DNP's failing the test????

menetopali · Mar 29, 2009

Thanks, so to date, no MD or DO has ever passed the NCLEX-RN exam. Is that right?

This is a poor comparison as noted, no one is eligible to sit for the NCLEX if they did not attend nursing school. A similar pattern is a point of critisism of the current medical license exams (USMLE & COMPLEX) that has been raised by NPs.

ashap123 · Mar 29, 2009

This discussion topic has reminded me of why we need to keep our patients as our focus and not get sucked into jealous turf wars full of politics and "comparison" stories. The bottom line is this: Physicians and Advanced Practice Nurses are educated differently, practice under different theoretical models, think and act differently with similar outcome goals. Because we have traveled different paths to achieve our education does not mean one is any better than the other, only different and unique in our own areas of specialty. Does it really suprise anyone that NURSES do not score well on Medical exams? Duh, we think differently! The practices that are the most successful incorporate the strengths of many disciplines so that their patients are well cared for along the entire spectrum of health. Though the diagnostics and differentials are the similar in both medical and advanced nursing professions, it is the manner of delivery (and the reimbursal rates) that differentiate the two. Some patients like the kind of person who quickly spouts out differential diagnoses, and then confidently reports the treatment plan. Others prefer someone who will listen, educate and offer alternatives to individualize care and empower the patient. Successful practices will have both. Healthcare is changing rapidly and those who will outlast will utilize the best components of all disciplines to go the extra mile and take care of people in the manner in which the patient deems most satisfying. After all, we are all educated and trained according to tried and true standards...

PS As an ACNP, we are commonly referred to as "career residents." We do the grunt work the physicians either don't want to do or don't get paid enough to do because our focus is on holisitic caring for the patient. I don't believe the precious "residency" time makes or breaks a provider. Anyone can gain experience on the foundation of an exceptional education and become a great provider.

forpath · Mar 29, 2009

The bottom line is this: Physicians and Advanced Practice Nurses are educated differently, practice under different theoretical models, think and act differently with similar outcome goals. Because we have traveled different paths to achieve our education does not mean one is any better than the other, only different and unique in our own areas of specialty. Does it really suprise anyone that NURSES do not score well on Medical exams? Duh, we think differently!
Though the diagnostics and differentials are the similar in both medical and advanced nursing professions, it is the manner of delivery (and the reimbursal rates) that differentiate the two. Some patients like the kind of person who quickly spouts out differential diagnoses, and then confidently reports the treatment plan. Others prefer someone who will listen, educate and offer alternatives to individualize care and empower the patient.
PS As an ACNP, we are commonly referred to as "career residents." We do the grunt work the physicians either don't want to do or don't get paid enough to do because our focus is on holisitic caring for the patient. I don't believe the precious "residency" time makes or breaks a provider. Anyone can gain experience on the foundation of an exceptional education and become a great provider.

I am by no means an expert on this particular test, but it was my understanding that the material for the DNP exam was taken from the Step 3 exam, and then altered by the nursing organization administering the exam so that it would be more applicable to what the DNP candidates were taught. So, I'm not sure it was a straight-forward "medical" test the DNP candidates took.

Perhaps you feel anyone could become a great provider in primary care given enough time. Of course they could. How much time is enough? 1 year? 10 years? I presume many people, including myself, would likely prefer that they see someone who is, for the most part, beyond the steepest part of their learning curve before they entrust their care to them.

But when you speak of specialties (cardiology, ENT, dermatology, pathology, etc), a residency, and for many of us, a fellowship is the only way to gain a minimal level of competence in that specialty before one has to take care of patients or provide pathologic or radiologic diagnoses. Many specialties cannot be covered in medical school (or DNP school) in sufficient detail and therefore post-graduate training is absolutely "precious".

I would submit to you that all recent med school and DNP grads are minimally competent to practice medicine and nursing, respectively. The major difference is, MDs/DOs are forced to undergo additional rigorous training (~60-120 hours/week) in residency/fellowship and then take additional board exams before they are allowed to care for their own specialty patients, whereas DNPs can be simply released on the general populace without supervision in a number of states and with minimal supervision in many others. So yes, in the medical model, a residency does make or break a provider in terms of specialties. Anyway you look at it, there is a steep learning curve following graduation for both professionals, the difference is, in the medical model, there is someone who is intensely looking over the shoulder of the medical graduate. The same can simply not be said about the nursing model in a number of settings.

Don't get me wrong, I also feel very strongly that a 3 year family practice residency is not nearly enough training to take care of the exceedingly broad needs of the patients in their panel. If one honestly feels that they know enough to competently practice psychiatry, pediatrics, OB/Gyn, dermatology, internal medicine (including its subspecialties, like endocrine, cards, etc) and some others after only 3 years of residency, then they are way smarter and more confident in their abilities than I am. And if one thinks they can do it after only 4 years of school (MD/DO or DNP), well, you get my point.

wowza · Mar 29, 2009

Thanks, so to date, no MD or DO has ever passed the NCLEX-RN exam. Is that right?

