DNP Article

zenman · Dec 3, 2007

how did it get so badly distorted???

cause nursing can't even decide on an entry level degree, lol!

boomer28 · Dec 7, 2007

I guess I am confused by the negativity towards Dr. Mundinger's article. I actually felt empowered by it as an MSN student considering continuing on for a DNP. She clearly described the role of the DNP, emphasizing the benefit to patients in terms of health management (prevention, education, family centered care) that physicians generally do not do. I agree with her that patients are better off if they are seen by a provider that has both medical and nursing skills. I am not saying that a DNP should take the place of an MD, I am just pointing out that in the entire meshwork of collaborative care that should take place in the treatment of a patient, it would be beneficial for a patient to see a specialist MD and also have continued care by a DNP.

In regards to the length of the program, what I have heard is that the current MSN has so many credit hours already, it is practically on par with what a doctorate would be in other specialties, so that is one reason they want to change to a DNP. I'm all for it and I'm excited about the changing role in advanced practice nursing.

oldiebutgoodie, RN · Dec 9, 2007

What concerns me is that some of the DNP programs aren't clinical, they are aimed at administrative/business skills. Why not just get an MBA?

And I agree with the others, the DNP needs to be standardized. I am in an MSN program, and this school is now offering a DNP which has NO CLINICAL COURSES at ALL. What???? It just looks like several years of busywork to me.

Oldiebutgoodie

Trauma Columnist · Dec 10, 2007

Oldiebutgoodie - I just had a conversation with the soon-to-be director of our newest DNP program. She couldnt' even answer simple questions like how many hours? What courses? What opportunities will this provide me with?

That is very concerning.

oldiebutgoodie, RN · Dec 10, 2007

Oldiebutgoodie - I just had a conversation with the soon-to-be director of our newest DNP program. She couldnt' even answer simple questions like how many hours? What courses? What opportunities will this provide me with?
That is very concerning.

It certainly doesn't give the DNP any credibility.

And over on other forums, (PA and student doctors) the wagons are circling ANTI-DNP (and by extension, anti-NP), which can't be good for our profession.

It seems that ivory tower nursing schools are so enamored with this, that they are willing to drop the clinical aspects of our training, even at the BSN level. A non-clinical DNP will NOT improve an NPs diagnostic and treatment skills.

Oldiebutgoodie

PediASL · Dec 11, 2007

Has anyone submitted an editorial on the subject? for example, in response to DNP article by Mundinger. (no i have not yet, either)

I feel the need to express these opinions (anti dnp) to those who think that the entire nursing community is behind this movement.

I would love a forum where the general public/other medical professionals are given this info from both sides!

oldiebutgoodie, RN · Dec 11, 2007

Has anyone submitted an editorial on the subject? for example, in response to DNP article by Mundinger. (no i have not yet, either)
I feel the need to express these opinions (anti dnp) to those who think that the entire nursing community is behind this movement.
I would love a forum where the general public/other medical professionals are given this info from both sides!

Well, you can post comments on the Forbes site.

SN2bExpAt · Dec 12, 2007

I have been thinking. The theory is that DNPs will be able to bill insurance companies just like docs, right? This would suggest that they are not earning a yearly salary.

Mundinger suggests superior care because of the "Noctor" approach, which is adding a caring, holistic approach on top of being Tx'd and Dx'd, correct? I can only assume that a visit to a DNP would be more time consuming due to the assumption that doctors only treat, while Noctors treat AND care.

If DNPs can bill per patient, it will not take them very long to realize that treating more patients per day = more billings per day = a fatter Christmas turkey, and then some. I cannot believe people would be so naive to believe that ALL NURSES not take the same opportunity that doctors do in Primary care. Mundinger, in her own words, suggests "superior care." Well, I believe that superior ability can breed superior ambitions. To suggest that DNPs are somehow exempt from a basic human drive, GREED, is foolhardy to say the least.

