DNP: Mirroring the Path of DO?

[AF2BSN]

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. 

0.02¢

[myoglobin, ASN, BSN, MSN]

38 minutes ago, AF2BSN said:

It would seem there is growing concern. 

https://www.live5news.com/2020/11/04/nurse-practitioner-field-grapples-with-question-whether-standardize-curriculum-nationwide/

 

I would argue that most of that "concern" is driven by the AMA and their lackeys who wish to maintain their dominance and roll back the progress that RN's and NP's have made over the decades. There are already many standardized elements of NP education including the three P courses, and the requirement to have a certain number of clinical hours, and the requirement to take various board certified exams. Our opponents will never be satisfied, because their goal is to limit competition rather than to improve outcomes (in many cases). Even most medical school use various approaches to teach the curriculum. Should their be an evolution in standards, absolutely. Is the current system failed? I would argue that it is not and instead offers the greatest opportunity for the advancement of education in the history of Nursing. Nurses (RN's, NP's, BSN, ASN and others) need to use our unified lobbying efforts to push back against important gains in practice scope and autonomy.  

[AF2BSN]

36 minutes ago, myoglobin said:

I would argue that most of that "concern" is driven by the AMA and their lackeys who wish to maintain their dominance and roll back the progress that RN's and NP's have made over the decades. There are already many standardized elements of NP education including the three P courses, and the requirement to have a certain number of clinical hours, and the requirement to take various board certified exams. Our opponents will never be satisfied, because their goal is to limit competition rather than to improve outcomes (in many cases). Even most medical school use various approaches to teach the curriculum. Should their be an evolution in standards, absolutely. Is the current system failed? I would argue that it is not and instead offers the greatest opportunity for the advancement of education in the history of Nursing. Nurses (RN's, NP's, BSN, ASN and others) need to use our unified lobbying efforts to push back against important gains in practice scope and autonomy.  

Not the students in the article, or in this thread, or the 5000 strong FB group? Or the many others who recognize there is a problem? We wouldn’t have the AMA or physicians pushing back if we had a leg to stand on. They’re not targeting PAs, because PA curriculum is actually standardized. You don’t have PAs taking online tests. You don’t have PAs finding their own preceptors. You don’t have PAs writing papers on nonsense.

Your continued defense of a broken system is astounding. There is no standardization in NP training aside from broad standards that schools choose how to meet. Don’t get me started on 3Ps and their lack of rigor. How can there be standardization when I can elect to take not one, but TWO different tests for acute care boards? How is that standardized? 

It’s clear we will never agree on this. Time will tell. I’m guessing the NP profession is in for a rude awakening. 

[myoglobin, ASN, BSN, MSN]

MD's like PA's more because in almost every case they cannot work independently. Thus, they are not a threat.  I am not saying that there cannot be improvements in the system. Rather, I choose to always try to focus on those elements that are positive and to try and provide as many opportunities as possible for RN's to advance their careers. I don't believe that having an option to take multiple certification exams is intrinsically a "bad thing" either. In my case as a Psych NP there is only one certification exam.  Understand, that physicians are very influenced (I would assert far more than RN's and NP's) by money and there is a long history of them (as a profession) taking large amounts of money from pharmaceutical firms to "push" certain medications. Here is an article that "touches" on the problem https://www.propublica.org/article/we-found-over-700-doctors-who-were-paid-more-than-a-million-dollars-by-drug-and-medical-device-companies  . In "my area" Dr. Stahl was on the payroll for Takeda earning several million per year,  at the same time that he was pushing unfounded claims for some of their medications such as Trintellix (as being effective for anxiety, this was subsequently retracted in his textbook.  One of the reasons (I believe) that NP's provide equivalent or superior care is that they do a better job (on average) and focusing on patient needs rather than profit maximization. If you think "we" will ever meet a threshold that MD's find acceptable then I would argue that you are sadly mistaken.  Thankfully, NP's have been found safe and effective in numerous studies on outcomes and are more cost effective at a time when Medicare, Medicaid, and other health care systems are stretched to the limit. If we progress towards a more socialized system then our contribution will be even more magnified.  

[Angeljho, MSN, NP]

11 hours ago, AF2BSN said:

Not the students in the article, or in this thread, or the 5000 strong FB group? Or the many others who recognize there is a problem? We wouldn’t have the AMA or physicians pushing back if we had a leg to stand on. They’re not targeting PAs, because PA curriculum is actually standardized. You don’t have PAs taking online tests. You don’t have PAs finding their own preceptors. You don’t have PAs writing papers on nonsense.

