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¢

[dianah, ASN]

3 hours ago, myoglobin said:

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.

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[Angeljho, MSN, NP]

3 hours ago, myoglobin said:

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.  

Oh yeah, I know MDs can do fellowships. It's still a form of post graduate training. There are also NP fellowships (although not the same, of course). Still, there are options for NPs to gain post graduate training. I just want to see NP education become more rigorous. There's this huge push for NPs to obtain their DNP degree, but there should be a push for better NP education first. I feel like the image of NPs is becoming increasingly negative with malpractice cases now coming to light. I don't even know if I can support NPs owning their own practices anymore.

[myoglobin, ASN, BSN, MSN]

44 minutes ago, Angeljho said:

Oh yeah, I know MDs can do fellowships. It's still a form of post graduate training. There are also NP fellowships (although not the same, of course). Still, there are options for NPs to gain post graduate training. I just want to see NP education become more rigorous. There's this huge push for NPs to obtain their DNP degree, but there should be a push for better NP education first. I feel like the image of NPs is becoming increasingly negative with malpractice cases now coming to light. I don't even know if I can support NPs owning their own practices anymore.

Well I only pay $75.00 month for over 2million in liability coverage the psychiatrist I did clinical under paid about 5 times that. According to my insurance company it is because NP get sued less often for lower average settlements.

[myoglobin, ASN, BSN, MSN]

3 hours ago, Angeljho said:

Oh yeah, I know MDs can do fellowships. It's still a form of post graduate training. There are also NP fellowships (although not the same, of course). Still, there are options for NPs to gain post graduate training. I just want to see NP education become more rigorous. There's this huge push for NPs to obtain their DNP degree, but there should be a push for better NP education first. I feel like the image of NPs is becoming increasingly negative with malpractice cases now coming to light. I don't even know if I can support NPs owning their own practices anymore.

Well, I think a good "starting point" would be the residency programs such as those offered through Thrive (formerly Midlevel U). These might evolve to become a "marketplace standard" in many places even if not mandated by law. 

[AF2BSN]

On 12/20/2020 at 7:37 PM, myoglobin said:

Well I only pay $75.00 month for over 2million in liability coverage the psychiatrist I did clinical under paid about 5 times that. According to my insurance company it is because NP get sued less often for lower average settlements.

Eh, I think that's more a function of level of acuity and recoverability. Most attorneys don't look at NPs as a deep well of funds and liability limits are higher for physicians. 

https://www.nejm.org/doi/full/10.1056/NEJMsa1012370

Psychiatry is at the bottom of the list for claims and payout for physicians according to this. It's not a stretch to extrapolate that PMHNPs would be even lower based on factors I mentioned above. As expected, invasive procedure specialties are much more at risk. 

[Tegridy]

Its not mirroring anything unless residency becomes a requirement.

[AF2BSN]

3 hours ago, Tegridy said:

its not mirroring anything unless residency becomes a requirement

Did you read the OP, or just read the title?

[Tegridy]

4 minutes ago, AF2BSN said:

Did you read the OP, or just read the title?

read all of the above and the responses, people discussing classes but the topic of GME is left out so I added it

[AF2BSN]

2 hours ago, Tegridy said:

read all of the above and the responses, people discussing classes but the topic of GME is left out so I added it

My initial post specifically mentions residency and fellowships. 

[myoglobin, ASN, BSN, MSN]

On 12/23/2020 at 5:51 PM, AF2BSN said:

Eh, I think that's more a function of level of acuity and recoverability. Most attorneys don't look at NPs as a deep well of funds and liability limits are higher for physicians. 

https://www.nejm.org/doi/full/10.1056/NEJMsa1012370

Psychiatry is at the bottom of the list for claims and payout for physicians according to this. It's not a stretch to extrapolate that PMHNPs would be even lower based on factors I mentioned above. As expected, invasive procedure specialties are much more at risk. 

Whatever, the reason it is good to have low Liability Insurance premiums.

[Tegridy]

On 1/3/2021 at 3:31 PM, AF2BSN said:

My initial post specifically mentions residency and fellowships. 

It should be Mandatory though not optional