Nurse Practitioner: MSN vs. DNP - Salary and Benefits
By: Kathleen Gaines BSN, RN, BA, CBC
According to the U.S. Bureau of Labor Statistics, the need for advanced practice nurses, which includes Nurse Practitioners (NP) and Doctor of Nursing Practice (DNP) nurses, is expected to grow by 31% by 2026. This is much faster than the national average of other healthcare-related professions. In 2016, there were 203,800 working nurse practitioners in the United States with an estimated growth of another 64,200 NPs by 2026. Current changes to healthcare have given additional opportunities for nurses. As the Baby Boomer generation continues to age, there will be an overwhelming need for advanced practice nurses, especially those specializing in geriatrics.
I am interested in becoming a Nurse Practitioner in the future. Should I pursue an MSN or DNP?
First, start with obtaining your MSN and sitting for the NP boards. DNP school will often be paid for by your employer if it is relevant to your current job. Plus, you can work as an NP without having a DNP.
What is the average salary of a DNP?
According to the U.S. Bureau of Labor Statistics, DNP prepared nurse practitioners earned an average of $135,830. Top paying states for DNP-prepared individuals are California, Alaska, Oregon, Hawaii, and Massachusetts.
Are DNPs paid more than an NP with only an MSN?
According to a 2018 Salary Survey conducted by Lippincott Solutions, nurses who earned a DNP earned an average of $7,000 more than nurses who earned their MSN and had an average annual salary of $94,000, while Medscape reported an average annual salary of $97,000.
Is a Master of Science in Nursing (MSN) the same as a nurse practitioner?
Yes! In order to be a nurse practitioner, you must have your MSN. After graduating from an accredited NP program, you will have earned your MSN and then once you sit for your state NP boards you will earn the title of a nurse practitioner in your specialty.
Is a DNP a more advanced degree than an MSN?
A DNP is a terminal degree. This means that it is the highest degree that can be earned in that specialty. An MSN is NOT a terminal degree.
How long are MSN to DNP programs?
Programs can be completed in 1-2 years of full-time study or 3-4 years of part-time study. Most DNP programs will allow students five years to complete the degree.
Are DNPs called Doctors?
Technically, nurse practitioners that have earned a DNP are doctors but are not called this in the clinical setting. Those that teach in academia will be referred to as Dr. but those that practice solely in a hospital or outpatient setting will be referred to as a nurse practitioner. Referring to an NP as Dr. can cause confusion with patients. Most patients, when meeting someone with the title of doctor, will assume the person is an MD. Certain states have rules that indicate a nurse practitioner with a DNP must inform patients they are a doctoral-prepared nurse practitioner. Certain healthcare organizations may also restrict the use of doctor for NPs.
What is the role of a Nurse Practitioner?
Nurse Practitioners deliver advanced care to a variety of patients in the clinical setting. According to the American Association of Nurse Practitioners (AANP), NPs work “autonomously and in collaboration with healthcare professionals and other individuals, to provide a full range of primary, acute, and specialty health care services.”
These services include:
- Order, perform and interpret diagnostic tests
- Diagnose and treat acute and chronic conditions
- Record and examine medical history, diagnoses, and symptoms
- Prescribe medications
- Manage patients’ overall care
- Educate patients and families on disease prevention and plan of care
- Monitor and operate medical equipment
- Perform physical examinations and patient observations
- Collaborate with other healthcare professionals
- Detect changes in a patient’s health and change the treatment plan if necessary
In 23 states, nurse practitioners have “full practice authority” which means they do not have to work under the supervision of a doctor. Full practice states include Oregon, Maine, Alaska, Hawaii, Washington, and Iowa. In states with reduced practice (Ohio, Pennsylvania, and Utah) and restricted practice (Texas, California, and Florida), NPs must have a medical doctor sign certain medical patient care decisions. NPs have prescriptive privileges in all 50 states and can administer controlled substances in 49 states.
Nurse Practitioner Specialties
For those considering advancing their nursing career, it is important to research all possibilities before choosing the best-suited program. Differences between programs may be subtle and only noticeable upon further investigation. All programs are a combination of clinical application and didactic coursework. The didactic coursework can be offered in an online format. Depending on the program, some students might have to find their own placement for NP clinical while others will assist students in finding suitable arrangements. This is important to consider depending on your location, as clinical locations may be limited or reserved for only specific local universities.
Nurse Practitioners have a master’s degree, known as an MSN, as well as board certification in a specialty. This specialty is determined prior to apply to a program. It is important to note that not all specialties are offered at schools so determining a specialty before researching programs is key. Once accepted into a specific program it can be difficult to switch and not all coursework will be transferable.
- Family – Primary or Acute
- Pediatric – Primary or Acute
- Adult-Gerontology – Primary or Acute
- Women’s Health/Gender-Related
- Psychiatric/Mental Health
Not sure which specialty to focus on? Generally, nurses use prior work experience to determine the NP path they will take. The differences between specialties will determine the course load. Nurses specializing as a neonatal nurse practitioner will focus specifically on neonates and the management of neonatal diseases. They will not have to take courses in geriatric medicine. Programs often require a certain number of years’ experience in a specialty before acceptance into the program.
Some specialties cover a broad spectrum, such as family and trauma, and these nurses will have to take a wide variety of courses. Individuals should expect to take courses ranging from pediatrics to geriatrics, even if they plan to only work with one specific age group.
Nurse practitioners can specialize even further with additional classes and certification exams. Classes for these are generally done online and might require individuals to contact other NP programs to obtain needed requirements. Nurse Practitioners can often complete on the job training in subspecialties.
