Considerations for a true practice doctorate

Published

Specializes in Urology.

So I was in my thinking chamber today (the shower) when I got to thinking about the DNP as the practice doctorate for NP's. I feel that the DNP has turned into a cloak and dagger form of PhD in nursing. I'm told in my masters classes that there is a big push to put out more nursing doctorates mostly for research (see i knew the DNP was a covert PhD!). There is not much to delineate the two and it got me thinking about what would NP's want for a true practice doctorate.

Currently DNP's are touted by educators, nursing management, nursing "leaders" (god I hate when they call themselves that), informatics, nurse practitioners, etc. It seems the DNP is a catch all for anything related to nursing which I find to be a terrible idea. Nurse anesthesia jumped ship on this idea and created their own practice doctorate the DNAP so why couldnt NP's. I dont want to be lumped into a degree with non-prescriptive, non-patient seeing nurse doctorates. Since a lot of what the NP does is specific to patient care, why not have a clinical doctorate related more to that instead of more theory, research, ethics, etc. I'm fairly certain my masters covered all of those pretty good and if I wanted to do any of those thats what the PhD is for! It's to the point now that stigmatized by even getting a DNP as in I dont want it for the fact that it does little for NP's. Even if they changed how it functions how would you tell that for those who already have it?

So what do you all want in a true practice doctorate? How can NP's distinguish themselves from catch all DNP. Just some food for thought and hopefully some good ideas.

Up Vote Up Vote ×
Specializes in Outpatient Psychiatry.

I think some medical school-related courses would be reasonable. The first two years of the medical curriculum typically include gross or prosected anatomy, physiology, cellular biology, biochemistry, immunology, neuroscience, embryology, genetics, psychopathology, microbiology, pharmacology, and pathology. I don't know if anyone really needs that level of anatomy course. However, NPs would probably benefit, collectively, from more training in biochemistry, cell biology, genetics, physiology, immunology, neuroscience, and pathology. Many med schools are taking a systems based approach to the various organ systems. That may work as well. I think everyone needs to do some rotations in the major medical specialties such as internal medicine, pediatrics, general surgery, ob/gyn, family med, psych. Time in fam med, emerg med, sports med, etc. would give people opportunities to brush up on procedures, and particularly some ENT, derm, and opthal time might be helpful for many NPs.

My ideal training would have included some biochem, cell bio, genetics, physiology, pathology, neuroscience, immunology, pharmacology, psychopathology, and psychopharmacology. Again, ideally, I would have completed some rotations in medicine, general peds, (or conceivably family medicine), neurology, and psychiatry. I'd like to be better versed in ECGs and be able to make some sense of at least head CTs and MRIs as well as EEGs. Again, this would be psychiatry-specific. It isn't unreasonable. If all of the courses I listed were three semester hours of credit each that would only be 30 hours. Most NPs end up taking around 42 hours. Most programs I've seen equate 1 hour of credit with 90 hours of clinical practice thus an addition 12 hours would translate to 1,080 clinical hours rather than the 700-750 most get. I think NPs need to shoot for at least 1,000 if not closer to 1,500. As many as 2,000 would be beneficial, but then I believe we'd start erasing some of the economical benefits that NPs, as "midlevel" providers, bring into the picture. As it happened, I spent three years working on the NP master's. It didn't really need three years, but that's the rapidity with which the university would offer the courses. I think for future doctoral-branded NPs, a full three year curriculum could and should include more clinical or scientific coursework, training in core medical specialties, and increased clinical training in their chosen specialty.

I am of the opinion that NPs should be licensed generalists, i.e. qualified to treat all age groups in all settings, similarly to PAs, but with a built in, mandatory specialization in some field (such as psychiatry for myself). By our present standards, however, I think all but the peds folks need to do some internal medicine rotations, and all the but adult people need to do some time in peds. I think we all need some neuro training except perhaps the women's health people. Beyond that, all you somatic folks need some training in general surg (acute abdomens and office procedures) and conceivably ob/gyn. I really have no idea what the scope is for adult and peds NPs regarding ob/gyn. Everyone needs some training in behavioral medicine, at minimum, because a lot of you send people to psych on some really foolish arrays of medications. (On my soap box, don't fear the psychotropics. busprione is crap, hydroxyzine is not curative, there are indeed meds for sleep beyond quetiapine, newer meds aren't really 'better,' and TCAs aren't scary, but I get it this illustrates the compartmentalized nature of NPs and healthcare in general.)

