Doctoral degree to become an NP???

Editorial Team / Admin · Jun 2, 2006

Hello, pixieree,

If you read the vision statement, you will find this is one of the things the PTB are making sure doesn't happen ~ that present NPs don't lose their credibility.

To answer your question, no, presently existing NPs will not have to "upgrade" their credentials in order to continue practice. It will be the same principle as relates to those who practice now with less than an MSN ~ those who became NPs via preceptorships and receiving certifications. The latter still practice as NPs without MSN preparation.

Editorial Team / Admin · Jun 2, 2006

in 2004, the american association of colleges of nursing (aacn) endorsed the position statement on the practice doctorate in nursing which was brought forward by the task force on the practice doctorate.

here are links for the position statement, faqs and current list of dnp programs:

american association of colleges of nursing position statement on the practice doctorate in nursing ~ october 2004

american association of colleges of nursing ~ frequently asked questions ~ position statement on the practice doctorate in nursing

list of doctor of nursing practice (dnp) programs

FNP/DNP · Jun 8, 2006

Has anyone else heard the following?:
Columbia School of Nursing will introduce a four-year "doctor of nursing practice" doctoral program that teaches much broader skills, such as evaluating clinical studies and setting up independent practices. As they gain these new skills, nurse practitioners are branching out beyond primary care to fill a growing need for personnel in many areas of medicine, including specialties such as long-term care providers for the elderly.
I think this is an absurd idea for nurse practitioners. A 4 year doctoral degree to become a nurse practitioner? This will actually be a REQUIREMENT to become an NP by the year 2015 if certain nursing interest groups get their way. WHY is there such a big push for this if nurse practitioners really aren't planning on competing with physicians like the special interest groups claim? The degree will teach NP's how to set up INDEPENDENT PRACTICES...how is this not competing with physicians? NP's having a doctoral degree may want to be referred to as "Doctor"...how is this not competing with physicians? I think this requirement may very well hurt the profession as a whole by doing the following: Decreasing the number of NP applicants, creating friction between physicians and NP's due to title use and physicians viewing NP's as competition, and create more role confusion for the public regarding nursing and the concept of the nurse practitioner.
Let's look at this idea folks. One goes to school for his or her BSN (Typically 4 to 5 years). Then one goes to school 4 more years for the Doctorate of Nursing Practice Degree. That's 8 to 9 years. Then he or she gets a position starting at $60,000 - $70,000 a year, if he or she is lucky (I have met NP's starting out as new gaduates making $54,000/year). No residency will be required like traditional medical school, but you can bet the universities offering such a program will charge you quite a pretty penny for the doctoral degree. (Just look at schools offering the PharmD, the DPT, the Aud.D, etc. These programs ARE EXPENSIVE, costly, and time consuming.) Then, to make things more fun, NP's will have to go against the grain of the medical profession (the AMA, including specialty groups of MD's and DO's) to fight for priveleges to practice independently in states unaccepting of the NP as an independent provider. Then there will be fights about getting empaneled by insurance companies for direct reimbursement for services provided. This will not be a smooth transition...this will be a war! The AMA is a powerful entity, both politically and socially.
Now don't get me wrong. I WANT to become an NP. But I want to get mine in 30 months as opposed to 4 years. I DO NOT want to be a doctor. I do NOT want to be called "doctor". I especially do not want to be a "doctor nurse". If I wanted to spend all that time in school, like the new degree proposes, I would GO to medical school. This way I would get a well respected MEDICAL DEGREE in the same amount of time, complete my residency, and then start out making $130,000/year (on average) instead of $60 - 70,000 a year. Oh, and I wouldn't have to worry about "physician collaboration", independent practice restrictions, being reimbursed by insurance companies, prescriptive privileges, or public confusion about my role in the healthcare system. And don't fool yourselves, many other intelligent people will see things my way too, which will lead to LESS NP's, which is a BAD thing for the profession.
Nursing isn't ready for this idea right now. There are too many other issues nursing needs to worry about first. What do you think about this issue?

I have to disagree with you. I have my DNP and have been a practicing FNP for 6 years. The full time NP's where I work make 100,000 per year. I am quite certain that my doctorate has advanced me professionally in terms of salary and aquiring NP positions. The DNP is not intended for NP's to have independent practice. That is a state legislated issue. The DNP is to recognize that Master's level programs are inadequate to prepare one to practice at a novice level once graduating from the NP program. I felt very confident when I graduated that I was competent and ready for a busy practice. The clinical doctorate brings credibility to our profession, and don't kid yourself into thinking it isn't necessary. It isn't easy being a nurse practitioner, it is a constant fight and the more credentials we have and the more competent we are, the more we will be respected by our physician colleagues.

