DNP's failing the test????

TX RN · Mar 17, 2009

I'm just wondering why PA's are hanging out on a NURSING board.

OK. I asked for it, let the roasting begin! :trout:

oldiebutgoodie, RN · Mar 17, 2009

I'm just wondering why PA's are hanging out on a NURSING board.
OK. I asked for it, let the roasting begin! :trout:

David posts on our board, the physician assistants board, and the student doctor board. His posts and responses are always very well thought out, actually based on facts and research! I believe he is pursuing a PhD right now in Health Policy or something like that (David, please correct me if I am wrong). This partially explains his presence on these boards. However, I think that he is also an excellent advocate for midlevel clinicians, and (from what I understand) he is an excellent clinician. So, we are lucky he is posting with us!

Oldiebutgoodie

MissDoodaw · Mar 17, 2009

Not a roast, but my :twocents: ....

First of all, I will say I always look forward to reading David's posts. I know they will be knowledgeable, in depth and provide me with an intelligent perspective. I know I am not the only one. He has provided advice to countless NP's and students on this board and many of us are grateful for his presence, as well as any other presence willing to use their time and effort to share their insights with us.

In general, I feel we should strive to have a board that is inclusive, rather than exclusive. We will be getting information from different sources which should provide a more well rounded perspective and let us explore 'the other side of the story'.

prairienp · Mar 17, 2009

not a roast, but my ....
first of all, i will say i always look forward to reading david's posts. i know they will be knowledgeable, in depth and provide me with an intelligent perspective. i know i am not the only one. he has provided advice to countless np's and students on this board and many of us are grateful for his presence, as well as any other presence willing to use their time and effort to share their insights with us.
in general, i feel we should strive to have a board that is inclusive, rather than exclusive. we will be getting information from different sources which should provide a more well rounded perspective and let us explore 'the other side of the story'.

agree, we should allow any and all to post on this nursing board. we set a good example for the pa board, which historically is quite intolerant of np posts, especially those not in step with pas. although i do not always agree with mr. carpenters posts, i do respect his thoughtfulness. i often wonder if he wasn't a nurse or is married to a nurse.

menetopali · Mar 17, 2009

I would think that if you want to get involved in policy reform the PhD would be a better way to go. You could focus on just the policy and not have to worry about the clinical stuff. the DNP is supposed to be a Clinical Degree.

I would agree except that the nursing "leaders" effectively created more of an issue by allowing non-APRNs to earn a DNP and by defining it as a "practice" degree instead of a "clinical" degree.

CraigB-RN, MSN, RN · Mar 17, 2009

I would agree except that the nursing "leaders" effectively created more of an issue by allowing non-APRNs to earn a DNP and by defining it as a "practice" degree instead of a "clinical" degree.

Thanks for the addition to my post. I just posted in another thread my thoughts about how we as a coperate body called nursing to often let our leaders bring us places we don't want to go. I hate it evertime I hear someoen say PhD light when taking about the DNP. I wish I had a time machine. I already know of two APN who quit the MCG DNP program because it didn't turn out to be what they wanted. I hope it doesn't turn into the ND, I don't think it will.

In the military we used to have a running joke, don't call me sir, call me seargent because I work for a living. I see some of this discusion fall into the same area. I don't want to be called Dr. There are a lot of PhD's and such out there. I want to be called Proffesor and have it said in a tone, that means I'm respected for giving my students the tools to make their own choices and how they want to change their, thoughts and beliefes. Hmm I just had shivers, i actually remember all that Affective Domain stuff. :)

menetopali · Mar 17, 2009

I'm not quite sure what you were trying to say about medical students have more... time? clinical experience?
The people who make the DNP are pushing for similar rights to a physician but do not want to have to jump through any of the hoops that medical students have to. They want to have their cake and eat it too.
Frankly it seems like a very political move to me. If they really wanted to advance the education, why make a doctoral degree? Why not just keep the masters and just make it a bit longer? Because they want the name "doctor" so that they have an easier time making headway further into the medical field. Were the education similar I think I would have a much easier time swallowing this but it is not and as I have posted earlier it is full of worthless courses that do not add to the core foundation of medical knowledge.

first - the MSN was already longer than most masters degrees (as the BSN is longer than most bachelors and the ADN is longer than most associates) so simply extending the program without altering the degree awarded made no academic sense.

second - the political motivation behind limiting access to care and access to NPs is straight out of the AMA as if they actual have the right to regulate another profession.

