The Doctor of Nursing Practice (DNP) is a professional degree in nursing. In the United States, the DNP is one of three doctorate degrees in nursing, the others being the research degrees PhD and the Doctor of Nursing Science. Internationally, since the 1990s, there have been a wide number of doctorate degrees available for nurses, including DProf, PhD and others. Internationally all such doctoral nursing degrees include mandatory research elements and take longer than a single year to complete. DNP in North America The curriculum for the United States DNP degree builds on traditional master's programs by providing education in evidence-based practice, quality improvement, and systems leadership, and is typically more clinically-oriented than PhD or DNS degrees. Advanced practice registered nurses (APRNs) include the nurse practitioner (NP), certified registered nurse anesthetist (CRNA), Certified Nurse‐Midwife (CNM), and the clinical nurse specialist (CNS) and are prepared in master's-degree programs. Although approximately 52% of nurse anesthetist programs will award the DNP, the remaining 48% may use the title doctor of nurse anesthesia practice (DNAP). Education requirements in the United States According to the American Association of Colleges of Nursing (AACN), transitioning advance practice registered nursing programs from the graduate level to the doctoral level is a "...response to changes in health care delivery and emerging health care 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." According to the AACN, "...benefits of practice-focused doctoral programs include: development of needed advanced competencies for increasingly complex clinical, faculty and leadership roles; enhanced knowledge to improve nursing practice and patient outcomes; enhanced leadership skills to strengthen practice and health care delivery; better match of program requirements and credits and time with the credential earned; provision of an advanced educational credential for those who require advanced practice knowledge but do not need or want a strong research focus (e.g. clinical faculty); enhanced ability to attract individuals to nursing from non-nursing backgrounds; increased supply of faculty for clinical instruction; and improved image of nursing." Transitioning toward the doctorate In the United States, the American Association of Colleges of Nursing (AACN) recommended that all entry-level nurse practitioner educational programs be transitioned from the Master of Science in Nursing (MSN) degree to the DNP degree. The American Association of Nurse