The DNP and what it means for the APN

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i know there has been a lot of debate whether or not nps will have to be doctorate prepared to practice. well i was just browsing on the university of iowas website, this is what i found:

more about the dnp degree

the american association of colleges of nursing requires that by 2015 all nurse practitioners entering advance practice be prepared at the doctorate level. learn more about the emerging role of the dnp check these links:

www.aacn.nche.edu

www.nonpf.com

here's the link i found this information at

http://www.nursing.uiowa.edu/academic_programs/graduate/dnp/index.htm

what are your thoughts on this?

Specializes in Nursing Professional Development.
All I can say is that the ANCC "recommended" the BSN as an entry level for RNs 30 years ago and that didn't come to pass. I'm not worried about needing a doctorate in my lifetime - lol.

One thing is different between the DNP issue and the BSN entry into practice issue.

The vast majority of schools that prepare APN's are actively involved in the organizations (such as AACN) that support the DNP. Also, those schools can see the DNP as an opportunity to teach more courses, bring in more revenue, and prepare more doctorally-prepared nurses to be available to teach (more teachers = lower salaries for teachers). So ... it's in the schools' best interest to have flourishing DNP programs.

If the majority of schools switch their APN programs from Master's level to DNP level ... the change will happen over time as fewer and fewer MSN-only APN's exist. As the DNP grads become the majority, they will make the rules for advanced practice.

With the BSN entry-level issue, the numbers are different. The schools producing ADN's and Diploma's are numerous (more numorous?) and produce large numbers of graduates each year -- producing lots of voters to pressure legislators to keep the ADN and Diploma programs alive. Those schools and consituencies are also well-represented on the Boards of Nursing that govern the practice of nursing. And finally, hospitals want to keep a large supply of ADN grads handy because they keep nursing wages down. So ... there are a lot of people who exert a lot of political pressure to maintain the status quo.

The numbers and the political influence with the 2 issues are very different. I don't have a crystal ball ... but the DNP train seems to be leaving the station as more and more programs convert from MSN to DNP. Fortunately for those existing APN's, these things usually take several years to play out -- when this sort of change occurs, existing people in a role are usually grandfathered in.

if there is a new standard for NPs, it should be as universal as possible - and clinically focused. Is this in the making?

Ironically, it appears so far that most DNP curricula are simply adding more non-clinical courses to the existing NP training, to emphasize "leadership" and provide a broader outlook/understanding of the larger healthcare milieu, rather than adding a stronger or more in-depth clinical focus. (Perhaps that is because the existing MSN programs have been doing a fine job of preparing people for the clinical role just fine all these years and didn't need improving. :rolleyes:)

Specializes in Nursing Professional Development.
Ironically, it appears so far that most DNP curricula are simply adding more non-clinical courses to the existing NP training, to emphasize "leadership" and provide a broader outlook/understanding of the larger healthcare milieu, rather than adding a stronger or more in-depth clinical focus. (Perhaps that is because the existing MSN programs have been doing a fine job of preparing people for the clinical role just fine all these years and didn't need improving. :rolleyes:)

I agree. The apparent motive for upgrading the APN educational standards was NOT because current APN's are providing poor patient care -- but rather for a couple of other reasons.... such as political clout and the lack of education in areas such as research & evidence-based practice, public health, etc. So, the DNP courses are not focused on the direct patient care aspect of the roles, but rather on the "health care leadership" aspects of the roles.

