It is true that nurses commonly function at a level other disciplines do only with higher degrees. In other words, a Critical Care ASN, let alone a BSN, both do work that a Bachelor's-degreed person in another field wouldn't be allowed to touch. This means that while doing their actual jobs, often they rub elbows at the higher levels of practice/education/research with other disciplines carrying higher credentials, and despite their knowledge level, therefore have lower status in a degree-besotted medical community.
What isn't acknowledged is how much of the post-graduation experiential learning takes place in nursing and other medical fields, and therefore how much is learned after the initial credential....this is just not true of dentistry, PT or other fields where the experience matters, but does not triple the knowledge level in just a few years. The only parallels are in disciplines which have similarly wide areas of clinical focus, such as medicine itself and, perhaps, a paramedic working in the city. You have to “see it all and do it all”, with a very wide scope.
The difference in doctors and nurse or PA training is that the doctors do those 10,000 hours before graduation, and the nurses and PAs do them on the job, earning about what the medical student does in his/her stipend, though the nurse gets paid by an employer. (Well, actually, the PA who is not a hospitalist will not be gaining those “see it all” hours in primary care; those you see in the acute care environment. But that’s another topic.)
Please understand, I am not comparing nursing and medicine as being the same discipline; on the contrary, I feel strongly that they are very different disciplines except in hospitalist work, where the philosophy and perspective are different, but the body of knowledge and experience demanded is quite similar. In most of AP Nursing, it is a different type of practice altogether, with only a bit more overlap than, say, a chiropractor has with medicine. Market forces cause most APNs to assume demi-doctor roles too often, and put too little emphasis on holistic care, patient educations, etc.
What is also often ignored is the fact that the average MSN program is considerably longer than a Master's degree in many other fields, and often requires the nurse to have 2 years of post-licensure practice before even applying to an NP program. Thus you have a BSN + 2 years of additional paid on-the-job training (4000 hours), plus 2.5 average years of post-grad education, plus the minimum 500-600 supervised hours. So the graduate has the undergrad clinical hours, plus 4000 basic RN practice hours, plus 550-700 supervised APN hours, or close to 6000 in all.
Of course, some have many more years of nursing practice in several different areas, such as dialysis, or oncology....each representing quite a residency. Even though those do not include the APN perspective, the amount of useable experience about the workings and behavior of sick bodies and minds and families under stress is huge—and irreplaceable. (In contrast, other primary-care disciplines such as medicine LEAVE that intensity after graduation, not go there for the start of, let alone the rest of, their careers. Which may be why some can honestly say, “I’ve forgotten more than you’ll ever know.” Precisely.)
Furthermore, what makes the internship/residency so valuable, whether paid or not, is that it DOES take place after the basic framework of knowledge is present upon which to build. New experiences strengthen and add to what has already been learned, and make it easier to comprehend future novel experiences. That exponential growth type of learning happens faster every year, and that is why entering a graduate program with a few years of nursing experience makes for much more learning in the same 600 hours than for the students who don't have it. (An one legitimate reason why experienced nurses rightfully scorn highly-educated nurses who don’t recognize that, or whom have never worked in acute care.)
But the bottom line is you have: BSN + 2 yrs experience, + 2.5-3 years for the MSN=8.5-9 years for the APRN, plus—what? another 2 or more years for the DNP?
What this means is that the MSN was ALREADY devoting the time and the money to be considered well-educated practitioners...but without the "scholarly" and research additional focus, and training or didactic /formal additional clinical training. This left them handicapped and disrespected....but having spent as much time, effort and funds on their “just a Masters" degrees as doctorates have in many other disciplines.
Now, how does that resemble the Associate-degreed nurse doing critical care, back in the days when "mandatory BSN" was coming? Yep—the problem is not primarily that nurses are under-educated....it’s a very sexist problem: The nurses educations are mislabeled, under-RATED, and under-RECOGNIZED.
Consider how little education a medical doctor has in research and evaluation of EB medicine. Far less than does a student of psychology, for example. Do we look down on them because they are not dually-degreed PhD/MDs? No, they learn that in practitioner-update seminars after they enter practice—but we instantly cower in shame and hurry to make amends, if we as APNs are scorned because we also lack that focus in our degree plan.