FNP/DNP · Jun 8, 2006

when i read the vision paper i was supportive of this new change.
look at many of the doctorial programs now are 6-8 years (you can still get into med school with 2 years college same with optometry, chiropractic, pharmacy... not common but possible) looking at current nurse education 4 years for a bsn and many np programs are 3 years in length and many are in excess of the 36 credit hour minimum for a masters. if they increase the clinical portion to one year rather than 500 hours (fte equivalent of 3 months) i feel np graduates will be better prepared to function in a team environment. i finished two np programs and both were lacking in clinical exposure for my employers expectations of me. so you spend an extra 6-12 months in clinical time to develop skills not that bad of a change in education.
the fact they also are thinking about residencies for that clinical year is an exciting idea for me. pharmacy, optometry, physical therapy, md/do all have residencies i have only been able to find 6 residencies/fellowships for nps with an internet search.
even with a dnp we will still be nurses. we approach patient in a different manner than md/do with overlap in skills and functions. i am not a replacement for a physician instead i offer services that compliment other health care providers to provide patient care. i believe nps should be independent providers legally but no provider practices alone in the current health care environment. rather we should be held accountable for our actions and stop functioning as an extension of a physician.
just my opinion....
jeremy

jeremy,

i agree 100% with everything you say here. as a student it is probably disillusioning to envision 4 years of graduate school to become a nurse practitioner. once you are practicing you only wish you had learned more. i would have loved to have had a longer residency. as an aside, i work in the emergency department and the nurse practitioners always exceed the md's in patient satisfaction on press ganey scores. do the physicians like it- no. interestingly, one of them asked to shadow the np's sometime to see what we do that makes patients so satisfied!

thanks for your comments. it is nice to see some support for the dnp.

markdanurse · Jun 8, 2006

I have to disagree with you. I have my DNP and have been a practicing FNP for 6 years. The full time NP's where I work make 100,000 per year. I am quite certain that my doctorate has advanced me professionally in terms of salary and aquiring NP positions. The DNP is not intended for NP's to have independent practice. That is a state legislated issue. The DNP is to recognize that Master's level programs are inadequate to prepare one to practice at a novice level once graduating from the NP program. I felt very confident when I graduated that I was competent and ready for a busy practice. The clinical doctorate brings credibility to our profession, and don't kid yourself into thinking it isn't necessary. It isn't easy being a nurse practitioner, it is a constant fight and the more credentials we have and the more competent we are, the more we will be respected by our physician colleagues.

Finally, someone who thinks a doctorate degree in nursing is a necessity. Masters' level programs are inadequate? Really? Then why are there so many NP's with masters degrees that are doing just fine in the clinical arena? You need a doctorate degree to properly prepare an NP? I have a better idea...take out all of the advanced nursing theory fluff from the NP programs, and put in its place more clinical hours at the master's degree level. Yes, you and I both know nursing leadership is trying to create another breed of healthcare provider that is INDEPENDENT...first MD, then DO, now NP. And the best way to do that is to make the NP a doctoral degree. Then comes the almighty one-liner: "...the more credentials we have and the more competent we are, the more we will be respected by our physician colleagues." Here is another misnomer...if we have a doctorate degree being a nurse, maybe the physicians will finally respect us." Nope. Not as long as you have the word "nurse" in your title. I have spoken to many ER physicians I currently work with, and many of them laugh at the thought "Doctor Nurse". Many have asked, "Why bother?" Most have asked, "Why not just go to medical school?" Seriously, you got your BSN, then a 4 year doctoral degree to be an NP...why not just go to medical school? It's like saying having a PharmD is necessary to be a Pharmacist, or a DPT to be a Physical Therapist, or an Aud.D. to be an audiologist. Does it really take a doctoral degree to dispense medications all day? Or to exercise a patient and formulate a care plan? Or to test a person's hearing and fit him or her for hearing aids? Answer: No. Please...all of these professions have managed to get caught up in the degree-hype game. Apparently, so have you. Doctors do not look at DrNP's, DPT's, and PharmD's as their peers and you know that. More education IS better...more money for universities, more money for college professors, more money for student loan companies. On the academic level, we have confused MORE with BETTER. Just look at the 100 richest people in America...over a third of them are college dropouts. HMMM...how could this happen? They don't have MBA's? Thus, they can't possibly be good in business, can they? NP's were created to assist physicians, not compete with them. Let's keep it that way. If you want to be so independent, try being a physician, NOT an NP.

platon20 · Jun 9, 2006

I agree with markdanurse.

