DNP Article

SN2bExpAt · Nov 28, 2007

Along with a doctorate and the title of "doctor," the fact that a nurse practitioner has fulfilled this certification requirement will instill confidence in patients that DNPs have the expertise to serve as their health-care provider of choice.

Oh boy, lines are gonna be drawn with jackhammers in the near future.

/me grabs a bag of popcorn....this is going to get real ugly in the near future.

DaisyRN, ACNP · Nov 30, 2007

thanks for sharing that article...

i see that she's a dean for a school of nursing, so i can understand her bias... but i'm grateful for it. so many people are presenting the concept negatively as a threat to the medical community, but i'm glad she emphasized its proposed societal benefits while acknowledging that first and foremost: they're still nurses.

Trauma Columnist · Nov 30, 2007

Thanks for the article - sure to stir debate and that is what we need.

One of the first issues I have with the DNP is there is no standardization. I have looked at a couple of programs and none have the same objectives, goals, classes or content. This is the first thing that needs to be resolved.

Second (and this should probably be first), we must have the acceptance or at least the tacit support of the medical community. I live in IL and I doubt the AMA is going to support this. IL is ahead of the game for APN support at the moment but we just recently got rid of the MD on the nursing state board.

tencat · Nov 30, 2007

Let's see....eight year curriculum, rigorous test.....reimbursement rate from Medicare at 80% of what a physician can get.......gee what a great idea to get a doctorate in nursing..... :uhoh3: might as well go to medical school and get paid a WHOLE lot more for the same amount of work to get there. I just don't see nurses flocking to DNP programs to make much less money than a physician for a similar amount of education. Unless some things really change with Medicare reimbursement and insurance reimbursement, the number of nurse practitioners is going to decrease. The time commitment and expense will just not be worth it for most of us, I think.

DaisyRN, ACNP · Nov 30, 2007

let's see....eight year curriculum, rigorous test.....reimbursement rate from medicare at 80% of what a physician can get.......gee what a great idea to get a doctorate in nursing..... might as well go to medical school and get paid a whole lot more for the same amount of work to get there. i just don't see nurses flocking to dnp programs to make much less money than a physician for a similar amount of education. unless some things really change with medicare reimbursement and insurance reimbursement, the number of nurse practitioners is going to decrease. the time commitment and expense will just not be worth it for most of us, i think.

i have to counter your comments... because i don't agree. "eight year curriculum" -yes, cumulatively from start to finish, but medical school is a minimum, best case scenario (passing mcat first time, getting accepted first time, getting chosen for residency first time, etc.) of 8 years from whenever you decide to do it. for some rns/apns, to go on a get a dnp will only take a couple years. i have looked into the texas tech program which will be starting up next year and its 48 credit hours over 6 semesters. 6 semesters is a lot less than 8 additional years for me to go to medical school at this point in my life. the dnp provides apns the ability to achieve a higher level of education without having to do an additional 8 years. i don't think that the dnp was established so kids will say, "i want to be a dnp when i grow up." i think its a progression for career-oriented learners in the nursing field to expand on their knowledge level.

and i do not see nps going anywhere... i foresee just the opposite occurring. midlevels will continue to flourish because the rising costs of education for all of us is overwhelming, but for medical students, it takes them years before they can actually acknowledge their larger salaries because of the cost of education (i read about this in several articles recently)/malpractice/etc. there is still such a deficit in health care providers to rural areas and in underserved populations, so midlevels are needed more than ever, in my opinion. as for reimbursement issues, it is my understanding that it is continuing to rise... gradually, but it is rising.

DaisyRN, ACNP · Nov 30, 2007

thanks for the article - sure to stir debate and that is what we need.
one of the first issues i have with the dnp is there is no standardization. i have looked at a couple of programs and none have the same objectives, goals, classes or content. this is the first thing that needs to be resolved.
second (and this should probably be first), we must have the acceptance or at least the tacit support of the medical community. i live in il and i doubt the ama is going to support this. il is ahead of the game for apn support at the moment but we just recently got rid of the md on the nursing state board.