Your continued defense of a broken system is astounding. There is no standardization in NP training aside from broad standards that schools choose how to meet. Don’t get me started on 3Ps and their lack of rigor. How can there be standardization when I can elect to take not one, but TWO different tests for acute care boards? How is that standardized? 

It’s clear we will never agree on this. Time will tell. I’m guessing the NP profession is in for a rude awakening. 

Yes, the AMA is also going after PAs. I agree that NP education could be more rigorous, but the AMA would still be targeting NPs regardless. CRNA and PA education are both more rigorous, yet the AMA and PPP (Physicians for Patient Protection) are still going after those professions. Why? Because it definitely is about power and control at the end of the day. I am a huge advocate of strengthening NP education, because I think we owe it to our patients to better ourselves by pushing our knowledge to higher standards, but I would never trust or side with physician organizations.

With that being said, I do think NP curricula will see a change in the future. Hopefully, they mirror CRNA programs in terms of rigor. I also hope prior experience becomes a definite requirement, because I now see that some people are bypassing working as an RN. That should not be happening.

[djmatte, ADN, MSN, RN, NP]

I still maintain if NP education wanted to increase the value of their DNP, they should change the overall curriculum. Use the MSN as a broad NP education level akin to PA education. Allow them the opportunity to be flexible in where they choose to work, but expand the areas in which they train and Do clinicals.   Use the DNP with specialty and board certification focus.  

[DrCOVID, DNP]

3 hours ago, djmatte said:

I still maintain if NP education wanted to increase the value of their DNP, they should change the overall curriculum. 

You should watch the video posted by @af2bsn. The big problem is there is no national standardized curriculum - which is frankly appalling and the fact nursing associations haven't done that boggles the mind. Till this happens we will have large discrepancies between online only schools and those with reputations like Hopkins, Vanderbuilt or Incarnate Word.

3 hours ago, djmatte said:

Use the DNP with specialty and board certification focus.  

My last semester (16 weeks) is focused on board certification, 256 patient clinic hours and a leadership course. 

[londonflo]

2 hours ago, adammRN said:

My last semester (16 weeks) is focused on board certification,.......

How is this different than teaching to the test? I don't mean this meanly or smugly but in a genuine interest of your curriculum. Surely the previous semesters were dedicated to your learning the content necessary to provide safe, competent care. Why does one need an additional course to pass the boards? I see this in undergrad programs too. Why? Some will say that boards do not reflect what it really is to practice. But don't they test the underlying content that allows one to modify their practice for an individual while practicing?

[KetafolDNP, DNP, CRNA, NP]

On 12/1/2020 at 6:54 AM, djmatte said:

I still maintain if NP education wanted to increase the value of their DNP, they should change the overall curriculum. Use the MSN as a broad NP education level akin to PA education. Allow them the opportunity to be flexible in where they choose to work, but expand the areas in which they train and Do clinicals.   Use the DNP with specialty and board certification focus.  

I agree with you, NP curriculum needs an overhaul. There’s wild variety in the content provided to APRNs between different universities. Then certifying bodies are to blame. Period. Yes the universities should take more pride in their product but at the end of the day many of these universities are NP programs as a lucrative business model and so long as their graduates pass boards why should they bother improving their curriculum. 

So I maintain they NP boards need to centralize. There are plenty of medical schools that teach heavily towards the boards. The difference is that the USMLE is centralized - there is only one board that administers this exam, and the exam is challenging and comprehensive. There should be one board exam for each NP specialty, and they should be comprehensive. This way programs have to offer comprehensive education

The exam to be a CRNA is this way. It is challenging, some 10% of graduates will not pass after two attempts, and then need remediation by their university. If your university performs poorly on the boards the university can loose accreditation. 

On a different note (more style than substance)-  NP programs (and nursing in general) are also notoriously bad at describing their coursework. Courses like “FNP practice 1” and such should have more descriptive terms so on-lookers understand what our coursework entails. I applaud universities who name courses such as “primary care of the adult”, “Diagnosis and management of episodic illness” etc. I’d encourage more universities to divide their big 4 or 5 credit, non-descript classes into fewer-credit, more specific titled courses

[londonflo]

On 12/1/2020 at 1:28 PM, KetafolDNP said:

 If your university performs poorly on the boards the university can loose accreditation. 