Given that between .5 and 1% of medical students are nurses you would be incorrect. You could argue that the pass rate for physicians that have taken the test is 100%. On the other hand the pass rate for RNs that have completed medical school is assumed to be around 95% (the norm).
David Carpenter, PA-C

Foiled again

rnhunter · Mar 29, 2009

That is very interesting. How will this work for those in other specialties? such as ACNP, PNP, NNP, CRNA, ect. we are very specialized and do not get all components that would be on the USMLE.

menetopali · Mar 30, 2009

I am by no means an expert on this particular test, but it was my understanding that the material for the DNP exam was taken from the Step 3 exam, and then altered by the nursing organization administering the exam so that it would be more applicable to what the DNP candidates were taught. So, I'm not sure it was a straight-forward "medical" test the DNP candidates took.
Perhaps you feel anyone could become a great provider in primary care given enough time. Of course they could. How much time is enough? 1 year? 10 years? I presume many people, including myself, would likely prefer that they see someone who is, for the most part, beyond the steepest part of their learning curve before they entrust their care to them.
But when you speak of specialties (cardiology, ENT, dermatology, pathology, etc), a residency, and for many of us, a fellowship is the only way to gain a minimal level of competence in that specialty before one has to take care of patients or provide pathologic or radiologic diagnoses. Many specialties cannot be covered in medical school (or DNP school) in sufficient detail and therefore post-graduate training is absolutely "precious".
I would submit to you that all recent med school and DNP grads are minimally competent to practice medicine and nursing, respectively. The major difference is, MDs/DOs are forced to undergo additional rigorous training (~60-120 hours/week) in residency/fellowship and then take additional board exams before they are allowed to care for their own specialty patients, whereas DNPs can be simply released on the general populace without supervision in a number of states and with minimal supervision in many others. So yes, in the medical model, a residency does make or break a provider in terms of specialties. Anyway you look at it, there is a steep learning curve following graduation for both professionals, the difference is, in the medical model, there is someone who is intensely looking over the shoulder of the medical graduate. The same can simply not be said about the nursing model in a number of settings.
Don't get me wrong, I also feel very strongly that a 3 year family practice residency is not nearly enough training to take care of the exceedingly broad needs of the patients in their panel. If one honestly feels that they know enough to competently practice psychiatry, pediatrics, OB/Gyn, dermatology, internal medicine (including its subspecialties, like endocrine, cards, etc) and some others after only 3 years of residency, then they are way smarter and more confident in their abilities than I am. And if one thinks they can do it after only 4 years of school (MD/DO or DNP), well, you get my point.

It is this very steep learning cutrve that physicians are helped through via residencies. unfortunately those with an economic agenda, instead of a patient agenda, block the inclusion of DNPs in residency programs (even though there are many empty slots) and cry "poor" when nursing seeks funding for NP residency programs.

forpath · Mar 30, 2009

It is this very steep learning cutrve that physicians are helped through via residencies. unfortunately those with an economic agenda, instead of a patient agenda, block the inclusion of DNPs in residency programs (even though there are many empty slots) and cry "poor" when nursing seeks funding for NP residency programs.

So are you insinuating that DNPs should be admitted into medical residency programs?

menetopali · Mar 30, 2009

i'm not insunuating as much as saying outright that DNPs (and frankly all new NPs) should be able to participate in federally funded and closely mentorred experiences after graduation and before flying solo so to speak.

forpath · Mar 30, 2009

i'm not insunuating as much as saying outright that DNPs (and frankly all new NPs) should be able to participate in federally funded and closely mentorred experiences after graduation and before flying solo so to speak.

For all the reasons I mentioned above, I completely agree with you. Unfortunately, it obviously has to be something the nursing community does on its own, including lobbying congress for additional funds for post-graduate training. There is simply no way a DNP could enter a medical residency.

prairienp · Mar 30, 2009

So are you insinuating that DNPs should be admitted into medical residency programs?

I would suggest they should be treated equally with funding. If our tax dollars are used to fund medcial residency, our tax dollars should also be used to fund NP education. Or neither should be funded. Can you imagine the outcry if residency was no longer funded? This was a primary aspect of health care reform in 1994, as you know, nothing has changed.

forpath · Mar 30, 2009

I would suggest they should be treated equally with funding. If our tax dollars are used to fund medcial residency, our tax dollars should also be used to fund NP education. Or neither should be funded. Can you imagine the outcry if residency was no longer funded? This was a primary aspect of health care reform in 1994, as you know, nothing has changed.

Sure, if you can get congress to pay for it. And obviously, from an absolute perspective, you do not need nearly as much money to fund DNP residencies as you do medical ones. I do not think ceasing the federal funding of medical residencies if DNPs can not get funding is a viable option, especially in this economic climate. You would not be able to fund the training of a significant number of medical trainees, and then, talk about a physician shortage!!