Not all NPs have to work in a subspecialty. This is an individual decision and does not have to be based on past nursing experience. Nurse practitioner subspecialties are focused on a specific condition, body organ, clinical focus, environment, or sub-population.
The subspecialties include:
- Allergy & Immunology
- Emergency Medicine
- Holistic Care
- Occupational and Environmental Health
- Palliative Care
- Pain Management
- Plastic Surgery
- Sleep Management
- Sports Medicine
According to Payscale.com, Psychiatric Nurse Practitioners are the highest paying specialty. These NPs treat patients with the following conditions: bipolar, anxiety, depression, schizophrenia, OCD, and oppositional defiance disorder. Psychiatric Nurse Practitioners can expect to make on average $102,676. Reported salaries are highest at The Veterans Administration (United States) where the average pay is $121,733. Other companies that offer high salaries for this role include Daymark Recovery Services, Inc., earning around $108,498. Behavioral Health Group and Centerstone pay the lowest at around $90,000.
What is a Doctor Of Nursing Practice (DNP?)
Doctors of Nursing Practice (DNP) deliver high-quality advanced nursing care in a clinical setting, similarly to an NP; however, these individuals have taken their career a step farther. A DNP is a terminal degree for advanced practice nurses.
The American Association of Colleges of Nursing (AACN), states that transitioning from advanced practice NP degrees to the doctoral level is a “…response to changes in health care delivery and emerging healthcare needs, additional knowledge or content areas have been identified by practicing nurses. In addition, the knowledge required to provide leadership in the discipline of nursing is so complex and rapidly changing that additional or doctoral level education is needed.”
Essentially, DNP graduates are leaders in advanced nursing practice that bring evidence-based knowledge into the clinical setting to help improve healthcare outcomes and strengthen the leadership role of nurses in both the clinical and academic setting.
DNP Roles and Responsibilities
Individuals with a doctorate degree can function in a provider capacity but most work to generate new scientific and clinical knowledge in nursing and healthcare. Conversely, NPs practice primarily in clinical settings and do not focus on scientific and academic research in their practice. For this reason, most DNPs work in academia, as administrators, and/or researchers.
In 2018, on average NPs make an annual salary of $113,930, according to the U.S. Bureau of Labor Statistics; interestingly, there is minimal concrete data on the average annual salary of a DNP. Healthcare salary trends suspect DNPs average $125,000 to $150,000 per year. The U.S. Bureau of Labor Statistics has very limited data on DNP salaries but the reported average is $135,830. This average is based off only a small number of reported salaries. The key determining factor for salary is the career nurses pursue after obtaining an advanced degree. A Chief Nursing Officer will earn more than a Nursing Professor. Ultimately, additional advanced education is reflective of higher annual salary earnings.
It is impossible to determine which DNP specialty has the highest salary but hospital administrators, DNP-prepared certified nurse midwives, and DNP-prepared certified nurse anesthetists are at the top. Certified Midwives can earn on average $147,820 in the San Francisco, California area while certified nurse anesthetists can earn $285,460 in Akron, Ohio according to the 2019 U.S. Bureau of Labor Statistics.
- The benefits of a DNP program according to the AACN are,
- enhanced knowledge to improve nursing practice and patient outcomes
- enhanced leadership skills
- increased supply of faculty for clinical instruction
- development of needed advanced competencies for increasingly complex clinical, faculty and leadership role
Top 5 DNP Programs In The U.S
The 2019 U.S. News & World Report ranks the best DNP programs in the country. These programs are highly competitive and vary in size and price.
The top 5 are as follows:
- Johns Hopkins University
- Duke University and Rush University (tie)
- University of Washington
- Vanderbilt University
- University of Maryland - Baltimore
Johns Hopkins, Duke, and Rush have consistently been in the top 5 DNP schools the last several years. Rush University has the largest DNP program with over 800 enrolled students while Johns Hopkins and Duke have approximately 200 DNP students.
To pursue a DNP, individuals already would have completed a traditional or accelerated BSN program and have an MSN. There are only a handful of programs that accept students into the DNP program without an MSN. These programs are bridge programs that offer BSN-DNP programs. Students will work to complete coursework for an MSN and then continue directly into the DNP curriculum. An MSN program takes approximately 2 years full time while a DNP program can vary between 1-4 years. Overall it takes approximately a decade for a new nursing student to obtain all three degrees (BSN, MSN, DNP).
Masters Degree or Doctorate Degree?
In 2004, the American Association of Colleges of Nurses developed a position statement suggesting that all schools move towards DNP programs in combination with an MSN degree for advanced practice nurses. The goal would be for all programs to have incorporated the new curriculum and suggested guidelines by 2015. Pre-existing advance practice nurses would enroll in fast-track programs to obtain their DNP.
The AACN explains, “The DNP provides a clinical option for advanced preparation in nursing practice that is more comparable to other interprofessional education.” It is believed that by earning a DNP, nurse practitioners will be more prepared and better suited to take care of their patients.
While this goal has not been obtained, major universities are graduating an increasing number of DNPs each year. The AACN felt that this was important because nurses often work with other healthcare professionals in their field who have more training and education and a DNP can provide nurses with an education that is comparatively advanced. As of right now, the plan continues to be re-evaluated each year.
Healthcare is a fluid industry that is constantly changing with advancements in medicine and new technology. It is vital that advance practice nurses stay abreast of recent changes and the trends that are emerging. Employers feel a key way to do this is through advanced education. While some jobs require a DNP it is still a relatively new and underutilized nursing degree. With bold position statements by the AACN and AANP, DNP programs are rising and the number of applicants is increasing on a yearly basis.
Comparison: MSN vs. DNP