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Discussion

DNP - Changes in Education?

Ok, let me start off by saying that I am only a Licensed Pratical Nurse and I have A LOT of questions and statements to make.

I have been an LPN for 7 years now and I'm actually enrolled in a college bridge program to obtain my ADN, then will transition to BSN. After I obtain my BSN, I hope to bridge to DNP/ACNP certifications.

I want to become a DNP/ACNP to better manage my patients in an acute care setting. I currently work on a Medical/Surgical floor and for the most part I like that the atmosphere, but I feel like the FNPs that work here with the PCPs and Hospitalists do not have enough control to effectively manage their patients without the PCPs/Hospitalist stepping in.

Which is fine, I understand that a FNP is not a MD and in some states require that physician partner.

Due to the recent recommendations that the entry-level to all clinical specialities will be DNP (or DNAP for CRNAs) do you think the education will eventually change? Let me explain myself. Right now physicians are, for lack of a better term, whimpering with their tails behind their back due to the whole ideal NPs and various other "clinical" specialities will be graduating with a clinical doctorate and most states do not hold restricitions of the NP calling themselves doctors infront of the patients. I do not see this an issue myself as long as the NP acknowledges to the patient what s/he has her doctorate in.

(Example: If I am a DNP/ACNP, I would address myself as Dr. Soandso and I will be your nurse practioner.

One of the main issues that I have read in recent months is physicians believe NPs do not receive enough clinical education to even be on par with a MD. Which in some cases I can see as being true, but a NP seems to grow with experience as does a MD.

I feel like if a DNP had less theory courses and more clinical courses the DNP would hold a higher respected place among physicians that will be our partners in the future of practice. If they are going to seperate the clinical doctorate (DNP) from the academic doctorate (PhD). Then I think they should split the education the same. I agree that some theory is required, but if it takes approximently three-four years after your BSN to become a DNP, then surely the next three and four years of your life isn't going to be theory oriented. Why not make the DNP more clinically oriented by teaching stronger pathophysiology, pharmacology, and dianogstic training. Clinical rotations....

I can some day the DNP becoming the next physician creditinal just like when the DO emerged.. but that is my opinion....

Any thoughs?

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    I think that if you want to practice like a physician ... that maybe you should be become a physician. It's unlikely that the DNP academic degree will ever be the same as an MD because they are in 2 different disciplines. There will remain a difference in the forseeable future.

    If being an NP (as it now stands and is expected to evolve over the next decade or so) is not to you liking ... and neither is being a physician ... then maybe you should consider being a Physician's Assistant. That's a third option for you.

    Either way, I think you should look carefully at all 3 roles before investing a lot of time and money in an education that might not lead to a career that satisfies you.

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    In my area, they are programs that have geared to doctorate nursing. A few have the BSN-DNP component where you get your MSN in a NP program, then proceed to the doctorate level. MSN programs have advanced patho, pharmacology, and assessment in them i.e. breast exams, pap exams, rectals etc...the "practitioner assessments"in their coursework.

    This program I'm referring to has a 3 year-5 year completion time frame.

    Historically, doctorate nursing has been in practice for decades. The Dean at my PN school was a doctorate since the 1980s, at that was in 2004 I went in my PN program. A CEO at one of the area hospitals I worked for was inspired to be a Dr because of his aunt who was a APN who had her doctorate. "They called her Dr.", he said, "she saw patients, took care of patients...if I figured out then she was a Doctor in nursing, I would have preferred to go that route instead of medical school!" :)

    Most Drs in my area, desire for Medical School to be tailored like nursing school...if there are ones who have the insecurity of an NP, that is those particular Dr's issues. My metro area has been a driving force for research, technology and complex care, so the state has been pretty CRNP friendly and nurse friendly in broadening the scope of care. CRNP's have been writing prescriptions for years in my state, and recently adopted the authority to sign vital records. More is to come in the scope of CRNPs in my states and surrounding states.

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    I would like to see the studies you found that show MDs provide superior care.?

    AANA/COA are going to require a doctorate for entry level CRNAs on or after 2025. That doctorate can be a clinical or research doctorate. The AANA and COA haven't made a distinction in the type of doctoral degree (clinical or research) that is required as of yet.

    The DNP is not designed to give you more clinical experience. The DNP is designed to make you an expert in the use of research. The current MSN already makes for competent APNs that provides care at least on par with their physician colleagues.

    American Association of Colleges of Nursing | DNP Fact Sheet

    • The changing demands of this nation's complex healthcare environment require the highest level of scientific knowledge and practice expertise to assure quality patient outcomes. The Institute of Medicine, Joint Commission, Robert Wood Johnson Foundation, and other authorities have called for reconceptualizing educational programs that prepare today’s health professionals.
    • Some of the many factors building momentum for change in nursing education at the graduate level include: the rapid expansion of knowledge underlying practice; increased complexity of patient care; national concerns about the quality of care and patient safety; shortages of nursing personnel which demands a higher level of preparation for leaders who can design and assess care; shortages of doctorally-prepared nursing faculty; and increasing educational expectations for the preparation of other members of the healthcare team.
    • In a 2005 report titled Advancing the Nation's Health Needs: NIH Research Training Programs, the National Academy of Sciences called for nursing to develop a non-research clinical doctorate to prepare expert practitioners who can also serve as clinical faculty. AACN's work to advance the DNP is consistent with this call to action.
    • Nursing is moving in the direction of other health professions in the transition to the DNP. Medicine (MD), Dentistry (DDS), Pharmacy (PharmD), Psychology (PsyD), Physical Therapy (DPT), and Audiology (AudD) all offer practice doctorates.

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