There seems to be a lot of opinions about what role NP's should fill in health care. I offer my personal view for the future of advanced practice nursing. Please critique my proposal, as I am not a Nurse Practitioner I suspect some of my views might miss an obvious limitation or reality of nursing practice.
Near term: eliminate the proposed requirement for all NP programs to transition to DNP by 2015. emphasize NP collaboration with physicians as a mid-level practitioner. Revise and expand the curriculum for DNP and / or begin to model the curriculum after medical and osteopathic schools. Push for an expanded scope of practice for DNP's as primary care providers
Far term: Give DNP's full practice rights (they will probably have to take a route like DO's, begin with family practices and gradually expand into all specialties) Maintain masters degree prepared NP's as mid level providers with supervision or collaboration with DNP's and MD's/DO's
Are there any glaring errors or problems with this proposal?
I understand that I just don't see NPs working for DRs preferentially over DNPs. I imagine that most NPs would either get their DNP or would be equally likely to work for a DNP as a DR. From my observation, Nurses talk a lot of smack but when it comes to doing a job they are generally professional and get down to buissness.
and the vast majority of pediatricians, internists, podiatrist, psychiatrist all do clinical research and contribute to the knowledge base… right (sarcasm)
you don’t need a masters degree in engineering to fix a car, you don’t need a medical degree to treat the vast majority of issues that present in a general practice. i am not trying to devalue the research the doctors do, but that level of education isn't nessisary for what nps do.
well, you've only looked at med school, np curriculum but md education continues to residency and fellowship which requires research before you graduate (acgme rule). not all mds publish continuously but it's very likely that prior to become full pledged physician that they have contributed meaningful knowledge to the medical literature. you really need to do more research and should probably read acgme rules and not just lcme, people tend to forget how much physician train. and no i've never, seen any significant np or pa published research, even from phd-trained nurses, i just never encounter them, but i bet that you and your advance practice colleagues read and use physician-written research articles, guidelines, textbooks.
and i agree, you dont need a doctorate to perform much of the bedside work but we get doctorates because we go above and beyond the minimum to ensure quality and produce academics that will disseminate knowledge, not something many midlevels do or can do. but just because they can do general, uncomplicated bedside work does not make their degrees, skills, knowledge equal to a physician's.
i try not to lump mds and phds together because we do very very different research and publish in different journals. we dont do as much basic science research as phds, we just dont have the time, equipment, expertise to do that but not many phds publish clinical research either because they just dont have the clinical background to do so. there are many combined md, phds that do both and pretty much 90-95% of md schools in the us offer combined md, phd degrees, my school graduate eight of them per year. many phd programs are also offered in medical schools and many of those phds teach our classes and mentor us during our research, again not something you find in nursing, pa schools.
Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care.
You obviously do not understand the plans for transitioning the DNP degree. Master's Prepared NP's will be grandfathered in, we will continue to work as we currently are. We are not going away. Please, get informed about this topic!!!! Why don't you go find some NP's and talk to them. Go talk to faculty at your nearest university that offers graduate nursing degrees specifically the DNP.
Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care.
Preface: I am not an NP -- just a curious well-wisher who has been involved in roles for nurses with graduate education for years.
This proposal sounds like it might be a "divide and conquer" strategy -- one that might actually be very appealing to some of the more devious physicians.
Step 1: Divide the NP's into 2 camps, MSN & DNP
Step 2: Pit them against each other MSN vs. DNP
Step 3: Support the MSN group as their practice will require supervision from a physician. Fight against the DNP group as they will be competition for physicians.
Step 4: Enjoy the show and the financial rewards that will come after reigning in MSN practice to fall under physician control and the competitive, independent DNP practice is defeated. The nurses will beat each other up in the fight and the physicians will end up controlling it all.
None of the above will happen, MSN's will be grandfathered in, and with the ANCC retiring some NP specialties, those that keep current certification will still be allowed to practice.
Thank you for stating you are not an NP, but it is obvious from everything you wrote.
In my state, we have independent practice so your step 3 is moot, no physician involvement is required. Did you know there are a few other states with APN/APRN have completely independent practice? You and the OP clearly do not understand all that is involved.
Did you know there are some universities that are accepting non NP's in their dnp programs??
So DNP does not equal a NP in every case, though originally the DNP was intended at the clinical doctorate for NPs.
Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care.
interesting theory, i just don't see msn nps and dnps taking up arms against each other. assuming dnps were given the same practice rights as physicians (with or without the amas blessing) i would imagine msn nps would prefer to work under dnps.
you are in serious need of needing to get informed about the dnp proposal. it is extremely obvious you do not understand that is is the terminal degree.
each state board of nursing is what dictates scope of practice, not the degree that is held, so it is up to each state.
what do you mean by "same practice rights as physicians"? again, as an np in a state with independent practice, (meaning np's can & do have their own clinics/practices without physician involvement) your statement makes no sense.
as to working "under dnp's, why would i need to work "under" anyone?????again, independent practice is what the nurse practice act in my state grants nps, with full prescriptive just like physicians.
Sailornurse:I think you have either misread or misinterpreted my posts. Obviously those who currently practice with MSN degrees will be allowed to continue to do so. My proposal is to keep the MSN prepared NP even if that means that new graduates of MSN NP programs have to work with a limited scope of practice. I have researched the nursing programs in my area, they all offer the DNP as a post masters degree. There are no BSN-DNP programs in my area. Finally, I understand that individual states regulate the scope of practice / rules for all licensed professionals. Not just healthcare workers. That still doesn't preclude anything I have posted.
None of the above will happen, MSN's will be grandfathered in, and with the ANCC retiring some NP specialties, those that keep current certification will still be allowed to practice.
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You misunderstood my post. I was reponding to the OP's suggestion to create 2 different levels of NP -- one at the MSN level and one at the DNP level. I was NOT saying that the current plans for the nursing profession involve 2 different levels.
I am fully aware of what a DNP is ... the types of students being accepted into programs, etc. I was not commenting on the the REAL current situation. I was commenting on the proposed 2-tiered system described by the original post.
Perhaps you should go back and re-read the original post so that you can place the later comments in this thread in their proper perspective.
I was not commenting on the the REAL current situation. I was commenting on the proposed 2-tiered system described by the original post.
Perhaps you should go back and re-read the original post so that you can place the later comments in this thread in their proper perspective.
llg, I was going to say that to sailornurse...that he or she had completely misunderstood your response to the OP. That person's response felt like a libelous attack on you! I appreciate your posts.
Ummm, Benzos, don't know how to break this to you, but, all of my instructors in my graduate program are doctoral-prepared nurses who also practice as nurse practitioners, so I don't know what criteria you are basing your information on. All of my instructors are well published authors of research in their field. In fact, my physiology instructor also taught med school students. Come to think of it, most of my professors in my BSN program had their PhD and practiced as NPs.
Please do a little research before spouting off unsubstantiated statements regarding nursing on a nursing board.
llg, PhD, RN
13,469 Posts
really? you don't know much about nursing, do you? nursing is full of infighting. just do a little research on the entry-into-practice issue.