Doctor of Nursing Practice (DNP): My Personal Pro's and Con's - page 5

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... Read More

  1. Visit  Will352nd profile page
    2
    Quote from OneDNP
    I have a few comments on the original thread and some of the replies.



    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.
    Not quite right. PA's were one of the answers to primary care shortage in 60's. It had nothing to do with "the MD's answer to NP's". The PA model was never to indended to just be an "assistent" to the physician. The role was, and is, to extend healthcare while working with the supervision of a physician. Supervision is defined as "available for consult/advise"....not "under the thumb" as frequently suggested/implied on this site. Most States have done away with the archaic chart co-signature rules and the Physician doesn't have to be in the same building...just available. Sounds a lot like collaboration doesn't it? The "assistant" title has been the bane of the PA since it's onset...it is what it is.

    The first NP program (what we recognize as an NP today) was developed in 1965 at the University of Colorado. Dr. Eugene Stead tried to implement his PA model using nurses in 1964, but he was disillusioned by the by the push-back he was getting from the organized nursing organizations at the time. He went with military medics with his first PA class in 1965 instead. The value of nursing was recognized, but it was the decision of the NURSING organizations not to go with Steads model as opposed to Stead answering to the NP model tit for tat. Sources: Physician Assistant History Society and AANP - Historical Timeline

    NP's have it pretty good in regards to practice laws...and good on them. But it has little to do with being "better" or being more "competent", and everything to do with having a better lobby that is independent of the BOM. I know you didn't imply this and it is not an accusation, but it is "implied" quite a bit throughout the NP community.

    IMO, there will never be a merging of PA and NP. Most PA's were not nurses so it would make it difficult for them to practice "advanced nursing". NP's were not trained in the medical model and would have to build a stronger base in the core sciences to meet the curriculum of a PA program. Different approaches for the same goal...treat the patient.

    Just some thoughts from a guy who considered NP and PA and went with the PA model.
    RNJohnny23 and MandaRN94 like this.
  2. Visit  elkpark profile page
    3
    Quote from Will352nd
    But it has little to do with being "better" or being more "competent", and everything to do with having a better lobby that is independent of the BOM.
    I hear this quite a bit from people outside of nursing in a variety of contexts (not just related to NP practice), and I'm always amused. Where on earth did you get the idea that the "nursing lobby" is powerful or effective? If that were true, the entire face of US healthcare would be v. different from what it is now. Just as one example, TPTB in nursing have been pushing for close to 40 years to make the BSN the minimum eligibility for licensure, and they are no closer to getting that mandated than they were then. They've only convinced one state to try it, and that state rescinded the legislation several years later. The ANA has been advocating for some version of a single-payer system for healthcare in this country at least since the '90s, and they're no closer to getting that implemented than they are to flying to the moon. Any political/professional advances made by nursing happen not because of the power or know-how of the "nursing lobby," but because other, more powerful, stakeholders on a particular issue see it as a benefit for them and/or their constituents. And nursing is very rarely able to get anything passed/implemented/changed if the physician community isn't willing to go along with whatever it is.
    CCuser, MandaRN94, and SycamoreGuy like this.
  3. Visit  Will352nd profile page
    1
    Quote from elkpark
    I hear this quite a bit from people outside of nursing in a variety of contexts (not just related to NP practice), and I'm always amused. Where on earth did you get the idea that the "nursing lobby" is powerful or effective? If that were true, the entire face of US healthcare would be v. different from what it is now. Just as one example, TPTB in nursing have been pushing for close to 40 years to make the BSN the minimum eligibility for licensure, and they are no closer to getting that mandated than they were then. They've only convinced one state to try it, and that state rescinded the legislation several years later. The ANA has been advocating for some version of a single-payer system for healthcare in this country at least since the '90s, and they're no closer to getting that implemented than they are to flying to the moon. Any political/professional advances made by nursing happen not because of the power or know-how of the "nursing lobby," but because other, more powerful, stakeholders on a particular issue see it as a benefit for them and/or their constituents. And nursing is very rarely able to get anything passed/implemented/changed if the physician community isn't willing to go along with whatever it is.
    It's interesting to the hear that you don't think the AANP and the ANA as a whole, don't have clout. You described that change is difficult...yes, it is. You won't get it all and there will always be push-back from other organizations. But change happens....eventually.

    The AAPA is subset of the AMA that has little intrest in pushing the needs of the AAPA. The AANP has the backing and clout of the ANA, which is a beast. Power and numbers = money.

    The AANP has an organization within that is dedicated to State and Federal legislation...the AAPA can't even get their foot in the door. Again, it's power in numbers....money talks.

    AANP - Legislation/ Regulation Have a look, I cruised this for about 5 mins and saw more legislative initiatives being pushed now than the AAPA has been able to accomplish in ten years.

    Really, you guys should be proud of your organization. I'm sure it's not perfect, but there are tangables that you can see.
    NRSKarenRN likes this.
  4. Visit  elkpark profile page
    2
    Quote from Will352nd
    It's interesting to the hear that you don't think the AANP and the ANA as a whole, don't have clout. You described that change is difficult...yes, it is. You won't get it all and there will always be push-back from other organizations. But change happens....eventually.

