Latest Comments by OneDNP

OneDNP 1,536 Views

Joined: Sep 19, '12; Posts: 7 (43% Liked) ; Likes: 5

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    The 2015 rule for DNP degrees simply means that the minimum entry to practice for APRNs will be doctoral rather than master level. It does not mean if you are currently an NP or in an MSN-NP program that you have to get a DNP by 2015 to continue practicing or sit for boards. It also does not mean if you want an MSN in education or administration that you have to have a DNP to teach or manage. This happened with pharmacy in 1995 If you graduated from pharmacy school in 1994 or prior, you could be a master-level-trained pharmacist. If you graduated from pharmacy school in 1995, your program would have to have been doctoral level in order to sit for boards. There are plenty of masters level pharmacists practicing with the same scope-of-practice as their doctorally prepared counterparts (though likely making less money if years of experience are close). This is currently happening with physical therapists, but I think they have until 2017 to implement the DPT and phase out the MPT.

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    I graduated with my DNP (certified FNP/PMHNP) this year and just started my orientation at the Louisville VA. In my orientation class, I was the only APRN in a group of 3 RNs and one LPN. I am really grateful to the folks on here who have shared their stories on the VA hiring process, though nearly all of them are for RN positions. If anyone is interested in the process for advanced practice nurses, especially anyone working in Mental Health, feel free to read my experience:

    The short version is, from application to walking into orientation, it took 223 days (7 months and 9 days), though I could have started up to a month earlier if I did not have previous commitments to patients, conferences, and travel. Had I been certified as a PMHNP at the time I applied in April, I likely would have been hired initially and started within 90 days.

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    For folks who want to know scope of practice by state, this is a great resource that breaks down a few common areas such as prescriptive authority and independent practice:

    There are also links at the bottom of the page to more detailed resources.

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    jh07418 - I am a PMHNP/DNP and an FNP. If you are interested in becoming a psych-NP, there are a number of quality programs across the country and many require little to no experience as a psych nurse. I graduated from UTHSC and they offer duel certification FNP/PMHNP in their 3-year BSN-DNP program. Since you already have psych experience as an RN, you will be prepared, but I agree you should shadow and talk to a few PMHNPs in your state to see if the work is right for you. There are so many opportunities within the role, especially since they are incorporating more of the CNS therapy-focus into NP education.

    mpolen - you will graduate prepared to perform medication management and individual/group/family therapy in the hospital and community settings, but you have to check your state practice acts for NP scope.

    APNA is a great resource for links to programs, state information, and upcoming legislation: Advanced Practice Psychiatric Nurse Resources - American Psychiatric Nurses Association

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    I do not want to get overly dramatic, but it sounds like your bosses are using the current job market to their advantage and while they are telling you how great you are with the kids, you are absolutely expendable. This behavior sounds institutional and I would be surprised if you heard management on other units was significantly better. You need to write an account of everything that has occurred since things started to go south and collect all correspondences regarding transfer requests, disciplinary actions, injuries, refusals, ect. Prepare it as though you were going to present it to your state board of nursing in defense of your license. In fact, you may want to ask for guidance from them - after all, the BON is there to protect the public from nurses, an if you feel you are being out in a situation that will lead to patient harm, they will listen.

    Please honor your own sanity. Best to you in this difficult situation.

  • 1
    Lizlaw likes this.

    @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!

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    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.