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  • Mar 22 '16

    I have a few comments on the original thread and some of the replies.

    Everyone does understand that the "should I get a DNP" question only pertains to those who are already NPs in clinical practice or NP students, right? In the next few years, this question will be moot because the MSN-NP degree is being phased out. Just as with the Bachelors of Medicine in the late 1800s to as recently as the Master's of Pharmacy in the 1990s, the profession is simply replacing one degree for another that contains a few more requirements. The DNP is also an attempt to streamline the current hodge-podge of clinical nursing doctorate titles. In most cases, this means instead of taking 2 years to get an MSN that allows you to sit for whatever board exam you are studying for, it will take 3 years plus a few hundred clinical hours and a capstone project instead. Is it degree creep? Yes. But it is a trend most other health professions have been changing over to in the past few decades and nursing, as usual, is just one of the last to join the party.

    Judging by PTs, pharmacists, and psychologists I know who were grandfathered in prior to their professions making a doctorate the minimum entry to practice, it is unlikely the DNP will make a difference to reimbursement or opportunity over the next decade or so, if ever. I have APRN and CNS friends who have been practicing for a number of years with no good reason to get the DNP unless they want to double-board in another specialty. I was FNP certified and used the DNP to get my PMH certification from a school with the second oldest DNP programs in the country and one of the first to offer the soon-to-be standard BSN-DNP programs. Yes, there are poorly organized, money-grubbing programs that have been slapped together to meet the 2015 deadline, but I can name at least 3-ADN "franchise" schools that are not fully accredited yet churn out LPNs and RNs at a high profit with marginal education. You have to do your research and talk to current students and graduates of the program you are looking at, no matter what the discipline. But more importantly, you have to know what you want out of your career and lifestyle as a whole. There are a lot of things you can do with an RN besides become an APRN, and many of them are more lucrative with a lot less risk - this is why a couple of years of practice is invaluable before jumping into more school.

    If you want to be a clinical practitioner, possibly teach clinical at the undergraduate level or precept at the graduate level, and think you might be interested in conducting small-scale EBP research and evaluative projects you can be directly involved with, the DNP in your area of specialty is where you should look. This is why the DNP is considered the terminal CLINICAL PRACTICE degree for nursing. If your goal is providing education at the university level or conducting larger grant-funded research projects with a lot of publications, why the heck would you want to be an advanced practice provider in the first place? Of course, interests change as life goes on, but if you already know at the RN-level that you want to be the next great theorist, basic RN practice should provide all the clinical necessary for real-world experience before moving onto the PhD or EdD. If you want to focus on nursing management and administration, well, get a law degree.

    I say that only slightly in jest.

    On the matter of MD training hours: Medical school applicants are not required to have a single hour of clinical practice before entering their program and generally do not touch a living patient until their second year of schooling when they are around age 24. The person with a BSN degree of the same age who applies to an NP program would have already had 4000 hours (assuming a 36-40 hour work week) of independent, basic nursing practice in addition to the undergraduate clinical training with patients that they started around age 19. True, the RN-level practice is not as independent as those providers with advanced degrees, but the core skills of assessment, organization, interpersonal dynamics, experiential knowledge base, and holistic care management are developed and refined. This "basic practice" is the foundation for advanced practice, and to ignore these hours when comparing training programs is neglectful and manipulative from those who try to belittle our profession. I would further argue, and the satisfaction and outcome research bears this out, that when it comes to primary care, the cost of medical training and drain on medicare to fund primary care residencies is neither cost-effective or efficient. The problem is not that NPs have fewer hours of training than MDs, the problem is perpetuating the belief that one actually needs 10000 hours of school to deliver quality primary care. This is an oversimplification, but I liken it to taking beginning Spanish over and over when you are already fluent in 2 dialects. How much education do you really need to deliver quality primary care? There is a capstone project for you!

    On PA doctorates and such: It is my understanding that the PAs were created as the MDs' answer to NPs, though certainly the role has changed over time. I think PAs have a huge semantic hurdle to overcome given that it contains "physician" and "assistant" in the title. I suppose the discussed replacement of "physician associate" is a little better, but that still sounds far more handmaiden-like than nurse practitioner. Then again, when I tell people I am a nurse practitioner, I still get some folks asking me if I plan to get my RN. I have enough trouble in my own profession without taking on their concerns, but one thing I will speak out on is the occasionally proposed (by MDs, usually) merging of PAs and NPs into a single MLP or physician-extender title. No thanks.

    On the DNP experience: I graduated in May and kept a blog of my journey to the "Dr. Nurse." One of the running jokes I heard when I talked about pursuing a doctorate in nursing was the old "there can't be that may ways to change a bandage," however I was enriched in ways I did not expect and it translates to how I care for patients.

  • Mar 5 '16

    @Feistn - awesome points. A large percent of ER visits are related to mental health disorders, domestic violence, and intoxication of some form. These patients encounter a lot of stigma and are often labeled by their disease and their complaints neglected as a result (yes, people with bipolar actually can have a stroke!). Admittedly, psych is not the best place to start if the ER is where you want to be, but it is not because of losing your familiarity with physical tasks, but with the differences in prioritization and time management. If there is any way you can float to a med-surg unit with monitored beds or to a step-down unit, you would have the most comprehensive foundation for an ER career. Or, you may like mental health so much that you will want to work in the psych-ER!