2015 DNP

kdrose01 · Sep 20, 2011

And personally I don't want patients calling me a Doctor unless i'm a Medical Doctor, I would feel like a fraud.

I think that's really sad, since the debate about the title "doctor" extends far beyond the medical profession. Many physicians want that title designated only for them and not for scholars who have PhDs, though the title historically has stemmed from those who perform scholarly research and not those studying medicine. It's a name to be shared by those who have earned the title through academia and not to be reserved for those of a particular profession.

All of my family and friends who've toiled away in academia for years (including my mother who holds a PhD in nursing) worked incredibly hard for their degrees, so it's not a fraud to refer to any of them as "doctor" simply because one particular profession has commandeered the title. If you do earn your DNP, proudly own your title. My mom's brother, a physician, proudly refers to her as Dr. :)

By the way, after my mom earned her PhD, she said the physicians with whom she worked treated her with more respect. There's certainly something to be said for promoting education among nurses.

kdrose01 · Sep 20, 2011

In my experience, it has been possible to discuss the pros and cons of pursuing a BSN, MSN, PhD or DNP without even inadvertently insulting people to whom those things have great value. That some people continually make comments fully intended to deride the DNP, rather than discuss, is a psychological phenomena which mystifies me.

I'm currently in an ABSN program after spending years climbing the corporate ladder. During my time in corporate America, I've never heard of anyone being accused of "drinking the Kool-Aid" because they wanted to pursue more education for personal or professional reasons. I can't wrap my head around why nurses attack one another over attaining a higher education - isn't that something that is valued in America? Very sad, indeed. Opinions are certainly valuable, but the unprofessional and disrespectful attacks over a difference of opinion are a detriment to nurses and the profession as a whole.

A few weeks ago, I witnessed foul-mouthed nurses throwing each other into lockers in the break room as a game on my clinical floor. That kind of behavior would never be acceptable in the corporate world, and it hurts the image of nursing. Several of my classmates and I questioned if we wanted to be nurses after witnessing that kind of hooliganism in the work place because we didn't leave our cushy jobs for that nonsense. It was not the only time I've witnessed a complete lack of professionalism among nurses, which is part of the reason I think so many of my highly educated classmates will unfortunately move on from hospital nursing (where we need really good nurses). That being said, I've also seen some fantastic and professional nurses on the clinical floor, who have set really great examples - they're also the ones who are anxious to move on, though. However, in order to improve the image of nursing and job satisfaction, the lack of professionalism and disrespect amongst one another will have to stop. Otherwise, nursing will lose some really nurses as they revert to corporate America or all move onto NP/DNP positions.

bsnanat2 · Sep 21, 2011

I'm currently in an ABSN program after spending years climbing the corporate ladder. During my time in corporate America, I've never heard of anyone being accused of "drinking the Kool-Aid" because they wanted to pursue more education for personal or professional reasons. I can't wrap my head around why nurses attack one another over attaining a higher education - isn't that something that is valued in America? Very sad, indeed. Opinions are certainly valuable, but the unprofessional and disrespectful attacks over a difference of opinion are a detriment to nurses and the profession as a whole.
A few weeks ago, I witnessed foul-mouthed nurses throwing each other into lockers in the break room as a game on my clinical floor. That kind of behavior would never be acceptable in the corporate world, and it hurts the image of nursing. Several of my classmates and I questioned if we wanted to be nurses after witnessing that kind of hooliganism in the work place because we didn't leave our cushy jobs for that nonsense. It was not the only time I've witnessed a complete lack of professionalism among nurses, which is part of the reason I think so many of my highly educated classmates will unfortunately move on from hospital nursing (where we need really good nurses). That being said, I've also seen some fantastic and professional nurses on the clinical floor, who have set really great examples - they're also the ones who are anxious to move on, though. However, in order to improve the image of nursing and job satisfaction, the lack of professionalism and disrespect amongst one another will have to stop. Otherwise, nursing will lose some really nurses as they revert to corporate America or all move onto NP/DNP positions.

