Doctor of Nursing Practice (DNP): My Personal Proís and Conís - page 5

by juan de la cruz Guide

31,270 Views | 56 Comments

The Doctor of Nursing Practice or DNP degree has been one of the biggest buzzwords in Advanced Practice Nursing. The mere mention of it creates a stir of emotions and strong opposing opinions perhaps of the same magnitude as the... Read More


  1. 3
    I support DNP movement. In short, I think DNP should be a requirement BUT the curriculum should be revised to include more clinical content
  2. 0
    @traumaRus- yes I am called an educator. Fine. The 'pseudo CNS' means I do that job as well as educator because we have no CNS and it dovetals into the whole mentor educator role. I suggesated to the Director I could be called something other than CNS, su7ch as you suggest, but she also can'yt think out of the box.
  3. 0
    Hey juan de la cruz, I noticed in another thread you had mentioned that UCSF was going to have another meeting about the DNP. Did you attend it? I'm wondering how that meeting went and if they're moving in the direction of starting a DNP program...
  4. 0
    I didn't go to the meeting as I was working. I don't know anyone who did but I can ask for the meeting minutes.
  5. 0
    I have a few comments on the original thread and some of the replies.

    Everyone does understand that the "should I get a DNP" question only pertains to those who are already NPs in clinical practice or NP students, right? In the next few years, this question will be moot because the MSN-NP degree is being phased out. Just as with the Bachelors of Medicine in the late 1800s to as recently as the Master's of Pharmacy in the 1990s, the profession is simply replacing one degree for another that contains a few more requirements. The DNP is also an attempt to streamline the current hodge-podge of clinical nursing doctorate titles. In most cases, this means instead of taking 2 years to get an MSN that allows you to sit for whatever board exam you are studying for, it will take 3 years plus a few hundred clinical hours and a capstone project instead. Is it degree creep? Yes. But it is a trend most other health professions have been changing over to in the past few decades and nursing, as usual, is just one of the last to join the party.

    Judging by PTs, pharmacists, and psychologists I know who were grandfathered in prior to their professions making a doctorate the minimum entry to practice, it is unlikely the DNP will make a difference to reimbursement or opportunity over the next decade or so, if ever. I have APRN and CNS friends who have been practicing for a number of years with no good reason to get the DNP unless they want to double-board in another specialty. I was FNP certified and used the DNP to get my PMH certification from a school with the second oldest DNP programs in the country and one of the first to offer the soon-to-be standard BSN-DNP programs. Yes, there are poorly organized, money-grubbing programs that have been slapped together to meet the 2015 deadline, but I can name at least 3-ADN "franchise" schools that are not fully accredited yet churn out LPNs and RNs at a high profit with marginal education. You have to do your research and talk to current students and graduates of the program you are looking at, no matter what the discipline. But more importantly, you have to know what you want out of your career and lifestyle as a whole. There are a lot of things you can do with an RN besides become an APRN, and many of them are more lucrative with a lot less risk - this is why a couple of years of practice is invaluable before jumping into more school.

    If you want to be a clinical practitioner, possibly teach clinical at the undergraduate level or precept at the graduate level, and think you might be interested in conducting small-scale EBP research and evaluative projects you can be directly involved with, the DNP in your area of specialty is where you should look. This is why the DNP is considered the terminal CLINICAL PRACTICE degree for nursing. If your goal is providing education at the university level or conducting larger grant-funded research projects with a lot of publications, why the heck would you want to be an advanced practice provider in the first place? Of course, interests change as life goes on, but if you already know at the RN-level that you want to be the next great theorist, basic RN practice should provide all the clinical necessary for real-world experience before moving onto the PhD or EdD. If you want to focus on nursing management and administration, well, get a law degree.

    I say that only slightly in jest.

