[FNP/DNP]

Originally Posted by Snoopd

I understand the importance of education as it relates to competency of practice and personal fulfillment, but how much more could someone expect to earn with a doctorate in nursing? We work in an industry that rewards a BSN with an extra dollar over an ADN, and a Masters can expect to get a dollar more that a BSN. Pocket change, it's insulting. Can our profession make a doctorate financially rewarding? I don't think so. The universities offering these programs will enrich themselves. It also means job security and possibly job creation for instructors, but how financially rewarding will it be for the degree seeker? Are you going to earn $200,000 or $300,000 as a "doctor of nursing"? Of course not. You'll have your fancy little title and degree and will be working in an industry that can't possibly provide you with the compensation that should accompany that many extra years in school. On the CBS news they had an employment story about what the in demand jobs are. The biggest group of these jobs were technical ADN type trades such as electricians, construction, and of course ADN nurses. These positions paid more than most 4 year degree "white collar" jobs. What's the point? One needs to be in demand to receive a higher level of compensation. It's not the degree, it's the public's demand, and the public's perception of the service that they are receiving, that create financial value and compensation for the practitioner of that trade or expertise. As the news story said - "for 50 years people have been told to go to college and get a 4 year degree" but now we have millions of people with 4 year degrees (they are a dime a dozen, what high school grads were 30-40 years ago) who have crummy "cubicle" jobs and mountains of student loans. I don't think that there is a financial "floor" that can support or justify a nation-wide requirement to get a doctorate to be a NP or CRNA. Snoopd.

I understand what you are saying. My situation is unique because I am a university professor and I need the doctorate. I don't think it should be a REQUIREMENT for nurse practitioners or CRNA's. Unfortunately though, at least in my area, they are turning out some nurse practitioners who haven't been exposed to very much in their educational experience. I think that the doctoral degree, with more clinical hours will eliminate some of this problem. I think it should be the individual's choice though, not mandated.

As far as income goes- who goes into this for the money? The PhD's I teach with have years of education and certainly aren't making the money. Its a decision to rise to the top of your profession, which isn't always about the almighty dollar. We need to get away from not getting education because it doesn't pay as well- it is really about making yourself the best you can be at what you do. I'm not asking others to do it, just explaining what went into my decision. For me it had the most to do with the desire to attain a tenure track position at a university. I don't use the title doctor in practice- it would be confusing and deceiving to the patient.

[PA-C, DO]

Originally Posted by Traveler

I believe East Tennessee State University does.

My big question with this whole debate is why. Assuming that a nurse first gets their BSN. The last 2 years in school is spent on nursing. If they go on to get their MSN that is another year and a half to two years. That is 3.5-4 years in school just for nursing. A doctor spends four years in medical school since the first 4 years is just general ed. If this requirement comes to be, APRN's would have more medical education than doctors.

I certainly hope you do not believe that any NP has more medical training than a physician. Shall we compare here?

1) All physicians have a bachelor's degree first, and at least 75% of them have these degrees in hard sciences. Most RN's take the basic A&P, chem, micro etc...and then get their BSN. As much as you don't want to hear this, those hard science courses in undergrad are way more relevant to the practice of "medicine" than are those nursing courses taught in the BSN degree.

2) Medical students go through 4 more long hard years of school, while NP students usually work and go to school at the same time. I don't know any medical students that had time to work. The average NP program has 500 hours of minimum clinical hours, while medical school has a minimum of 6000 hours in years 3 and 4 of medical school.

3) Physicians go through a minimum of 3 more years of residency. Np's do not.

I think you will see that there is no way to compare the two. Please don't say things like this as it only fuels the fire in an already touchy debate.

I do want to say though that I am proud to know some of you RN's and NP's who feel this push to DNP is just not necessary. As one of you humbly and rightly stated, a DNP will still just be a nurse. I can tell you that this issue is being discussed very cautiously among physician organizations, and presently there are dozens of states with this issue on their legislative agenda. NP's stand to alienate themselves from the physicians who currently employ them, which will not help you gain future collaborative physician agreements I can promise you. When do you think enough will be enough?