third - as i have said elsewhere, the DNP, MD, DO, PharmD, DC, DDS, DPM, DPT, EdD, PsyD, DVM, DMD, OD, and PhD are all doctors and none of them have the same education as any of the others (the closest two are MD & DO followed by DDS & DMD and PsyD/EdD/PhD in psychology). why would the DNP want the exact same education as an MD to provide patient-centered, safe, effective, timely, efficient, and equitable care when the MD/DO fails to meet, or even address, five out of six of these aims. while some of the DNP material is fluff, much of the non-medical material is directly aimed at improving quality of care that the physician led system has failed to address. i here medical students talk about things they consider "fluff" that are essential to nursing's approach to care like communication, ethics, care coordination, presentation, and other 'soft skills' that are essential to providing quality care.

back to the OP:

first time out & small sample size do not make a good study of a trend. the ACP and the AANP both state that nursing should develop their own exams - unfortunately nursing has failed to do so beyond the current eleven different specialty exams at the masters level (two are for the FNP). i assert that there needs to be a shift in preparation to include more clinical time, less theory fluff, keep the public health and financing courses, fewer stats & research courses, and more in depth clinical courses with a federally funded DNP residency after graduation.

having said that, should it ever mirror the MD/DO curriculum? - No, a thousand times over. the MD/DO curriculum has failed to provide safe, effective, equitable, patient-centered, efficient, and timely care for decades (IOM 2001) while killing thousands (IOM, 2000) and leaving rural America with ever shrinking access to care by physicians (IOM, 2005). the DNP is a separate and distinct model of care and education from the MD/DO; not better, not worse, not perfect, but definitely different.

in my ever so humble opinion, the DNP could certainly stand to increase the clinical material and the MD/DO curriculum is in desperate need of more education in interdisciplinary care (that means outside of medicine - not among specialties), health care policy and finance, and basic communication skills. it is not the place medicine to dictate to nursing what education is appropriate for nursing, and it is not the place of nursing to dictate to medicine how to educate their students.

just my :twocents:

cruisin_woodward · Mar 18, 2009

I would agree except that the nursing "leaders" effectively created more of an issue by allowing non-APRNs to earn a DNP and by defining it as a "practice" degree instead of a "clinical" degree.

I have no interest in a PhD. I strongly feel that policy change etc should come from people, "in the field" if that makes sense? I feel the same way about research, although I think PhDs and DNPs should be working together on the research. I also feel that a DNP will make a better teacher than a lot if PhDs...because they are working, "in the field". I love it when a professor is teaching med surg or patho, and they have no personal input to add to the lecture, or the input is old and outdated!! So, for me at least, the DNP seems perfect for my goals.

For the record, I really don't care if I'm called, "Dr" or just, "Amy". BUT I do think that if I've earned it, I should be allowed to be called Dr, if that iswhat someone chooses...some of my nursing instructors went by, "Barb", some went by, "Dr Barb", some went by, "Dr Smith", some by, "professor" all were PhDs...

menetopali · Mar 18, 2009

I have no interest in a PhD. I strongly feel that policy change etc should come from people, "in the field" if that makes sense? I feel the same way about research, although I think PhDs and DNPs should be working together on the research. I also feel that a DNP will make a better teacher than a lot if PhDs...because they are working, "in the field". I love it when a professor is teaching med surg or patho, and they have no personal input to add to the lecture, or the input is old and outdated!! So, for me at least, the DNP seems perfect for my goals.
For the record, I really don't care if I'm called, "Dr" or just, "Amy". BUT I do think that if I've earned it, I should be allowed to be called Dr, if that iswhat someone chooses...some of my nursing instructors went by, "Barb", some went by, "Dr Barb", some went by, "Dr Smith", some by, "professor" all were PhDs...

i have no objection, and in fact support the idea, of having those who teach still being out in the field. This idea was pushed as early as the 1950s by L. Cristman but has fallen by the wayside in many ways. My point was that to achieve the "highest practice degree in nursing", one should be "an advanced practice nurse". as a political matter it makes defense of the DNP as a 'practice' or 'clinical' degree very difficult when presenting it to the lay public. as a practice matter it muddies the waters as to what having a DNP means, or doesn't mean, to patients. as an educational matter - DNPs may or may not be able to obtain tenure making their participation in university governance more difficult.

as for the title issue, i am of the mind that we must use the title we have earned (Dr. Barb, PhD or Dr. Smith, PhD in your example). to do otherwise devalues the credential we have earned and the profession we earned it through.