So the “old school” APN is lacking in well-roundedness when it comes to understanding EBP? The MSN programs need to dump some (not add on even more with the DNP) of the extensive repetition of 4th-year- BSN courses about public policy, health care legislation, administration, reimbursement...and make the DNP a clinical degree—albeit one with lots of ability to evaluate and add to the fund of EBP knowledge. What’s so hard about that? Are we training lobbyists, administrators, researchers-- or clinicians? Aren’t those other roles why we have the other MSNs and PhDs?
Yes, make the MSN the door to “clinical leader”, and the fork in the road t research, clinical practice, administrator, or policy activist—the doctoral roles. Grandfather the previously-educated ones not just out of necessity and fairness or even generosity, but because they learned on the job what will be spoonfed to incoming generations, as is often the case in a rapidly-developing field. (Honor pioneers, don’t scorn them as old-school! Duh: They are why the role exists!) That’s not what is happening, though.
What do we do? Instead of reworking/renaming and improving what we have, we hurry to stuff it with even more (now officially doctoral-level) “filler” courses—about 3 year’s worth, actually-- that don’t add clinical knowledge or much discernment for EBP development, but do add “education units” and money and time to the “new APN” DNP degree. Those filler courses—looking like just what they are-- also make us look foolish and lacking in self-respect, when the intent is just the opposite. They make us look stupid, in that when we feel under-educated for a role we already play, our solution is to dash out and add useless NON-clinical filler, and hit our pioneering and hopeful APRNs over the head with the new “standards” and accompanying costs.
No, nursing should long ago have made the basic APRN entry degree a DNP, but before they padded the MSN with so much time and money!
Now, in order to simply recognize the expertise the APRN has, and credential nurses accordingly, we won’t just correct the APRN educational programs to include the necessary extra foci of research, etc. Nor will the 1 or 2-year pre-grad school practice recommendation be incorporated instead as part of the formal degree plan, as it perhaps should be. Instead, a correction will mean adding even more time and money. No 8-year doctorate for nursing! It’s 9-10 years or bust for us—Never mind we’ll never be able to pay off the loans, given what APNs make in most places.
The DNP should not pile on top of the existing MSN practitioner programs; it really SHOULD replace them for clinical practice areas. The "grandfathering" that is needed is simple recognition that current APNs with MSNs already have the DNP, minus (in some but certainly not all cases) some catch-up knowledge in the areas of research, EBP evaluations, etc.
It should not add more bloat and administrative/philosophical/nursing theoretical “filler” to an already bloated Master’s program, and worst of all, offer very little increased CLINICAL expertise! No wonder other professions sometimes make fun of nursing’s scramble to attain equality; it’s too obvious, and it shows poor self-image. Ironically, this is just what the “new consensus model” is supposed to fix. We’re visibly “trying too hard” instead of demanding recognition for what we already are asked to do—and do quite competently, thank you!—as we always have at the ASN, BSN, and MSN—and yes, LPN-- levels. To be fair, we must say that many an LPN knows more on some medical and psychiatric topics than does many a practitioner of other disciplines with BS and MD degrees. I know; I’ve worked with them!
What is needed during the transition is a post-APN DNP "bridge", not a 5-year DNP for BSNs, nor a 2-3 year DNP on top of the 6-7 (including those 2 RN practice years) already demanded!
You just won't get nurses to spend 12-plus years and 140 k on educations earning 80-90k, doing whatever the AMA wants to allow them to do (i.e.; the high-volume, low-knowledge, boring but bread-and-butter essential “leftovers” in medical care), while skimming off 75% of their earnings, and complaining that NPs are shamefully under-educated MD-wannabees! We need an eight-year (top to bottom) Advanced-Practice doctoral program.... and stronger education for the public about what is medicine and what isn't.
(You younger nurses may not know that in the 1950's only doctors drew blood, started IVs, inserted tubes in any orifice, etc. Now, of course, LPNs do those things, and technicians, too. Likewise, its a ridiculous red herring to refer to primary care by APRNs as medicine-only territory, or to claim that RNs who do advanced nursing, AND can provide those very basic services along with the more important work of education etc, (i.e. nursing!) are trying to be demi-doctors. )
It's an insult to the intelligence of the public and the practitioner. Adding the DNP on as just extra money and hours or "term papers due" (whether as a 2nd post-grad degree, or a straight-shot from the BSN) instead of reworking the current programs to a more reasonable time frame and cost, is a mistake. Instead of boosting the APRN up to a higher level of prestige and recognition more in line with what he/she actually does, it's reaching down from the Ivory Tower to yank her up by the collar, "Get your act together! Can't you see that little old MSN is demeaning us real nursing scholars?!"