating. I love asking questions. So the Ph.D. route really gave me a platform to ask the questions, ask them in a scientific way, and use different methods to answer those questions.”

Riingen is asked often by both PLNU nursing students and alumni if they should pursue a Ph.D. or a DNP.

“I hear that question all of the time, and my first question back to them is always, ‘What do you want to do? Where is your heart?’” Riingen said.

“My advice to a young nurse considering graduate school would be to look within your own organization, identify people who are in roles using their doctoral degree, and ask them about it,” Ryan shared. “There is so much value in hearing firsthand what the role looks like, what their challenges are, and what their greatest contributions are in that role. Identifying your own strengths and what makes you excited is important, too. Take time to self-reflect on what you’re truly passionate about.”

Nurses Share Their Thoughts on Graduate School

PLNU recently launched its DNP program, meaning that the School of Nursing now offers a doctorate degree in addition to a BSN for traditional students, an RN to BSN for adult students, and an MSN with a clinical nurse specialist track. Current students in the DNP program have found the decision to go back to school to be a worthwhile move for their nursing career.

Mary Kay Shibley is currently the manager of clinical informatics and the electroconvulsive therapy department (ECT) at Sharp Mesa Vista. She started PLNU’s DNP program this past fall.

“I truly love what I do, but I got to this place where I started to ask myself questions about what I want to do down the road. I knew I wanted to get an advanced degree in nursing but I did not want to get a Ph.D. because to me, the Ph.D. is all about research, and I’ve never been interested in just doing research,” Shibley said. “I’m a do-er. To me, the DNP was the perfect degree because it allows me to implement things that have already been researched by other nurses.

Shibley is hoping the DNP helps her move up in Sharp Healthcare related to informatics and leadership because she recognizes the importance of technology in the healthcare field. She wants to be able to implement policy changes at the administrative level. A few months into the DNP program at PLNU, she has no regrets about her decision to go back to school.

“So far I love the program. I love the ability to do the work during the week and through the web conferences where I can connect with everyone else in the course. Some of us live far away, so we’re not going to get together physically, but I love that we can get together in those web conferences that are facilitated by the instructors,” Shibley shared. “I did various research on DNP programs since I’m working full-time and could not back off from that since I have two children who are going to hit college in about three years. In looking at the various programs, I wanted a program that offered me the ability to work on my own but also to connect with others in a meaningful way.”

Jose Chavez (07, MSN 16) started the DNP program this past fall as well. He is currently a critical care critical nurse specialist and covers the cardiac intensive care unit and the cardiac telemetry unit at Cedar Sinai. He saw the DNP as the next valuable step for his career aims in nursing.

I’m a do-er. To me, the DNP was the perfect degree because it allows me to implement things that have already been researched by other nurses.

“Nurses are expected to take on bigger roles with all of the changes, and are often expected to have an advanced degree,” Chavez said. “These changes in healthcare include more technology and an aging population, which means that nursing will continue to have more responsibility within the healthcare industry. Continuing on to get a DNP furthers my stance in the profession, and that’s where it’s headed with terminal degrees. It prepares me in being able to apply the science and push healthcare and my career forward. My dream is to be able to push nursing into new directions, especially by advancing it in different countries.”

He is also happy with his decision to pursue his DNP.

“The DNP program at PLNU has been great. My peers in the program are well established in their careers,” Chavez said. “It’s cool to see their point of view and to hear about their experiences. I’m getting all of these different points of view that I usually wouldn’t within my own specialty, such as within anesthesia or behavioral health. It’s also a smaller program, and I can really feel the community, even as a DNP student.”

Related Article: Larry Rankin, Ph.D., shares why a DNP is more important for nurses than ever.

Ryan earned her BSN and MSN at PLNU, and is now attending the University of San Diego for her Ph.D. She can’t say enough about the value of going back to school to get an advanced degree beyond just the BSN, whether that’s an MSN, DNP, or Ph.D.

“I wish it was mandatory for everyone to get a degree beyond the BSN, just because I think there is so much value in continuing to expand your horizons and skills in nursing. And with as fast as healthcare is moving, you can’t stay stagnant and constantly have to be thinking about how you are going to adapt and innovate,” Ryan said. “Nurses really need to be leading and innovating some of the changes going on in healthcare.

Shibley offered advice to those nurses who have been out of school for several years and are hesitant to go back. She understands the hesitation, as she herself spent many years away from school before starting PLNU’s DNP program.

“It’s never too late,” Shibley said. “The last time I was in school for my master’s was twenty years ago. We have a nurse anesthetist in the program who hasn’t been in school for thirty years. But we’re all doing it together. You’re never alone and the teachers are great support. PLNU has a plethora of opportunities for you to learn and grow, and so don’t be afraid to try it.”

 

Are you Ready to Advance Your Nursing Career?

If so, PLNU offers a master’s in nursing with a clinical nurse specialist track as well as a DNP program for those looking to earn a terminal degree. PLNU’s School of Nursing supports students through every step of the journey. We would love to help you determine your next steps.

Speak with one of our admissions counselors at (619) 329-6799 or gradinfo@pointloma.edu today.