    The AAPA is subset of the AMA that has little intrest in pushing the needs of the AAPA. The AANP has the backing and clout of the ANA, which is a beast. Power and numbers = money.

    The AANP has an organization within that is dedicated to State and Federal legislation...the AAPA can't even get their foot in the door. Again, it's power in numbers....money talks.

    AANP - Legislation/ Regulation Have a look, I cruised this for about 5 mins and saw more legislative initiatives being pushed now than the AAPA has been able to accomplish in ten years.

    Really, you guys should be proud of your organization. I'm sure it's not perfect, but there are tangables that you can see.
    Sure, all the national nursing organizations have divisions that are "pushing" state and federal initiatives -- but how many of those ever get passed?? I stick by my belief that, if the nursing "lobby" were as powerful as many non-nursing people seem to believe it is, the entire healthcare system in this country would look and function radically different than how it does now. I'm sorry you're unhappy with your own professional organization(s), but we (nurses) are not calling the shots or getting what we want. The very idea is laughable.
    CCuser and MandaRN94 like this.
  5. Visit  Will352nd profile page
    1
    I am comparing and contrasting the AANP and the AAPA....this isn't a pi@#ing contest.
    RNJohnny23 likes this.
  6. Visit  feeneishia profile page
    0
    This a very interesting article. I always thought that getting my BS in Business and MBA wouldn't help my furture nursing career at all, but this article made me think it might not be so bad to have after all. It gives me hope for the furture. I plan on becoming a Nurse Pracitioner. I just love having options!
  7. Visit  Jules A profile page
    1
    This is an old article so I'd be interested to see if the OPs opinion stands.

    The DNP would be very attractive to me if it was a selective admissions program with a focus on enhancing my skills and knowledge as a clinician which it does not. It appears the cow is out of the barn so very soon everyone and their Mother will feel entitled to be called "Dr." with minimal to no expectations that the person is actually a skilled clinician on any level. It makes me both sad and embarrassed to be a nurse although on the flip side the really amazing NPs are usually recognized as such in local circles.
    elkpark likes this.
  8. Visit  suetje profile page
    1
    I agree with Julie A. The "standards" to raise nursing practice are all great, but what really IS the value of a DNP? It should reflect skills with clinical practice yet I hear the students I work with tell me, 'The nurses that teach us with Doctorates are clueless. I'd rather have an MSN be my clinical educator because they often have been at the bedside." Just because you have a doctorate does not make youa clinical expert. And yes, I also think NPs and PAs are an asset to all of us. I thought about getting my PA because I was more interested in the hands on type thing. But there is a fine line between NP's and PAs and in our Academic institution they do the same thing.
    Jules A likes this.
  9. Visit  PsychGuy profile page
    1
    Before I go further, let me qualify that I'll receive my MSN on 5/16/15. I chose Psych advanced practice a career and not "nursing" as a career so I don't have anything directly invested in nursing. Nursing was merely the path to do the job of a psychiatric evaluator, prescriber, etc. Does that make sense?

    I am of the opinion that for an APRN to move into healthcare management the most obvious route is that of a graduate certificate in healthcare administration focusing on such content as healthcare finance and economics, personnel management, and healthcare policy as those things are deficient in MSN programs for APRNs. However, the MSN is sufficient (sometimes too much) in breadth to need more training in research, public health, nursing theory, etc. Frankly, I feel like MSN administration degrees are meritless. If I were going to spend 42 semester credits on a master's degree in an area of healthcare administration I would rather pursue an MHSA or MBA of any focus.

    With respect to the PhD, I must attest that I have of recent months been mulling over the idea of a PhD. It would not do anything whatsoever for me clinically, but it would certainly add to my knowledge base and give me the clear opportunity to pursue academia. My personal interests for a PhD lend towards experimental psychology, and must of the research I've done for my last year of a three year MSN has not been drawn from any nursing research. Put bluntly, I am not interested in studying or furthering the theories of nursing. However, I fully understand that a PhD in nursing has merits, and if I were not constrained by nursing-heavy research and theory I would likely pursue a much shorter nursing PhD.

    The DNP is another option I've given cursory regard. However, it is merely 33 semester credits, and they are geared towards application and translation of research into practice. Clearly, this isn't worthwhile for me referring to the previous paragraph. The remainder of the courses are business-esque while the PhD at the same state university includes one "healthcare as a business" type of course. I'm not presently ready or interested in healthcare administration. I don't believe in many of the current policies nor am I in favor of satisfaction-driven reimbursement thus I will not administer a program based on those demands.

    I think a knowledge gap is still in place. I would prefer a master's program for NPs more aligned with PA programs yet maintaining the inclusion of a specialty focus. For the soon to be master's grad or the NP already in practice it would be foolhardy to enter such a fictitious master's program. That leads me back to existing norms, and I feel that a "midlevel" or physician extender does not need to match degrees with a physician. If that be the case, why even have mids or extenders in practice? In summary, if you want research go for a PhD, if you want admin, get a cert or another master's. I think the DNP is, unfortunately, a folly.
    Jules A likes this.
  10. Visit  juan de la cruz profile page
    1
    Glad to see the discussion still going...

