NURS 7410 Discussion Board question 4: Transition in Practice – BSN to DNP


NURS 7410 Discussion Board question 4: Transition in Practice – BSN to DNP

Professional Transition in Nursing Practice – BSN to DNP

Change is inevitable in nursing practice, and at one point, a practitioner may want to do something else or improve their competencies and scope. Improvement in my competency levels will improve the quality outcomes of my care. Doctor of Nursing Practice (DNP) programs was introduced in the United States in 2004 by the American Association of Colleges of Nursing (AACN) following the recommendation by the National Academy of Medicine, then referred to as the institute of medicine (Bowie et al., 2019). By transitioning from BSN to DNP, I aim at achieving a doctor’s degree in my subspeciality of nursing, mental health nursing. I expect this transition to improve my scope, expertise, knowledge, skills, and attitudes in mental health nursing (Sebastian et al., 2018). I am well acquainted with my scope of practice and responsibilities as a registered nurse. The advancement of my practice in the BSN-DNP transition, however, will hone my roles and improve the specialization and ethical, legal, and practice roles. I don’t expect this transmission to be smooth and uneventful. Various aspects of this transition worry me. The purpose of this discussion is to express my issues of concern in the BSN-DNP transition.


Scope of Practice

The scope of practice of DNP-prepared advanced practice nurses varies from that of the registered nurses without any specialization. The scope of my practice as a DNP-prepared nurse will need to meet employer requirements as well as those of my patients and their families. Various employers have specific expectations from DNP nurses that make the scope somewhat ‘subjectively variable.’ Before being hired by practice employers, I will be expected to perform roles and responsibilities of advanced practice registered nurses who are MSN prepared and the primary responsibilities and functions that a registered nurse performs. Some practice employers will require that DNP nurses perform roles beyond their areas of specialization because they have advanced learning and skills in the nursing practice (Hammersla et al., 2021). This issue concerns my future scope of practice because of the need to adjust to the heterogenous employer and client expectations.

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The scope of practice of a DNP nurse includes roles in the management, quality improvement programs, project management, clinical teaching, research process in nursing, and direct patient care (American Association of Colleges of Nursing, 2020). DNP does not entirely alter the scope of practice of DNP nurses. According to Tenhunen et al. (2020), DNP nurses’ actual scope of practice remains the same as those of other APRNs. However, they collaboratively work with master’s prepared nurses as change agents, nurse educators, nurse leaders, and evaluators of care (McCauley et al., 2020). DNP nurses have terminal expertise in nursing education and practice and can work in clinical areas or leadership systems. With these expanded roles, I will have expanded opportunities. However, this will come at collaborative and coordination roles above those of a BSN-prepared registered nurse.

The expansion of my roles will come with criticisms from other similar-level nurse cadres. DNP is considered a terminal degree in nursing. Many clients may think that means I would work at similar levels with a physician or MSN-prepared nurse. Despite being a terminal degree, criticisms and negative comments have been made about DNP nurses. Some schools of thought may argue that DNP is a watered-down Doctor of Philosophy in Nursing (Ph.D.), while others would argue that it is not worth the cost of training. These are some of the concerns that I will have to deal with as a DNP nurse. The truth remains that a DNP is not a physician, and DNP is not a role but a degree. I will have to work in the same capacities as APRNs and master’s prepared nurses.

Ethics in DNP Nursing and Professional Relationships

As a DNP nurse, I will have full competence in nursing leadership and advanced practice. Expanded leadership and management come with various ethical responsibilities. Generally, nurses are responsible for upholding ethical values in practice and leadership. However, nurse leaders and managers face decision-making responsibilities in challenging cases of an ethical dilemma that impact patient care outcomes. Various controversies have arisen due to the title ‘Dr.’ that DNP nurses are accorded upon their graduation and licensure. This title is academically appropriate, but care recipients may confuse the titleholder with physicians and other professionals in healthcare that hold the same tile, thus the expectations aforementioned. Pursuing DNP training and education should be purely for professional and career advancements. Critics of DNP have argued that the pursuant of this degree do so for titles and increments in income they would earn with the title. This concept ethically puzzles me. Advancing my nursing management and clinical practice expertise will be solely for patient care quality improvement and professional career advancement. Therefore, I aim to collaborate with Ph.D. nurses to enhance and further translate nursing science into practice. Transitioning from BSN to DNP come with other ethical responsibilities not mentioned here, and I feel ready to uphold my ethical principles and codes learned in undergraduate training.