I have no problem with anyone furthering their education. In fact, I support that. The discussion (and disagreement) here is the DNP in its present form, not about people furthering their education. The DNP is not the saving grace of the nursing profession that many hold it out to be. It could be, but it is not in its present form. Extensive additional classes in nursing research and nursing theory will in no way make one as good a clinician as additional science based courses like more patho, pharm and medical classes. That is the point of this discussion. It amazes me how anyone who is for the DNP in its current state feels that anyone who dissents is being disrespectful and unprofessional. That kind of one track thinking is the definition of drinking the koolaid. The DNP misses the point and misses a great opportunity. It is, in my opinion, "Phd lite". Nursing leadership has put it out there as the "must have" degree but it offers very little benefit. It offers no more benefit than any other doctorate would. It should offer very specific additional knowledge and skill, but it does not. The great inconsistency in programs just proves how much the DNP misses the mark. Does that mean that it is worthless? No, but it does not hold the value that nursing leadership is trying to put on it. Like any other education, the DNP is for those who want it, but it will not give you anymore clinical ability than a doctorate in Public Health. It should, but it won't. The whole stance of the DNP supporters in this thread is the very essence of dogma. Cool your jets and take another swig. Just remember: No matter how much of it you drink, its still only koolaid. Unless something drastic changes it'll never be wine, and that's a shame.

kdrose01 · Sep 21, 2011

The DNP is not the saving grace of the nursing profession that many hold it out to be. It could be, but it is not in its present form. Extensive additional classes in nursing research and nursing theory will in no way make one as good a clinician as additional science based courses like more patho, pharm and medical classes. That is the point of this discussion. It amazes me how anyone who is for the DNP in its current state feels that anyone who dissents is being disrespectful and unprofessional.

I don't look at the DNP as being a savior for the nursing profession; I see it as a doctoral option for NPs who want to earn a doctorate that is geared toward leadership positions and will still allow them to practice as NPs, whereas the PhD is really geared more toward leadership, research, and academia. The research component of the DNP is necessary, since the premise of a doctorate is to include research. I understand your point regarding

Anyway, as I said before, opinions are fine, and I recognize that not everyone supports the DNP. That's fine too. However, I do feel that the way in which one communicates his or her opinion is important, which is why I wrote what I did. It was not a comment directed at anyone specifically, but I did see some comments on here that were not especially respectful, which made me think of the unprofessionalism I've witnessed thus far.

I can't remember where I saw it, but someone said that the DNP will not make nurses equivalent to doctors (physicians, really). No, it won't. Nursing is nursing. Medicine is medicine. And nurses will not be physicians unless they attend medical school; however, they are doctors if they earn a doctorate. It's not even about trying to turn nurses into physicians; it's about expanding their scope of practice and allowing nurses to receive the respect they deserve - like it or not, the more education one has, the more options and respect he or she generally has too.

bsnanat2 · Sep 21, 2011

I don't look at the DNP as being a savior for the nursing profession; I see it as a doctoral option for NPs who want to earn a doctorate that is geared toward leadership positions and will still allow them to practice as NPs, whereas the PhD is really geared more toward leadership, research, and academia. The research component of the DNP is necessary, since the premise of a doctorate is to include research. I understand your point regarding
Anyway, as I said before, opinions are fine, and I recognize that not everyone supports the DNP. That's fine too. However, I do feel that the way in which one communicates his or her opinion is important, which is why I wrote what I did. It was not a comment directed at anyone specifically, but I did see some comments on here that were not especially respectful, which made me think of the unprofessionalism I've witnessed thus far.
I can't remember where I saw it, but someone said that the DNP will not make nurses equivalent to doctors (physicians, really). No, it won't. Nursing is nursing. Medicine is medicine. And nurses will not be physicians unless they attend medical school; however, they are doctors if they earn a doctorate. It's not even about trying to turn nurses into physicians; it's about expanding their scope of practice and allowing nurses to receive the respect they deserve - like it or not, the more education one has, the more options and respect he or she generally has too.

