As Washington continues to struggle with a growing physician shortage, the state’s nurse practitioners and other ARNPs are successfully filling the void, thanks to their ability to practice independently without physician oversight or collaborative agreements. That’s good news in a state that ranks 26th in the nation in terms of the ratio of physicians to residents.
A 2019 study found that a number of factors are contributing to the physician shortage in Washington, including the spiking demand for healthcare services spurred by a population that is getting bigger and growing older, as well as the growing number of physicians reaching retirement age.
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The Washington Office of Financial Management revealed that between 2010 and 2040, the population of the state is projected to increase from 2.5 million to 9.2 million people. Combine that with the fact that 16% of the state’s population is 65 years of age or older, and it’s clear why the Evergreen State has a physician shortage on its hands.
ARNPs in Washington State—and elsewhere across the country—are the reliable and cost-effective answer to a lack of physicians. In Washington, these advanced practitioners can diagnose and prescribe treatment, including pharmaceuticals, independent of physician oversight.
Washington’s ARNPs don’t take this level of autonomy lightly, which is why many are earning the Doctor of Nursing Practice (DNP) since it reflects the advanced level of care they provide in an increasingly complex healthcare environment.
The DNP allows nurses to succeed at the highest levels of clinical practice, take on positions in administration and executive leadership, earn a bigger paycheck, and advance the nursing profession.
RNs choose the DNP as a path to initial ARNP certification, while current ARNPs choose it when transitioning to administration or executive leadership, or to advance in clinical practice, which may include adding another patient population focus.
Along with offering an increasing number of DNP programs with entry points for both BSN- and MSN-educated nurses, more nursing schools are now offering the curriculum online.
Earning a Doctor of Nursing Practice (DNP) in Washington
Qualifying DNP programs in Washington that have received accreditation through the Commission on Collegiate Nursing Education (CCNE), as well as online programs that may hold accreditation through the Accreditation Commission for Education in Nursing (ACEN) incorporate at least 1,000 post-baccalaureate practice hours, 500 of which can be carried over from a master’s program.
All accredited programs are available in one of two general areas of focus, with specialty tracks in each:
- Advanced practice nursing direct care focus (nurse practitioner, clinical nurse specialist, nurse midwife, nurse anesthetist)
- Aggregate/organizational/systems focus (health policy, informatics, public health, administration, executive leadership)
More working RNs and ARNPs in Washington are opting for the flexibility of accredited online programs. These programs include all the rigor of a campus-based experience while offering convenient 24/7 access to online study materials. Students of online programs would complete their practicum requirements at local partner sties.
Many online and campus-based DNP programs offer either an accelerated or part-time pace:
- Traditional DNP programs entail about 1.5-2 years of study
- Part-time DNP programs take about 2.5 years of study
- Accelerated programs are usually completed in a year
DNP programs are available to both bachelor’s-prepared RNs and MSN-prepared RNs and ARNPs:
- Post-Bachelor’s BSN-to-DNP programs designed for BSN-educated nurses allow students to earn an MSN before transitioning to DNP-level coursework, all in one continuous program. Those in an ARNP track would obtain national certification in their role and primary patient population focus as well as initial ARNP licensure before they make the transition to the DNP component of the program. Tracks in an aggregate/organizational/systems focus are also available.
- Post-Master’s MSN-to-DNP programs designed for nurses that already possess an MSN enable RNs to pursue advanced practice certification and licensure and existing ARNPs to advance their expertise in their current patient population focus or add another specialty or population focus. Tracks in an aggregate/organizational/systems focus are also available.
DNP Program Components and Practicum Requirements
- DNP Core – The DNP consists of coursework in health policy, health information systems, nursing theory and research, evidence-based practice, quality improvement, and statistics.
- Specialty Courses in Students’ Chosen Focus – Courses align with the specialty track, whether in direct patient care or in an aggregate/organizational/systems focus.
- DNP Project – Students conclude their DNP studies by working in concert with faculty members to choose and implement a research project in their specialty. Completion of a DNP Project entails producing a manuscript suitable for publication in a peer-reviewed journal or for presentation at a conference. Students generally defend their results on campus, although one of Washington’s programs allows its students to use Skype for their defense. Examples of DNP Projects presented recently in Washington include:
- Delivering Culturally Competent Care to LGBTQ Adolescents
- Development of a Post-Graduate FNP Residency Program at a Community Health Clinic
- Investigating Barriers in Healthcare to meet Women’s Needs in Early Pregnancy Loss
- Healthy Eating and Active Living of Youth in Malheur County
- Practicum Hours – National accreditation standards for DNP programs require that these students obtain at least 1,000 hours of post-baccalaureate training. As many as 500 hours gained during a master’s program can be applied to this total.
Students must obtain their clinical hours at healthcare sites that have established agreements with their school, so they must prepare in advance to secure a clinical site and a preceptor to supervise them. Almost all nursing school programs provide clinical sites in long-term and acute care settings, and many expanded their use of outpatient sites. While healthcare organizations throughout Washington serve as sites for clinical training, demand is exceptionally high in the Puget Sound area, so clinical opportunities are limited there.