FWIW, wheeling patients thru like a carnival ride was a huge problem in British Columbia. Some docs were seeing up to 50 patients a day. The provincial gov't finally stepped in and capped Family Physicians to seeing 25 patients a day. Will there be this kind of watchdog over DNP's who get a little greedy? They cannot even decide on a standardized, universal curriculum............

core0 · Dec 12, 2007

I have been thinking. The theory is that DNPs will be able to bill insurance companies just like docs, right? This would suggest that they are not earning a yearly salary.
Mundinger suggests superior care because of the "Noctor" approach, which is adding a caring, holistic approach on top of being Tx'd and Dx'd, correct? I can only assume that a visit to a DNP would be more time consuming due to the assumption that doctors only treat, while Noctors treat AND care.
If DNPs can bill per patient, it will not take them very long to realize that treating more patients per day = more billings per day = a fatter Christmas turkey, and then some. I cannot believe people would be so naive to believe that ALL NURSES not take the same opportunity that doctors do in Primary care. Mundinger, in her own words, suggests "superior care." Well, I believe that superior ability can breed superior ambitions. To suggest that DNPs are somehow exempt from a basic human drive, GREED, is foolhardy to say the least.
FWIW, wheeling patients thru like a carnival ride was a huge problem in British Columbia. Some docs were seeing up to 50 patients a day. The provincial gov't finally stepped in and capped Family Physicians to seeing 25 patients a day. Will there be this kind of watchdog over DNP's who get a little greedy? They cannot even decide on a standardized, universal curriculum............

There are two issues here. One is billing. Medicare and most insurance companies will not differentiate between NPs and DNP. The DNP right now still must have a collaborating physician to bill and gets 85% of the physician rate unless billing incident to for outpatient and the same unless they are cobilling for inpatients. This would have to be changed in federal law and medicare regulation. The problem is that medicare reimbursement is a zero some game. Any money paid to NPs would have to be taken out of some other area of medicare reimbursement. This is a very difficult task. Even if you believe that physicians don't care about the "doctor" part or independence, I can assure you they really care about reimbursement.

The other issue is about time in encounters. You can bill on time in both an outpatient and inpatient setting. However it is more profitable to see more patients of lower acuity than fewer patients of high acuity. The worst case is spending lots of time for low acuity. The reimbursement for preventive medicine is really low. The real way to make tons of money is to do a lot of procedures. But that has its own ehtical challenges.

David Carpenter, PA-C

amzyRN · Dec 16, 2007

I think the curriculum of the DNP should include more advanced anatomy, physiology, pharmacology, and more clinical hours, basically more stuff for medical diagnosis. It could be like a NP/MD hybrid or something of the sort that would allow NPs to have more expertise in complex cases, which would allow for an expanded scope of practice, higher salary, and more independence. The motivation would be to refine clinical skills and acknowledge the symbiotic relationship between nursing and medicine. As mentioned by many other people on different threads, nursing has tried to repudiate the aspects of medicine inherent in it's practice. Nursing could take the moral high ground and instead of setting itself apart from medicine entirely, it would acknowledge that nursing includes the medical model.

Also, maybe medicine could transform itself also, to include a more holistic approach to treating illness that would look at the person as an "irreducible whole".

Old ideas that I just thought I'd share.

J

caldje · Dec 16, 2007

I think the curriculum of the DNP should include more advanced anatomy, physiology, pharmacology, and more clinical hours, basically more stuff for medical diagnosis. It could be like a NP/MD hybrid or something of the sort that would allow NPs to have more expertise in complex cases, which would allow for an expanded scope of practice, higher salary, and more independence. The motivation would be to refine clinical skills and acknowledge the symbiotic relationship between nursing and medicine. As mentioned by many other people on different threads, nursing has tried to repudiate the aspects of medicine inherent in it's practice. Nursing could take the moral high ground and instead of setting itself apart from medicine entirely, it would acknowledge that nursing includes the medical model.
Also, maybe medicine could transform itself also, to include a more holistic approach to treating illness that would look at the person as an "irreducible whole".
Old ideas that I just thought I'd share.
J

Good post but you miss one thing.

If we took the best of both worlds and accepted our faults there wouldn't be anything to talk about on allnurses. Nobody would need to tell the world why they are better than everyone else!

oldiebutgoodie, RN · Dec 16, 2007

Good post but you miss one thing.
If we took the best of both worlds and accepted our faults there wouldn't be anything to talk about on allnurses. Nobody would need to tell the world why they are better than everyone else!

Or on the PA forum, either. They also have spirited discussions about which profession is better. Guess what they think!

Oldiebutgoodie