2015 DNP

nursemark29 · Jul 19, 2011

Reasons why I choose not to drink the Kool-Aid offered by the AACN and the Universities who are sponsoring the DNP degree:

1. There have been studies conducted showing that MSN prepared nurse practitioners perform as well as, if not better than, physicians in diagnosing and managing medical illness and diseases in patients. Where is the empirical or statistical data showing that a DNP will improve the care rendered by NP's? I have read the AACN's white paper on the DNP degree, and foundit to contain mainly conjecture and opinion as to why the degree is necessary.

2. Yes, it will cost quite a bit more to become an NP via the DNP route. The current MSN/FNP programs are between 47 to 50 credits. The average DNP program is between 73 and 85 credits. At Arizona State University, the cost is $847 per credit hour. At 48 credits under the old MSN/FNP program at ASU, the cost for the degree was $40,656, not including books and other fees. The current DNP/FNP program is 85 credits, making the total program $71,995. That's a mere difference of $31,339.

3. Let's look at the University of Minnesota. The current rate for their MSN program is only $614 per credit hour. Under their old MSN/FNP program at 48 credits, the total cost was $29,472. The current DNP/FNP program is 82 credits with a per credit hour cost of $877.89 (and that's in-state tuition), the total cost is $71,986.98. That's a difference of $42,514.98. (Yes, the university does charge the full rate of $877.89 per credit for all 82 credits of the BSN-DNP program, because the credits are now DOCTORAL level, remember?)

4. Student loans need to be payed back. These horrible harbingers of indentured servitude take years to escape from and eat away quite a bit of your post tax income. So if you are a nurse practitioner and want to work in an underserved area, and you have $72,000 of loans hanging over your head (not including possible undergraduate loans), a meager income of say $75,000 - $80,000 a year to start will not exactly inspire an NP to work in an underserved area. (Perhaps if those loans are forgiven to work in a medically underserved area, then yes it would, but not every NP will get this deal.)

5. It takes an average of 2.5 years to complete an MSN/FNP program at 48 credits. The universities are telling us it only takes about a year to a year and a half longer to complete a DNP beyond the MSN level. So if it takes 2.5 years to complete 48 hours, do they really expect us to believe we can complete 37 credit hours in only 1 to 1.5 years? I don't see it happening. Try 4 - 5 years total, unless the student doesn't have to work.

In closing, it is my opinion that the DNP is nothing more than a way for the universities to take in huge amounts of revenue. I have found no evidence to support the DNP as being necessary to provide increased quality of patient care. It does not increase scope of practice. It does not dramatically increase salary offers. What does it do to help the profession? In my humble opinion, not much. Just my opinion...

bsnanat2 · Jul 19, 2011

I am all for education. I am all for anyone who gets the DNP. In my own investigation and consideration, it is not worth it for me. In looking at the additional requirements, there seems to be little clinical value in the additional education above a MSN (yes, all education has value). I have made the personal decision to apply to MSN programs and only one DNP (just because I do like some of their ideas). The bottom line is that it is not, nor has it ever been a law or requirement. MSN's will not be grandfathered in...they don't need to be as MSN is the standard. DNP has been suggested, not mandated. Yes, many universities are dropping their MSN programs, but many are not. The DNP, like the BSN will become the standard..... one day. It will happen the same way, not largely through legislation, but through the market. Many hospitals are only hiring BSN's and of the ones I know of that are still considering ADN's, the BSN's get first choice and only BSN new grads are being put in specialty units....ADN's are put in med/surg or peds only. Most schools will eventually shift to the DNP option, and as their numbers grow (like BSN's), they will become the preferred....but not for a while. Let's be real here. If all schools could offer the BSN, ADN programs would disappear. MSN programs that remain will do so only because the schools do not have the resources in place to offer doctorates. Besides the economic interest of academia, the usual degree creep, and the bloated self-view/self-interest of academics, the DNP movement will cut down on the number of Advance Practice Nurses which will drive up salaries and keep the market from being flooded. I am all for access, but some of these schools do seem to make it too easy to get a MSN. The bottom line is that people like to have the latest and the greatest. More will eventually opt for the DNP so they can feel that they have gotten the best available. Again, they won't be in the majority for a while.

