DNP: Mirroring the Path of DO?

londonflo · Dec 2, 2020

On 12/1/2020 at 6:30 PM, adammRN said:

Regurgitating knowledge for an exam is low level (boards), but the foundation of higher tiers of learning and application.

I do appreciate your thoughts on testing. A test can be constructed to only test knowledge and comprehension and that is at the lowest level. But test construction, which is a subject and practice field of its own and can be used to test critical thinking and higher levels of learning. Of course test performance is not actually making real life decisions but higher level test questions are designed to force the tester to know and correctly apply 2 (or more) concepts simultaneously to solve a problem. To approach the skill of testtaking it does help to learn what type of questions will be employed and strategies for answering them. This should never be left to the end of a program, rather it should be integrated into the testing procedures, starting with the first test.

On 12/1/2020 at 6:30 PM, adammRN said:

That is the real problem with lacking curriculum rigor/clinical time; theoretically you should be better prepared bc you put in more time.

I see a lot of short time alotted for ABSN and DEMSN programs but it doesn't necessarily reflect poor curriculums. The development of a curriculum that continuously builds on previous content designed to meet an expected outcome is the important part. Real world application concurrent with the content helps reinforce the concepts. I do agree though that time does promote growth in the learner's skills such as caring.

Subee2, BSN, MSN, CRNA · Dec 15, 2020

I just read in my alumni magazine that only 15% of DNP programs have any clinical content. So if they can't produce advanced PRACTICE nurses, what are they good for? If you can become an NP online, we have lost control if our own profession and an online DNP is even more egregious. If it's not going to be a practice degree, then remove the word from the title. The CRNA's and the midwives are the only programs fulfilling their educational obligations to the patient and to the student.

myoglobin, ASN, BSN, MSN · Dec 15, 2020

2 hours ago, Undercat said:

I just read in my alumni magazine that only 15% of DNP programs have any clinical content. So if they can't produce advanced PRACTICE nurses, what are they good for? If you can become an NP online, we have lost control if our own profession and an online DNP is even more egregious. If it's not going to be a practice degree, then remove the word from the title. The CRNA's and the midwives are the only programs fulfilling their educational obligations to the patient and to the student.

I would agree that CRNA's and midwife's in some ways do a better job, but are worse in others. I worked with two ICU nurses who made it to their final one or two semesters in CRNA school with great grades, but where the MD doctor they worked under gave them poor clinical grades and they were "expelled" from the program each owing about 80K in student loan debt for the program. In Florida (at the time in the early 2000's) there was a relatively strong cultural bias against having CRNA's and the power to pass/fail was put in the hands of those potentially with an agenda. At least the other NP professions are less subject to this issue. I also believe that the Thrive residency program could become something of "a standard" to advance education standards providing more clinical experience.

Subee2, BSN, MSN, CRNA · Dec 16, 2020

2 hours ago, myoglobin said:

I would agree that CRNA's and midwife's in some ways do a better job, but are worse in others. I worked with two ICU nurses who made it to their final one or two semesters in CRNA school with great grades, but where the MD doctor they worked under gave them poor clinical grades and they were "expelled" from the program each owing about 80K in student loan debt for the program. In Florida (at the time in the early 2000's) there was a relatively strong cultural bias against having CRNA's and the power to pass/fail was put in the hands of those potentially with an agenda. At least the other NP professions are less subject to this issue. I also believe that the Thrive residency program could become something of "a standard" to advance education standards providing more clinical experience.

I'm wondering if these two CRNAs were in the program owned by MD's which I was stunned to find even existed. Such a conflict of interests against the students I couldn't believe that education model was allowed to exist. Students did sue the program. Yes, the standards are slipping for CRNAs because but they all have more serious prereqs and no need to waste your money on the application if you don't have experience and clinical references.

myoglobin, ASN, BSN, MSN · Dec 16, 2020

4 hours ago, Undercat said:

I'm wondering if these two CRNAs were in the program owned by MD's which I was stunned to find even existed. Such a conflict of interests against the students I couldn't believe that education model was allowed to exist. Students did sue the program. Yes, the standards are slipping for CRNAs because but they all have more serious prereqs and no need to waste your money on the application if you don't have experience and clinical references.

I believe they attended Advent Health University in Orlando. I have no way of knowing if their failings were valid or not. My point is that any process (becoming a CRNA) that requires you to put in so much effort and exposes you to that sort of "capricious" ability to fail (based upon the opinion of one clinical instructor) isn't the sort of program I would want to attend. Especially as someone who is severely ADHD in a world of "OCD" type clinicians.

Subee2, BSN, MSN, CRNA · Dec 17, 2020

On 12/16/2020 at 12:32 AM, myoglobin said:

I believe they attended Advent Health University in Orlando. I have no way of knowing if their failings were valid or not. My point is that any process (becoming a CRNA) that requires you to put in so much effort and exposes you to that sort of "capricious" ability to fail (based upon the opinion of one clinical instructor) isn't the sort of program I would want to attend. Especially as someone who is severely ADHD in a world of "OCD" type clinicians.