Just like with staff nurses, not all APN's are interested in being leaders. Some just want to diagnose/treat the individual patients and then go home. Just as with staff nurses, that's where the conflicts arise from.

i agree. the apparent motive for upgrading the apn educational standards was not because current apn's are providing poor patient care -- but rather for a couple of other reasons.... such as political clout and the lack of education in areas such as research & evidence-based practice, public health, etc. so, the dnp courses are not focused on the direct patient care aspect of the roles, but rather on the "health care leadership" aspects of the roles.

just like with staff nurses, not all apn's are interested in being leaders. some just want to diagnose/treat the individual patients and then go home. just as with staff nurses, that's where the conflicts arise from.

agree, nps have and will continue to provide excellent patient care. the clinical issue is often confused. several have suggested the dnp is not "more" clinical oriented compared to the ms fnp, rather non clinical courses have been added. my understanding is that the current minimal requirement for clinical hours is 500 for the fnp, with the dnp the minimal requirement is 1000 hours. at least form a quantity perspective the number of required hours will double. all too often fnp preparation is being criticized as we only currently require 500 hours of clinical.

i would also like to agree that the dnp is only currently a recommendation. but, in truth the dnp is going to happen, the momentum is overwhelming. the suggestion that since 28% have stated they are not planning a dnp program does not indicate they won't being going dnp. it means that have not declared if they are converting to the dnp. what i heard from the ancc representative is that programs should be planning to convert by 2012, so that those students graduating in 2015 will have the dnp. she suggested not waiting until 2015 to start admitting students for the dnp curriculums.

Specializes in a lil here a lil there.

A "small" side note to this discussion is the point that "Most" FNP programs require far more than 500 hours. I have not found a program requiring less than 585 and most are more in the range of 620 to 800 hours. Ours is 720 hours. Sooooo, a bunch of 1K /credit hour x 40hrs of tuition for 1 more clinical course and 280 hours more clinicals, AND you get to argue if u have the right to be recognized for your achieved level of education, i.e. "Doctor Nurse. Sounds like a bargain.............

a "small" side note to this discussion is the point that "most" fnp programs require far more than 500 hours. i have not found a program requiring less than 585 and most are more in the range of 620 to 800 hours. ours is 720 hours. sooooo, a bunch of 1k /credit hour x 40hrs of tuition for 1 more clinical course and 280 hours more clinicals, and you get to argue if u have the right to be recognized for your achieved level of education, i.e. "doctor nurse. sounds like a bargain.............

i agree, what is required isn't always what is done. my np ms program required 350 clinical hours or so back in the mid 80s, but i was actually closer to 1200. when other professionals review expectations they refer to the required minimal not what most are really doing. thus, at least the 1000 min for dnp is a step up, i am sure that these dnp students will be doing more than the 1000 required, going beyond the clinical hour expectations.

i agree, what is required isn't always what is done. my np ms program required 350 clinical hours or so back in the mid 80s, but i was actually closer to 1200. when other professionals review expectations they refer to the required minimal not what most are really doing. thus, at least the 1000 min for dnp is a step up, i am sure that these dnp students will be doing more than the 1000 required, going beyond the clinical hour expectations.

i agree that the 1000 hours of the dnp is a step up and that many will do more than those 1000 hours. nonetheless, i think people shouldn't be complacent and should try to push for standardization of the clinical rotations. that way, the variation in clinical experience (and thus clinical ability) wouldn't happen and dnp schools would be putting out a uniformily solid product.

I agree that the 1000 hours of the DNP is a step up and that many will do more than those 1000 hours. Nonetheless, I think people shouldn't be complacent and should try to push for standardization of the clinical rotations. That way, the variation in clinical experience (and thus clinical ability) wouldn't happen and DNP schools would be putting out a uniformily solid product.

One irony (that has been noted by others) is how well we've managed to standardize most of BSN and ADN education. From my research, most programs leading to an RN share a general curriculum, with classes and clinicals in fundamental areas (adult m/s, peds, OB, psych, etc.) and subjects (pharm, pathophys, plus the diseases and care of patients in each specific clinical area). Our "fluff" was minimal (short class including nursing dx in the very beginning), otherwise a very clinical/rational program (state U BSN). My local CC offered ADN is set up very much the same.

My point is how I can see why some of us pre-grad students (well, technically a grad student now, I guess) can come out of this, be taken aback by both APN and DNP curriculums, and become the fanboys of PA curricula that we see here and elsewhere. Undergrad nursing education covers multiple populations, is based solely on medical science, and is geared to producing a competent entry-level nursing professional.