nursemark29 · Jul 19, 2011

I question whether or not requiring the DNP movement will cut down the number of advanced practice nurses and drive up salaries. Why? There are quite a few P.A. programs out there, and they have no intention of going to a doctorate degree. When we see positions posted, they usually ask for an NP or a PA. There are still some bachelor degree PA programs and even some associate degree programs. Because all PA programs are standardized in their curriculum regardless of the degree conferred, the medical community understands these programs are academically rigorous and have trained the graduates in what they need to know. Nursing has become so focused on degrees that they fail to understand what the P.A. community already knows... standardize the curriculum regardless of the degree and you will have quality providers. Furthermore, if you can pay a P.A. less than a "doctorally" prepared nurse practitioner, you will choose the P.A. I have so many NP friends, and they all say the same thing, MOST physician groups and hospitals are notoriously cheap. If NP's overprice themselves due to having a "doctoral" degree, the P.A.'s will be more than happy to fill those positions. Many physicians also like PA's because they are trained in the same allopathic model that they were trained in, but the NP model can vary significantly from school to school. Even the DNP can vary (i.e. DrNP versus DNP). The DNP is overpriced, overinflated, and unnecessary. The MSN nurse practitioner model isn't broken and clearly works, so why is nursing trying to "fix" it? PA's are here to stay and will remain in competition with the NP's. Remember, most physicians and hospitals are more concerned with scope of practice than they are with the degree the provider holds. (i.e. Case in point, I work with PA's that hold associate and bachelor's degrees in physician assisting, and they make as much as, if not more than, the master's level prepared NP's in the group.) Just my two cents...

Guinea · Jul 20, 2011

1. There have been studies conducted showing that MSN prepared nurse practitioners perform as well as, if not better than, physicians in diagnosing and managing medical illness and diseases in patients.

This is mostly false. It's only true in very specific cases and diseases investigated by the studies.

You are essentially saying that primary care physicians are fools for going through so much more education and training (something like a minimum of 15,000 clinical hours versus a minimum of 1,500-3,000). This kind of BS is not going to help your relations with physicians, whom you will be working with on a frequent basis.

Anyone with a modicum of common sense will realize that those extra years of education and training that a physician has will have a positive impact to care that may not be captured by the limited and flawed studies you cite. Even if you personally are the best and most competent nurse practitioner in the world, others studying to be NPs may severely fall through the cracks at a higher rate than that of physicians, given the shorter duration of training and fewer repetitive drilling especially in the direct entry NP programs. See for instance the anxiety in this thread of not passing the DNP certification exams on the first try, something that 95% of US medical students pass with harder exams.

Dr. Tammy, FNP/GNP-C · Jul 20, 2011

reasons why i choose not to drink the kool-aid offered by the aacn and the universities who are sponsoring the dnp degree:
1. there have been studies conducted showing that msn prepared nurse practitioners perform as well as, if not better than, physicians in diagnosing and managing medical illness and diseases in patients. where is the empirical or statistical data showing that a dnp will improve the care rendered by np's? i have read the aacn's white paper on the dnp degree, and foundit to contain mainly conjecture and opinion as to why the degree is necessary.
none exist due to the recent entry of the dnp.
2. yes, it will cost quite a bit more to become an np via the dnp route. the current msn/fnp programs are between 47 to 50 credits. the average dnp program is between 73 and 85 credits. at arizona state university, the cost is $847 per credit hour. at 48 credits under the old msn/fnp program at asu, the cost for the degree was $40,656, not including books and other fees. the current dnp/fnp program is 85 credits, making the total program $71,995. that's a mere difference of $31,339.
at $847 a credit--that's highway robbery! shop around. many schools offering under $300 unit. isu and usi are two.
3. let's look at the university of minnesota. the current rate for their msn program is only $614 per credit hour. under their old msn/fnp program at 48 credits, the total cost was $29,472. the current dnp/fnp program is 82 credits with a per credit hour cost of $877.89 (and that's in-state tuition), the total cost is $71,986.98. that's a difference of $42,514.98. (yes, the university does charge the full rate of $877.89 per credit for all 82 credits of the bsn-dnp program, because the credits are now doctoral level, remember?)
$614 a credit? see above.