Agreed. Advent's passing rates for the board exams is well below the average. Wolford us another program with a history of low pass rates and I can't find they are regionally accredited which has been an old issue with them. Florida has made such huge educational progress in the last two decades rising up from the bottom of the barrel to the top in school rankings. Maybe that's why they are (or were) reluctant to participate in regional accreditation of Wolford, who, BTW asked the accreditation board for CRNA's to increase it's student body to 100 and was denied. CRNA Education isn't what it used to be with your instructor monitoring your progress over the time if the program. Too many sausage factories out there, especially in Florida and Texas.

KetafolDNP, DNP, CRNA, NP · Dec 17, 2020

19 minutes ago, Undercat said:

Agreed. Advent's passing rates for the board exams is well below the average. Wolford us another program with a history of low pass rates and I can't find they are regionally accredited which has been an old issue with them. Florida has made such huge educational progress in the last two decades rising up from the bottom of the barrel to the top in school rankings. Maybe that's why they are (or were) reluctant to participate in regional accreditation of Wolford, who, BTW asked the accreditation board for CRNA's to increase it's student body to 100 and was denied. CRNA Education isn't what it used to be with your instructor monitoring your progress over the time if the program. Too many sausage factories out there, especially in Florida and Texas.

The amount of CRNA programs has been relatively steady over time because it’s an enormous undertaking to create a program. Wolford I think is an unfortunate example of how the system should work. The board exam for CRNAs is very challenging. Wolford students did not have an acceptable pass rate for some time. They were put on probation and then eventually lost accreditation which means they close. This is one way to preserve academic integrity in the profession. If CRNAs had multiple board exams competing for your money then those wolford students may have passed no problem and the profession would have been worse off.

Subee2, BSN, MSN, CRNA · Dec 17, 2020

On 12/17/2020 at 9:54 AM, KetafolDNP said:

The amount of CRNA programs has been relatively steady over time because it’s an enormous undertaking to create a program. Wolford I think is an unfortunate example of how the system should work. The board exam for CRNAs is very challenging. Wolford students did not have an acceptable pass rate for some time. They were put on probation and then eventually lost accreditation which means they close. This is one way to preserve academic integrity in the profession. If CRNAs had multiple board exams competing for your money then those wolford students may have passed no problem and the profession would have been worse off.

I've taken those boards;) I don't know what younger CNRA's think but us old timers argue against multiple sponsors for boards would b a slide downhill. Today's students have a different mindset today and don't want to work independently when my generation HAD to work independently. The regulations concerning billing were much different . Working alone was so much more rewarding than being a corporate widget, but the "kids" seem to not want the responsibility. Education now reflects that new reality.

Angeljho, MSN, NP · Dec 20, 2020

On 12/15/2020 at 3:33 PM, Undercat said:

I just read in my alumni magazine that only 15% of DNP programs have any clinical content. So if they can't produce advanced PRACTICE nurses, what are they good for? If you can become an NP online, we have lost control if our own profession and an online DNP is even more egregious. If it's not going to be a practice degree, then remove the word from the title. The CRNA's and the midwives are the only programs fulfilling their educational obligations to the patient and to the student.

DNP is not a clinical degree. It's a nursing practice degree. There's a difference. When you finish NP school at the MSN level, you're expected to be competent to practice. If you want to enhance your skills and knowledge, you can do post graduate training. However, if you're looking to obtain a DNP because you feel it should give you clinical knowledge to improve practice as a provider, then that's a flaw with NP programs at the MSN level, because you should already be competent enough to practice. You can't have two separate degrees (with one being higher than the other) that claim to ready NPs for practice. You're either ready or you're not. Once you become a PA, that's it. Once you become an MD, that's it. Once you become an NP, that's it. As I said, any of these clinicians can do post graduate training (and it's basically required for MDs), but it makes no sense to expect a whole other degree to improve your skills. Instead, you should be asking why you don't feel prepared from an NP Program.

CRNA programs have always been more rigorous than NP programs. Their DNPs are still the same content, it's just required. There are DNP programs with NP tracks, but most of these programs still have you do NP coursework like a standard MSN program before you move on to the DNP portion. There is no extra clinical content in the DNP portion. If the DNP were to become a requirement for NP practice, programs would be similar to what I just described.

The DNP degree was always meant for advanced practice nurses to tackle healthcare in a different way than directly seeing patients as a clinician. Instead, it trains advanced practice nurses to look at existing research and apply that research to current practice—this is why it's considered a practice degree. You're not improving practice as a provider; you're improving practice on a much larger scale. For instance, if there is a town that has high mortality rates because it lacks true healthcare access, the DNP nurse will work to establish a connection to healthcare. It's still improving practice, and you're doing it on a much larger scale in contrast to providing care to a capped caseload of patients. This is also why the DNP degree is available to nurses who are not APRNs.