Though still unclear on several fronts, my research into several DNP program mission statements seems to indicate they are outright seeking to create a hybrid clinician/administrator, "health care leadership", however they call it. More like a APN with a population v. individual focus. I can conceive of the need (or at least usefulness) of such a position, I just don't see it as a natural progression from the clinically minded, individual patient seeing APN.

If the DNP is to be inevitable, I could see it's current incarnation as one of several possible tracks to take (hey, this is what nurses do with education, right? Make it too complex?). So, say you have the current DNP, for any MSN who wanted that "healthcare leadership"-type role. For non-APN MSNs, the DNPs 1k (or whatever) clinical hours can get them up to speed as an APN. For MSNs who are APNs already, the clinical hours can act as they seem to do now, largely as training in the population-level clinical areas.

A second track (again, assuming DNP becomes the law of the land) would be what many APNs seem to really want around here. This would be a clinical doctorate, focused on developing clinical abilities. So, much more advanced pharm and patho (and in greater amounts), with either super-specialization (like APNs are now), or geared toward an advanced form of undergrad nursing (i.e. or like current PA training) producing a generalist provider. I would think that this second option would appeal much more to BSNs vs. APNs, the latter who may just want to take their current specialty to a higher level rather than going back, with the former being eager to rotate through surgery, ob/gyn, psych, whatever.

Just throwing things out there, but my bottom line is that making the DNP the "law of the land", without offering variations, is going to perpetuate the battle we are having amongst ourselves.

Specializes in Nursing Professional Development.
One irony (that has been noted by others) is how well we've managed to standardize most of BSN and ADN education. From my research, most programs leading to an RN share a general curriculum, with classes and clinicals in fundamental areas (adult m/s, peds, OB, psych, etc.) and subjects (pharm, pathophys, plus the diseases and care of patients in each specific clinical area). Our "fluff" was minimal (short class including nursing dx in the very beginning), otherwise a very clinical/rational program (state U BSN). My local CC offered ADN is set up very much the same.

My point is how I can see why some of us pre-grad students (well, technically a grad student now, I guess) can come out of this, be taken aback by both APN and DNP curriculums, and become the fanboys of PA curricula that we see here and elsewhere. Undergrad nursing education covers multiple populations, is based solely on medical science, and is geared to producing a competent entry-level nursing professional.

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While I think you raise a good point, your knowledge and experience with undergraduate curricula seems very limited. There is actually a good deal of variation across the country, with some schools emphasizing the social sciences and humanities as much the physical sciences. And it's hard for me to believe that anyone would think that all undergraduate nursing curricula in the US are based on "medical science." The idea of basing nursing care on medical science is downright heretical in many schools!

While I think you raise a good point, your knowledge and experience with undergraduate curricula seems very limited. There is actually a good deal of variation across the country, with some schools emphasizing the social sciences and humanities as much the physical sciences.

Are we speaking here in terms of prerequisites, or the nursing courses themselves? While I have seen variation in the former, and varying degrees of theory in the latter, I was under the impression that core undergrad nursing programs lay out there coursework in roughly similar ways. So you'd have pathophysiology and pharmacology, 1-3 semesters of "Medical/Surgical", psych, ob/peds, maybe a "fundamentals" course in the beginning. My particular BSN differed from the local adn by adding gero, community, and research methods (extra credit of pharm as well, if I am remebering correctly, and this is not including differences in required pre-reqs). Are these core areas not fairly uniform across RN education, allowing for variations in the weight given to nursing theory, "Entry to Practice/NCLEX Prep"-type courses, etc.?

And it's hard for me to believe that anyone would think that all undergraduate nursing curricula in the US are based on "medical science." The idea of basing nursing care on medical science is downright heretical in many schools!