It is far better to improve the curriculum as a whole for the students, than to add a coaching class at the end. That is what separates excellent programs from the 'run of the mill'. Review the curriculum before you enroll. If there is a course dedicated to helping you pass the boards or an exit exam required,  you need to re-think if this is a comprehensive program that will provide a sound foundation for practice as a new grad, new NP or new MD.

On 12/1/2020 at 1:28 PM, KetafolDNP said:

There are plenty of medical schools that teach heavily towards the boards.

Like Caribbean Medical Schools?

Quote

The second big issue is passing the USMLE. The USMLE is required to practice medicine in the United States. Unfortunately, many Caribbean medical schools have a reputation for graduating students that end up failing the USMLE.

Not all medical schools teach to the boards and those are the ones with an excellent curriculum that is updated and revised as needed.

[KetafolDNP, DNP, CRNA, NP]

On 12/1/2020 at 2:06 PM, londonflo said:

It is far better to improve the curriculum as a whole for the students, than to add a coaching class at the end. That is what separates excellent programs from the 'run of the mill'. Review the curriculum before you enroll. If there is a course dedicated to helping you pass the boards or an exit exam required,  you need to re-think if this is a comprehensive program that will provide a sound foundation for practice as a new grad, new NP or new MD.

Like Caribbean Medical Schools?

Not all medical schools teach to the boards and those are the ones with an excellent curriculum that is updated and revised as needed.

I agree that the curriculum alone should be enough to pass the boards, and that a board prep course can be a red flag. Making board exams harder would mean that a university would need to rethink its entire curriculum to make sure it’s comprehensive. Many US based medical schools weave USMLE prep into their curriculum, because the exam is far reaching and challenging and delivered in three steps. 

It’s very hard to assess a programs curriculum before matriculating. Course depth is not clear by a curriculum and most universities do not allow non-enrolled students to view syallabuses. 

[myoglobin, ASN, BSN, MSN]

I would also point out that "boards" are not necessarily the best measure of who will be a good clinician.  The Psychiatrist that I trained under failed the boards three times before passing, but is almost universally loved by his patients.  Of course there needs to be a "minimum" level of knowledge, but just because someone  (or a given school) does better at preparing you for the boards does not necessarily mean that it is "better".  This is especially, the case for those like myself who make heavy use of CAM approaches like SAM(e), Saint John's Wort, standardized lavender extract, Omega three fatty acids, exercise, yoga,  early morning sunlight/therapy lamps and other "alternative" modalities.  No doubt some curriculums would have frowned upon these being preferentially included in my care plans ahead of more standardized depression modalities such as SSRI's for depression. Also, I don't necessarily care about NP's getting "paid more" by increasing scarcity. Rather, I would prefer they earn more by creating NP owned/managed practices even in non IP states and those practices focusing more on "passing through" more revenue to workers (including NP's).  While, I believe the current system can and should be improved I am also grateful for the opportunity that it provided for me to move from an ICU RN to an Independent practice setting earning about 400% of what I did in bedside. Were it not for the "online" modality I would have never been able to return to school as an older student working nightshift in the ICU.  Also, the fact that I was "required" to find my clinical sites was also a blessing since it meant that I could find someone conducive to my schedule and personality.  Rather, than trying to be more like MD's, PA's or others we should celebrate the unique differences that being NP's affords us in providing excellent care to patients.

[DrCOVID, DNP]

5 hours ago, londonflo said:

How is this different than teaching to the test? I don't mean this meanly or smugly but in a genuine interest of your curriculum. Surely the previous semesters were dedicated to your learning the content necessary to provide safe, competent care. Why does one need an additional course to pass the boards? I see this in undergrad programs too. Why? Some will say that boards do not reflect what it really is to practice. But don't they test the underlying content that allows one to modify their practice for an individual while practicing?

The point of boards is to make sure that you are familiar with basic concepts related to practice... if you study for boards you should learn more about practice?  

A major point people miss is school is mostly what the student makes of it. Even if you are in a *** program, you can blame the program, or get the degree and still be a good provider. You can dedicate yourself to study or not, take an interest of being a good provider or not. I had trouble the first year staying interested, years 2 & 3 were much better because I'm actually interested in psychiatry and like being in clinic and helping people. We learn the most from practice. You can read books all day. Regurgitating knowledge for an exam is low level (boards), but the foundation of higher tiers of learning and application. Application of knowledge and helping people is why we are here. That is the real problem with lacking curriculum rigor/clinical time; theoretically you should be better prepared bc you put in more time.

If a nurse cares about helping people, they will take it upon themselves to be a good provider. I took the rest of the time I had this semester to try to learn more about my field and study my weak areas.