Clarification on the DNP requirement of 2015

[umbdude]

Hi-

I'm a bit confused about the whole 2015 DNP requirement for APRNs. Does this mean a DNP, instead an MSN, is required in order to become a Nurse Practitioner starting 2015? Is this applied uniformly in all States or do States have their own "flexibility" on how this is handle? (I live in MA.)

If DNP is required, I wonder if MSN programs will be phased out and replaced by DNP programs or maybe integrated into the DNP programs. In a clinical setting, will the scope of practice expand for someone with a DNP vs someone with an MSN? Or are they moving to DNP because they believe that MSN programs are already very much a doctoral program relative to other health professions?

Thanks in advance for your thoughts.

umbdude

[wtbcrna, MSN, DNP, CRNA]

*** Not me. Other fields have shared the same concernes being expressed by some in nuring about meaningless degree inflation. Two I have some knowlage of (though family) are engineering and social work.

Having concernes about or being opposed to degree inflation in NO WAY indicates anyone is "balking" at advanced education.

I don't remember the big debate over mandate for clinical doctorates for pharmicists, OT, and PTs.

I graduated with 82 semester credit hours for my MSN that is not degree inflation that simply not getting the degree to go with the work.

I didn't say you were balking at higher education, but nurses in general which is evidenced on numerous threads on here.

[wtbcrna, MSN, DNP, CRNA]

Three years programs for NA school is a bygone conclusion. Whether all programs start the minimum 36 months now or in 2022 it is going to happen. IMHO 2 years is not enough time for CRNA programs, and apparently the COA feels the same way.

*** My CRNA friends tell me they were well prepared in 24 and 27 month programs. However I haven't been through NA school and am not in a position to have an informed opinion. Just wanted to make note of conflicting opinions on the subject.

And that is why I stated "IMHO", but that still doesn't explain why the COA and various leader in CRNA community disagree that 2 years is long enough for CRNA school.

By the way I would encourage anyone that thinks they are well prepared after 2 years of NA school to come join the military as a CRNA and deploy within the first couple of months after school. Then I think those opinions might change a little.

[wtbcrna, MSN, DNP, CRNA]

*** I am curious if you think requiring a doctorate for entry to practice for CRNAs will change the CRNA vs AA dynamic? Will AAs be more compeditive than CRNAs due to the shorter / cheaper preperation?

No AAs are a political tool. The only thing that makes AAs competitive is politics and political lobbying. AAs can only work in an ACT practice which by definition is inefficient.

[PMFB-RN, RN]

No AAs are a political tool. The only thing that makes AAs competitive is politics and political lobbying. AAs can only work in an ACT practice which by definition is inefficient.

*** Yes I understand that AAs can only practice in an ACT enviroment, and only in a handful of states, and I have some small idea about the politics behind them. All my hunting and fishing buddies are CRNAs that used to work in ICU with me.

I was really thinking of the NP vs PA. In many practices NPs and PAs do the same work and are paid the same. Both are supposed to be cost effective providers of health care. If a DNP were required for NPs, thus significantly increasing the cost of their training, wouldn't they be at a disadvantage with PAs?

[PMFB-RN, RN]

And that is why I stated "IMHO", but that still doesn't explain why the COA and various leader in CRNA community disagree that 2 years is long enough for CRNA school.

*** Not every organization makes it's decisions based strictly on what os best. People look out for their own interests.

By the way I would encourage anyone that thinks they are well prepared after 2 years of NA school to come join the military as a CRNA and deploy within the first couple of months after school. Then I think those opinions might change a little

.

*** Certainly the military is it's own world and had unique demands. Are military CRNAs expected to deploy within the first couple months of graduation? RNs and MDs don't, or didn't when I was in the army.

You graduated with an MSN. How long did that take? I would assume, without really knowing, that it was a 24 or 27 month program. In what ways were you unprepared? How do you expect your doctorate to better prepare you for deployment? Certainly many CRNAs in the military graduated from 24 or 27 month programs and were then recruited into the military. How is their practice deficient?

The U of M DNP program didn't add a single clinical hour or clinical related class when it changed from MSN to DNP. Their students actually do the DNP year first then enter into the exact same NA education the MSN students have alwasy recieved.

[wtbcrna, MSN, DNP, CRNA]

*** Yes I understand that AAs can only practice in an ACT enviroment, and only in a handful of states, and I have some small idea about the politics behind them. All my hunting and fishing buddies are CRNAs that used to work in ICU with me.