My master's included a couple of one credit hour courses in practice management, and I think all NPs need this or something better. It provides some of the business spin to healthcare and sadly most NPs are caught up trying to be altruists rather than business persons. I'm sure there are still some old physicians that would work for a carton of eggs or piece of cow, but we all provide a cognitive skill that isn't readily available to most persons outside of healthcare. We, as a body, should emphasize the importance and necessity of this and use it to boost our revenues. If you're making more money, you're likely seeing more people, and thus likely helping more people so the altruists can even be happy under this model.

Up Vote Up Vote ×

My ideal DNP education?Prior nursing experience must be mandated.

Up Vote Up Vote ×
Specializes in Outpatient Psychiatry.
My ideal DNP education?Prior nursing experience must be mandated.

How much and what kind?

Up Vote Up Vote ×
Specializes in Urology.

@psychguy

I like the idea of having a business related class, especially in independent practice states! Definately a good class to have and focus on how the local legislation works, how to set up your own practice, etc. I pretty much agree with your first post, a lot of good things included in there.

Up Vote Up Vote ×

@PsychGuy

You forgot to mention 'Clinical Diagnosis I & II' and the mighty Histology (eye roll) when it comes to med school curriculum... Power to NP if they are able to do their job with a lot less!

A poster said in another thread that NP classes might not have these names, but they cover all these stuff in their curriculum... It does not seem to be the case from reading your post.

I think the ideal would be 2 1/2 year basic science with clinical rotation, and 1 year of some sort of residency or internship....

Up Vote Up Vote ×
Specializes in Outpatient Psychiatry.

No, they don't cover that stuff. Most NPs get "the three P's" advanced physiology/pathophysiology (compressed-lite class), advanced pharmacology, and advanced health assessment (that has no P?). That's as sciencey as we get. We also take courses that include some disease process and diagnostics, but I think it's still too limited. I think histology is unnecessary for us. The clinical diagnosis is a good idea, but I think that's where med students often begin seeing human patients, lol. As RNs, NP students have done that sufficiently I think. We do need help on our diagnostic examination techniques, and that's usually what the advanced health assessment covers. My class covered it quite well, but there was never enough opportunity to put that new found knowledge into practice so I've forgotten most of it. For example, assessment of the individual muscles of the rotator cuffs.

I really think it could be squeezed into a year of basic science, a year or general rotations (perhaps less) and a year of specialty training in our chose NP fields. I think it would give us all the opportunity to become licensed generalists much akin to what the FNPs can do (but in more detail because we're revamping the whole thing), and those FNP folks can go on and do another year of just fam med clinic stuff.

@PsychGuy

You forgot to mention 'Clinical Diagnosis I & II' and the mighty Histology (eye roll) when it comes to med school curriculum... Power to NP if they are able to do their job with a lot less!

A poster said in another thread that NP classes might not have these names, but they cover all these stuff in their curriculum... It does not seem to be the case from reading your post.

I think the ideal would be 2 1/2 year basic science with clinical rotation, and 1 year of some sort of residency or internship....

Up Vote Up Vote ×
Specializes in Outpatient Psychiatry.

Right. We've got to be clued in on the political and economic factors of our professions. We've got to make more money, get out names out there, rub shoulders with business and government leaders, and dump some of our increased income and name into lobbying.

@PsychGuy

You forgot to mention 'Clinical Diagnosis I & II' and the mighty Histology (eye roll) when it comes to med school curriculum... Power to NP if they are able to do their job with a lot less!

A poster said in another thread that NP classes might not have these names, but they cover all these stuff in their curriculum... It does not seem to be the case from reading your post.

I think the ideal would be 2 1/2 year basic science with clinical rotation, and 1 year of some sort of residency or internship....

Up Vote Up Vote ×
Specializes in Nephrology, Cardiology, ER, ICU.

Moved to DNP forum

Up Vote Up Vote ×

needs physics, biochem, and organic chem.

Up Vote Up Vote ×
needs physics, biochem, and organic chem.

Not sure how knowledge in kinematics, solid/fluid mechanics, waves, magnetism, electricity, optics will help a NP. After all, NP are midlevel providers.They don't need to know all these stuff. That's kind of overkill IMO. However, I agree that some knowledge in gen chemistry, orgo and biochem might make them better practitioners...

Up Vote Up Vote ×
Specializes in Urology.
Not sure how knowledge in kinematics, solid/fluid mechanics, waves, magnetism, electricity, optics will help a NP. After all, NP are midlevel providers.They don't need to know all these stuff. That's kind of overkill IMO. However, I agree that some knowledge in gen chemistry, orgo and biochem might make them better practitioners...

I agree with Anders on this one. No need for hard sciences at the doctorate level, perhaps some during BSN, maybe even masters level and even then it wouldnt be necessary.

Up Vote Up Vote ×
+ Join the Discussion