4. student loans need to be payed back. these horrible harbingers of indentured servitude take years to escape from and eat away quite a bit of your post tax income. so if you are a nurse practitioner and want to work in an underserved area, and you have $72,000 of loans hanging over your head (not including possible undergraduate loans), a meager income of say $75,000 - $80,000 a year to start will not exactly inspire an np to work in an underserved area. (perhaps if those loans are forgiven to work in a medically underserved area, then yes it would, but not every np will get this deal.)
get into a cheap program. pay as you go. i spent less than $20k over 2.5 years. no bills to pay afterward. if you really want big bills to pay back, goto medical school.

5. it takes an average of 2.5 years to complete an msn/fnp program at 48 credits. the universities are telling us it only takes about a year to a year and a half longer to complete a dnp beyond the msn level. so if it takes 2.5 years to complete 48 hours, do they really expect us to believe we can complete 37 credit hours in only 1 to 1.5 years? i don't see it happening. try 4 - 5 years total, unless the student doesn't have to work.
in closing, it is my opinion that the dnp is nothing more than a way for the universities to take in huge amounts of revenue. i have found no evidence to support the dnp as being necessary to provide increased quality of patient care. it does not increase scope of practice. it does not dramatically increase salary offers. what does it do to help the profession? in my humble opinion, not much. just my opinion...

not sure about this. i kicked it in the ass to complete dnp in 16 months. there are many in my cohort extending beyond two years--post msn.

nursemark29 · Jul 20, 2011

Guinea, Wow! There were quite a few words in your post that put words in my mouth. First, I respect physicians and what they've gone through to get where they are. Second, the study I was talking about was published in JAMA, not just nursing journals. Where did I say anywhere that physicians were fools? Implying that I lack common sense is a personal attack. You don't even know me, or my educational background. I am well aware that the study has flaws, and in my opinion, most studies do. But I felt this study made a very valid point about master's prepared NP's. I don't believe a DNP should be a degree that is forced upon the nursing community as a whole, especially when there are studies showing the effectiveness of master's level education for nurse practitioner preparation. For the record, I work with physicians all the time. I am unimpressed with many of them. I've caught many of their mistakes as a registered nurse, including some that could have been deadly for the patient. I've been talked down to by them when it was not warranted. I've seen them throw temper tantrums like little children when they don't get their way. I've seen them demean people that are beneath them in the medical hierarchy, or should I say caste system? I've seen them try to blame nurses for their mistakes instead of owning the mistakes like they should have. To be honest, your post is reminiscent of how a physician would reply to the study I cited. For being the most educated "professionals" in the medical food chain, I've seen many examples of them being less than a professional. Again, I never called physicians "fools". I never demeaned their education. One more thought... what do they call the medical student who graduated last in his class... that's right..."Doctor".

nursemark29 · Jul 20, 2011

Dr. Tammy,

I was looking at your educational accomplishments, and I am quite impressed. I am an Excelsior College graduate also. I'll be in University of Phoenix's MSN/FNP program as of November 11th of this year.

Just some thoughts. My problem with the DNP is that even though it is a new degree, there were no surveys given to current advanced practice nurses asking for their opinions on the DNP degree. There could have been some type of research done to help back the AACN's position of why this degree is needed. The complete and utter lack of hard data dumbfounded me when I read the white paper.

I agree that there are cheaper schools, especially with distance education; however, the point I was making is that universities are seriously jacking up their prices due to the degree being called "doctoral" instead of "master's". I have nothing against anyone who wants to get the DNP. I just don't like the idea of students being forced into it and the universities overcharging for it.

I have friends who are currently completing the post-masters DNP program. My post was based on what they said... basically, there is no way they were able to complete it in 1 year. I have to commend you for getting it done in 16 months... that's almost unheard of. The issue I take is the universities telling the students that it's "only one more year" as a way to push the DNP degree to increase their revenue stream.

I only want to know one thing if you will oblige me. Was what you learned in the DNP degree program useful to you as a practicing nurse practitioner? More specifically, did it help you be a better nurse practitioner?

