DNP's taking certification exam similar to USMLE by 2012?

mige · May 23, 2009

I think this is what is getting all the medical students in a tizzy. How dare DNP's take the same exam as MD's take when they have so much less education is what most are saying over at the SDN. However, one should also remember that the NP associations are similarly unwelcoming of this idea. Per the official AANP statement on this new certification and I quote, "AANP is not supportive of plans for an added layer of certification for DNP's at this time, particularly one that involve the profession of medicine. It is inappropriate for one profession to credential or regulate another, as this is clearly in the purview of nursing".
I am personally as confused as everyone else. ABCC came up with this certification with seemingly no prior consultation with all NP groups. USMLE Step 3 tests knowledge as a general medical practitioner. It covers medical care across all age groups. It seems appropriate for those who trained as an FNP. But not all NP programs are geared towards this kind of clinical practice. I for one received training in the care of adults with emphasis on the acutely ill. I did not receive any training in peds, women's health, and psych. If I do get a DNP, I should not be expected to take an exam that covers more content than I had in my NP training.
It is much too early to predict how this new exam is going to be accepted. The ABCC board appears to be composed of deans and other members of the academia both in the fields of nursing and medicine. Right now I am bound to say "what are they thinking?"
For those who want to find out more about this certification, here's the weblink:
http://abcc.dnpcert.org/about.shtml

This shouldnt be an excuse not to take the step 3. My wife is a surgical resident and she has to take Step 3 even though is 60-70% internal medicine with pediatrics/OB-GYN and surgery. She hasnt had an IM rotation in 2-3 years!!

forpath · May 23, 2009

They are already starting to take it...

From the ABCC website, "The content of the exam is focused on evidence based clinical care. Clinical evidence is applied to practice by many direct care providers; its application is not limited to the medical discipline. The exam is not intended to test graduates from the diverse DNP models of education, but rather to test clinical competency in comprehensive care for the graduate whose doctoral education is focused on direct clinical care."

As you all probably know, 45 experienced NPs with DNPs took the test recently...50% passed. Besides the fact that that is a mathematical impossibility, what do you all think of those results in light of the ABCC's description of what the test is supposed to measure? To me, this means that 50% are incompetent to practice as DNPs and should not be allowed to until they pass, just as MDs/DOs are not allowed to practice until they pass theirs. Some have criticized it as being a physician-aimed test, but Mundinger says the test that was administered was designed especially for APNs.

n_g · May 24, 2009

As you all probably know, 45 experienced NPs with DNPs took the test recently...50% passed.

The level to pass was also set lower. That's something to consider if this test is mandated for all DNP's. What if the medical groups force the real USMLE step 3 on us?

prairienp · May 25, 2009

they are already starting to take it...
from the abcc website, "the content of the exam is focused on evidence based clinical care. clinical evidence is applied to practice by many direct care providers; its application is not limited to the medical discipline. the exam is not intended to test graduates from the diverse dnp models of education, but rather to test clinical competency in comprehensive care for the graduate whose doctoral education is focused on direct clinical care."
as you all probably know, 45 experienced nps with dnps took the test recently...50% passed. besides the fact that that is a mathematical impossibility, what do you all think of those results in light of the abcc's description of what the test is supposed to measure? to me, this means that 50% are incompetent to practice as dnps and should not be allowed to until they pass, just as mds/dos are not allowed to practice until they pass theirs. some have criticized it as being a physician-aimed test, but mundinger says the test that was administered was designed especially for apns.

i think the results are exactly what many of us anticipated. the test is not worthwhile and has no meaning to practicing dnps. the test has nothing to do with if they can practice. the test will most likely go away now. the proof of how well nps provide direct patient care is in the research studies. all of these new dnp students will be doing practice improvement projects, further enhancing practice outcomes for nps. research has far more impact on np practice than abcc test results on 50 dnps.