    On the matter of MD training hours: Medical school applicants are not required to have a single hour of clinical practice before entering their program and generally do not touch a living patient until their second year of schooling when they are around age 24. The person with a BSN degree of the same age who applies to an NP program would have already had 4000 hours (assuming a 36-40 hour work week) of independent, basic nursing practice in addition to the undergraduate clinical training with patients that they started around age 19. True, the RN-level practice is not as independent as those providers with advanced degrees, but the core skills of assessment, organization, interpersonal dynamics, experiential knowledge base, and holistic care management are developed and refined. This "basic practice" is the foundation for advanced practice, and to ignore these hours when comparing training programs is neglectful and manipulative from those who try to belittle our profession. I would further argue, and the satisfaction and outcome research bears this out, that when it comes to primary care, the cost of medical training and drain on medicare to fund primary care residencies is neither cost-effective or efficient. The problem is not that NPs have fewer hours of training than MDs, the problem is perpetuating the belief that one actually needs 10000 hours of school to deliver quality primary care. This is an oversimplification, but I liken it to taking beginning Spanish over and over when you are already fluent in 2 dialects. How much education do you really need to deliver quality primary care? There is a capstone project for you!

    On PA doctorates and such: It is my understanding that the PAs were created as the MDs' answer to NPs, though certainly the role has changed over time. I think PAs have a huge semantic hurdle to overcome given that it contains "physician" and "assistant" in the title. I suppose the discussed replacement of "physician associate" is a little better, but that still sounds far more handmaiden-like than nurse practitioner. Then again, when I tell people I am a nurse practitioner, I still get some folks asking me if I plan to get my RN. I have enough trouble in my own profession without taking on their concerns, but one thing I will speak out on is the occasionally proposed (by MDs, usually) merging of PAs and NPs into a single MLP or physician-extender title. No thanks.

    On the DNP experience: I graduated in May and kept a blog of my journey to the "Dr. Nurse." One of the running jokes I heard when I talked about pursuing a doctorate in nursing was the old "there can't be that may ways to change a bandage," however I was enriched in ways I did not expect and it translates to how I care for patients.
    Last edit by traumaRUs on Sep 20, '12 : Reason: deleted personal blog link -- terms of service
  6. 0
    Quote from OneDNP
    Everyone does understand that the "should I get a DNP" question only pertains to those who are already NPs in clinical practice or NP students, right? In the next few years, this question will be moot because the MSN-NP degree is being phased out. Just as with the Bachelors of Medicine in the late 1800s to as recently as the Master's of Pharmacy in the 1990s, the profession is simply replacing one degree for another that contains a few more requirements. The DNP is also an attempt to streamline the current hodge-podge of clinical nursing doctorate titles. In most cases, this means instead of taking 2 years to get an MSN that allows you to sit for whatever board exam you are studying for, it will take 3 years plus a few hundred clinical hours and a capstone project instead. Is it degree creep? Yes. But it is a trend most other health professions have been changing over to in the past few decades and nursing, as usual, is just one of the last to join the party.
    The DNP does not only pertain to those who are already NP's and NP students. There are DNP programs offered to those with a nursing administration or nursing education focus not to mention the fact that other APN groups have DNP programs too (CRNA, CNS, CNM). The MSN is not being phased out. Many schools are adopting a BSN to DNP format but that decision is voluntary on the school's part. There is no mandatory requirement to transition to all DNP by 2015. For that to happen, four things must be in place: 1. all schools have to offer a DNP, 2. NCSBN participating boards of nursing must require a DNP, 3. national certification boards (ANCC, AANP, AACN, PNCB, NCC) must require a DNP, and 4. CMS must require a DNP to obtain an NPI number. AACN and NONPF are recommending the 2015 deadline, both these entities have nothing to do with NP regulation.

    Quote from OneDNP
    If you want to be a clinical practitioner, possibly teach clinical at the undergraduate level or precept at the graduate level, and think you might be interested in conducting small-scale EBP research and evaluative projects you can be directly involved with, the DNP in your area of specialty is where you should look. This is why the DNP is considered the terminal CLINICAL PRACTICE degree for nursing. If your goal is providing education at the university level or conducting larger grant-funded research projects with a lot of publications, why the heck would you want to be an advanced practice provider in the first place? Of course, interests change as life goes on, but if you already know at the RN-level that you want to be the next great theorist, basic RN practice should provide all the clinical necessary for real-world experience before moving onto the PhD or EdD. If you want to focus on nursing management and administration, well, get a law degree.
    The issue I raised with academia is the fact that some schools do not grant tenure to DNP trained faculty. Sure, if all you want is to teach undergrad and NP labs in a university setting and go contract to contract each academic year that's good for you. I prefer the same level of respect as other Associate/Assistant/Full Professor with PhD's. If that's not going to happen I am not sure I want this degree. NP preceptors are volunteer faculty - they receive no salary from the schools. Why would you need a law degree for nursing management and administration?