I look forward to your response.

Mark

BabyLady, BSN, RN · Jul 20, 2011

So here's the deal. I don't see our profession as being so malicious as to tell someone who has graduated an MSN level nurse practitioner program that they started before the year 2015, "Oh well. It's 2015 now. You need to get a DNP degree, or else we won't let you get licensed as a nurse practitioner." I'm absolutely certain that they will grandfather those people who were accepted into an MSN level N.P. program before the year 2015 so they can take their boards and practice for what they were trained to do. I will be done with my program in late 2013 or early 2014. Even if I were done in 2015, I would not worry, as I am certain I could easily present my case to the certifying body and would be granted an exception. As others have also stated, I do not know of even one certifying body that states a DNP will be required to be certified as a nurse practitioner. So for those of you that are worried, just concentrate on school and getting through it... that will be challenging enough. You will be a nurse practitioner when you are done.

This wouldn't happen anyway, nor is it even mentioned in the PROPOSAL. I have no idea why people think that "grandfathering" is even part of the equation...it never has been and never will be.

Even back before you had to have an MSN to be an NP, when the MSN-NP became the standard, that only applied to NEW applicants applying for credentials, it had no impact at all on the ones that were already licensed to practice.

Same thing with the DNP..that will only apply to NEW graduates IF the measure comes into fruition.

BabyLady, BSN, RN · Jul 20, 2011

This is mostly false. It's only true in very specific cases and diseases investigated by the studies.
You are essentially saying that primary care physicians are fools for going through so much more education and training (something like a minimum of 15,000 clinical hours versus a minimum of 1,500-3,000). This kind of BS is not going to help your relations with physicians, whom you will be working with on a frequent basis.
Anyone with a modicum of common sense will realize that those extra years of education and training that a physician has will have a positive impact to care that may not be captured by the limited and flawed studies you cite. Even if you personally are the best and most competent nurse practitioner in the world, others studying to be NPs may severely fall through the cracks at a higher rate than that of physicians, given the shorter duration of training and fewer repetitive drilling especially in the direct entry NP programs. See for instance the anxiety in this thread of not passing the DNP certification exams on the first try, something that 95% of US medical students pass with harder exams.

I would have to disagree with you on that.

The major difference between nurses and physicians is that physicians come and review the chart, talk to the patient for 5 minutes, write an order and leave.

It is nurses, who stay with the patient for 12 hours a day and see, first-hand, how the subtle early signs of a disease process/condition begin to show.

The vast majority of NP's have that nursing experience before they go to NP school. Virtually all physicians only have their experience in classroom settings, doing rounds where they spend no extended time with the patients and reviewing charts and writing orders.

MASSIVE DIFFERENCE in training, you are correct, but hours doesn't necessarily equal expertise.

Ever watch the show mystery diagnosis? Ever noticed how a person can visit 10 to 20 physicians and NONE of them can accurately diagnose the patient and then this patient that has zero medical training is able to diagnosis themselves, finds the right specialist, who confirmed what 10 to 20 other physicians couldn't do?

It is because NP's are ultimately Advanced Practice NURSES. They are taught to critically think, they are taught to listen, they are taught to watch, they are taught that you have to remain open minded and not get arrogant about your own abilities.

I wouldn't go to an NP for everything, but the good ones, would be able to catch so much that a slacking MD would miss.

