APRNs should only be DNPs!

[Lovanurse]

Hi all! First, I want to say that I am NOT starting this thread to start a war. I am working on my very last assignment for my DNP/FNP (graduating 5/4). 1300 clinical hours were required for graduation and was completed in Peds, Geri, clinical diagnostics, Adult 1 & 2 and OB/GYN. Anyway heres the issue...An APRN is a NP, CNS, CRNA or CNM. (I put this here because, I myself, mixed up the letters and initially thought the issue was about ARNPs). Non APRNS are those nurses who have a master's in*nursing*education, nursing administration or another area. They are not clinicians. They do not have a*patient*population they care for.*Please*review the*consensus*documents for further*explanation. RMU accepts only APRNs in our post master's DNP*program. Other DNP programs accept non APRNs. This is*the*debate. *Can a*post*master's DNP program be*appropriate*for an APRN who does not have a patient population?

[traumaRUs, MSN, APRN]

Sure why not?

I'm not sure your title of this thread is what you want it to be. The title makes me believe that YOU think all APNs should have to have a DNP. However, in your post, you talk about non-APNs obtaining DNPs.

Perhaps you could clarify??

[Lovanurse]

Sorry for the confusion. I may have made the topic description a little dramatic. But I don't have an opinion on this issue yet. I am still researching the issue. I am trying to get a feel for what other APRNs (who are already practicing) think about this topic. Should a DNP only be designated for clinicians? Or is the DNP role also important for nurse educators and other non-practicing APNs? Or maybe nurse educators should get PhDs instead of DNPs because it is supposed to be a clinical doctorate?

[traumaRUs, MSN, APRN]

Got it now.

I think a DNP is fine for non-clinical people.

After all, if I was to go back to school now, a DNP wouldn't add to my clinical skillset IMHO. However, it would offer me more education in research/education.

[Corey Narry, MSN, RN, NP]

Agree with TraumaRUS. I'm basing my opinion on the current status of the DNP being a practice doctorate, not a clinical doctorate. You can certainly get into a BSN to DNP program with a nurse practitioner track (or other APN specialties) but that's just one focus of the degree. The AACN document on DNP Essentials elaborates further that Aggregate/Systems/Organizational is the other focus of this degree. Their statement opens up the opportunity for non-APN's to pursue the same degree and have it tailored for such types of nursing practice. In AACN's own words and I quote from their document:

"DNP graduates in administrative, healthcare policy, informatics, and population-based specialties focus their practice on aggregates: populations, systems (including information systems), organizations, and state or national policies. These specialties generally do not have direct patient care responsibilities. However, DNP graduates

practicing at the aggregate/systems/organization level are still called upon to define actual and emerging problems and design aggregate level health interventions.

These activities require that DNP graduates be competent in advanced organizational, systems, or community assessment techniques, in combination with expert level understanding of nursing and related biological and behavioral sciences. The DNP graduate preparing for advanced specialty practice at the population/organizational/policy level demonstrates competencies in conducting comprehensive organizational, systems, and/or community assessments to identify aggregate health or system needs; working with diverse stakeholders for inter- or intra-organizational achievement of health-related organizational or public policy goals; and, designing patient-centered care delivery systems or policy level delivery models."

Source: http://www.aacn.nche.edu/publications/position/dnpessentials.pdf

[Lovanurse]

Good point. That is true. I forgot it is a "practicing" doctorate. But I guess I dont understand the difference between "practice" & "clinical". Isn't it implying the same thing. Nurse educators and nurse researchers aren't "practicing" either. Most of what I've learned in health policy was practice related. It was all about learning how to read legal briefs for malpractice suits, who can sue me and for what, medicare/ credentialing information, charting, and things of that nature. Evidence based Practice was also "practice related" as we were trained to diagnose and treat based on current evidence. But I wasn't aware that these individual classes were tailored to each individual program.

[Corey Narry, MSN, RN, NP]

The way I look at it, "clinical" denotes practicing in a direct patient care capacity, "practice" is more broad - a nurse educator is practicing the skill of pedagogy within the nursing context. To me, it's the "Nursing Powers that Be's" fault for not getting it together in the first place. The initial impetus for the DNP as I remember it right was to improve clinical education in nurse practitioner programs. The early documents on the DNP was very much NP-focused. But then, as in anything that has to do with nursing, everyone wanted a seat at the round table and the final DNP Essentials document opened up a loophole for non-APN's to pursue the DNP. It further cheapened this degree to the point that many for profit online-only institutions (i.e., Walden, Capella - schools with no reputation for clinical education) are offering it.

