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.
"Practice doctorate"? What does that even mean? If the objective is for a non physician to approximate their medical practice, the closest model is podiatry.
Do that and you'll have something that approaches "street cred" and actual clinical competency that is implied in the term "doctor".
"Practice doctorate"? What does that even mean? If the objective is for a non physician to approximate their medical practice, the closest model is podiatry.
Do that and you'll have something that approaches "street cred" and actual clinical competency that is implied in the term "doctor".
Short that, its just nursing chest thumping.
I am going to be the devil's advocate here: Other health professions (Pharmacy, PT etc..) have done it, why not nursing?
I am going to be the devil's advocate here: Other health professions (Pharmacy, PT etc..) have done it, why not nursing?
Have you looked at the curricula for PT and Pharm doctorates? Those professions have enhanced what they were already teaching. I'm all for nurses developing a SIMILAR model. The DNP as we know it is horse ****.
I am going to be the devil's advocate here: Other health professions (Pharmacy, PT etc..) have done it, why not nursing?
It isn't a question of whether or not to do it. It's a question of how so as not to have a vast variation in clinical ability with identical credentials.
And I don't think pharmacy and PT are analogous at all. Those deal in a very narrow practice spectrum and there isn't really an advanced practice pharmacist or physical therapist.
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.
You bring up the CRNA's picking up the DNP and making it a requirement and I just wanted to clarify a few things in case your point was unclear. I start my CRNA DNP program in August and have just completed the rigorous and years long preparation for applying and even having a snow balls chance in hell to get in to a program.
I was required to take the GRE, I was required to have three reputable critical care physicians or anesthesiologists who have worked with me to formally write a letter of recommendation, GPA must be 3.5 or greater to even hope to get in, must have worked a minimum of 1 year full time in an ICU with high acuity (although most people accepted have 3 or more years), must obtain your CCRN certification which is notoriously hard and also expensive, must fly to the programs location if selected to do in person interviews with the professors, the list goes on and on.
Then when the program begins you have 3-3.5 years of full time structured clinical and didactic education that is well known for it's rigorous and overwhelming nature. You aren't even allowed to work during the program because of the risk of you dropping out by being spread too thin.
Also during the entire program you are required to write a research project that they purposefully don't call a "thesis" but is still required to be quality research that your goal is to get published in well known medical journals and be presented in front of other medical professionals at the end of your 3 years.
I've already looked at the schedule for the courses and descriptions for the next three years and pretty much none of it is what I call nursing fluff.
I say all that to say that I completely agree with everything you said in regards to DNP's for education and nurse practitioners and pretty much everything nursing related besides anesthesia.
CRNA is attempting to take the DNP and make it what it should be in the first place. They will hone it and shape it even better as the next few years pass as all the programs have to be DNP. I hope that the NP's will follow suit.
so it sounds like it was almost has hard to get into as PA school
Yeah, the masters level PA program that takes people with an undergrad in English, absolutely no clinical knowledge who thinks Lasix is an eye surgery and will never be a doctorate program due to their overlord MD's insecurities is the exact same as the CRNA school requirements/experience I listed above.
Bhahaaahaha. This must be Jimmy Fallon writing one liners. Thanks for that.
Yeah, the masters level PA program that takes people with an undergrad in English, absolutely no clinical knowledge who thinks Lasix is an eye surgery and will never be a doctorate program due to their overlord MD's insecurities is the exact same as the CRNA school requirements/experience I listed above.
Bhahaaahaha. This must be Jimmy Fallon writing one liners. Thanks for that.
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"Practice doctorate"? What does that even mean? If the objective is for a non physician to approximate their medical practice, the closest model is podiatry.
Do that and you'll have something that approaches "street cred" and actual clinical competency that is implied in the term "doctor".
Short that, its just nursing chest thumping.