While you may see the difference between physicians and DNP's there are many who promote the DNP as an equalizing of nurses to physicians. Nursing is its own field, but one should not be so foolish as to think that this degree will somehow equal the medical school education because it simply doesn't. That's not what you said, but many DNP supporters use this thinking as an argument for the DNP. The DNP is geared toward leadership, not clinical practice which is what it is supposed to be. We all know the implication of using the title Doctor in a medical setting. Are physicians the only ones who have earned a doctorate? No, but again we know the implication of using the title without any other explanation. Why not promote a title such as Nursing Doctor and promote using the title physician instead of just doctor? JD's, PharmD's, PT and OT doctorate holders don't have this inferiority complex about being called doctor, so why should nursing?

elkpark · Sep 21, 2011

It's not even about trying to turn nurses into physicians; it's about expanding their scope of practice and allowing nurses to receive the respect they deserve ...

I have not seen any mention so far, in any of the discussion/debate regarding the DNP, of an expansion of scope of practice. If you have some reference for that, I would love to see it.

While you may see the difference between physicians and DNP's there are many who promote the DNP as an equalizing of nurses to physicians.

Once again, the only people I've seen even suggest the notion that a DNP degree would make someone anywhere near the equivalent of a physician are Mundinger at Columbia and her small cohort of disciples. She has written a few articles pushing this agenda (and the ones I saw were in the context of promoting Columbia's DNP program, specifically), and, in a classic case of "the squeaky wheel getting the grease," lots of people (esp. in medicine :rolleyes: ) have noticed them, and those few articles get quoted and referred to over and over again -- which makes it appear that there is a sizeable group out there making this argument, but, if you look closer, I believe you'll find that it's all Mundinger (or possibly those associated with her). If you have other documentation, I'd be happy to see it.

ccso962 · Jan 21, 2012

a classic case of "the squeaky wheel getting the grease,"

I couldn't agree more. I have seen numerous articles, TV spots, news reports, etc. proclaiming that "soon your doctor may be a nurse" or some variation there of. These articles all seem to miss the fact that advanced practice nurses have been practicing, and practicing safely, for years. A lot of these take the stance that yesterday nurses were just there to wipe away the poo, and today they dare to assert that they might be able to care for a patient. Oh please parish the thought...:-)

I think the really devestating thing about these types of reports (and this "squeaky wheel" syndrome) is that it uses the term "independent" to some how suggest "all alone". Keep in mind that the MD primary care provider may have an "independent" practice, but if the patient needs a heart transplant he doesn't take them to the back room and perform the surgery right there. Instead he will "collaborate" with a cardiovascular surgeon and still manage the primary care needs of the patient. I don't think that anyone would assert that the family physician who needs to refer a patient to a specialist is somehow "unqualified" to "independently" run a practice. However, the few, and yes folks I really believe it is the few, physicians who feel the need to repeatedly announce that only physicians are "qualified" to "independently" handle patient care seem to want to send the message to an uninformed public that any physician can handle any patient any time for any condition completely by themselves without the need for collaboration. How ridiculous is this?

On the flip side the few "squeaky wheel" advanced practice nurses that want to assert that a DNP is exactly the same as an MD seem to do the same only on the nurses side of the fence. Why do these few have such a need to make sure that the whole world understands that while they have a nursing degree they are just as good as a person with a medical degree? I would think they have a nursing degree because they wanted to go to nursing school since, at least in the part of the country I live in, I have never seen a big black bus going around forcing people to be a nurse if they really want to be a doctor. These nurses, while probably good intentioned, do more to hurt the case of advanced practice nurses than they do to improve it.

Patients choose a provider for a number of reasons. Most people do not choose a provider based on which side can scream louder that they are the best. My wife's primary care provider is an FNP. She sees this provider because of her personality, the accessibility of her office, and the intelligence with which she provides care. If she was an MD and had the same qualities then my wife would probably still see her for her primary care needs.

Are there bad advanced practice nurses? Sure. Are there bad physicians? You bet. And guess what folks, the choice of educational setting, degree, and speciality really has nothing to do with it. Some people are just better at certain things than others.

With regards to the DNP I think the main thing to remember is that the degree is what you have, the degree is not who you are. You can have 13 doctorates after your name (in any number of fields) and still be a bad clinician. Likewise you can have 14 years of residency under your belt and this does not, in and off itself, make you a better clinician, diagnostician, or health care provider. Think about this: how many times have you asked a health care provider you come in contact with as a patient (especially in an acute care setting) where they went to school as a undergrad, what they majored in, how well there grades where, how many times they applied to professional school before they were accepted, how many schools turned them down, what there grades were in professional school, and what their instructors in school and clinical or residency have to say about them? Chances are you don't for obvious reasons.