BabyLady, BSN, RN · Jul 20, 2011

Oh no I agree 100% that if you have earned a doctorate (clinical or otherwise) and you want to refer to yourself as doctor then that is great. I am simply saying that not everyone agrees with that. In fact if you look around on most of the other medically relevant forums there are plenty of people discussing the problem of confusion to patients by multiple people being called doctor in a health care setting not just NPs. I happen to know of more than one hospital where pharmacists are NOT allowed to refer to themselves as doctor period.
As for the PA calling themselves doctor I worked with two PAs (both working in the ER) who had earned doctorates (one in Health Science (DHSc) and the other a PhD in Health Related Studies). Neither of these PAs saw any reason to refer to themselves as doctor so I don't know how the hospital would have reacted if they had.
I am not aware of ANY entry level PA programs at the doctorate level...YET. There seems to be quite a bit of discussion out there on the internet about some PAs wanting to have a clinical doctorate option especially in light of the move to DNP. I don't know that the AMA would back this move, or the AAPA for that matter either. Keep in mind there are still PA programs that award the Bachelor's and a couple in California that still award Associate's degrees although the curriculum is all standardized for the most part and it all depends on pre-reqs etc. at the various schools.
As far as people getting in a tizzy when DNPs want to be known as a doctor and not other providers I think this, again, may depend on the region of the country you are in. There is still plenty of discussion on the forums out there about whether a pharmacist should be called doctor for instance, and even within the pharmacy profession there is division on this issue. I think maybe it seems more like its all DNPs on this site, because this site is geared toward nurses. I can assure you though that on sites geared toward medical students, residents, etc. there is plenty of dissent for anyone other than an MD or DO to be called doctor.

There is a finite difference between confusing the patient and EDUCATING THE PUBLIC.

It is time to educate the public.

The last time I had surgery, I had no less than 4 MD's enter my room and here is how the conversation went:

MD: "Hello, My name is Dr. Smith....I am here to take a look at your incision."

ME: "...and you are?"

MD: "I'm Dr. Smith"

ME: "Are you a psychiatrist, surgeon, endocrinologist, cardiologist...what?"

MD: "I'm a medical doctor".

ME: "So you are a resident?"

MD: "No, I am the general surgeon".

Granted, I will ADMIT I was being sarcastic, but my point was made: I should know which disciplines are coming into my room and who is looking at me.

NOBODY, should be introducing themselves as Dr. without an explanation of who they are...for example

I'm Dr. Smith, I am your Cardiology resident.

I'm Dr. Jones, I am your Anesthesiologist.

I'm Dr. Doe, I am your General Surgeon

I'm Dr. Patel, I am a Nurse Practitioner

There are several pharmacists in my hospital and in surrounding pharmacies, ALL of them are referred to as "Dr. ____".

When in the hospital, they refer themselves as a Dr. ____, I am the Pediatric Pharmacist.

You know why I should support the title, because after the public is educated, it will show the level of expertise of the person who is treating you.

If you are treated by Ms. Smith the NP, you know she has an MSN, If you are treated by Dr. Smith, the NP, then you know she has a DNP.

It is only as confusing as we make it out to be and I personally, don't believe the majority of people are that stupid.

PMFB-RN, RN · Jul 21, 2011

You know why I should support the title, because after the public is educated, it will show the level of expertise of the person who is treating you.

*** The idea that the degree a nurse holds is an indicator of the nurses expertise is absurd. I am the Rapid Response Nurse for my hospital. I have years of high acuity critical care, level I trauma, transport, and ER experience. CCRN, CEN and CRNI certifications. I am an ACLS instructor and have years of paramedic experience as well. That anyone would assume that the new grad with a direct entry MSN has more expertise than I do cause I do not have a masters is ridiculous.

Guinea · Jul 21, 2011

It is because NP's are ultimately Advanced Practice NURSES. They are taught to critically think, they are taught to listen, they are taught to watch, they are taught that you have to remain open minded and not get arrogant about your own abilities.
I wouldn't go to an NP for everything, but the good ones, would be able to catch so much that a slacking MD would miss.

Yeah, you're just so open-minded and not arrogant about your abilities that you think NPs are better than MDs.

And what do you think residency is? A classroom setting? Why do you think residents work 30 hour shifts? How many patients do you think medical students on clerkships follow at a time?

Are there great NPs with decades of experience who are wonderful assets to the team? Absolutely. But you're kidding yourself if you think the plethora of recent online NP programs and direct entry NP programs are even remotely equivalent to the MD-residency combination, let alone superior. NP graduates from these newer programs today are nowhere in the same league as the previous generation of critical care nurses who went to NP programs after a decade of experience. Yet they have the audacity to feel superior to those MSNs because they took a couple fluff classes in elementary statistics and have a degree with the word Doctorate in it.

And BTW, I think Illinois just made it illegal for DNPs to call themselves Doctors in the clinical setting.