I realize there are many people who find no value in a DNP. I have to say that I’m a little disappointed in my BSN-DNP program, especially in the era of the pandemic. One of the things that shocked me was sitting in an advanced assessment course and overhearing cheering from some students. What were they celebrating?
Passing their NCLEX.
How are you sitting in an NP Program learning to practice medicine (yes, I said it) and not even a licensed nurse? When I have conversations with new grad nurses it just astounds me. To further my dismay, the rigor just doesn’t seem there. For those doing online programs, especially new grads, how do people expect online tests/a few papers/500hrs of clinicals to produce an independent practitioner? I’m in-seat at a prestigious public school and it still seems like a total mind-bending affair.
The more I think about it, the more I wish the DNP would have a higher bar for entry, deeper dive into sciences, offer more clinical rotation hours, offer Step 1/2, and offer more residency/fellowship training. I realize there are many of you who would scoff at this, but hear me out. If the DNP is going to be the terminal degree pushed on nursing, where is the value? Are people honestly okay with standing next to a residency trained MD/DO and saying they’re equivalent? If you’re being honest, you can’t say that. So, then what?
A recent survey by MDs and DOs showed virtually no difference in their practice and perception of care— despite osteopathic medicine touting holistic medicine and inclusion of manipulative therapy. Why can’t nursing step in to fill the care shortage, provide this type of care, and show our colleagues we deserve to practice medicine next to them? There are many who were trained in the 70s, 80s, and 90s who feel they were well prepared. That’s not the world we live in today, however. Online programs have diluted rigor, over saturated the market, and reduced pay.
It’s time for a change and it’s time to say enough is enough. Not everybody deserves to be an NP. Everybody does deserve the best care possible, however. If nursing is truly about taking care of patients they should support this. Help the DNP evolve like the DO did, but keep your roots.
@adammRN while I appreciate that nursing is a separate discipline than medicine, It’s definitely medicine at the graduate acute care/critical care level. “Advanced nursing assessment” is kabuki to keep ourselves from being forced into supervision under physicians. Otherwise, I completely agree with your posts.
@RiverRat788 if I could go back in time I definitely would. I’m here now looking across the DNP landscape and hoping to make a positive change in the next decade. I would love to reach out to MD/DO academic colleagues to form a beefier NP curriculum. Hell, an NP to MD/DO bridge should be an option for those who would like it.
The DO medical school close to me has a PA to DO pathway. Not certain of all the details, but if a PA who is well trained , an NP could do it.
Another thought...this was brought up at Match Day for one of my girls.
There are are not enough residency spots for all medical school grads. These are funded by CMS. We were all encouraged to contact our state and federal representatives for more funding.
Anyone remember the days when medical school grads could put up and shingle and got into practice the next day. There is no reason that nurses with intense training could not fill that role. It used to be called "General Practitioner"
Why would I even pursue a DNP since with a Masters I earn equivalent money as a PMHNP (around 250K as a first year graduate in an IP state). Indeed, had I decided to practice in Florida (which is not IP for Psych NP's) I still had no less than three Psychiatrists willing to be my "collaborator" for fees ranging from 7% to 13% of my gross. Note that in none of these cases would they have directly supervised me (although two of the three said they would call me back and answer any question within about 24 hours). Thus, my point is we essentially have IP in most every state. It's just that in some states we have to "work out a deal" to pay some money to an MD (granted some states have more specific requirements about chart reviews, but even in New York State one of the most restrictive where I almost accepted a position, my supervising psychiatrist explained that she would only be meeting with me about once per month). Also, it is worth noting that the path for DO's to IP was not without strong opposition from MD's at one time. They did not "give in" out of the goodness of their hearts, but rather as something of a compromise. Thus, to a great extent the issue is moot. NP's have "effective" IP almost everywhere and outright IP in many states like Washington where I currently practice.
Yes, but would my training be improved from actually seeing patient, completing the excellent online CE courses at places like The Carlat Report, The Psychopharmacology Institute, and elsewhere or completing more courses mainly to do with nursing research, administration, and a plethora of other topics that have little if anything to do with clinically managing patients? Also, given my heavy emphasis on complementary and alternative approaches the benefit would be even further diluted.
Consider here are the classes that I would need to complete at the University of Southern Indiana in order to earn my DNP (the same place where I earned my MSN): Which of these would help me provide even better care to the many clients that I see on a day to day basis and even if they would, would they do so more effectively than the precious ten hours or so I have to spend per week in highly focused clinical education? The maxim of "opportunity cost" applies and if I went back to school it would likely mean deferring payment on the 160K that I owe in student loan debt (at least I could not take any more debt as I am at max) and it would mean giving up the 250K in income that I am currently on pace to earn. It would also probably mean not attending the two or three multiday conferences that I attend (due to their cost) on focused topics like ADHD and refractory depression.
Leadership and Organizational Systems Core Courses
NURS 721 - Systems Leadership and Inter-Professional Collaboration5 credit hours
NURS 724 - Health Care Policy and Strategic Planning3 credit hours
NURS 725 - Resource Utilization in Health Care4 credit hours
NURS 727 - Healthcare Technology and Informatics3 credit hours
Total Hours15 credit hours
Evidence-Based Practice Core Courses
NURS 713 - Theory and Practice3 credit hours
NURS 715 - Analytical Methods for Population-Based Care4 credit hours
NURS 717 - Cultural Diversity2 credit hours
Total Hours9 credit hours
Specialty Practice Courses
NURS 854 - Critical Appraisal of Practice I3 credit hours
NURS 855 - Synthesis of Nursing Practice3 credit hours
@myoglobin I think you’re debating a specter— I’m not promoting you getting a DNP nor ever said it was a wise decision. My OP stands that a clinical DNP should more closely align with the DO/MD with regards to depth of training. Maybe as a PMHNP you felt good after 500 hours of training practicing psychiatry, but a lot of ACNPs feel terrified in an ER or ICU. To say that you’re prepared for IP after 500 hours is... questionable. Especially today with little to no requirement for prior nursing experience. I’m glad you make a lot of money and have a lot of autonomy. I hope the glut of new grads with no experience doesn’t put downward pressure on your future salary.