In closing remember the old saying "what do you call a doctor who graduates at the bottom of his medical school class", thats right you still call him doctor; however, the same can be said for the DNP graduate who graduates at the bottom of their class too.

In todays health care environment all practitioners and staff have to work together to provide the best possible care for the patient, and this type of "squeaky wheel" bickering only causes there to be less cooperation not more. And that, my friends, is what affects the safety of a patient far more than which school or degree you chose.

DrZaphod, BSN, MSN, DNP, RN, NP · Jan 21, 2012

I would very much like to have a so-called "clinical" doctorate contain further pathophysiology, neurobiology, neurochemistry, psychopharmacology, and even neuropsychology classes, with some leadership and theory electives. Looking at the current state of the DNP programs, they actually remind me of many of the Masters level and even Bachelors level nursing classes, which for me, were not helpful or educative; that is, "nursing theory," "leadership," etc. Those classes belong in the 100 level classes: further leadership skills can be received from real world experience or even business-type degrees. The PhD programs do not look much better, although I admit that the "PhD" still carries more weight than a DNP.

For one, the DNP is probably going the way of the EdD and PsyD - if one is not academic or in healthcare one probably does not know what those titles mean. Also, one university told me that the DNP was two years in addition to my MSN, but the PhD was another five years. That is a large discrepancy, particularly when neither degree has any classes that are of interest to me.

However, I DO want the title doctor, although I have no interest in the profession of physician. The title lends credibility to patients and other staff, and works much better than, "Hello, my name is Joe Smith and I'm a nurse practitioner in xxx." A patient's response is often, "Where's the doctor?"

I just wanted to comment on all I read in this thread and add my opinion. I suppose my biggest question is whether or not a MSN prepared nurse practitioner can forego the nursing doctorate and get a doctorate in, say, Geriatrics, or Human Sexuality, or Neurobiology, or any number of interesting avenues. Then, just don't let one's license lapse. Hey, they already did away with my certification less than two years after I received it, so I can never let my license lapse anyway. Frustrating times.

ccso962 · Jan 21, 2012

I would very much like to have a so-called "clinical" doctorate contain further pathophysiology, neurobiology, neurochemistry, psychopharmacology, and even neuropsychology classes, with some leadership and theory electives.

That is, at least from what I can understand, the underpinning of the legitimate concerns over the DNP program. Some claim that the DNP "must have research" because that's what "doctorate degrees are about". I would disagree though. The DNP is supposed to be a clinical doctorate (such as MD, DO, OD, AuD, PharmD, etc.), and not a research doctorate (which of course is known as a PhD). Clinical doctorates must have clinically relevant material more so than research. Does that mean that holders of clinical doctorates don't need to understand research? Not at all, but I would much rather my clinician know how to diagnose a condition rather than how to set up a research study or manage a health care organization (in fact there are already graduate degrees and careers that are designed specifically for these other two purposes).

Furthermore, these clinically relevant classes need to be taught in a classroom and provide hands on training and clinical interaction with real patients. There is really no way that a person can learn to provide hands on care to a patient strictly by studying online. Hybrid classes might work as long as there was a sufficient practical and clinical component, but, regardless of the previous work experience of the student, there is really no excuse for a school (or professional for that matter) to claim that online only classes can produce a compentent health care professional.

I really don't understand why some people seem to be opposed to the addition of more clinically relevant classes to the DNP curriculum. It is really hard, in my opinion, for these people to argue that they want to be on par with a physician, but at the same time be opposed to the addition of clinically relevant content. I know that the first response to this for most people is the "nurses have already had relevant clinical exposure" and that is all fine and well on the surface, but it just doesn't excuse a lack of clinical education in a clinical doctorate program. I have heard some DNP advocates (such as the "squeaky wheel" types I refered to in a previous post) claim that nurse practitioners, by virtue of their previous experience, have already had clinical exposure relevent enough to be able to function, compentently, as provider of health care. This is the "I have worked around physicians long enough that I can basically do their job" mentality, but unfortunately this just doesn't work in real life. The really interesting thing about this is that you never see that sentiment expressed in the reverse (i.e. that physician has worked around nurses long enough that he is basically an RN). The fact of the matter is that most nurses would be offended by this, and rightfully so. Nursing is a profession that requires specific training, skills, understandings, and practice. The same is true with physician education and the medical profession. Shouldn't the same be true for advanced nursing practice?