Legal Issues in BSN-DNP Transition

There are various legal implications in the transition to the Doctor of Nursing Practice (DNP). The development of the DNP program in the United States was a legal process that was enhanced by relevant bodies, including AACN. Legal concepts arise in the regulation and licensure, reimbursements, and transition from master’s to doctoral programs. The concept of practice authority has been a recent issue in the united and nearly half of the states have embraced the full practice authority for nurses. Various APRNs in some states in the US are still limited in their authority to prescribe medication independent of physician supervision. Unfortunately, DNP nurses are not viewed as APRNs, and the boundaries for the scope of their practice and the use of their titles ‘Dr.’ are not apparent in the legal laws of some states (Bowie et al., 2019). There are no well-established provisions for the scope of practice for MSN and Ph.D. nurses in all states. Legally, controversies still exist in the scopes of clinical practices in states where their cadres are not fully recognized by their titles (California Association for Nurse Practitioners, n.d.). Reimbursement issues are specific for each state, just like the practice authority.


Becoming a DNP nurse is an interesting professional advancement despite the legal and ethical hurdles that come during training and practice. Social and professional criticism have been reported against the DNP nurses. However, remaining committed is vital in this bold professional career advancement. Collaboration with other terminal degree-prepared nurses cannot be overemphasized. This is because DNP nurses have expanded roles in leadership and practice.


American Association of Colleges of Nursing. (2020, October). AACN fact sheet – DNP. Aacnnursing.Org.

Bowie, B. H., DeSocio, J., & Swanson, K. M. (2019). The DNP degree: Are we producing the graduates we intended? The Journal of Nursing Administration49(5), 280–285.

California Association for Nurse Practitioners. (n.d.). FAQs – California Association for Nurse Practitioners. Canpweb.Org. Retrieved March 10, 2022, from

Hammersla, M., Belcher, A., Ruccio, L. R., Martin, J., & Bingham, D. (2021). Practice and Quality Improvement Leaders Survey of Expectations of DNP Graduates’ Quality Improvement Expertise46(6), 361–365.

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 Outlook68(4), 494–503.

Sebastian, J. G., Trautman, D. E., & Cary, A. H. (2018). Moving ahead with the transition to the doctor of nursing practice. Nursing Outlook66(2), 105–107.

Tenhunen, M. L., Heinonen, S., Buchko, B. L., & Frumenti, J. (2020). The expert role of the DNP-prepared nurse impacting healthcare systems: Bench to bedside, classroom to the boardroom.


NURS 7410 Discussion Board question 4

iscussion Question #4 – Prompt


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Submit your Discussion Board Question #4 Response here.

As many of you know, I was once a brand new PMHNP as a second career. Transition issues abounded. Then when I worked in the palliative care role, I became a novice until I had some “legs” under me.

BSN-to-DNP Students – One of the most unsettling issues for a new nurse practitioner is facing the boundaries of scope of practice. You are very familiar with the scope of practice of a Registered Nurse. But moving into the new role with an expanded scope of practice can be daunting. What worries you about this transition? Please talk about issues from various perspectives, especially scope, professional relationships, legal, and ethical perspectives.

Certificate Students – As an APRN, you successfully navigated the transition from the RN scope of practice at the generalist and specialist levels to the advanced level of practice. But moving to a new specialty, you are once again somewhat of a novice. What worries you about this transition? Please talk about issues from various perspectives, especially scope, professional relationships, legal, and ethical perspectives.

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