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?
Specializes in Critical Care, Emergency, ACNP, FNP.
DOs became equivalent to MDs because DO schools changed their curriculum to match that of MD schools. So, as a DO, you have the exact same curriculum as you do with MD schools (with the exception of OMM). MDs/DOs go through the same training during med school, learn the same things, go through the same residencies, etc. MD and DO training is 99.9999999% the same. That's why DOs are equivalent to MDs.
If midlevels changed their curriculum to reflect 4 years of med school + a minimum of 3 years of residency training involving tens of thousands of hours of clinical training (which is what MDs/DOs do before practicing independently), I'm pretty sure no one would be complaining and physicians would be fine with it. You'd have no one opposing you if that's the case. Make sense?
For one thing, it would still be a battle since much of this is economic. More importantly, however, is why would nursing do this? What's the point? People should then just go get allopathic or osteopathic training. Nursing offers a unique perspective and approach that should never be lost. I don't want to see DNPs go the way of DOs and seemingly lose the discipline-specific values, skills, and offerings that uniquely add to the healthcare landscape.
BTW, if NPs are midlevels, what are staff nurses? We need to use another term or simply say NPs, PAs, CRNAs, CNMs, CNSs, etc...
After reading the Institute of Medicine's "The Future of Nursing: Leading Change, Advancing Health" (found here: The Future of Nursing: Leading Change, Advancing Health) I have really rethought my proposal. Expansion of practice rights for NPs is a Given but I am not so sure they need the "Physician" title. Perhaps that is too much like getting into bed with the enemy. I do hate to see the DNP become the standard. Currently most MSN NP programs are around 40 - 60 credit hours, DNP adds another 20 - 30, PA programs are 75 - 95 Credit hours and are still masters programs.
Specializes in ICU, CV-Thoracic Sx, Internal Medicine.
After reading the Institute of Medicine's "The Future of Nursing: Leading Change, Advancing Health" (found here: The Future of Nursing: Leading Change, Advancing Health) I have really rethought my proposal. Expansion of practice rights for NPs is a Given but I am not so sure they need the "Physician" title. Perhaps that is too much like getting into bed with the enemy. I do hate to see the DNP become the standard. Currently most MSN NP programs are around 40 - 60 credit hours, DNP adds another 20 - 30, PA programs are 75 - 95 Credit hours and are still masters programs.
Keep in mind that PA applicants are not required to have any clinical experience/exposure. A bulk of the disparity between program credit hours between PA and NP programs is in the clinical hour requirements.
NP applicants hold a BS in nursing and at a minimum have had basic nursing education with some clinical experience. Even still, I would be inclined to guess that the majority of NP applicants have at a minimum 5+ years of clinical experience. Not sure if this is tracked by an institution.
Keep in mind that PA applicants are not required to have any clinical experience/exposure. A bulk of the disparity between program credit hours between PA and NP programs is in the clinical hour requirements.
NP applicants hold a BS in nursing and at a minimum have had basic nursing education with some clinical experience. Even still, I would be inclined to guess that the majority of NP applicants have at a minimum 5+ years of clinical experience. Not sure if this is tracked by an institution.
The majority of PAs nowadays actually do have experience prior to PA school. Many schools require 1000-2000 hours of direct patient contact to even apply, and those who don't require it certainly give preference to those who do. PA schools are full of nurses, EMTs, MAs, RTs, phlebotomists...you name it.
I'm sure there are some out there who manage to get around it, but zero experience PA students are a rarity in today's schools.
But you're right...there is a greater focus on clinicals due to the nature of the experience they're getting, I believe. PAs don't specialize. Even if they do have experience, their time was probably spent in one field. Versus nurses who usually spend at least a year in their speciality and simply continue with it in their studies.
I want to add that (and I admit I'm a bit weird) I've really enjoyed reading med students and Physician's opinions on the matter of expanding the role of the NP on a couple forums on the Internet. I haven't been there since I officially made the switch from pursuing Md to pursuing Np, but I can assure you...their opinions were generally not favorable. And back then, dnp programs were brand new, so the conversation was purely hypothetical. I'd kill to see how the tides have changed :-)
Specializes in ICU, CV-Thoracic Sx, Internal Medicine.
The majority of PAs nowadays actually do have experience prior to PA school. Many schools require 1000-2000 hours of direct patient contact to even apply, and those who don't require it certainly give preference to those who do. PA schools are full of nurses, EMTs, MAs, RTs, phlebotomists...you name it.
