Doctoral degree to become an NP???

[VickyRN]

The American Association of Colleges of Nursing (AACN) is calling for the requirement of doctorate in nursing for advanced practice nurses, such as nurse practitioners, nurse midwives, clinical nurse specialists, and nurse anesthetists. This new degree will be called a Doctor of Nursing Practice and, if the AACN has its way, will become the entry level for advanced nursing practice.

AACN Position Statement on the Practice Doctorate in Nursing

[amzyRN]

Here's a concern I've had for a while- Let's say the DNP curriculum is updated to include much, much more in depth clinical coursework. While, I like the idea of this, I have a feeling that the medical community will say that the DNP is too much like MD/DO training, and that DNPs really are trying to take over. (this is hypothetical, and by no means my opinion).

However, IMHO, I do think that often independent practice is becoming confused with the DNP. I really wish the powers that be would keep these two separate issues.

Thoughts?

What does "independent practice" mean? Does it mean that NPs MUST collaborate with physicians? Don't NPs already have independence within their own scope of practice?

I don't think extra medical science classes could hurt though.

I see what you mean about the fear of NPs taking over and the fear of "equality" with physicians. Things have to change though.

j

[linearthinker, DNP, RN]

At my school, with permission, graduate nursing students are permitted to take didactic classes within the medical school. I am taking biochem next fall. I wish I had taken it earlier, but better late than never. That is the only course I have time for in my MAT plan unless I want to be at this six years. My MAT plan is 15 semesters with 9-11 hours a semester. I simply cannot do more than that at $1,185 a credit hour, lol. One has to graduate and earn an income at some point!

[NurseKJ]

What does "independent practice" mean? Does it mean that NPs MUST collaborate with physicians? Don't NPs already have independence within their own scope of practice?

I don't think extra medical science classes could hurt though.

I see what you mean about the fear of NPs taking over and the fear of "equality" with physicians. Things have to change though.

j

To me, when "independent practice" is mentioned on these boards, and in literature from nursing organizations, I think they are referring to an NP who is permitted to practice without ANY physician involvement/collaboration.

IMHO, it seems a mute point, because no healthcare provider (even physicians) are completely independent- ie, they need to refer to other specialties, or need chart reviews for one reason or another, or they answer to a medical board at their institution, ect. Which is very similar to what is expected of NPs as well.

I suppose, the independence movement is financially motivated in most cases; NPs want to be able to bill 100% of what physicians can bill... perhaps I am way off, but that's just my take on the current situation.

So, to take it back to the original thread topic, perhaps the DNP is an attempt at equal reimbursement? Just throwing out ideas here- I still haven't decided if the DNP is worth my while at the present time.

Thanks.

[amzyRN]

Why not DO? They are much more into the view of the "whole body" view. An old roommate of mine went to DO school because she also had similar views on treating the person, not the disease/symptoms.

I don't know enough about the DO say. But I mean more than just "whole body". I also think living beings are more than their physical bodies. Nursing encompasses that viewpoint. I'm not sure DO does.

I mean there's more "psychology" to nursing than regular medicine.

I like that about nursing and I also like nursing and how it includes being a patient advocate and teacher.

I also don't care about having a smaller scope of practice for diagnosing disease than physicians do also, because that's just a small part of what I want to do.

But because NPs do diagnose disease now, it would be great to know more about how that part works and more science classes would do that and give the degree more richness, in my opinion.

Are you considering med school?

[amzyRN]

To me, when "independent practice" is mentioned on these boards, and in literature from nursing organizations, I think they are referring to an NP who is permitted to practice without ANY physician involvement/collaboration.

IMHO, it seems a mute point, because no healthcare provider (even physicians) are completely independent- ie, they need to refer to other specialties, or need chart reviews for one reason or another, or they answer to a medical board at their institution, ect. Which is very similar to what is expected of NPs as well.

I suppose, the independence movement is financially motivated in most cases; NPs want to be able to bill 100% of what physicians can bill... perhaps I am way off, but that's just my take on the current situation.

So, to take it back to the original thread topic, perhaps the DNP is an attempt at equal reimbursement? Just throwing out ideas here- I still haven't decided if the DNP is worth my while at the present time.

Thanks.

Thanks for explaining that to me. I think the DNP may include equal reimbursement but I also think it's probably to enhance the field of nursing as a "discourse" (growing academic and clinical body of knowledge).

j

[linearthinker, DNP, RN]

To me, when "independent practice" is mentioned on these boards, and in literature from nursing organizations, I think they are referring to an NP who is permitted to practice without ANY physician involvement/collaboration.

IMHO, it seems a mute point, because no healthcare provider (even physicians) are completely independent- ie, they need to refer to other specialties, or need chart reviews for one reason or another, or they answer to a medical board at their institution, ect. Which is very similar to what is expected of NPs as well.

I suppose, the independence movement is financially motivated in most cases; NPs want to be able to bill 100% of what physicians can bill... perhaps I am way off, but that's just my take on the current situation.

