Doctorate for Advanced Practice Nursing??

[bookwormom]

I read an article in a nurse practitioner journal a few days ago that said there is a move for all advanced practice nurses to be educated at the doctoral level by 2015. (It wouldn't affect anyone already in an advanced practice position.) What do you think of this? Is it likely to fly?

I have very mixed feeling about this. Does anyone have a good understanding of the implications? How would it affect MSN preparation, etc?

[bookwormom]

After reviewing the links posted by Siri, it appears to me that a doctorate of nursing practice could allow one to teach, but would exclude one from the tenure track. Not a good thing!!! If you are outside the academic setting, tenure doesn't seem too important, but within the academic setting, it really counts. Without it, you are pretty much an "at will" employee, and not only lack job security, but are alson limited in the amount of participation in academic governance.

[carolinapooh, BSN, RN]

After reviewing the links posted by Siri, it appears to me that a doctorate of nursing practice could allow one to teach, but would exclude one from the tenure track. Not a good thing!!! If you are outside the academic setting, tenure doesn't seem too important, but within the academic setting, it really counts. Without it, you are pretty much an "at will" employee, and not only lack job security, but are alson limited in the amount of participation in academic governance.

Which, to my thinking, makes a DNP no different than a DPT (or whatever the initials are that the PT folks are using now) or a PharmD. In academia, you’re nothing without a PhD. I have no desire to have a PhD, as I have no desire to get wrapped up in the whole tenure deal and in research (the thought bores me). Professors at pharmacy schools have PhDs (in addition to their RPh or PharmD), just like professors anywhere else. Professors at med schools have their MD and a PhD. A PhD is an academic credential in a way that “MD”, or “PharmD” or “DNP” is not.

[SharonH, RN]

I have mixed feelings about this. On the one hand, I am excited at any attempts to raise the level of skill and education for nurses. I also think that a good point is made in that the Master's degree for nurses already requires significantly more hours than other Master's degrees and if it is going to take 3-4 years to obtain an advanced degree then why not go on and obtain a practice doctorate. I am always disappointed that the knee-jerk response from nurses from any attempt to raise our educational standards seems to be always NO.

However there have been some good points made in opposition to this new degree. So now we have 4 doctoral degrees and this will make 5. Clearly that is too many. I would like to see 3-PhD for education, DNSc for research and DNP for clinical doctorate. I am sure that there are those who would argue that even that is too many. And I am against the current multiple modes of entry into the profession. We need to get that cleared up and yet, we haven't been able to in 40 years.

There are also regulatory issues. NPs do not have equal practice privileges in all states and CNSs do not even have title privileges in all states. No matter how many degrees I get as a CNS, as far as the state of Georgia is concerned I have the same scope of practice as an ADN nurse. This needs to be addressed before we go further. That's just my two cents.

[llg, PhD, RN]

However there have been some good points made in opposition to this new degree. So now we have 4 doctoral degrees and this will make 5. Clearly that is too many. I would like to see 3-PhD for education, DNSc for research and DNP for clinical doctorate. I am sure that there are those who would argue that even that is too many. And I am against the current multiple modes of entry into the profession. We need to get that cleared up and yet, we haven't been able to in 40 years.

.

As you probably know from having read my previous posts, I am in totally agreement with the gist of your post. However, I would like to point out... that in all other degrees, the PhD is the research degree. I think we should be consistent with the other disciplines on that issue.

In many (most?) cases, the DNSc degree was started by schools that wanted a PhD program, but didn't want to have to deal with the university politics that the PhD degree requires. So, they made an equivalent degree that by-passed some of the required committee approvals, etc. To, me, that was a big mistake as it makes us look bad in the eyes of other disciplines.

In my "perfect world," the PhD would be the academic doctorate -- for teaching and research (since faculty are required to do both) and philosophy. Another degree (DNS? DNP? whatever?) would be for practice. That would make us similar to other disciplines that have 2 doctorates -- one academic, the other practice. But I would be open to considering a third degree IF everyone would get together and agree to abide by the group consensus and stick with the intent of the decision and not keep adding more every time they feel like it.

I also don't mind 2 entry levels -- IF -- everyone would agree to be consistent in what the 2 levels meant. The problem is, people feel free to bend and stretch things to suit their particular desires. That shouldn't be allowed.

llg

[1Tulip]

I agree (in principle) with Sharon about the problem of the MSN. Takes 2-3 years and doesn't cut you any slack when you go for your PhD. My PhD is in one of the biological sciences, and it was annoying that all my classmates had been admitted right from their undergraduate degree.