forpath · May 25, 2009

i think the results are exactly what many of us anticipated. the test is not worthwhile and has no meaning to practicing dnps. the test has nothing to do with if they can practice. the test will most likely go away now. the proof of how well nps provide direct patient care is in the research studies. all of these new dnp students will be doing practice improvement projects, further enhancing practice outcomes for nps. research has far more impact on np practice than abcc test results on 50 dnps.

so would you go so far as to say that the same would be true of any licensing exam, that they are not worthwhile? why take medical boards, the nclex, the bar exam, sit for phd comps, etc? and how do you ensure that every student is getting an equal educational experience if you do not have a standard metric by which you compare them all?

if all 50 nurses passed the exam with flying colors, would you still say the test was not worthwhile or would you say "see? dnps are the bomb."? i think it would be a mistake for the test to go away, as it would damage the image of the profession. "we took the test, half of us failed, so we're not taking that test anymore. it's too hard. but hey, bring us your children and other loved ones."

and why would you say that it has no meaning to practicing dnps? it was supposed to measure minimal clinical competence of new dnps (who were experienced nps when they took the test, by the way) and mundinger said it was designed specifically for dnps. if one cannot prove minimal competence on paper (which is based on knowledge), then why should one be able to practice? in my opinion, the failures of this test are incompetent to practice until they pass, and even then they are suspect.

how should we measure minimal competence of healthcare practitioners? wait until they kill a few and then let the free market take care of it?

prairienp · May 26, 2009

so would you go so far as to say that the same would be true of any licensing exam, that they are not worthwhile? why take medical boards, the nclex, the bar exam, sit for phd comps, etc? and how do you ensure that every student is getting an equal educational experience if you do not have a standard metric by which you compare them all?
if all 50 nurses passed the exam with flying colors, would you still say the test was not worthwhile or would you say "see? dnps are the bomb."? i think it would be a mistake for the test to go away, as it would damage the image of the profession. "we took the test, half of us failed, so we're not taking that test anymore. it's too hard. but hey, bring us your children and other loved ones."
and why would you say that it has no meaning to practicing dnps? it was supposed to measure minimal clinical competence of new dnps (who were experienced nps when they took the test, by the way) and mundinger said it was designed specifically for dnps. if one cannot prove minimal competence on paper (which is based on knowledge), then why should one be able to practice? in my opinion, the failures of this test are incompetent to practice until they pass, and even then they are suspect.
how should we measure minimal competence of healthcare practitioners? wait until they kill a few and then let the free market take care of it?

i was not aware this was a "licensing" exam. in reality the exam appears to have been created/designed for the dnps from a specific program coordinated by mundinger. many nurses forget that the dnp is a program of study, whereas a np is a specialty area (cns, cnl, cnm). we have certification exams for nps, that have in fact served us well over the years. in addition, states issue a license to nps to practice, which add another layer of protection for the health care consumer. we should continue to measure the competence of nps with the certification exams and licensing methodologies that have been in place for years. nps have historically been the most researched component of nursing, everything from educational level to practice to practice outcomes. with the new influx of dnp np we should see even more outcome studies reflecting the efficacy of np practice in the us. we should not base a dnps ability to practice on one exam offered for the first time to 50 dnp students.

forpath · May 26, 2009

i was not aware this was a "licensing" exam. in reality the exam appears to have been created/designed for the dnps from a specific program coordinated by mundinger. many nurses forget that the dnp is a program of study, whereas a np is a specialty area (cns, cnl, cnm). we have certification exams for nps, that have in fact served us well over the years. in addition, states issue a license to nps to practice, which add another layer of protection for the health care consumer. we should continue to measure the competence of nps with the certification exams and licensing methodologies that have been in place for years. nps have historically been the most researched component of nursing, everything from educational level to practice to practice outcomes. with the new influx of dnp np we should see even more outcome studies reflecting the efficacy of np practice in the us. we should not base a dnps ability to practice on one exam offered for the first time to 50 dnp students.

excellent points.