[Snoopd]

Thanks for "knowing some of us" who "are just nurses". I predict in another 5-10 years we will not be required through state statutes to legally collaborate with you on anything, so your "cautiously discussed concerns" will be so much wasted energy as the "golden age" of physician controlled monetary medicine disappears, and cost effective collaborative care given by practitioners with their own expertise replaces most of what you do and what you try to bill for. Your 2 minute assessments of patients and six figure death rate of patients do little to help you "cautiously discussed concerns" with legislators, or the public. Many studies have already proven the safety record of NP's and CRNA's - some of these studies state their safety records exceed those of the MD's and DO's. I guess that upper level chemistry class didn't do much to prevent that patient's unfortunate death. So I guess the MD's and DO's should stop belly aching about their high insurance premiums - they are there for a reason. You are in the twilight of a profession that will greatly change as society, legislators, insurance companies, and individuals realize that you offer only one facet to their health care solution. Perhaps you will play more of a role in research in the future and have even less patient contact. Ah, sort of glad to know you, see yah around, maybe? Snoopd

Originally Posted by PA-C, DO

I certainly hope you do not believe that any NP has more medical training than a physician. Shall we compare here?

1) All physicians have a bachelor's degree first, and at least 75% of them have these degrees in hard sciences. Most RN's take the basic A&P, chem, micro etc...and then get their BSN. As much as you don't want to hear this, those hard science courses in undergrad are way more relevant to the practice of "medicine" than are those nursing courses taught in the BSN degree.

2) Medical students go through 4 more long hard years of school, while NP students usually work and go to school at the same time. I don't know any medical students that had time to work. The average NP program has 500 hours of minimum clinical hours, while medical school has a minimum of 6000 hours in years 3 and 4 of medical school.

3) Physicians go through a minimum of 3 more years of residency. Np's do not.

I think you will see that there is no way to compare the two. Please don't say things like this as it only fuels the fire in an already touchy debate.

I do want to say though that I am proud to know some of you RN's and NP's who feel this push to DNP is just not necessary. As one of you humbly and rightly stated, a DNP will still just be a nurse. I can tell you that this issue is being discussed very cautiously among physician organizations, and presently there are dozens of states with this issue on their legislative agenda. NP's stand to alienate themselves from the physicians who currently employ them, which will not help you gain future collaborative physician agreements I can promise you. When do you think enough will be enough?

[FNP/DNP]

Originally Posted by PA-C, DO

I certainly hope you do not believe that any NP has more medical training than a physician. Shall we compare here?

1) All physicians have a bachelor's degree first, and at least 75% of them have these degrees in hard sciences. Most RN's take the basic A&P, chem, micro etc...and then get their BSN. As much as you don't want to hear this, those hard science courses in undergrad are way more relevant to the practice of "medicine" than are those nursing courses taught in the BSN degree.

2) Medical students go through 4 more long hard years of school, while NP students usually work and go to school at the same time. I don't know any medical students that had time to work. The average NP program has 500 hours of minimum clinical hours, while medical school has a minimum of 6000 hours in years 3 and 4 of medical school.

3) Physicians go through a minimum of 3 more years of residency. Np's do not.

I think you will see that there is no way to compare the two. Please don't say things like this as it only fuels the fire in an already touchy debate.

I do want to say though that I am proud to know some of you RN's and NP's who feel this push to DNP is just not necessary. As one of you humbly and rightly stated, a DNP will still just be a nurse. I can tell you that this issue is being discussed very cautiously among physician organizations, and presently there are dozens of states with this issue on their legislative agenda. NP's stand to alienate themselves from the physicians who currently employ them, which will not help you gain future collaborative physician agreements I can promise you. When do you think enough will be enough?

I should have known this reply was not coming from a nurse-glad to see that. I am not sure what place that physicans have to consider the education of advanced practice nursing. I don't see them involving themselves in the DPT programs or the Pharm D programs which are essentially the same thing. This has nothing to do with independent practice and everything to do with advancing the profession. Why don't you educate yourself a bit more about the practice doctorate before replying to this thread.