So, to take it back to the original thread topic, perhaps the DNP is an attempt at equal reimbursement? Just throwing out ideas here- I still haven't decided if the DNP is worth my while at the present time.

Thanks.

ITA that that is exactly what is meant by independent practice, and ITA that it is largely about money. Since I am not interested in money (after meeting expenses, I don't really know what to do with it) I don't really have a dog in that fight. On a personal level, I don't care if I bill at 50%, 100% or 110% of physicians. On a professional level, I care quite a bit, but I leave that argument for another thread.

I do not believe the DNP is about equal billing at all, nor do I think the DNP is about independent practice. I think the DNP is about improving nursing education. Those other issues are ancillary to the debate about whether or not the DNP does improve nsg ed.

I respectfully disagree that independent practice is a moot point. I think independence, while not at all the point of earning a DNP, is a very big deal and one that needs a lot of careful scrutiny before it becomes reality. As I said upthread, I do believe it will be the reality of primary healthcare, but I believe it must be done purposefully and methodically, with great forethought, and much scholarly debate to ensure excellence in its execution. That is in everyone's best interest. I just think that this can be done, and should be done, without malice.

[amzyRN]

At my school, with permission, graduate nursing students are permitted to take didactic classes within the medical school. I am taking biochem next fall. I wish I had taken it earlier, but better late than never. That is the only course I have time for in my MAT plan unless I want to be at this six years. My MAT plan is 15 semesters with 9-11 hours a semester. I simply cannot do more than that at $1,185 a credit hour, lol. One has to graduate and earn an income at some point!

That's great!

j

[wowza]

here's a concern i've had for a while- let's say the dnp curriculum is updated to include much, much more in depth clinical coursework. while, i like the idea of this, i have a feeling that the medical community will say that the dnp is too much like md/do training, and that dnps really are trying to take over. (this is hypothetical, and by no means my opinion).

however, imho, i do think that often independent practice is becoming confused with the dnp. i really wish the powers that be would keep these two separate issues.

thoughts?

i think the issues get linked because the same people who created the degree were the biggest cheerleaders early on as well as the largest forces pushing for expanded practice rights. it is hard to deny that at least in part, the dnp was created for political motives, at the expense of students. so, unfortunately the two are intertwined.

i'd consider it. but there are things about medical school that i don't like. one is the philosophy of how people are viewed. physician's diagnose and treat disease. patients are reduced to symptoms of disease and this is encouraged in medicine. something is missed when that is done and i would not want to spend 4 intense years with that basic framework.

i don't think people can be broken down into symptoms or that the whole is just a sum of it's parts. there's too much rigidity in traditional medical school for me.

j

this philosophy is from the old guard and was phased out in the 1980s and 1990s. having gone through medical school i can tell you the patient centered approach is jammed down our throats, as is cultural literacy and a host of other things that are very obvious if you even have an ounce of social aptitude.

why not do? they are much more into the view of the "whole body" view. an old roommate of mine went to do school because she also had similar views on treating the person, not the disease/symptoms.

.

do is a good option, but the idea that they treat the "whole patient" and md's do not is somewhat of a myth, especially now. perhaps 30 years ago that would have very much been the case. on the bright side, the do option is a bit more forgiving in terms of grades and mcat scores and will allow you to "replace" a bad grade that has been retaken. they are also thought to be more open to older, non-traditional students.

i do not know what the md students and pas that visit this forum would say, but physicians i know personally are all for nps having more and better education. i am not personally acquainted with any physician who feels threatened by nps or dnps, but i suspect that is b/c i don't know very many young docs and only one student. the criticism i hear from them is just what the more plaintive voices here have been saying for 90+ pages: there should be more hard science, and more clinical hours, and some standardization across the board. other than that, i have never met a medical or nursing professional who didn't think that the dnp in general is a positive step for nursing and ultimately for patients.

i know quite a few physicians who are indeed wary of independent practice for nps b/c, let us be honest, we are all acquainted with a np or two that is not well suited to it for one reason or another. i don't know anyone who would generalize and say "no np should ever practice independently." i think they are all appropriately concerned about the details. how are these independent nps going to be educated, credentialed and assured to be competent on a continual basis? so far there are inconsistent and poorly defined answers to these reasonable questions in many states. some boards of nursing have not done a stellar job of policing our own, and this is worrisome. of course, other professional boards have also made errors of judgment along the same lines historically, but i don't think this point lessens the responsibility of the boards of nsg to adequately ensure public safety. there are going to be nps who are extremely well suited to it and who will provide excellent care. separating the wheat from the chaff is going to be difficult and controversial but i do think independent practice is going to be the new reality. i don't think anything is going to impede that at this point, but the transition will be contentious. i do not see any way around that. i suspect that in two generations the primary care physician will be a thing of the past.

