The Doctor of Nursing Practice: From Start-Up to Impact.

The doctorate of nursing practice (DNP) began, much like any start-up, to meet the demands of a quickly evolving market. At once exciting and controversial, rich with opportunity and risk, as well as highly visible with respect to both its achievements and shortcomings, the DNP had much in common with other, more familiar start-ups. It entered a market dominated by credentials that were established, effective, and respected: the doctor of philosophy (PhD) and doctor of education (EdD) degrees.Now, more than 10 years in, it is time to transition from the behaviors of a start-up to those of a successful endeavor thriving as a result of attention to market conditions and demands. It is no longer sufficient to be the next big thing: it is time to deliver clear, added value.This article shares key themes from a conversation that began at the first annual DNP Impact Conference, sponsored by Johns Hopkins University School of Nursing, in which participants considered the challenges and demands of the market 10 years into DNP education and practice. One hundred twenty nurse leaders from service and academia joined for two days to reflect on the progress of the degree, the graduates who earn it, the curricula that prepare them, and the demands and opportunities in markets that employ them.BACKGROUND FRAMED BY DIFFUSION OF INNOVATION THEORYIdeas move over time from what is known as innovation to what is accepted as common practice. The process proceeds through clear phases, and those who adopt the innovation are identified according to the point at which they come aboard (Rogers, 1962). As background to this account of the DNP Impact Conference, Rogers' Diffusion of Innovation Theory is used to trace the 10-year history of the DNP as it penetrated education and practice.InnovatorsThe first to embrace change, according to Rogers (1962), are innovators, risk takers who share an affinity for new things and solutions. In Rogers' model, the innovators represent roughly 2.5 percent of the market. The American Association of Colleges of Nursing (AACN) in 2004, with the help of Case Western University, Columbia University, and other institutions, opened a dialogue about the demands and challenges facing nursing practice and movement toward the DNP began. Innovators participated in this conversation.The innovation itself was informed by calls from the Robert Wood Johnson Foundation and the Institute of Medicine (1999) for transformational models of care, interprofessional collaboration, and educational reform that would prepare professionals to increase safety and improve quality. The conversation evolved and much is written about the events that followed (Apold, 2008). Innovators drew distinctions between the research doctorate and the practice doctorate in order to inform curriculum development and conversations about scholarship.Early AdoptersThose who next enter the process, according to Rogers (1962), are opinion leaders, trendsetters, and role models attracted to competitive advantage. Comprising roughly 13 percent of the market according to Rogers, these early adopters have the resources to assume risk. In the case of the DNP, early adopters shared, with innovators, a common intent to prepare advanced practice registered nurses (APRNs) with three attributes: a deep foundation in the science and the discipline that would enable them to critique and apply evidence in the provision of direct care, strong leadership knowledge and skill, and the practiced ability to inform and drive policy (Mundinger, Starck, Hathaway, Shaver, & Fugate-Woods, 2009; Potempa, 2011).Early adopters implemented DNP programs that were diverse in their curricula and pedagogies. For some, the focus centered on achieving expedient translation of evidence to solve important practice problems. This focus enhanced performance in support of the "Triple Aim": patient experience, quality of life, and value (Berwick, Nolan, & Whittington, 2008). …