[markdanurse]

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?

[brownrice]

I have not researched this issue at all, however, I am suspect of the forces that drive certain action in higher education....consider that universities are really a big business--don't get confused and think there just so super altruistic--NOT. They are out to gain recognition and make a profit. The entities swirling around them are even more profit hungry--the entrance exam testing centers, the book publishers, companies financing ed loans, etc, etc. If they examine how to increase profit, it can be done very simply by requiring more education.

I agree with you that this idea of the doctoral degree for nurses is absurd. Did the pharmacists and PT's really need it too? I don't think so.

So, if I were forced to research this issue (which I wouldn't waste my time on otherwise) I would bet that at the root of it lies some lobbying from someone who stands to make a profit or gain recognition for their ego. Or, the AMA.

Medicine is so screwed up in the US already--quality of life v. healthcare dollars spent is abismal. So, these "bright" people are thinking, let's make it even tougher to find a provider to go out into rural areas to deliver healthcare, let's make them go to school for at least twice as long--what a fabulous idea! It ought to discourage quite a few that can't afford it. On top of that, let's confuse the public and give them the title of "doctor".

If these people who are all for the four year degree truly cared about quality of healthcare, they could figure out how to provide healthcare to the 45+million uninsured in this country. Much better use of their political struggles in my opinion.

[platon20]

NPs ALREADY HAVE INDEPENDENT PRACTICE!

Why would we want to get a doctorate just for that?

Doctorate for nurses makes very little sense.

If htey are going to make the training that long, you might as well go to medical school.

[texas-rn-fnp]

I am in FNP program through ISU.

I was forwarded a document through the school that said by 2015 the NP program will be a 3 year grad program that gives you a DNS. There are supposed to be a few schools out there like this already, but all schools are supposed to be changing to this by 2015. The NP program will be grounded in FP and then you will have to do a post grad didactic and residency if you want a specialty. Yes, this is becoming closer to a medical degree. Yes, NPs are going to be more competative with docs.

RE: salary. It is VERY dependant on location. I am now living between Sacramento and SF. I have seen job postings for FP docs out here for only $118-125k. In contrast, most FNP postings in San Antonio advertise for $85k. I have even seen some for up to $125k in SA. That is a major difference, especially considering the cost of living difference. Sadly, I know new RN grads in New England that can't even get a job. Location is a major determinant of salary and cost of living.

[texas-rn-fnp]

Originally Posted by brownrice

I have not researched this issue at all, however, I am suspect of the forces that drive certain action in higher education....consider that universities are really a big business--don't get confused and think there just so super altruistic--NOT. They are out to gain recognition and make a profit. The entities swirling around them are even more profit hungry--the entrance exam testing centers, the book publishers, companies financing ed loans, etc, etc. If they examine how to increase profit, it can be done very simply by requiring more education.

I agree with you that this idea of the doctoral degree for nurses is absurd. Did the pharmacists and PT's really need it too? I don't think so.

So, if I were forced to research this issue (which I wouldn't waste my time on otherwise) I would bet that at the root of it lies some lobbying from someone who stands to make a profit or gain recognition for their ego. Or, the AMA.

Medicine is so screwed up in the US already--quality of life v. healthcare dollars spent is abismal. So, these "bright" people are thinking, let's make it even tougher to find a provider to go out into rural areas to deliver healthcare, let's make them go to school for at least twice as long--what a fabulous idea! It ought to discourage quite a few that can't afford it. On top of that, let's confuse the public and give them the title of "doctor".

If these people who are all for the four year degree truly cared about quality of healthcare, they could figure out how to provide healthcare to the 45+million uninsured in this country. Much better use of their political struggles in my opinion.

The system is already messed up. We obviously know how many nurses we are short, then the system is not conducive to bringing in new nurses. Just look at how most NP programs are leaving you on your own to try and find a preceptor. Then most of the potential preceptors either are not interested in being one or they only take med students. This is a school responsability.

[jer_sd]

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