Look guys the bottom line is there is a whole helluva lot of degree inflation going on here.

It started with doctors. They decided that they wanted to elevate their degree to doctoral level so they could look good to the public.

Next up? Pharmacists. Just like doctors, pharmacists decided that they would look more "important" in the eyes of the public if they ramped up to a doctoral degree program. It wasnt always that way, and there's very little evidence to show that doctoral educated pharmacists are better than bachelors.

Then we have the physical therapists. Just like doctors, just like pharmacists, PTs also decieed that they too wanted the doctoral degree so they could call themselves "doctor" and look good to the public.

As if on cue, the optometrists decided that they too wanted a doctoral degree.

Now, nurses all of a sudden want to do the same thing. Get real. There is very little substance and a lot of hype to this plan. This is nothing more than a superficial "feelgood" measure thats totally unnecessary.

Everybody and their brother now wants the "doctoral" degree program. It has NOTHING to do with clinical outcomes and EVERYTHING to do with wanting to elevate your status in society.

Stop the insanity already. Next thing you know, doctors will add a new degree program called the "super duper doctoral degree" thats 20 years long. Next thing you know, pharmacists, physical therapists, optometrists will want to do the same thing. This is all a bunch of crap based on insecurity and nothing more.

Editorial Team / Admin · Jun 9, 2006

It has NOTHING to do with clinical outcomes

Illogical statement and grossly inaccurate as well.

platon20 · Jun 9, 2006

Illogical statement and grossly inaccurate as well.

Sorry you are wrong. There is no evidence that longer training leads to better clinical outcomes.

Take for example CRNAs vs MDAs and NPs vs MDs

IN both cases, the nurses have substantially less training than the doctors, yet studies have proven over and over again that clinical outcomes are IDENTICAL.

This is a publicity move, pure and simple. NPs are ALREADY JUST AS GOOD AS DOCTORS. Adding more training time wont result in any changes to outcomes.

Editorial Team / Admin · Jun 9, 2006

platon20, you are definitely allowed your opinion.

SharonH, RN · Jun 9, 2006

I agree with markdanurse.
Look guys the bottom line is there is a whole helluva lot of degree inflation going on here.
It started with doctors. They decided that they wanted to elevate their degree to doctoral level so they could look good to the public.
Next up? Pharmacists. Just like doctors, pharmacists decided that they would look more "important" in the eyes of the public if they ramped up to a doctoral degree program. It wasnt always that way, and there's very little evidence to show that doctoral educated pharmacists are better than bachelors.
Then we have the physical therapists. Just like doctors, just like pharmacists, PTs also decieed that they too wanted the doctoral degree so they could call themselves "doctor" and look good to the public.
As if on cue, the optometrists decided that they too wanted a doctoral degree.
Now, nurses all of a sudden want to do the same thing. Get real. There is very little substance and a lot of hype to this plan. This is nothing more than a superficial "feelgood" measure thats totally unnecessary.
Everybody and their brother now wants the "doctoral" degree program. It has NOTHING to do with clinical outcomes and EVERYTHING to do with wanting to elevate your status in society.
Stop the insanity already. Next thing you know, doctors will add a new degree program called the "super duper doctoral degree" thats 20 years long. Next thing you know, pharmacists, physical therapists, optometrists will want to do the same thing. This is all a bunch of crap based on insecurity and nothing more.

Is it possible that over the years, as healthcare has advanced both technologically and in body of knowledge that more education is needed to be proficient in this field? I certainly think so and that is a valid reason to offer advanced degrees.

markdanurse · Jun 10, 2006

Is it possible that over the years, as healthcare has advanced both technologically and in body of knowledge that more education is needed to be proficient in this field? I certainly think so and that is a valid reason to offer advanced degrees.

Okay Sharon, I'll bite here. Yes, IF NP's were able to do absolutely EVERYTHING that their MD counterparts can do, and this includes major surgeries, admitting patients to hospitals and overseeing the ENTIRE care process, and FULL prescriptive abilities in EVERY state in the U.S. without physician collaboration, then YES, the doctoral degree in nursing practice might prove useful. But as it is, the NP role was not created to replace physicians, right? NP's do handle complex cases...on occasion. But you and I both know that the truly complex cases go to the physician. Is the DrNP going to change that role? Will the DrNP give NP's the right to do everything that MD's do? My bet is that YES, one day this may happen, because that is what the nursing leaders who have proposed the DrNP want. These leaders deny this, but we both know this is the case. But as is the case right now, NP's do not have unlimited scope of practice. The AMA will also make sure of this fact too, regardless of the NP being doctorally prepared.