hey trauma,

i agree that the problem is lack of consistency in programs... this is why i am not planning on pursuing this degree any time soon. the american association of college of nurses has compiled a list of dnp programs: http://www.aacn.nche.edu/dnp/dnpprogramlist.htm in case anyone else is interested in looking at more information, and it seems that they are trying to establish standardized competencies and programs. they have come up with "the essentials of doctoral education for advanced practice nurses" because this is what texas tech references for their dnp curriculum... here's ttus site: http://www.ttuhsc.edu/son/doctorate/

the american academy of nps does not recommend starting a dnp program until these kinks are worked out... and consistency is noted.

platon20 · Dec 1, 2007

Mary Mundinger just declared open war with all MDs. Easy for her to do from her ivory tower, but for the NPs down in the street she just did a great disservice.

Sorry folks but NPs are not going to win a direct war with doctors. NPs can work the rural areas independently because no docs want to go there, but NPs are NOT going to displace MDs in urban settings--I'm sorry thats just not going to happen. In most of the country, NPs must be able to work with MDs in a collaborative setting. NPs need good working relationships with MDs to survive in the group practice model that the vast majority of NPs work in.

Mundinger's comments make that impossible, since she's basically arguing that NPs are SUPERIOR to MDs, not just in primary care, but the specialty fields too! Thats outrageous! :uhoh3:

95% of DNPs are employees of doctor-owned groups. Thats not going to change, regardless of whether all NPs get doctoral degrees or not.

As for Medicare increasing NPs reimbursement to 100% of doctor-level reimbursement, thats not going to happen either. Doctors havent gotten any kind of reimbursement increase for 8 years running now, so to expect that their going to give it away to NPs is ridiculous.

The SGR formula that CMS uses wont allow that kind of increased payment. Doctors have been fighting tooth and nail every year just to prevent a DECREASE in reimbursement.

Doctors do have a choice. They can hire PAs instead of NPs. It wont matter in the rural areas, because NPs already have independent practice and doctors dont want to work there anyways. But in the urban areas, if NPs alienate doctors using the same kind of rhetoric that Mundinger spewed, then you will start seeing MDs hiring less NPs and more PAs.

Is that what Mundinger wants? Because thats what her comments will bring down on the profession.

n_g · Dec 1, 2007

Who wants to place bets for how long Mundinger keeps her job? :lol2:

PediASL · Dec 1, 2007

"Along with a doctorate and the title of "doctor," the fact that a nurse practitioner has fulfilled this certification requirement will instill confidence in patients that DNPs have the expertise to serve as their health-care provider of choice." -Mundinger

I am so frustrated after reading this article. She really is giving the NPs a bad name. I have the respect of my collegues, medical and other, through working and earning this respect. I do not need a 'doctoral' degree to harness peoples' confidence in me as a practitioner.

I so anger over nursings' need to 'prove themselves', they havn't even been able to standardize things at so many levels, this only worsens that problem.

I still await the day that nursing is able to discuss themselves without having to say how good they are compared to MDs.

Ugh!

core0 · Dec 1, 2007

Who wants to place bets for how long Mundinger keeps her job?

You should look up the definition of tenure.

David Carpenter, PA-C

Burnt2 · Dec 1, 2007

"Along with a doctorate and the title of "doctor," the fact that a nurse practitioner has fulfilled this certification requirement will instill confidence in patients that DNPs have the expertise to serve as their health-care provider of choice." -Mundinger

I agree with PediASL. There is no need for another academia doctorate which does not do anything to expand clinical scope of practice and minimally enhances bedside clinical abilities.

Titles mean nothing to me. I have a CCRN and i have never signed my name with it and its not on my badge, because I do not feel need to impress upon other people what an amazingly important, super-intelligent, better-than-you nurse I am (not saying that other people want that when they display their CCRN, thats just how I feel if I use it). However, the knowledge I gained from it is invaluable.

In the same vein, if I had a DNP I wouldn't call myself a "doctor" because that would really mislead my patients, while not providing me with ANY expanded scope of practice.

what we need is a doctorate centered purely on medical/clinical practice. a nursing version of an MD/DO, if you will.

EDIT:

" In other words, as a patient, you get the medical knowledge of a physician, with the added skills of a nursing professional." -Mundinger

That statement blows my mind. Honestly. No cynicism here - does that appear deceptive to anyone else?