I'm sure there are some out there who manage to get around it, but zero experience PA students are a rarity in today's schools.
But you're right...there is a greater focus on clinicals due to the nature of the experience they're getting, I believe. PAs don't specialize. Even if they do have experience, their time was probably spent in one field. Versus nurses who usually spend at least a year in their speciality and simply continue with it in their studies.
I wonder if the patient contact hours are region specific. I'm familiar with the two local PA programs in the Galveston and Houston, TX area (Baylor and UTMB). Neither of which require PA applicants to have any type of direct patient contact hours.
I'm aware that PA applicants are diverse, and some do come from other professional health care disclipines like you illustrated. Intreseting point nontheless.
Keep in mind that PA applicants are not required to have any clinical experience/exposure. A bulk of the disparity between program credit hours between PA and NP programs is in the clinical hour requirements.
NP applicants hold a BS in nursing and at a minimum have had basic nursing education with some clinical experience. Even still, I would be inclined to guess that the majority of NP applicants have at a minimum 5+ years of clinical experience. Not sure if this is tracked by an institution.
Any citations to back up that statement that the majority of NP applicants have a minimum of 5+ years of clinical experience?
The rate at which direct-entry programs have been expanding, in addition to the fact that I haven't met a single nursing student during my 3 years (so far) on the wards who wanted to stay a "regular" nurse (ie. every one of them wanted to pursue an NP or CRNA degree), suggests otherwise...Of course, the number of nursing students I've encountered has definitely been less than 100, so there's some skewing there. But I get the sense, from talking with my nursing friends as well as reading around on these forums, that a lot of students who go into nursing want to become APNs as soon as possible rather than stay as floor nurses, etc. That's why I'm hesitant when I read a post like yours that states that the majority of NP applicants have 5+ years of clinical experience. That certainly may have been true a decade or more ago; these days, I'm not so sure anymore. So, if you have any actual data on hand regarding this issue, it'd be great if you could cite it. Thanks.
The majority of PAs nowadays actually do have experience prior to PA school. Many schools require 1000-2000 hours of direct patient contact to even apply, and those who don't require it certainly give preference to those who do.PA schools are full of nurses, EMTs, MAs, RTs, phlebotomists...you name it.
I'm sure there are some out there who manage to get around it, but zero experience PA students are a rarity in today's schools.
But you're right...there is a greater focus on clinicals due to the nature of the experience they're getting, I believe. PAs don't specialize. Even if they do have experience, their time was probably spent in one field. Versus nurses who usually spend at least a year in their speciality and simply continue with it in their studies.
Agreed. This has been my experience as well.
TX RN, even if some PA schools don't specifically require these hours of clinical experience, it's pretty much an unwritten requirement at most PA schools, from what I understand. It was similar for med school, where no school actually requires you to have clinical volunteering, shadowing, etc, but you'd have a ridiculously difficult time getting in anywhere if you didn't. I don't claim to be an expert on PA training, but based on my interactions with PAs, what Stephalump states appears to be true. I've yet to meet a PA who hasn't been an EMT, RN, etc, prior to becoming a PA. Interestingly, at least in my region, most of them seem to have been EMTs for a few years prior to starting PA school.
Oddly enough, I'm from the same area and those are the experience-not-required programs I was talking about. How familiar are you with UTMBs program?
Since I've never been there, I assume so many students have experience because the universities prefer it, even though they don't require it, but I'm not sure. But it's entirely possible that's due to their med school model. Students apply more broadly and try to make themselves attractive to as many schools as possible, including racking up experience hours?
My best friend has her eye on UTMB's PA school, and all her research says she needs years of experience, but the school's website mentions nothing about it. She has her Master's in Psychology and she's back in school to become an MA to get experience, but she's hoping she can get in without actually ever having to work. Patience isn't one of her strong points :)
There are plenty of Physicians and med students on here. Just look through this thread and you will see their comments
Oh yeah...I more meant that I enjoyed their unedited comments in their own private space amongst themselves. Although some have no problem leaving their opinions unedited here :)
KurtDNP
12 Posts
For one thing, it would still be a battle since much of this is economic. More importantly, however, is why would nursing do this? What's the point? People should then just go get allopathic or osteopathic training. Nursing offers a unique perspective and approach that should never be lost. I don't want to see DNPs go the way of DOs and seemingly lose the discipline-specific values, skills, and offerings that uniquely add to the healthcare landscape.
BTW, if NPs are midlevels, what are staff nurses? We need to use another term or simply say NPs, PAs, CRNAs, CNMs, CNSs, etc...