Yeah, I knew I was going to get called on that one. What I was trying to express was that the bulk of both my clinical and didactic instruction in my BSN coursework was based on (I don't know what else to call it) medical science. I'm sitting here struggling on the best way to express myself here, on what seems to be such a fundamental idea. When we are taught to listen to heart sounds (for example), we are taught what each sound means anatomically, the pathophysiological basis to variations on these sounds, what is abnormal, etc. When learning drugs, we studied kinetics and dynamics, s/e, dosages, etc.

I'm not sure what I'm supposed to call the empirical study/treatment of health and disease..."health science"? I know the arguments of "it's nursing when a nurse does it and medicine when a physician does it", and I have no desire to get into that circular debate here.

Here's what I think I am trying to say: RN and APN education are quite different. From what I am gathering, DNP education seems to aim for an extended form of APN education. When many, many people are asking why DNP education can't be more clinical, that sounds to me like asking why it can't be more of an extension of RN education.

Specializes in Nursing Professional Development.

Here's what I think I am trying to say: RN and APN education are quite different. From what I am gathering, DNP education seems to aim for an extended form of APN education. When many, many people are asking why DNP education can't be more clinical, that sounds to me like asking why it can't be more of an extension of RN education.

I agree with your basic point. Many people are unhappy with the DNP curricula because it is not focused on the diagnosis and treatment of an individual patient. Most of the courses focus on leadership roles and function that consider the care of large groups of people (populations) ... the ability to establish the best way to care for all patients with a certain condition, the ability to design and run programs, the ability to do and/or interpret research, develop and test protocols, ... etc. They assume that the DNP student has learned the basics of how to care for a single patient were learned in those clinical courses & preceptorships that were part of their MSN program.

Some people are only interested in "following the established guidelines" and providing care "one patient at a time." Not everyone is interested in being a leader. So, it's really more than just a change in the educational pathway, it is a change in the expectations of people in the NP role.

Undergraduate education also focuses mostly on teaching students to care for "1 patient at a time" (Even though a typical nursing assignment includes multiple patients, each is considered separately.) There are a few courses in BSN programs (research, leadership, etc.) that address broader issues, but they are usually not the focus of the entire program or the role that new graduates are expected to take.

I agree that also that there are a lot of similarities in undergraduate education as programs include content in the care of patients in the standard clinical areas. But there is similar sameness in most grad programs if you compare programs offering the same major. There is however, more variety in that there are different "tracks" or "majors" to choose from, which does produce more variation across focus areas -- and the new DNP is a major deviation from the old NP curricula.

As for "medical science" ... try ... phyisical science ... biological sciences ... life sciences ...etc. Those are the terms most often used to talk about courses like biology, physiology, anatomy, etc. "Medical science" is the field of medicine -- diagnosis and treatment of diseases, the discipline that MD's have their degree in. :)

Specializes in SICU, MICU, Med/Surg, ER, Private Duty.

i seriously doubt that the content of the dnp tracks that are currently available (majority of) will gain us any more respect by physicians. most of the dnp programs i have reviewed are very weak on clinical competence and heavy on the research and theory aspect, as well as the business side of healthcare. once i finish my msn, i will definitely wait until these schools get their act together and offer a truly "clinical" focused dnp curriculum. i have no doubt that a well focused dnp program would enhance our acceptance by the medical community, but the current trend looks to be more of an effort to increase the pool of teaching qualified nurses rather than a push for greater competency in healing. as to when it will be required, others had already pointed out that bsn had been a dream entry point for decades. in the current shortage of providers, it is ludicrous to believe they would hobble nps with such a requirement. we can't prove our worth as providers, if we have a tiny number of nps actually out there.

i totally agree... in 2015, watch.. there will be soo many dpn program out the wood works.. there will be soo many creative ways to get a dpn... just wait till 2015. i know there are some bsn/dnp program, but i going to go straight to a msn program, and wait to see what these scholastic institutions are going to be creative with the dnp...

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