When the MSN was developed, there weren't a lot (if any) PhD programs in nursing and it was pretty much as far as you could go, a terminal degree if you will. Now there are lots of nursing PhD programs (maybe too many?). I've always thought that we should make the MSN the first two years of the doctorate. If you want to stop there, fine. If you want to go further, you do no further "class-room" stuff, and go right into your research/dissertation, which should represent another two years of work.

I believe some graduate programs have done this in the past, but whether your MSN from another University would be transportable to such a program, I don't know.

[SharonH, RN]

In many (most?) cases, the DNSc degree was started by schools that wanted a PhD program, but didn't want to have to deal with the university politics that the PhD degree requires. So, they made an equivalent degree that by-passed some of the required committee approvals, etc. To, me, that was a big mistake as it makes us look bad in the eyes of other disciplines.

llg

I didn't realize that ws how the DNSc came about. How interesting.......and embarassing. What a mess.

[llg, PhD, RN]

I didn't realize that ws how the DNSc came about. How interesting.......and embarassing. What a mess.

The same is true for some DNS and DSN programs. PhD programs require that the program be supervised by the same multidisciplinary committees that govern all the PhD programs within the university. PhD programs are considered the "highest" academic degree and are usually conferred by the academic community as a whole -- not just by a single professional school.

When some nursing school wanted to start doctoral programs, they didn't want the hassle of meeting the requirements of the academic community as a whole -- so they opted to create "practice degrees" that would be conferred by the nursing schools instead of full PhD's. If you look at the curricula of some of these programs, they exactly match PhD programs. If they really wanted a different program, they would have different courses, etc. What they wanted was a PhD program without the PhD hassle. Yes, it is embarrassing.

What I have said above is not true of all schools: some school really did want a different focus to their doctoral programs and developed DNS programs that look significantly different from PhD programs. Also, it doesn't mean that the programs are of bad quality.

But I think the proliferation of lots of different degrees without any standardization is a big mistake. It makes us look bad -- and makes it harder for nurses to get the right credential, particularly as people move around the country where different degrees are offered. People find they don't have the "right" degree that the local school offers because they were educated elsewhere.

llg

[traumaRUs, MSN, APRN]

Linda - as per her usual - you are a wealth of knowledge. Thanks for all your information. I do want to respectfully add that for those of us who want a CLINICAL doctorate, in my opinion, the DNP is the way to go. Again...as with all education, it is predicated on what is available in your area, can you move to another area, how much can you spend, what your terminal goal is.

For myself, I did the MSN in management and leadership because I could easily get through it. However, I knew I didn't want to go into management, so I'm pursuing an APN as a post-master's certificate.

[elkpark]

When some nursing school wanted to start doctoral programs, they didn't want the hassle of meeting the requirements of the academic community as a whole -- so they opted to create "practice degrees" that would be conferred by the nursing schools instead of full PhD's. If you look at the curricula of some of these programs, they exactly match PhD programs. If they really wanted a different program, they would have different courses, etc. What they wanted was a PhD program without the PhD hassle. Yes, it is embarrassing.

I can vouch for this from my own experience -- while I was taking an MSN at a well-known, prestigious university quite a few years ago, the SON decided to develop a doctoral program. There was great interest and discussion about this (not involving the students, of course, but we knew it was going on), and it was finally announced that the new program was going to be a DSN degree. I was v. puzzled and disappointed, since the university is known for its rigorous academic standards -- I had assumed the new program would be a PhD. When I asked several of the faculty about this, no one really wanted to talk about it, and the faculty person I was closest to finally told me (after I kept pestering her) that many of the current faculty were v. unhappy about the final decision, because they had wanted a PhD program, too, but the SON administration had decided to go with the DSN because they didn't want to have to meet the high standards and requirements they would have to meet to offer a PhD. That would be too much trouble -- the DSN program would be much easier and cheaper ...