CraigB-RN, MSN, RN · Mar 18, 2009

I have no interest in a PhD. I strongly feel that policy change etc should come from people, "in the field" if that makes sense? I feel the same way about research, although I think PhDs and DNPs should be working together on the research. I also feel that a DNP will make a better teacher than a lot if PhDs...because they are working, "in the field". I love it when a professor is teaching med surg or patho, and they have no personal input to add to the lecture, or the input is old and outdated!! So, for me at least, the DNP seems perfect for my goals.
QUOTE]
Interesting concept, but i'm to much of a cynic to believe that will be the case. Again you have to look at more variables than the arrangment of the letters after a persons name.
The first is the assumption of DNP's working in the field more than PhD's. Once you move into the facaulty mode, the instructor of either going to work or not work. I can already point out APRN's who are faculty and although some are great and have lots of knowledge, they have no concept of education.
The conept of DNP being faculty isn't what the DNP is all about. It's was supposed to be a clinical application degree. Never about teaching.
As a profession, we need, all levels, non is inhearently better than another. There are always going to be good, bad, fantasitic and the what rock did you crawl out from under at all levels. Think about it. Think about the reality. For schools it's about money, and since there are no accredidation rules that limit admision to a program, you can go from a high schhool grad to a BSN and then (and it will happen, just look at the history) into an DNP program, wthout ever working.
In all the threads on the subject, the focus is always on the degree will help solve all out problems. It hasn't in the past 33 years I've been doing this, and I don't expect it to change. What are we going to do next, when non of this changes the world of health care we work in? WIth the DNP as the terminal degree, were do we go from there?

menetopali · Mar 19, 2009

the degree will not solve anything on it's own, that is dependent on the content of the degree, but it will provide a mechanism to shift perception.

silas2642 · Mar 21, 2009

first - the MSN was already longer than most masters degrees (as the BSN is longer than most bachelors and the ADN is longer than most associates) so simply extending the program without altering the degree awarded made no academic sense.
second - the political motivation behind limiting access to care and access to NPs is straight out of the AMA as if they actual have the right to regulate another profession.
third - as i have said elsewhere, the DNP, MD, DO, PharmD, DC, DDS, DPM, DPT, EdD, PsyD, DVM, DMD, OD, and PhD are all doctors and none of them have the same education as any of the others (the closest two are MD & DO followed by DDS & DMD and PsyD/EdD/PhD in psychology). why would the DNP want the exact same education as an MD to provide patient-centered, safe, effective, timely, efficient, and equitable care when the MD/DO fails to meet, or even address, five out of six of these aims. while some of the DNP material is fluff, much of the non-medical material is directly aimed at improving quality of care that the physician led system has failed to address. i here medical students talk about things they consider "fluff" that are essential to nursing's approach to care like communication, ethics, care coordination, presentation, and other 'soft skills' that are essential to providing quality care.
back to the OP:
first time out & small sample size do not make a good study of a trend. the ACP and the AANP both state that nursing should develop their own exams - unfortunately nursing has failed to do so beyond the current eleven different specialty exams at the masters level (two are for the FNP). i assert that there needs to be a shift in preparation to include more clinical time, less theory fluff, keep the public health and financing courses, fewer stats & research courses, and more in depth clinical courses with a federally funded DNP residency after graduation.
having said that, should it ever mirror the MD/DO curriculum? - No, a thousand times over. the MD/DO curriculum has failed to provide safe, effective, equitable, patient-centered, efficient, and timely care for decades (IOM 2001) while killing thousands (IOM, 2000) and leaving rural America with ever shrinking access to care by physicians (IOM, 2005). the DNP is a separate and distinct model of care and education from the MD/DO; not better, not worse, not perfect, but definitely different.
in my ever so humble opinion, the DNP could certainly stand to increase the clinical material and the MD/DO curriculum is in desperate need of more education in interdisciplinary care (that means outside of medicine - not among specialties), health care policy and finance, and basic communication skills. it is not the place medicine to dictate to nursing what education is appropriate for nursing, and it is not the place of nursing to dictate to medicine how to educate their students.
just my

So here's where you're kind of wrong-- when nurses start practicing medicine, this tends to grab the Board of Medicine's attention because you didn't jump through the hoops that you were supposed to, you didn't go through the rigorous training that everyone else did, and now you're saying that you're just as qualified to manage patient care with probably 1/3 of the training because you have "better communication skills."

I have to say, kudos to nursing because you guys are fantastically organized, something which medicine is not. You gals/guys have pretty much managed to practice medicine (with a few limitations) under the guise of nursing without anyone really caring until this whole DNP thing came around with Mundinger and her incentive to really push nurses into the domain of physicians-- true and complete independence. You really want to take over complex patient care without the training, without the knowledge, and in some cases, without the liability of a physician. Personally, I don't think you have a clue what you don't know. Go to med school for a year and you'll learn very quickly how little you know.

Are allopaths/osteopaths perfect? No way. We make mistakes, and we kill people. We get tired, we do dumb things. But that doesn't mean that you replace us with a lesser trained nurse with less knowledge, that just makes no sense whatsoever. If we're making mistakes in diagnoses, imagine the mistakes that you're going to make.