The DNP is acknowledged as a nursing practice doctorate and has been developed to create expert nurse clinicians regardless of nursing role. The DNP degree is a huge accomplishment for the nursing profession. Doctoral degrees included in the literature encompass DNPs, PhDs, and EdDs as well. The DNP project is the pinnacle for completion of the degree. Much like the nursing profession, there is not a standardized terminology for the project. The DNP opportunities are boundless and will build upon the fundamentals of nursing practice. This chapter provides an overview of the evolution of the DNP degree, different programs, and learning environments available. In addition, it is hoped that this chapter will create a vision for potential personal and professional options offered with pursuing the degree. Choosing the DNP degree will enhance multiple opportunities to open pathways in nursing that are not always available without a terminal degree.

Advanced nursing degrees lead to higher income opportunities and offer nurses a variety of positions in which they can play a critical role in patient interaction. With today’s population having a longer life expectancy, nurses with advanced degrees will be able to address patients’ primary care concerns. It is well known that nurse practitioners have taken on more prominent roles by assuming responsibilities that were previously performed by medical doctors. In recent years, there has been accelerated growth of online degree programs throughout the country and graduate nursing degree programs are no exception. Some online programs allow the graduate nursing student to attend an out-of-state school without paying out-of-state tuition, which can minimize debt and provide more convenience to the student. Some of the most well-respected colleges now offer online degree programs.

Education loans for advanced nursing degrees come in the following categories: Federal Direct Unsubsidized Student Loan; Federal Direct Grad PLUS Loan; Nursing Student Loan; and Private Education Loan. Federal Direct Student Loans are a form of financial aid that must be repaid with interest. Grad PLUS is a federal loan also funded by the Department of Education; its benefits are similar to those of Federal Direct Loans. Students should check with the financial aid office of their institution to determine whether the institution offers its own nursing student loan program. Private education loans are nonfederal loans made by a private lender such as a bank, credit union, or state agency, and there are no federal forms to complete. Graduate students who consider using private education loans often also consider using a personal residence or home equity loan to finance their education. Borrowing from retirement accounts also may be considered as a source for college funding.

The role of clinician, or direct care provider, for a DNP-prepared nurse is the least controversial of the roles currently embodied by nurses who hold the degree of DNP. The reason for this is simple: Advanced practice registered nurses (APRNs) were the intended population for the attainment of the degree since its inception. This chapter outlines the different specialties, certifications, and career options available with direct patient care. Although the chapter outlines a few of the challenges of the role, there are several counterpoints and advantages of the DNP-prepared nurse in direct patient care. The specialties and career options that are available are noteworthy and will serve as a guide for pursuing the DNP degree and finding the best role to enhance professional growth.

This chapter outlines the historical perspective on the advancement of the compact licenses, how this could benefit the profession and what next steps should be taken. The Advanced Practice Registered Nurse (APRN) compact is newer on the scene in terms of full enactment, but it has also been a part of the discussions about APRN practice since the initial discussions of registered nurse practice and the interstate compact in 2015. Conceptually, the APRN compact makes sense and takes the APRN Consensus Model document and moves it to a new level in that the proposed regulatory language includes a nod to the Consensus Model language. The actions and activities of the APRNs, the patients, and the employers have a role to play in the full implementation of the compact. Each APRN has to weigh and measure the need for the compact in their personal practice.

Advanced practice registered nursing is an exciting career choice with many opportunities and challenges. Advanced practice registered nurses (APRNs) are at the forefront of the rapidly changing healthcare system, filling myriad roles in organizations where they provide cost-effective, high-quality care. The term “advanced practice registered nurse” became the common umbrella term used to designate four specialty roles of nurses with formal post baccalaureate preparation: certified nurse midwives, certified registered nurse anesthetists, nurse practitioners, and clinical nurse specialists. A number of factors led nursing leaders to delineate these four APRN roles. A critical factor was obtaining legal status to be directly reimbursed for their nursing services. APRNs are educated within master’s or doctoral nursing programs and play key roles in providing culturally competent care. They assume leadership in developing new practice sites and innovative systems of care to enhance healthcare outcomes.

Certified Registered Nurse Anesthetists (CRNA) are advanced practice registered nurses (APRNs) licensed as independent practitioners who plan and deliver anesthesia, pain management, and related care to patients of all health complexities across the lifespan. The early leaders of this profession were amazing women who taught so many lessons that resonate today. CRNAs, and all APRNs, have a key role to play in the development of our nation’s health care policy. Nurse anesthetists must be willing to challenge the system when it is in patients’ best interests to do so while understanding that health care spending competes with other important needs of society, and efforts to reduce costs mean better access to care for all. The future is bright for this storied profession as health policy incentives align to reward the value that CRNAs bring to the patient experience.

Clinical decisions are based on clinical or diagnostic reasoning and clinical decision making skills. Clinical decision making in advanced practice nursing occurs as a continuous, purposeful, theory and knowledge based process of assessment, analysis, strategic planning, and intentional follow-up. It is both a cognitive and affective problem solving activity for defining patient problems and selecting appropriate management approaches. Several common or core features of clinical reasoning across health disciplines have been identified in the research. One core element is clinical knowledge that is interdependent and fundamental to clinical reasoning. A second core feature of clinical reasoning is an array of higher order cognitive skills and processes. The third feature associated with clinical reasoning is that it is highly context dependent. The complexity of the healthcare system and patients requires interprofessional collaboration and communication to ensure sound clinical decision making resulting in patient centered care.