I was really thinking of the NP vs PA. In many practices NPs and PAs do the same work and are paid the same. Both are supposed to be cost effective providers of health care. If a DNP were required for NPs, thus significantly increasing the cost of their training, wouldn't they be at a disadvantage with PAs?

NP and PAs are totally different than AAs and CRNAs. AAs were and are around solely for political reasons thought up by the ASA.

ACT practices are not cost effective. ACT practices benefit anesthesiologists. An ACT practice allows anesthesiologists to double their reimbursement compared to what they could make just working in a room as the sole anesthesia provider.

No, APNs are not at a disadvantage because there is not a shortage of students. You are assuming that the numbers of APNs are going to be lower d/t the transition to a DNP which is not true. NP training can be done part-time or even full-time while still maintaining a full-time RN job. PA training is pretty much 2 years of full-time training where most students cannot work. NPs will still have the advantage, because NP students can still work and goto school.

[wtbcrna, MSN, DNP, CRNA]

*** Not every organization makes it's decisions based strictly on what os best. People look out for their own interests.

.

*** Certainly the military is it's own world and had unique demands. Are military CRNAs expected to deploy within the first couple months of graduation? RNs and MDs don't, or didn't when I was in the army.

You graduated with an MSN. How long did that take? I would assume, without really knowing, that it was a 24 or 27 month program. In what ways were you unprepared? How do you expect your doctorate to better prepare you for deployment? Certainly many CRNAs in the military graduated from 24 or 27 month programs and were then recruited into the military. How is their practice deficient?

The U of M DNP program didn't add a single clinical hour or clinical related class when it changed from MSN to DNP. Their students actually do the DNP year first then enter into the exact same NA education the MSN students have alwasy recieved.

We try not to deploy new grads in the first 6 months, but that is not a regulation and does happen.

My program was 28 months and we lost 25% of our class. Most of those losses were d/t academic reasons.

I did not say I was unprepared for graduation, but unlike most of my civilian counterparts we were prepared for independent practice by the time we graduated. When I started my first job as a CRNA I had two days of orientation and was on call by myself within 2 weeks covering the entire hospital and OB.

There are not that many civilian trained CRNAs in the military. The military trains the majority of its own CRNAs. Most civilian NA programs do not train their students to be ready for independent practice right after graduation, and few NA programs do not train their students to work independently or even advocate that their students ever work outside of an ACT practice. A lot civilian NA programs have minimal regional anesthesia training also.

U of M (University of Maryland?) if I understand you correctly added a year to the program...? Again the point isn't the number of clinical hours you get between your MSN vs DNP. It is about how the DNP/DNAP is going to help develop your practice over the next 20-40 years.

USUHS added one semester to their program which was overloaded with credit hours. It stretched the program out giving the students more time for the course load. USUHS also lengthened the total calendar time students are in clinicals, and USUHS switched to more integrated school model versus its' old straight front-end model for NA school.

[PMFB-RN, RN]

ACT practices are not cost effective. ACT practices benefit anesthesiologists. An ACT practice allows anesthesiologists to double their reimbursement compared to what they could make just working in a room as the sole anesthesia provider.

*** Yes, I know exactly what ACT practice is. I have been in the OR during a CABG when the MDA stuck his head in the door ONE time during the whole case to say "how is it going?" to the CRNA. I also was there after the case when the MDA showed up to sign the charting. I know he gets half the bill rate to do that and that at that time he had 3 CRNAs who were actually doing the cases and that the MDA did absolutly nothing. He was in the ansestesia work room watching TV and napping.

[PMFB-RN, RN]

We try not to deploy new grads in the first 6 months, but that is not a regulation and does happen.

*** But it usually doesn't happen, at least not much.

My program was 28 months and we lost 25% of our class. Most of those losses were d/t academic reasons.

I did not say I was unprepared for graduation, but unlike most of my civilian counterparts we were prepared for independent practice by the time we graduated. When I started my first job as a CRNA I had two days of orientation and was on call by myself within 2 weeks covering the entire hospital and OB.

*** That sounds typical to me. In my hospital the CRNA who is on at night is on call for everything and does whatever case need to be done reguardless of what kind of case it is from CABG to trauma, to OB to neuro surgery. Some of my friends are in solo practice or belong to all CRNA practice groups. They get a little orentation then are on their own as the sole provider.

I don't understand how you could have been well prepared in only 28 months? It is your opinion that NA programs need to be 36 months, right?

There are not that many civilian trained CRNAs in the military. The military trains the majority of its own CRNAs.

