Considerations for a true practice doctorate

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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.

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.

My program had those classes and we had a semester of advanced diagnostics

Specializes in Neurosurgery, Neurology.
My program had those classes and we had a semester of advanced diagnostics

Which school?

Specializes in Outpatient Psychiatry.
My program had those classes and we had a semester of advanced diagnostics

Which classes?

The 3 P's and an entire semester of advanced diagnostics

Specializes in Outpatient Psychiatry.

Yeah, 3 P's aren't sufficient.

The 3 P's and an entire semester of advanced diagnostics
Specializes in NP, ICU, ED, Pre-op.

So I am in school right now for my FNP. I had an entire semester of Clinical Diagnosis (diagnostic and clinical reasoning) and the majority of my lectures were medical lectures.....I am also writing illness scripts till I am blue in the face (this is how they begin to teach clinical diagnosis in med school from what I understand). This has been very helpful to me but I didn't realize other schools do not do this.....

This training is further carried on throughout the rest of my classes. I guess I feel lucky for this...

Specializes in Family Practice, Primary Care.

My school kinda did this. We had a "clinical seminar" every semester and we'd discuss cases, learn EKG/EEG/MRI/CT/Xray interpretation from MDs, and have MDs lecturing on their specialties. SO glad I went there! I also got to do a hospitalist rotation, cardiology, endocrinology and more.

Specializes in Outpatient Psychiatry.
My school kinda did this. We had a "clinical seminar" every semester and we'd discuss cases, learn EKG/EEG/MRI/CT/Xray interpretation from MDs, and have MDs lecturing on their specialties. SO glad I went there! I also got to do a hospitalist rotation, cardiology, endocrinology and more.

(I hope that all the people on this site who post that it doesn't matter where you go to school, all programs are basically the same, it's up to the student, are following this thread.)

Specializes in Family Practice, Primary Care.
(I hope that all the people on this site who post that it doesn't matter where you go to school, all programs are basically the same, it's up to the student, are following this thread.)

Me too. It matters SO much. This is why I did not want to do an online program, because you miss the face to face interaction with fellow students and professors and miss out on having these kind of lectures and such. My school also arranged our primary care rotations and sent out a list of specialty rotations we could sign up for each semester (we typically could choose pediatric endocrinology, cardiology, pulmonology, hospice, sports med, asthma/allergy, ENT, hospitalist, and then more focused peds/IM rotations, geriatrics, LTC, subacute care, et cetera, something many schools don't offer even if they're brick and mortar).

I've also noticed from practicing away from my school in the midwest that there is a HUGE difference in quality between how I practice and how NPs from local schools in the midwest practiced. I was catching active TB, brain tumors, diabetic ketoacidosis, and other zebras in my first year of practice, usually on the first or second visit. I saw some new grads and even experienced NPs not give a second thought to some subtle yet alarming signs. Now that I am back where I graduated from NP school and pretty much all the NPs in the area are grads of this one school, I can see the difference in practice between where I was and now being back in New England. A lot of people complained about our program while we were in it, but I think once we all graduated and saw how good we turned out comparatively, we were glad we chose to go where we went.

Specializes in Registered Nurse.
Me too. It matters SO much. This is why I did not want to do an online program, because you miss the face to face interaction with fellow students and professors and miss out on having these kind of lectures and such. My school also arranged our primary care rotations and sent out a list of specialty rotations we could sign up for each semester (we typically could choose pediatric endocrinology, cardiology, pulmonology, hospice, sports med, asthma/allergy, ENT, hospitalist, and then more focused peds/IM rotations, geriatrics, LTC, subacute care, et cetera, something many schools don't offer even if they're brick and mortar).

I've also noticed from practicing away from my school in the midwest that there is a HUGE difference in quality between how I practice and how NPs from local schools in the midwest practiced. I was catching active TB, brain tumors, diabetic ketoacidosis, and other zebras in my first year of practice, usually on the first or second visit. I saw some new grads and even experienced NPs not give a second thought to some subtle yet alarming signs. Now that I am back where I graduated from NP school and pretty much all the NPs in the area are grads of this one school, I can see the difference in practice between where I was and now being back in New England. A lot of people complained about our program while we were in it, but I think once we all graduated and saw how good we turned out comparatively, we were glad we chose to go where we went.