    I didn't make the plunge to the DNP and have no plans to do it in the near future. I work in an environment where there aren't a lot of NP's with DNP's. That is partly because we are part of an institution that even in this year 2015, had not started to offer a DNP program. Not sure what the reasoning behind that is...elitism, funding, the fact that the Master's programs are flourishing with many applicants, it's probably all of those.

    I am not sure what an ideal DNP program would be in my case...I am a clinician foremost and I already learn everyday that I work by watching bench to bedside concepts come into action in my practice and updating myself of current evidence in day to day patient care decisions. If anything, I would pursue a doctoral degree to advance into leadership roles but I am afraid that would take me away from the bedside as a provider and that is not in line with my career goals.

    Down the line, I could see myself in academia and research and the PhD is the path for that but I am friends with a few who are in that field and the more I talk to them, the more unappealing it sounds.
    Jules A likes this.
  11. Visit  sauce profile page
    1
    I am on par with juan. it does not seem to add much worth to ourselves to get a dnp. I love school and love to learn but i believe i can add more to my practice just by reading books written by MDs and focusing on studying uptodate.

    Seems to just be another money sucking degree bloating scheme.
    PsychGuy likes this.
  12. Visit  DNP_FNP profile page
    2
    It is difficult to see the value in anything if you have not experienced it. In the same respect, it is difficult to see the value in the Doctor of Nursing Practice degree if you do not have it. I juxtapose this degree with the BSN degree. It is equally difficult for ADNs to see the value in the BSN degree from and ADN perspective. When the BSN came forth, everyone felt that it was idiotic and now it is commonplace. In my opinion, the DNP is similar. The DNP is definitely NOT a Ph.D. since the focus is on translation of existing evidence to improve patient outcomes and NOT generating new knowledge from scratch. The DNP degree, however, is a relatively novel one so it hard to predict the future benefits. How long did it take for researchers to determine that BSNs provide higher quality nursing care through enhanced critical thinking analysis and judgment?
    Does the DNP change your state scope of practice? Not really. Will it make you a better clinician? Possibly-depends on individual attributes of clinicians. Do those interviewing a new or old NP for a position care about the fact that you have a DNP? Not yet. I say, not yet, because research on DNP outcomes is yet to be obtained and disseminated.
    For those of you who doubt that the DNP will enhance your professional career for the cost of obtaining it, I can completely understand. At this point in time, the decision to get your DNP is a personal choice and empirical evidence to support the notion that DNPs provide better care is lacking. One of the greatest benefits that I can see from demanding that all schools conform to DNP model as the new standard for NPs is reduction of the number of NP graduates annually. This could go two ways. 1) The new standards truly produce the best and brightest while culling others...while reducing flooding of the NP market or 2) Institutions of higher education simply "water down" DNP curriculum so they can continue to make money off the massive NP market. The jury is still out.
    If I had to make my decision to do a BSN-DNP program versus a BSN-MSN program, I would still choose the BSN-DNP program. The future is uncertain. I didn't want to be 60 years old and unemployed because I chose the quick route (not to say that will happen).
    db2xs and Jules A like this.
  13. Visit  PsychGuy profile page
    1
    It makes no sense whatsoever to have a degree geared toward the translation of research into practice. I think it's stupid. We know that most nurses are merely task masters that do a variety of tasks throughout their day and go home with limited opportunity afforded to think. They rely, whether realizing it or not, on managers and policy makers to adopt new practice trends, and it makes no sense, coming from perspectives of time and money, for any type of clinical nurse to hold a doctorate in research translation. There's not going to be money for it, and any amount of degrees aren't going to change unit practices. For APRNs, the same applies. Read books. Read journals. Reference databases. Apply what you learn. A degree in research translation really doesn't broaden one's education. I have now taken three courses in research methodology and utilization and feel I can scrutinize any number of research articles to determine efficacy for my practice. A doctorate in nurse practice to me suggests one will receive advanced study in nursing practice. How is research translation direct nursing practice? I personally feel that APRNs could be better clinically prepared with most study of the -ologies and subspecialties. For example, I would LOVE to have taken specific coursework in medical biochemistry, neurobiology, neurology, etc, but instead I took a few research classes, nurse theory, advanced community concepts (whatever that was?!), and a myriad of other crap that doesn't help my practice. To be a psychiatric provider I don't need a doctorate in research translation, but I do need training in all the many areas that ultimately comprise my field.

    Any number of the following would have been much more welcomed:


    Neuroscience
    Neurobiology
    Neuroanatomy
    Neurology

    Personality Theory
    Psychoanalysis
    Interpersonal Psychotherapy
    Cognitive Behavioral Therapy
    Social Psychology electives even
    Psychometric interpretation

    Medical biochemistry
    Physiology
    Pathophysiology
    Pathology
    Pharmacology
    Psychopharmacology

    As it is, I had a course in "advanced physiology and pathophysiology" that was really a junk course (a topic of another discussion), clinical pharmacology (which was the best class I had), and psychopharmacology (which was the second best class I had).
    zumbadoctor likes this.

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