To streamline the process of identifying a clinical site and to help students maintain record of their practicum hours, Washington state instituted clinical consortia that schedule student experiences in major areas of the state. This process has improved access to available sites and decreased the workload involved in tracking clinical hours.
BSN-to-DNP and MSN-to-DNP Programs Available in Washington
The following DNP programs have been accredited by the Commission on Collegiate Nursing Education (CCNE) (current as of 2016). An additional campus-based DNP program in the state will start accepting students in 2017.
A larger selection of both CCNE and ACEN (American Commission for Education in Nursing)-accredited DNP programs are available online.
Gonzaga University
School of Nursing & Human Physiology
Spokane
Accreditation: CCNE
Post-Baccalaureate-DNP (online)
- Family Nurse Practitioner
- Psychiatric-Mental Health Nurse Practitioner
Post-Master’s-DNP (online)
- Leadership
Pacific Lutheran University
School of Nursing
Tacoma
Accreditation: CCNE
BSN-DNP (campus)
- Family Nurse Practitioner
- Psychiatric Mental Health Nurse Practitioner
MSN-DNP (campus)
- Family Nurse Practitioner
- Psychiatric Mental Health Nurse Practitioner
MSN-ARNP-DNP (campus)
- Clinical Nursing Practice
Seattle Pacific University
School of Health Sciences
Seattle
Accreditation: CCNE
BSN-DNP (campus)
- Adult-Gerontology Nurse Practitioner
- Family Nurse Practitioner
- Clinical Nurse Specialist
Post-Master’s-DNP (campus)
- Nurse Practitioner
- Clinical Nurse Specialist
Seattle University
College of Nursing
Seattle
Accreditation: CCNE and ACME
Advanced Practice Nursing Immersion (APNI)-DNP (campus)
- Adult-Gerontology Acute Care Nurse Practitioner
- Adult-Gerontology Nurse Practitioner
- Family Nurse Practitioner
- Family Psychiatric Mental Health Nurse Practitioner
- Nurse Midwifery
RN/BSN-DNP (campus)
- Adult-Gerontology Acute Care Nurse Practitioner
- Adult-Gerontology Nurse Practitioner
- Family Nurse Practitioner
- Family Psychiatric Mental Health Nurse Practitioner
- Nurse Midwifery
Post-MSN-DNP (campus)
- Health Systems Leader
University of Washington
School of Nursing
Seattle
Accreditation: CCNE and PNCB and ACME
Post-Baccalaureate-DNP (hybrid)
- Adult Gerontology Acute Care Nurse Practitioner
- Adult Gerontology Primary Care Nurse Practitioner
- Family Nurse Practitioner
- Nurse-Midwifery
- Pediatric Clinical Nurse Specialist
- Pediatric Nurse Practitioner Acute Care
- Pediatric Nurse Practitioner Primary Care
- Perinatal Clinical Nurse Specialist
- Population Health Nursing
- Population Health Nursing & Global Health MPH Concurrent Degree
- Psychiatric Mental Health Nurse Practitioner
Washington State University
College of Nursing
Pullman
Accreditation: CCNE
Post-Baccalaureate-DNP (hybrid)
- Family Nurse Practitioner
- Psychiatric Mental Health Nurse Practitioner
- Population Health Nurse
Post-Master’s-DNP (hybrid)
- Family Nurse Practitioner
- Psychiatric Mental Health Nurse Practitioner
- Population Health Nurse
Other DNP programs in the state not shown here may be regionally accredited or hold specialty accreditation through the Council on Accreditation of Nurse Anesthesia Educational Programs or the Accreditation Commission for Midwifery Education.
Opportunities Available to DNP-Prepared Nurses in Washington
Washington’s DNP-educated nurses hold executive, administration, and leadership roles, serve as nursing faculty, and practice in the clinical environment as advanced nursing clinicians.
The following job posts provide a look into some of the professional opportunities available to DNP nurses in Washington:
Family Nurse Practitioner, Orting Family Practice, Puyallup, WA
- Must hold ARNP and RN licensure in WA
- Master’s degree or higher; DNP preferred
Assistant Professor of Nursing – Graduate Programs – Seattle Pacific University, Seattle, WA
- Earned doctorate degree in nursing or a closely related discipline
- Unencumbered license as an ARNP in the State of Washington
- Board certification (ANCC or AANP) as either a family nurse practitioner or adult-gerontology nurse practitioner
Senior Lecturer Part-Time – Pediatric Nurse Practitioner Program, University of Washington, Seattle, WA
- DNP degree
- ARNP licensure in Washington State
- Minimum of two years of teaching experience
- Primary care PNP board certification is required
Psychiatric Nurse Practitioner – ARNP, Sea Mar Community Health Center, Vancouver, WA
- DNP preferred, MSN with experience
- Current RN credentials in Washington State
- Current ARNP credential in Washington State
Examples of DNP nursing positions were taken from a survey of job listings in January 2020 and are shown for illustrative purposes only. These examples do not represent job offers or positions that are currently available.