it is not a licensing exam, as it is voluntary. i would presume, however, that there is something more that a dnp learns with respect to clinical practice than is learned in fp school. otherwise, there would be no need for a dnp. if one wanted to achieve a doctorate level in nursing, one could pursue a phd, especially as you have stated that there are people looking to the dnps to provide more research. in addition, there must be more that is learned (or supposed to be learned) as half of the experienced nps who took the exam failed it. if it tested only the stuff they learned as nps (both during school and on the job), one would presume all would have passed. keep in mind that this test was, as you stated, designed for these nurses based on their program of study. and as it was the first test offered, one would think that mundinger would have motivation to see the test was fairly constructed. i just have a hard time rectifying the results with respect to clinical capacity.

if the dnp is going to be offered, there has to be a standardized assessment of their knowledge. every doctorate level has it, and they should be no different. as i said before, there has to be a metric by which you compare all practitioners, at least on paper, and this metric, in my opinion, should be a knowledge based test. if you cannot pass, you cannot practice.

the trouble, however, lies with the fact that there is probably very little difference between what an np does everyday and what a dnp does everyday. you probably cannot stop a licensed np from practicing when he/she cannot pass the dnp exam. so this all goes back to what a lot of people have said, why even have the dnp when there is a phd and an nd already developed? which raises a good question. did nds have licensing exams different from nps?

elkpark · May 26, 2009

I would presume, however, that there is something more that a DNP learns with respect to clinical practice than is learned in FP school. Otherwise, there would be no need for a DNP.

That is a very large presumption, at this point. Most of the current DNP programs are designed for people who are already practicing NPs (educated at the Master's level) to complete the additional requirements for a DNP, although the long-term plan is for people to go directly from the BSN to the DNP. The curricula I've looked at (casually, just out of curiosity) have had little or no additional clinical practice content, and have been focused on the research/management/systems/advocacy elements of the "role." The entire DNP concept is still controversial, and the larger nursing community (even the larger NP community) doesn't seem to be in a big rush to jump on Mundinger's bandwagon. It's not clear that future DNP programs will include significantly more clinical content than current MSN-level NP programs, at least partly because it's not clear that there's a need for more clinical education than NPs have always gotten.

There is a "standardized assessment" of NP knowledge and practice -- the national certification exam(s), which have been around for a long time. There have never been additional "licensing exams" for nurses at the doctoral level (ND, DNSc, DNS, etc.) because doctoral education in nursing has never before been about expanding or extending clinical practice -- all advanced practice education was at the Master's level, and all four advanced practice roles (CNS, CNM, NP, and CRNA) have national certification exams which have appeared to be working just fine all this time.

prairienp · May 26, 2009

\ the curricula i've looked at (casually, just out of curiosity) have had little or no additional clinical practice content, and have been focused on the research/management/systems/advocacy elements of the "role." the entire dnp concept is still controversial, and the larger nursing community (even the larger np community) doesn't seem to be in a big rush to jump on mundinger's bandwagon. it's not clear that future dnp programs will include significantly more clinical content than current msn-level np programs, at least partly because it's not clear that there's a need for more clinical education than nps have always gotten.

i agree the np community is not embracing mundinger's bandwagon, but they are embracing the dnp. look at all the programs that have or will transition to the dnp program of study. the transition to the dnp has been far faster than when we transitioned to the ms requirement. the guidelines i have reviewed call for a 1000 hour clinical minimum, where we currently have a 500 clinical hour requirement now for fnp.

we need to put things in perspective, look at the transitions of our fellow health care providers. pt, ot, pharmd, jd and md to the doctorate. i really believe we have placed as much or more effort and reflection into our transition to the dnp than others who transitioned into the doctorate. did we see a significant change in how drugs are distributed for pharmds? how about pt, what are they doing differently now that they have a practice doctorate? i did not oppose any of these other programs transitioning into doctorates. seems as if a few of our healthcare provider peers may have some difficulty with our transition to the practice edoctorate(as well as nurses).