If they do then I will have to compete more efficiently, and provide even better service and value to my clients. If that happens it will likely be the consumer or clients who benefit in terms of being able to find a provider and be seen in a reasonable period of time. I expect MD’s to be against IP in most cases, but I also expect nurses to be vociferous advocates for their professions. It is my assertion that the DNP curriculum as it is currently structured does little if anything to improve clinical acumen over the MSN (in fact it may even be worse in the sense that the clinical curriculum is so diluted with non clinical material). I would argue that NP’s provide equal or better outcomes than MD’s in primary care settings at a lower cost. If the educational standards are continually raised then the cost advantage will be eroded at least to some extent.
I think by enriching the curriculum for DNP, it definitely makes it a better incentive for one to pursue it. If they make it as rigorous as other programs (like some PhD programs), it would be more respectable and worthwhile to obtain.
What is there to be proud of if your doctorate level degree (which is supposed to be more clinically focused) doesn’t help your clinical practice, knowledge or acumen?
It would bring a lot more respect for the nursing profession from other providers if there was some serious re-structuring done.
Those are good thoughts (making the DNP more clinically focused), but in reality by the time that you walked that process through the myriad of boards, committees, and organizations that you would have to get on board you would probably be talking about five to ten years and in the process you would probably end up with just as much "educational bloatware" as the current DNP curriculum only it would just be longer. That's why I favor NP's whether they be MSN or DNP's getting out in the field and getting as much high quality education as possible (in my case as PMHNP through resources like The Carlat Report, The AANP, The Psychopharmacology Institute and elsewhere) and providing the high quality, holistic care that as a group we in fact already accomplish. I believe that we can not only equal the outcomes of the more educated MD's with whom we work with and compete, but literally outperform them by significant margins, if we utilize a truly integrative approach. Such an approach is at least partly facilitated by our ability to spend more time with clients due in part to the lower cost of our education. In Washington state where I practice it is rare to even find a psychiatrist (they exist so I've been told), but the vast majority of day to day mental health care is provided by therapists and Psych NP's.
Those are good thoughts (making the DNP more clinically focused), but in reality by the time that you walked that process through the myriad of boards, committees, and organizations that you would have to get on board you would probably be talking about five to ten years and in the process you would probably end up with just as much "educational bloatware" as the current DNP curriculum only it would just be longer. That's why I favor NP's whether they be MSN or DNP's getting out in the field and getting as much high quality education as possible (in my case as PMHNP through resources like The Carlat Report, The AANP, The Psychopharmacology Institute and elsewhere) and providing the high quality, holistic care that as a group we in fact already accomplish. I believe that we can not only equal the outcomes of the more educated MD's with whom we work with and compete, but literally outperform them by significant margins, if we utilize a truly integrative approach. Such an approach is at least partly facilitated by our ability to spend more time with clients due in part to the lower cost of our education. In Washington state where I practice it is rare to even find a psychiatrist (they exist so I've been told), but the vast majority of day to day mental health care is provided by therapists and Psych NP's.
I wonder why it’s so rare. Maybe there’s some kind of decline for students matching into psychiatry? They might be pursuing more competitive specialties.
I think that you will find that psychiatrists (and MD's in general) all things being equal prefer to practice in an environment where NP's do not have IP. For one NP's tend to put a competitive downward pressure on their salaries. Also, it makes it harder to build an "economy of scale" where the Dr. has numerous NP's working under them for a fraction of the wages that they could earn on their own. For example the MD/psychiatrist in Florida where I did my clinical work had maybe six NP's working for her making about 120K. They had 20 minute followups and 40 min intakes and you were expected to see no less than 25-30 patients per day. If you didn't like it "tough luck" since Florida wasn't IP and most other jobs were almost the same (or even worse). In Washington state you would have a hard time keeping an NP in the same environment because after awhile (a short while in many cases) the NP would ask themselves "why am I working like a slave, and having to treat patients like an assembly line of human suffering when I could go out on my own earn at least twice the money, see less patients, and spend more time with each client?". The reimbursements between Florida and Washington are not that different (I got to see the insurance billing numbers at the psychiatrist in Florida where I did clinical for a year), but the amount that was passed on to the NP was far less maybe 25% of the amount collected from insurance if that. Indeed, if Washington NP's "forced themselves" to see the same number of clients in Washington that they would have no choice but to see in most non IP Florida practices they would probably earn upwards of 500K per year (except that most Washington clients have a higher expectation and might not tolerate 20 minute followup appointments or 40 minute evaluations). Thus, if I am a MD Psychiatrist in many cases it makes more sense to move to a non IP state such as California or New York where they will not only tend to earn more themselves, but be in a better position to put the "economies of scale" into play.
RiverRat788
24 Posts
The DO medical school close to me has a PA to DO pathway. Not certain of all the details, but if a PA who is well trained , an NP could do it.