[Tinabeanrn]

Good points Juan. To loveanurse, I know what you are saying. I was confused also when my nursing instructor was getting her DNP and had her plain MSN for University of Phoenix. My first thought was, don't you have to be an NP to get your DNP? However, at the time I thought that DNP stood for Doctorate NP, not Doctorate in Nursing practice. Be that as it may, since it is a doctorate in nursing practice, I think that non clinical ppl should be able to obtain this title as well.

But hats off to you for your upcoming graduation. Thats awesome :)

[Psychcns]

I think it is confusing how these degrees come along...There used to be a phD in Nursing and another doctoral level degree called something like Doctor of Nursing Science. Why were these not adequate?

When I got my MSN in 1993, it was required that to be admitted to the psych cns program you needed at least one year of psych experience. My actual clinical hours in the program, I am told was 600 hours, which does not seem like a lot now, but then there were further practice requirements after graduation to become ANCC certified..and I think people were more willing to train you...

As Juan says above if the initial impetus of the dnp was to improve NP education, why was it necessary to create another degree? Couldnt the NP curriculuum be revised without creating a new degree.. It seems we now have at least three doctoral level nursing degrees, and you do not have to be an APRN to have a doctorate. OK..but the confusion of it all...

PS I just realized that DNP stands for Doctorate of Nursing Practice, I had also thought as the above post says that it was something to do with Doctorate of NP (Nurse Practitioner)!!! And I am fairly informed about these things!!

[pro-student]

I agree with the above poster in that the DNP is a practice-based degree though not necessarily limited to clinical practice. I have closely followed the DNP development from inception and, while some specific programs will describe their DNP as a clinical degree, the standards for the degree across the board do not strictly limit it to clinical practice. I would also contend that the DNP curriculums unanimously do not add any real clinical content. I'm sure that comment will have someone up in arms and I don't mean it to diminish the content or rigor of the degree. Notwithstanding, the content is focused exclusively on practice-related issues which could potentially have clinical significance (hopefully so). The majority of programs offer curriculums weighted heavily towards EBP with informatics, systems, and leadership content included. My point being, while all of that, in theory, could produce better clinicians, it could also produce better administrators, educators, and other areas of nursing practice. Therefore, I don't think it would make any sense to limit the degree to clinicians who, for decades before the DNP came around have been shown to be competent and successful without it.

P.S. - I realize that there are more and more BSN-DNP programs and DNP programs offering "add-on" credentials such as another APN specialty. However, I think if one where to examine just the "doctoral" portion of these curriculum (i.e. - adjusted for the coursework that is essentially the same as an MSN or post-master's certificate) the conclusion regarding not building on clinical content still holds true.

[zenman]

I think it is confusing how these degrees come along...There used to be a phD in Nursing and another doctoral level degree called something like Doctor of Nursing Science. Why were these not adequate?

We've also had (and maybe others) DNSc (Doctor of Nursing Science), ND (Nursing Doctorate), DSN (Doctor of Science in Nursing)...and you wonder why we are lost and confused...

[llg, PhD, RN]

As a nurse with a PhD (in nursing) who specializes in Nursing Professional Development, I see a strong need for a doctoral alternative that is not a PhD for people like me. And I don't think we should add a 3rd type of degree. The PhD and the DNP should be able to sufficiently cover everyone -- with the PhD emphasizing philosophy, theory, and research ... and the DNP focusing on practice -- ALL types of nursing practice and NOT just NP's, CNS's, CNM's, and CRNA's. Other types of nursing practice (e.g. administration, staff development, case management, informatics, etc. etc.etc.) also require leaders prepared at the doctoral level.

The actual patient care skills of the APRN's can be taught at the Master's level. It's the bigger picture and broader view that the DNP degree brings to the APRN. The other types of nurses need those courses, too.

Nursing practice is more than just direct patient care. Even Florence Nightingale said that. Those other functions of the nurse must also be respected and included in discussions of nursing practice.

The problem/confusion was made worse when some people started limiting the use of the word "advanced" to describe ONLY the practice of those 4 roles -- ignoring the fact that knowledge beyond the basic level is needed for other types of nursing at the highest levels. By claiming the exclusive use of the word "advanced," the leaders of those 4 roles have shut out all the other nurses in other specialties who also practice at an advanced level -- but who are now left with no reasonable phrase to use refer to the higher level of their practice.

And yes, I am fully aware of DNS, DSN, DNSc, etc. They just make matters worse, too.