NPs Are Breaking New Ground in Research
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“More NP-led research would unlock a healthier population. It would unlock new care models, new ways to prevent disease. It would answer some of those still unanswered questions.”Devon Noonan, PhD, Dorothy L. Powell Term Chair of Nursing and Associate Professor at Duke University School of Nursing
The healthcare community is a partnership between scientific research and clinical practice. For most of modern history, both arenas have been dominated by physicians. But as the healthcare workforce has expanded and the interprofessional care team emerged, nurse practitioners (NPs) have proven to be vital in delivering healthcare services in America. And, increasingly, they’re leading innovative and impactful new research.
NP-led research is still a relatively small area, but that’s likely to change in the near future. NPs bring a unique and valuable mindset to scientific research that considers the whole patient and the social and environmental factors that influence health. As the NP profession continues to expand and mature, NPs will play a pivotal role in delivering high-quality clinical care and conducting and leading cutting-edge research that benefits both patients and the healthcare community.
Read on to learn more about the opportunities, obstacles, and future of NP-led research.
Meet the Expert: Devon Noonan, PhD
Dr. Devon Noonan is Dorothy L. Powell Term Chair of Nursing and an associate professor at Duke University School of Nursing (DUSON). She received her BSN at Boston College, her MSN at Georgetown University, her MPH and PhD at the University of Virginia, and completed a postdoctoral fellowship at the University of Michigan.
Dr. Noonan’s research is focused on using community-engaged approaches to develop innovative health behavior change interventions, including digital interventions, to reduce risk for chronic diseases including cancer and cardiovascular disease. NCI has continuously funded her for the past five years to examine text-based intervention approaches for tobacco cessation in rural and medically underserved populations. Dr. Noonan teaches and mentors students across all programs at DUSON and is the co-director of the Duke National Clinician Scholars Program. She received the SNRS Mid-Career Researcher Award in 2023.
Life as an NP Researcher
NPs can go into research for any number of reasons. For some, it’s a savvy career move. For others, it’s personal drive. But most NPs in research, Dr. Noonan says, choose to get their PhD in nursing because they’re in practice and running into problems and questions that they can’t quite get the answers to. And, instead of giving up, they push through: deciding to figure out the answers for themselves.
“Most NPs have the qualities of good researchers: attention to detail, curiosity, persistence,” Dr. Noonan says. “These are general things, but they’re really important. If you came across the same clinical issues and questions all the time, and were not interested in developing new knowledge and new ways to figure those out, then you probably wouldn’t be driven to go get your PhD.”
There’s often a mix of purpose and kismet when selecting one’s first area of research. For Dr. Noonan, it was tobacco cessation. While she was getting her NP degree, one of her mentors developed the first NP training for tobacco cessation, and Dr. Noonan was one of the first NPs trained to deliver this tobacco cessation in her practice. Later, while working in rural and underserved areas, she noticed the lack of access her patient population had to standard tobacco cessation treatments and services. Spurred on by a family history impacted negatively through tobacco use, Dr. Noonan did research into digital interventions related to tobacco cessation that could reach patients with limited or no access to primary care services.
“Eventually, hopefully, your research is put into practice, though that may be many years down the road,” Dr. Noonan says. “But part of the reward is that the research you are doing is still directly benefiting many patients. And then you can take that new knowledge and use it to inform your practice, too. I think that’s the most rewarding piece.”
Differences of Degree: DNP and PhD
NPs who want to lead cutting-edge research should consider a PhD in nursing. These rigorous doctoral programs prepare NPs to become nurse scientists, with coursework and training in research methods and data analysis. NPs in PhD programs will work in small cohorts, with mentors with expertise in a specific study area.
Conversely, DNP programs are more clinically oriented, with a focus on helping NPs become expert clinicians who employ evidence-based care. NPs in DNP programs do get some exposure to research-related topics—and a subset of DNPs go on to lead their own research, too—but the tenor of that research tends to differ from what NPs with PhDs tend to do.
“Both the DNP and PhD degrees are very valuable,” Dr. Noonan says. “But I would say an NP with a PhD develops new knowledge that hopefully will lead to some practice change, and then an NP with a DNP would implement and evaluate that practice change.”
PhD in nursing programs may be less clinically focused than their DNP counterparts, but NPs with PhDs will draw heavily from their clinical experience when conducting and leading research. Dr. Noonan is a program director of the National Clinician Scholars Program (NCSP) at Duke University, which purposefully recruits NPs and other clinician nurses to engage in practice-based activities and research. Those two modes of nursing, practice and research, inform and improve one another—and for many NPs in research, the clinical element is crucial.
“There are fast-track programs that go directly from their undergraduate to a PhD,” Dr. Noonan says. “But I’ve actually had a few colleagues go back and get their NP degree after they’ve done their PhD. They’ve realized it’s another way to increase the impact of their work and research.”
Challenges and Opportunities in NP-Led Research
NP-led research is not without its challenges. Like all scientific research, securing funding is a persistent issue. The growth of NP-led research is also hindered by its small size: there are fewer NP PhDs available to mentor new NPs. DNP programs are plentiful, but many NP programs offer little exposure to research and NP-led researchers during their training.
“We need more clear pathways for NPs to get their PhD,” Dr. Noonan says. “So right out of their master’s degree, we want NPs to know that the PhD is an option, so they can weigh the benefits of a DNP versus a PhD.”
Another major challenge is that PhD programs pull would-be clinicians out of service for several years or at the very least limit their clinical hours. That’s a difficult sell at a time when healthcare access is limited in many parts of the US. But while it comes with a heavy upfront cost, the return on investment for an NP getting their PhD is hugely positive in the long run.
Most of the challenges in growing the size of NP-led research are also opportunities. The small scale and specific scope of nursing PhD programs mean participants get individualized learning and all the benefits of small class sizes. Those who go on to enter the field of NP-led research will also have the opportunity to join a list of firsts, while also having the privilege of training the next crop of would-be nursing researchers.
“It’s rewarding to get to bring up the people behind you,” Dr. Noonan says. “You get to help grow the profession.”
The Future of NP Research
The world of scientific research is, to the outside world, a slow-moving one: results are measured and re-measured, and potential impacts are studied and debated. But NP-led research is an area that’s likely growing faster than it appears. The NP profession has expanded rapidly in the 21st century, with many new specializations backed up by rigorous academic programs and clinical fellowships. Fittingly, it’s scientific research about the efficacy of NP practice that has helped facilitate its rise to prominence. As more NPs join the workforce, more will go into research, too. Patients, and the profession, will benefit.
“More NP-led research would unlock a healthier population,” Dr. Noonan says. “It would unlock new care models, new ways to prevent disease. It would answer some of those still unanswered questions.”
NPs bring a unique approach to the care they provide and the research they conduct. Their holistic approach to patients prioritizes the contextual elements impacting a patient, rather than simply treating their symptoms in isolation. As more of the medical community awakens to the importance of the social determinants of health, NPs—who have such concepts baked deeply into their education and training—will bring decades of expertise to research and practice.
“NPs bring their unique lens to research in understanding and treating patients where they are—in the context of where they live, work and play—and in a holistic manner,” Dr. Noonan says. “The primary care NP’s prioritization of wellness, health promotion, and prevention fit well with where our healthcare system is moving: towards more proactive rather than reactive care.”