    Quote from OneDNP
    On the matter of MD training hours: Medical school applicants are not required to have a single hour of clinical practice before entering their program and generally do not touch a living patient until their second year of schooling when they are around age 24. The person with a BSN degree of the same age who applies to an NP program would have already had 4000 hours (assuming a 36-40 hour work week) of independent, basic nursing practice in addition to the undergraduate clinical training with patients that they started around age 19. True, the RN-level practice is not as independent as those providers with advanced degrees, but the core skills of assessment, organization, interpersonal dynamics, experiential knowledge base, and holistic care management are developed and refined. This "basic practice" is the foundation for advanced practice, and to ignore these hours when comparing training programs is neglectful and manipulative from those who try to belittle our profession. I would further argue, and the satisfaction and outcome research bears this out, that when it comes to primary care, the cost of medical training and drain on medicare to fund primary care residencies is neither cost-effective or efficient. The problem is not that NPs have fewer hours of training than MDs, the problem is perpetuating the belief that one actually needs 10000 hours of school to deliver quality primary care. This is an oversimplification, but I liken it to taking beginning Spanish over and over when you are already fluent in 2 dialects. How much education do you really need to deliver quality primary care? There is a capstone project for you!
    I am not going to touch those statements.

    Quote from OneDNP
    On PA doctorates and such: It is my understanding that the PAs were created as the MDs' answer to NPs, though certainly the role has changed over time. I think PAs have a huge semantic hurdle to overcome given that it contains "physician" and "assistant" in the title. I suppose the discussed replacement of "physician associate" is a little better, but that still sounds far more handmaiden-like than nurse practitioner. Then again, when I tell people I am a nurse practitioner, I still get some folks asking me if I plan to get my RN. I have enough trouble in my own profession without taking on their concerns, but one thing I will speak out on is the occasionally proposed (by MDs, usually) merging of PAs and NPs into a single MLP or physician-extender title. No thanks.
    Never heard of a proposal to merge the NP and PA professions and again I'm not going to touch those other statements too
  7. 1
    NPs and PAs will never merge. Unless the PAs want to become nurses, lol. BON and BOM are two entirely separate entities, and honestly, the fact that NPs are overseen by the BON (and not the BOM) is what confers them a huge advantage.
    Conqueror+ likes this.
  8. 0
    "I prefer the same level of respect as other Associate/Assistant/Full Professor with PhD's. If that's not going to happen I am not sure I want this degree."

    That really depends on the school, I know of a state school that has a DNP (without a PhD) as the program director of graduate nursing.
  9. 0
    Quote from SycamoreStudent
    "I prefer the same level of respect as other Associate/Assistant/Full Professor with PhD's. If that's not going to happen I am not sure I want this degree."

    That really depends on the school, I know of a state school that has a DNP (without a PhD) as the program director of graduate nursing.
    Being program director does not guarantee tenure...the schools I've looked at (and are interested in teaching at if I ever do it), have two separate faculty rankings: clinical track and research, only research faculty gets tenure.

    I know that's how academia work. I am an NP in a medical center where our attendings are Professors in the School of Medicine. About half of their activities involve research/publishing and the other half is clinical practice. They all have MD degrees, not all have MD, PhD.
  10. 0
    Quote from juan de la cruz

    I am not going to touch those statements.
    good for you, I admire your restraint.


    No one wants to merge PA's and NP's. Maybe streamline how they both operate, and bring their scope up to full in areas where one is noticeably more free to practice fully, but its not exactly possible to make them the same thing.


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