If you feel that NP education should be stronger—and that's what I feel—then we should be fighting for NP Program educational reform. That's where the issue is. NP programs should parity the rigor of CRNA/PA programs—more clinical hours, more patho/pharm, more basic sciences, more rigorous tests, etc. Leave the DNP degree as it is. It's fulfilling its role.

myoglobin, ASN, BSN, MSN · Dec 20, 2020

2 hours ago, Angeljho said:

DNP is not a clinical degree. It's a nursing practice degree. There's a difference. When you finish NP school at the MSN level, you're expected to be competent to practice. If you want to enhance your skills and knowledge, you can do post graduate training. However, if you're looking to obtain a DNP because you feel it should give you clinical knowledge to improve practice as a provider, then that's a flaw with NP programs at the MSN level, because you should already be competent enough to practice. You can't have two separate degrees (with one being higher than the other) that claim to ready NPs for practice. You're either ready or you're not. Once you become a PA, that's it. Once you become an MD, that's it. Once you become an NP, that's it. As I said, any of these clinicians can do post graduate training (and it's basically required for MDs), but it makes no sense to expect a whole other degree to improve your skills. Instead, you should be asking why you don't feel prepared from an NP Program.

CRNA programs have always been more rigorous than NP programs. Their DNPs are still the same content, it's just required. There are DNP programs with NP tracks, but most of these programs still have you do NP coursework like a standard MSN program before you move on to the DNP portion. There is no extra clinical content in the DNP portion. If the DNP were to become a requirement for NP practice, programs would be similar to what I just described.

The DNP degree was always meant for advanced practice nurses to tackle healthcare in a different way than directly seeing patients as a clinician. Instead, it trains advanced practice nurses to look at existing research and apply that research to current practice—this is why it's considered a practice degree. You're not improving practice as a provider; you're improving practice on a much larger scale. For instance, if there is a town that has high mortality rates because it lacks true healthcare access, the DNP nurse will work to establish a connection to healthcare. It's still improving practice, and you're doing it on a much larger scale in contrast to providing care to a capped caseload of patients. This is also why the DNP degree is available to nurses who are not APRNs.

If you feel that NP education should be stronger—and that's what I feel—then we should be fighting for NP Program educational reform. That's where the issue is. NP programs should parity the rigor of CRNA/PA programs—more clinical hours, more patho/pharm, more basic sciences, more rigorous tests, etc. Leave the DNP degree as it is. It's fulfilling its role.

I agree to a great extent, but still feel that the DNP could contain more clinical coursework even if only to prevent losing skills/knowledge gained in the MSN/NP segment of the program. Also, I would question the ability to "change" health care delivery has a DNP given that so much of it is provided by MD's and PA's (certainly the ability to change it without practicing it). Thus, as an MSN I have "some ambitions" around changing psychiatric healthcare focused around the greater use of lifestyle interventions (early morning light, exercise, yoga) and evidence based CAM approaches that I believe are "under" utilized (such as SAM(e), Saint John's Wort, standardized lavender extract/Silexin) and integrated CBT therapy. If I am successful I will start a business and try to expand it locally, regionally and then nationally. That would (at least to some small extent) change that aspect of healthcare. I also aspire to encourage and empower NP's to manage/own their own practices (even in non IP states by paying MD's for collaboration where necessary or making them part owners). In this way I believe that NP's can double or triple their income and spend more time (on average with patients). Neither, of these objectives would be facilitated by my going back for a DNP as it is currently structured. Rather, they might however be advanced through actually creating/growing businesses and encouraging others to do the same. I just don't see the advantage of a DNP relative to a PhD. At least if I go back for my PhD I would be better equipped to teach during my retirement (I'm 51 and plan to retire around 75 and then may teach for another decade) or I could perhaps do a thesis on something like "the potential impact of artificial intelligence/expert systems on improving diagnosis and treatment by NP's"

Also with regard to education after the "primary" degree one could argue that the various fellowships that MD's can obtain is the equivalent of "extra education" and that NP's should perhaps be able to avail themselves of similar opportunities to enhance knowledge.

myoglobin, ASN, BSN, MSN · Dec 20, 2020

Also, why can we no longer edit? As someone with severe ADHD (not treated with medication) I try to use the "edit" function to clean of at least some of my "errors" such as using the word "has" above when I intended "as". This feature has not worked in awhile.

KetafolDNP, DNP, CRNA, NP · Dec 20, 2020

On 12/17/2020 at 6:42 PM, Undercat said:

I've taken those boards;) I don't know what younger CNRA's think but us old timers argue against multiple sponsors for boards would b a slide downhill. Today's students have a different mindset today and don't want to work independently when my generation HAD to work independently. The regulations concerning billing were much different . Working alone was so much more rewarding than being a corporate widget, but the "kids" seem to not want the responsibility. Education now reflects that new reality.

I don’t believe that today’s students mindset or training is less intent on independent practice. The younger generation of CRNAs is more likely to be a member of the AANA and contribute to the PAC...this alone shows greater professional engagement.

And for what it’s worth, when the NBCRNA wanted the whole profession to re-test to maintain licensure it wasn’t the younger generation that set its hair on fire ?