If it is completely unheard of to add more clinically relevant classes to the DNP curriculum then maybe DNP graduates need to undertake a residency prior to being released on their own.

Just my thoughts.

ccso962 · Jan 21, 2012

In an earlier post kdrose01 made the following statement "A few weeks ago, I witnessed foul-mouthed nurses throwing each other into lockers in the break room as a game on my clinical floor. That kind of behavior would never be acceptable in the corporate world, and it hurts the image of nursing.", and I basically wanted to respond to this.

While it is possible that it would not have been "acceptable behavior" in your area of the corporate world that does not mean that it does not happen in THE corporate world. I too have worked in the corporate world (for one of the largest employers in the USA) and rough housing and raucious humor occurred there all the way through the ranks. I guess the point I am making is that this comment makes a generalization about ALL based on the observation of a FEW. Really that is one of the biggest detriments to the idea of independent practice for advanced practice nurses (i.e. the notion that just because a small subset of the group (the "squeaky wheels" for instance) promote their own ideas does not mean that all advanced practice nurses have a "I want to be a physician" mind set). However the comments of these FEW have been used to make sweeping generalizations about ALL from organizations such as the AMA.

I really believe that we must try not to engage in generalizations since this type of behavior takes an elitist stance, and really that is not helpful to anyone.

Just my opinion.

zoidberg, BSN, RN · Jan 23, 2012

i do not support nurses trying to masquerade as physicians, but in the same way, i get annoyed when chiropractors, PTs, etc. are called doctor ____. with no explanation. You must investigate what ___ they are.

It should be: Dr. ___, the chiropractor, Dr. ___ your physician, or Dr. ____ your nurse practitioner.

And seriously, all NP's should refuse to pay for more nursing theory classes. I will get a DNP once it gives FNP's an opportunity to do extra clinical rotations in OB, peds, family practice, internal med, etc. , once it helps Psych NP's ACTUALLY gain enough exposure in psych to be effective clinicians, once it helps ACNP's learn from intensivists in-depth, once residencies are funded and respected in a similar manner as medical residencies (not as long, but still, acknowledge NP's), and seriously, provide NP's with more adequate pathophysiology and pharmacology education.

ccso962 · Jan 24, 2012

I sincerely agree that anyone who has earned a doctorate should be allowed to be called doctor. I could also understand the frustration of working in a place where everyone that is called doctor does so without explanation of exactly what type of doctor they are. In the hospital I used to work in those who were not MDs or DOs had to identify what profession they were after identifying themselves as doctor (if they chose to ID that way which most did not).

I am also in 100% agreement that the DNP needs more clinically oriented courses, and that advanced practice nurse residencies would be a great thing (both for the profession and for the patients). Since the DPT (Doctor of Physical Therapy) was mentioned it makes a very good comparison over how to upgrade a health care degree from a master's program to a clinical doctorate. When the physical therapy community decided to update the entry level degree to a clinical doctorate from a clinical masters one of the first things they did was add clinically relevant content and more patient contact. The pharmacy profession added quite a lot more clinically relevant information in their PharmD degrees from bachelors, and in the process expanded the scope of the profession (i.e. Clinical Pharmacists and clinical pharmacy residencies). Sadly, it seems that the DNP, alone among the world of clinical doctorates, is content to call itself a clinical doctorate without any increase in relevant clinical information. This is truely tragic since the DNP has the potential to really improve the clinical/medical education of advanced practice nurses, expand the scope of practice of said APNs, and better promote the profession as a health care practitioner. Sadly for all the dialogue in the world a theory class, a research class, classes on legal issues, and other strictly academic classes will never increase the clinical knowledge of the student, and as such the DNP will not become the catalyst for increased knowledge and autonomy in advanced nursing practice that it could be.