I also second your comment about the PhD being awarded by the university as a whole, vs. the other graduate degrees. At commencement at the same university, all the undergraduate degrees were conferred in one fell swoop by the word (and wave of the hand) of the university president, without the undergrads even getting up from their seats (no walking across the stage and getting your hand shook), and, later, the graduate schools all had their own small ceremonies in which you were awarded your degree by the Dean of your school (we did, at least, get our handshake). However, during the big, mass ceremony, after the speaker, EVERY PhD candidate was led up onto the stage one at a time and personally hooded by the president of the university, and everyone on the dais (including the commencement speaker) clustered around and shook each candidate's hand, while all the undergrads and all other grad students and all the families and friends in attendance watched, because it was such a BFD that these people had earned PhDs. There is a huge difference between a PhD and these "quick 'n dirty" doctorates, which I think most of the nursing community doesn't really appreciate.

I agree with you that this makes nursing look like a second-rate, "wannabe" academic discipline. Perhaps the current (traditional) nursing model makes so much sense to me because I started out in the fine/liberal arts (I am also a classical musician), and the degree "process" works the same way in the fine/performing arts -- the baccalaureate degree is your "foot in the door," the entry level (like generalist nurses) -- if you want to do something else for a living, or get a teaching certificate and teach music in the primary/secondary schools, or give piano lessons in your living room, or whatever, that's all you need. If you want to go on to be a serious performer (make a career of being a concert musician), you get a Master's in performance, which I think of as corresponding to advanced practice nursing. Then, if you want to go further, the next step is scholarship/research/teaching, and you get a PhD in something scholarly -- music history, musicology, theory, composition, or pedagogy.

I believe that this is a robust, defensible model for nursing (as it is for music and the other fine arts). I think the proliferation of "practice doctorates" just makes us look like both "wannabe" academics and "wannabe" physicians (how often does the discussion about practice or clinical doctorates include the "this will give us parity with the docs" argument). The nursing practice doctorates are, pretty much, a joke compared to PhDs in any discipline, and certainly a joke compared to the medical school/residency process (if anyone really believes that practice doctorates will make physicians take us seriously as equals, I have some swamp land for sale in FL that I'd love to tell you about ...)

I have followed much of the debate about this, and I'm completely unimpressed. I am still convinced that the Master's level is the appropriate level for advanced practice nursing education, and the doctoral level should be about scholarship/research. Why do we need to be "like" doctors, pharmacists, etc., anyway? We're a separate discipline and we can forge our own path.

[christvs, DNP, RN, NP]

I'm an RN who just got accepted into an MSN program to become an NP. After I complete this program I have absolutely no desire to get a doctorate because I don't have interest in research (although I frequently read nursing journals to stay up to date) and if I want to teach nursing students one day I know I can teach ADN students, LPN students and in some cases BSN students with my Master's degree in nursing. (I also already hold a MS degree in biology). I think it's great if some nurses want to get their PhD, or DNP degree, but I do not think it should be made a requirement to get a doctorate degree to become an NP. That is just my two cents worth.

-Christine

[llg, PhD, RN]

I can vouch for this from my own experience -- while I was taking an MSN at a well-known, prestigious university quite a few years ago, the SON decided to develop a doctoral program. There was great interest and discussion about this (not involving the students, of course, but we knew it was going on), and it was finally announced that the new program was going to be a DSN degree. I was v. puzzled and disappointed, since the university is known for its rigorous academic standards -- I had assumed the new program would be a PhD. When I asked several of the faculty about this, no one really wanted to talk about it, and the faculty person I was closest to finally told me (after I kept pestering her) that many of the current faculty were v. unhappy about the final decision, because they had wanted a PhD program, too, but the SON administration had decided to go with the DSN because they didn't want to have to meet the high standards and requirements they would have to meet to offer a PhD. That would be too much trouble -- the DSN program would be much easier and cheaper ...

.

Thanks for sharing your story. It is much like mine. I got my MSN years ago at a school that had recently started a DNS program. My faculty advisor confided the "behind the scenes" story to me much like your faculty insider told you.

Some of the DNS, DSN, and DNSc programs are quite good. I don't mean to insult the work that any of the graduates from those programs have done. But in the academic world, they will always be 2nd class citizens and I think it is unwise for the discipline of nursing to go that route for its terminal scholarly degree. I can understand the creation of a "practice doctorate," but the school leaders should get together and agree on ONE title for that degree so that there is no confusion about what it is.

The leaders who have created the mess of degrees that currently exist and who now propose making it all even messier should be ashamed of themselves. They are making a mess for the students and for the profession for their own personal interests. If they really had the interests of the students and the profession at heart, they would not be making things worse. They would be "cleaning up the mess."

llg

[traumaRUs, MSN, APRN]

I agree llg - there must be one practice doctorate.