Exploring the necessity of the establishment of the DNP program in Iran from expertise’s view was the purposes of this study. Although the DNP program promotes professional position at the leadership levels and improves the quality of nursing care and patient safety, participants had a clear concern about their management and organization in the clinical settings. The findings demonstrated the inadequate infrastructure resources are the important obstacles toward to offering to the DNP in Iran. The most major barriers, including curriculum, faculty members, clinical environments, salary, position, autonomy, and role definition as well as contextual factors. The Iranian's Medical Education Context is physician-centered .In this context nurses haven’t enough authority for driving positive changes in healthcare settings. This finding is similar to study of Vahedian-Azimi et.al (2014) (16).
Evidence shows that poor nursing practice environment and insufficient resources (17), inadequate support for involving in evidence-based practice, organizational barriers, lack of effective position of decision making, poor motivation for applying evidence in the practice and, preferring to follow doctor’s orders are the most important challenges in this issue (18, 19).
Certainly, shifting to new paradigm to solve these problems is not achievable only by the DNP without providing foundations. The DNP program is only one piece of the puzzle in solving these issues. Stoeckel and Kruschke (2013), assessed DNP-prepared NPs’ perceptions of the DNP degree, the results showed although the DNP programs improved those to in areas of population health, evidence-based practice, research, and, healthcare policy, it does not result in any significant progress in the clinical skills. Participants mentioned laws and regulations as barriers to the full practice of the DNP-prepared nurses (20).
Ambiguity the role of the DNP graduates in public and other healthcare professions mentioned as another of the significant concerns. In the same line, Udlis and Kimberly (2015) stated that multiple areas of ambiguity concerning the role of DNP-prepared nurse existed in research, academia and academia leadership and, scholarship (21).
According to DNP critics, the recommendation to the DNP degree without focusing on research is not applicable. In fact, this is a challenge facing DNP executive countries. It is essential to equip DNP students with clinical research skills, quality advancement competencies, and the opportunity to apply knowledge in the practice of desirable healthcare delivery (12). Therefore, the DNP programs and curriculums must continue to be refined and reformed (12, 22).
In addition to, the exponential growth in the number of the DNP programs in the U.S has raised significant concerns about the discipline’s continuing ability to build a body of knowledge at a suitable rate (7). Nickasch et.al (2018) in a mixed-method design, identified perceptions DNP- or PhD-prepared nurses about collaboration and utilization of DNP- and PhD-prepared faculty, staff, and administrators. The findings demonstrated DNP–PhD division, lack of collaboration, and sub-optimal utilization of DNP and PhD individuals. The Authors recommended administrators should make organizational changes that break down obstacles between DNP- and PhD-prepared faculty, staff, and administrators(23).
The failures to apply the knowledge generated by the PhD graduates and the need to improve quality of care have been the motives to make efforts to overcome this gap.
Brown and Crabtree (2013) noted that doctoral education is undergoing a paradigm shift that shows the need to more rapidly improve practice expertise and move the translation of research into practice. They proposed the creation of the DNP as one of the ways to achieve improved clinical practice and the translation of evidence into practice (24).
Although, the findings of our study showed the provision of infrastructure is an essential component in establishing the DNP program, DNP an opportunity to drive positive changes extracted as the second main categor. Some of the participants supported the DNP degree in the Iranian nursing education context as the most appropriate degree for providing advanced clinical practice, clinical leadership, and redesigning the health care system.
They believed due to technological advancement, complexity of healthcare systems, changing needs of patients need to improve specialized care and consequence improve patient outcomes. Feizolahzadeh et al. reported that the PhD graduates in Iran have excellent qualifications in management, education, and research. Clearly, graduates will not be able to meet the needs of clinical settings focused on specialized care. The current PhD program cannot improve the graduates’ clinical skills. Therefore, hiring them in the clinical settings will waste their time, energy, and expertise. The authors suggested designing and implementing the DNP program for advanced evidence-based practice (9).
The DNP nurses have a higher qualification as an equal member of the healthcare team who can make constructive changes at the macro level and lead the care system to positive changes in the future (25).
Murphy et al. concluded that collaboration between DNP and PhD-prepared nurses to advance the science and translation of research to practice, provides educational opportunities, facilitates healthcare delivery, and results in positive outcomes (1).
DNP-prepared nurses, as clinical leadership, can play an important role in changing the healthcare systems, improve specialized care, evidence-based practice, and patient outcomes (26).
Limitation
The qualitative design of the study with purposive sampling, generalization of research findings to the larger population is limited.