Do you truly believe healthcare has developed so technologically and its body of knowledge has become so advanced that to simply put an exercise regimen together for a post-op patient, and to show the patient how to perform the exercises requires a doctorally prepared P.T.? Do you really believe it takes a doctorally prepared audiologist to test a person's hearing and fit him or her for an appropriate hearing aid? Do you believe it takes a doctoral degree to dispense medications or even perform a drug review on a patient? Does it really take a doctoral degree to test a patient's vision and prescribe contact lenses and eyeglasses? Look at education versus scope of practice. These professions have a VERY limited scope of practice, unlike the physician. The physician requires a doctoral degree because he or she encounters an onslaught of medical problems. Physicians really MUST know pharmacology, advanced pathophysiology, minor and major surgical interventions, advanced anatomy and physiology, and so much more. THEY order the medications, the hearing exams, the physical therapy, etc...Not the practitioners that are supposed to be carrying out the physician's orders. So you may then argue that NP's do all that too. The answer is yes, they do, but to a limit. When things get too complicated, the NP appropriately sends the patient to the physician to seek higher level care. If the NP is NOT going to replace the MD, or at least compete with the MD/DO phenomenon, then the scope of practice remains limited, and a doctoral degree remains overkill. Thus, I cannot support the NP moving to a doctoral degree...UNLESS that doctoral degree meant NP's obtaining the SAME privileges as their MD counterparts.

Thus, I respectfully disagree with your quoted statement listed above. I think the degree creep these professions have been exhibiting is ABSURD based on the very limitations of their scope of practice. It seems like EVERY healthcare profession is going to the doctoral degree, and doing so unecessarily. The next thing you know, the requirement for radiology techs to obtain licensure will be at the master's level, and the minimal requirement for a janitor will be a bachelor of science in environmental services. Don't laugh...with the way things are going, this may one day be a reality. To me, it's the equivalent of requiring a bachelor's degree in computer science to do the job of a cashier at the local grocery store!

SharonH, RN · Jun 11, 2006

Do you truly believe healthcare has developed so technologically and its body of knowledge has become so advanced that to simply put an exercise regimen together for a post-op patient, and to show the patient how to perform the exercises requires a doctorally prepared P.T.? Do you really believe it takes a doctorally prepared audiologist to test a person's hearing and fit him or her for an appropriate hearing aid? Do you believe it takes a doctoral degree to dispense medications or even perform a drug review on a patient? Does it really take a doctoral degree to test a patient's vision and prescribe contact lenses and eyeglasses? Look at education versus scope of practice. These professions have a VERY limited scope of practice, unlike the physician. The physician requires a doctoral degree because he or she encounters an onslaught of medical problems. Physicians really MUST know pharmacology, advanced pathophysiology, minor and major surgical interventions, advanced anatomy and physiology, and so much more. THEY order the medications, the hearing exams, the physical therapy, etc...Not the practitioners that are supposed to be carrying out the physician's orders.

I don't know a lot about audiologists and optometrists so I will not comment on their preparation but I am flabbergasted that you think that all PTs do is put an exercise regimen together and train the patient to do them. Likewise, do you really believe that pharmacists only dispense meds and perform a drug review? You do realize both jobs require not only skills which apparently you do not see in your experience, but they also require a knowledge base to perform those tasks that you may not understand. You say that the physicians are the ones who order the PT, meds, etc and that they are the practitioners carrying out the orders. In my experience, pharmacists and PTs are often consulted as to the appropriate therapy for XYZ situation, etc. I equate your oversimplification of the scope of practice of PTs and pharmacists to someone saying that nurses don't need a degree because all they do is pass meds and put people on bedpans.

So you may then argue that NP's do all that too. The answer is yes, they do, but to a limit. When things get too complicated, the NP appropriately sends the patient to the physician to seek higher level care. If the NP is NOT going to replace the MD, or at least compete with the MD/DO phenomenon, then the scope of practice remains limited, and a doctoral degree remains overkill. Thus, I cannot support the NP moving to a doctoral degree...UNLESS that doctoral degree meant NP's obtaining the SAME privileges as their MD counterparts.

There are other reasons for the doctoral degree. It has been pointed out that the amount of time spent for a master's degree is almost equivalent to the time one would spend for a doctorate in other programs. There has been derision from some quarters(mostly medicine) about the inadequate amount of time spent preparing NPs. And who said that the NP is not to compete with the MD? In some markets they are and rightly so. Why shouldn't the healthcare consumer have a choice?