we have passed a tipping point imo, and there is no going back. the dynamics of health care delivery in this country are changing dramatically and i think will continue to change until some equilibrium is achieved. physicians have traditionally led the health care team, and i think that too is going to change because while individually they have given their all to their patients, collectively their organizations have been more selfserving. like unions have sometimes been more about the leadership than the membership, so has the ama, to it's long term detriment. out in the professional world, i do not see the hostility toward nursing in general and nps that i see on the internet. i do understand the confusion and ire of medical students/residents and very young or new physicians. i appreciate that they work incredibly hard and make tremendous sacrafice. i'd be frustrated too, and nps are easy target. i think it is misplaced, and that they will find it so when they get out there and start collaborating with excellent nps in professional practice. in the meantime, i don't blame them for being disturbed by changes that are taking place very quickly, long after they have made plans, commitments and sacrifices based on the previous model. i just think if there is a body they should be frustrated with, it is their physician leaders who have sold them out to the insurance companies, big pharma and health care corporations.

i am all for expanded np education. nps will have independent practice rights nationally within the next few decades, might as well make sure there is solid, standardized education in place.

while i think the dnp could be a positive step for nps, currently i think it does nothing more than add more tuition and more hastle for students. if they are not going to add clinically vital coursework, i don't see why students have to spend the extra money or the extra year. however, if it does address these things, i don't see why the dnp wouldn't be a vital primary care provider.

in terms of physician leadership/organizations being self serving, i don't think anyone can argue with that. currently only 19% of physicians are part of the ama for good reason. the ama has completely lost sight of who they are representing and what they should stand for. i also don't think anyone could argue that the nurses organizations do the same thing (or any other major organization for that matter, unions etc). they are specifically there to push their interests.

i think many medical students, myself included are very frustrated that people think you can just shorten medical education and have an adequate provider. having gone through medical school, i can tell you there is so much information out there, you cannot adequately teach it in just a few years. the sheer volume of information you need to know as a pcp is the reason family practice has added a residency and then lengthened it.

[linearthinker, DNP, RN]

... but I also think it's probably to enhance the field of nursing as a "discourse" (growing academic and clinical body of knowledge).

j

Yes, that is exactly how my academic community views the degree.

[linearthinker, DNP, RN]

i am all for expanded np education. nps will have independent practice rights nationally within the next few decades, might as well make sure there is solid, standardized education in place.

while i think the dnp could be a positive step for nps, currently i think it does nothing more than add more tuition and more hastle for students. if they are not going to add clinically vital coursework, i don't see why students have to spend the extra money or the extra year. however, if it does address these things, i don't see why the dnp wouldn't be a vital primary care provider.

in terms of physician leadership/organizations being self serving, i don't think anyone can argue with that. currently only 19% of physicians are part of the ama for good reason. the ama has completely lost sight of who they are representing and what they should stand for. i also don't think anyone could argue that the nurses organizations do the same thing (or any other major organization for that matter, unions etc). they are specifically there to push their interests.

i think many medical students, myself included are very frustrated that people think you can just shorten medical education and have an adequate provider. having gone through medical school, i can tell you there is so much information out there, you cannot adequately teach it in just a few years. the sheer volume of information you need to know as a pcp is the reason family practice has added a residency and then lengthened it.

i agree with much of what you said. just as a point of interest, my dnp will add an additional 10 full time semesters to my msn, not an additional year. admittedly, this is by my own choice. i have a wide variety of interests!

i don't know that the ana has been as corrupted as the ama. not b/c they are superior human beings with pure motives, lol, but b/c until now, there has been little by way of financial opportunity to stray from the general interest. that will change as money becomes more central to the debate. i'm no pollyanna, i am realistic about that much.

i do think that 4 years of med school and 4 years of residency is probably overkill to practice within a wellness model. however, since so much of our american population no longer fits into a wellness model, perhaps not. *i* would like to see nursing integral to changing that sad fact, and it is what i plan to focus on in my research and practice.

[NurseKJ]

linearthinker,

May I ask about your DNP program- when you say an additional 10 semesters, full-time, do you mean on top of an MSN? BSN? ADN? I'm just curious why it is so long? (with all due respect, of course)

Thanks : )

[linearthinker, DNP, RN]

My MSN program is 5 semesters. The DNP will take me an additional 10 semesters because I am taking many courses that are not required. I have allotted 2 full years (6 semesters) for my capstone project b/c my research project is going to use live subjects. This obviously will require IRB approval, which I'm told may take a whole semester in itself. I am also doing a post masters certificate in Global Health in the school of public policy. I believe, if all goes smoothly and one does the minimum didactic work, it can be completed in 5-6 semesters after the MSN. I am not aware of any possible way to do a DNP within one year, but just b/c I don't know it doesn't mean it isn't possible. An acquaintance of mine is at Rush. He was told 8 quarters for the post master's DNP and it has evolved into 12 and counting. He thinks 6 quarters (18 months) to complete the capstone project is grossly unreasonable, given the rigorous expectations of his committee. Again, I think much depends on the school and that brings us back to the issue of standardization.