Could not agree more. I used to think all NPs received the same basic level of education. Then we recently had a new grad NP join us for a program I had never heard of. She was so incompetent that management ended up placing her in a bedside nursing role- she was so far from being able to practice proficiently as an NP. Turns out the school has a very sketchy reputation- they did this girl a huge disservice by taking her money and sending her off into the profession with her skill level.

A couple things: The DNP is not like a PhD, nor is it a research degree. I have one of these in a different health science discipline from before I began my DNP program. Before I started my DNP program I compared the content to that of the PhD in nursing. PhD programs (in pretty much every discipline) are significantly longer and more focused on either research or academia. The difference is more than just the letters. PhD degrees also require that you challenge a topic with a thesis at the end. Every PhD program that's worth its salt also requires some type of entrance exam (i.e. the GRE) or may grant exemptions based on a stellar academic record with impeccable references from people who seriously matter. To my knowledge, most DNP programs do not require an entrance exam (probably none do), and I don't know of any that requires a thesis.

The DNP was supposed to have been a clinical doctorate but in their rush to bestow the "doctor" title on NPs the ANA and nursing academia messed it up. My DNP experience so far has been good, but that is because I am fortunate enough to have found really good mentors and clinical preceptors in clinical settings that provides me with the type of advanced clinical training that I think I need at this level. This is the big downfall of the DNP, and NP programs in general. They should have standardized clinical training where students are actually in a clinical environment with an experienced NP or physician and actually acquiring hands-on clinical skills in the various disciplines of medicine. Sort of like nursing school but at a much higher level, or more like the way the PA schools structure their programs. The point is that the clinical education needs to be consistent across the board. It should not be as simple as allowing us to just choose any preceptor that we can find so we can accumulate 'hours'. Compare the clinical experience of a DNP candidate who does clinicals in a community STD clinic to that of another DNP candidate who does clinical rounds with an internist in an acute care teaching facility... So, no. NP and DNP programs are not all the same---no matter what anyone says to try to prove otherwise.

That being said, I'm not knocking the DNP degree because I like the one that I'm in. I see the DNP as an introduction to and expansion on some of the topics that are relevant to the nonclinical side of NP practice but were not expanded on in the master's degree programs; and even with this nursing academia falls short. But it should be obvious to nursing academia that they need to stop calling it a clinical doctorate. They need to tweak it if they are going to call it 'clinical'. It should contain less theory/philosophy/political and culture care type stuff and more practical clinical and management content. Not that the former topics are irrelevant but we already learned them in the associates and bachelor nursing programs. No need to pad the advanced practice programs with that stuff as well. But it is way too late for them to try to change it now because there are already too many individuals who have a DNP who have little or no actual clinical experience or who have not seen or touched a patient in many years. They would need to come up with a whole new degree, and they would once again be heckled and ridiculed by the medical community for it. The CRNAs took the DNP and ran with it, but I believe that that was more about the schools keeping the students in longer so they could make more money. Ask any CRNA who graduated from their program before the DNP and they will tell you that there is no significant difference between how they were trained to deliver anesthesia compared to the way the DNAPs are being trained now.

To change advance practice nursing education into a model that more closely resembles the medical model of education means that it wouldn't really be nursing anymore, but medicine. They would have a difficult time selling it as being any different from PA school. One solution is to amalgamate NP and PA education into a hybrid program (sans all the BS nursing content) and come up with a whole new title for both PAs and NPs. God knows that the stuff I learned in NP school didn't have to take as long as it did. Also, I'm very certain that PAs don't like being called assistants any more than NPs like being called nurses. As well, the fly by night online programs and questionable clinical sites should all be abolished.

I'm doing the DNP because I want to and because I like it. But I don't see it as being very clinically relevant.

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