*** I am suprised at this. Considering that so many of our CRNAs deployed with the guard or reserve since 2003.

Most civilian NA programs do not train their students to be ready for independent practice right after graduation, and few NA programs do not train their students to work independently or even advocate that their students ever work outside of an ACT practice. A lot civilian NA programs have minimal regional anesthesia training also.

*** I ran this statement by a couple CRNA friends. I won't repeate what was said but let's just say they strongly disagreed with you. Of course all of them graduated from one of the 4 local schools but all were trained to be sole anestesia providers in rural areas. Obviously we don't know what "most" programs do, but that here in WI and MN graduate CRNAs ready for solo practice.

U of M (University of Maryland?)

*** U of Minnesota.

if I understand you correctly added a year to the program...?

*** Yes they added a DNP year onto the front of the program, then send students through the exact same NA program the MSN students have always done.

[wtbcrna, MSN, DNP, CRNA]

*** But it usually doesn't happen, at least not much.

*** That sounds typical to me. In my hospital the CRNA who is on at night is on call for everything and does whatever case need to be done reguardless of what kind of case it is from CABG to trauma, to OB to neuro surgery. Some of my friends are in solo practice or belong to all CRNA practice groups. They get a little orentation then are on their own as the sole provider.

I don't understand how you could have been well prepared in only 28 months? It is your opinion that NA programs need to be 36 months, right?

*** I am suprised at this. Considering that so many of our CRNAs deployed with the guard or reserve since 2003.

*** I ran this statement by a couple CRNA friends. I won't repeate what was said but let's just say they strongly disagreed with you. Of course all of them graduated from one of the 4 local schools but all were trained to be sole anestesia providers in rural areas. Obviously we don't know what "most" programs do, but that here in WI and MN graduate CRNAs ready for solo practice.

*** U of Minnesota.

*** Yes they added a DNP year onto the front of the program, then send students through the exact same NA program the MSN students have always done.

You can tell your CRNA friends that any program that has rotations through rural practices with independent CRNAs are not part of the group I was referring to...lol. The majority of CRNA programs are not in the midwest though. I always tell nurses interested in becoming a CRNA that you really need to be careful when choosing a school. There are NA schools that survive on just having the students do the minimum required number, and never having their students work outside of ACT practices.

The Army admits around 60 NA students a year and USUHS admits around 40 NA students a year. There are only around 140 CRNAs in the USAF. Most of those Guard and Reserve CRNAs were probably trained on AD in the military then switched from AD to Guard/Reserves.

I do think NA programs need to be longer to cover the amount of material they have to cover, and to make future providers that will be better able to utilize research through EBP. I also think that longer schools will allow the academic workload to be more manageable. 36 month NA programs are a foregone conclusion when the program switches to a Doctorate level program it will have to be at least 36 months.

The amount of time in clinicals is important, but the amount time spent in didactics is equally important.

There are still plenty of CRNA programs that are Masters level programs, if you don't want to the DNP/DNAP then you should pick one of those. The COA and the AANA have already determined that CRNAs will have to have their Doctorate to enter practice by 2025 or later. It is much easier to get your clinical doctorate now instead of changing your mind in the future and going back for additional 2-3 years though.

[PMNP]

I would add another dimension to consider is that the 3rd party payers may at some point start requiring the DNP for credentialing APNs-at which point it is really irrelevant what the states or certifying bodies 'require' for entry level into APN...if you cannot be credentialed w/3rd party payers you will not be employable. I suspect this may have something to do w/why an employer is already 'preferring DNPs' over MSNs. Just a thought from an MSN ARNP who decided to take the sage advice of someone who said if you plan on being in the workforce another 10 years or more it's in your best interest to obtain your DNP. After all, the state I am in (& came from) have eliminated their MSN programs. If you were an employer hiring an ARNP who would you hire-a DNP or MSN? P.S. all but 3 states require board certification to be licensed as an ARNP/APRN, so if your certifying agency (i.e. ANCC) requires the DNP to sit for the future exams the states by default will all 'require' the DNP if you think about it...like it or not the DNP is here to stay.

[PMFB-RN, RN]

The Army admits around 60 NA students a year and USUHS admits around 40 NA students a year. There are only around 140 CRNAs in the USAF. Most of those Guard and Reserve CRNAs were probably trained on AD in the military then switched from AD to Guard/Reserves.

*** I was wondering about this so I have asked around at work the last 4-5 days. Turns out none of them were trained in the military. All 5 I asked about it (1 navy reserve, 1 AF reserve, 3 army reserve/NG) were trained here in local NA programs. However all were already nurse corps officers before going to CRNA school.