DNP-Prepared Generalist APRNs

edmia, BSN, RN · Dec 27, 2013

Interesting. I consider FNPs as generalists and think that should be the base degree. After that, a certification should suffice in whatever specialty. Except for the CRNA which is a different thing altogether, I don't see why an FNP can't do birth as well. It's part of family care.

Sent from my iPhone using allnurses.com

matthewandrew, NP · Dec 27, 2013

That's a very interesting idea! Thank you for the response. I think FNP is the closest "generalist" APRN we have. I guess I'm just not a big fan of FNPs not being eligible to practice in acute care (except maybe in fast track ED). It differs with PA and MDs being able to practice in whatever setting and practice they choose after graduating. I think the DNP can be so much more. (Think of DO programs without OMM). Just a thought.

allnurses Guide · Dec 27, 2013

As of now registered nurses are prepared as generalist clinicians, meaning they have different rotations and able to practice in any setting after graduation. But when they transition into advanced practice, they must decide which specialty program they want to go into CNS, CNM, NP or CRNA. Within these routes, a nurse must also decide between primary care vs acute care, family, adult, pediatric, psychiatric, etc.
I think this may be too narrowing for some nurses and the profession. I think there should be DNP programs that prepare candidates to practice in all fields of advanced practice nursing. I think this would unite and elevate the nursing profession.
Just a thought to put out there. I'd love to hear the discussion.

Well this is true except for CRNAs who are trained to provide care to all ages and surgeries.

The APRN consensus model is supposed to provide some continuity between training of all APRNs. http://www.aacn.nche.edu/education-resources/aPRNReport.pdf

An APRN would have to be in school for decade or more to learn every possible speciality.

With the consensus model APRNs get similar background training in pharmacology, pathophysiology etc. then move onto their specialty training. This would be similar to the medical model of teaching physicians.

allnurses Guide · Dec 27, 2013

That's a very interesting idea! Thank you for the response. I think FNP is the closest "generalist" APRN we have. I guess I'm just not a big fan of FNPs not being eligible to practice in acute care (except maybe in fast track ED). It differs with PA and MDs being able to practice in whatever setting and practice they choose after graduating. I think the DNP can be so much more. (Think of DO programs without OMM). Just a thought.

PAs often require OJT to work in specialty areas and work under the direction of a physician.

Physicians cannot work in any area after graduation. Physicians have to apply and go through residency training before being allowed to work at most places especially speciality areas.

elkpark · Dec 27, 2013

As of now registered nurses are prepared as generalist clinicians, meaning they have different rotations and able to practice in any setting after graduation. But when they transition into advanced practice, they must decide which specialty program they want to go into CNS, CNM, NP or CRNA. Within these routes, a nurse must also decide between primary care vs acute care, family, adult, pediatric, psychiatric, etc.
I think this may be too narrowing for some nurses and the profession. I think there should be DNP programs that prepare candidates to practice in all fields of advanced practice nursing. I think this would unite and elevate the nursing profession.
Just a thought to put out there. I'd love to hear the discussion.

Really? You're talking about people completing one DNP program and being considered qualified to deliver anesthesia, deliver babies, manage psychiatric disorders, etc., etc., etc.????? Maybe I'm going to be the outlier on this, but I consider that one of the crazier ideas I've heard in a long time. Graduate education in nursing now only provides the minimum preparation to enter practice safely in a particular, specific specialty and role. I would certainly not be willing to be seen by anyone who had received such minimal preparation in so many specialties (talking about the "generalist APRN" degree, that is). How long would this "generalist" DNP program take? 10 years? As things stand now, people who find a particular advanced practice role "too narrowing" are welcome to pursue post-grad certificates in other specialties (and plenty of people do just that). IMO, watering down graduate education in nursing any more than we already have would do exactly the opposite of "unit(ing) and elevat(ing) the nursing profession."

BTW, wtbcrna, psych is switching to a "lifespan" model and is eliminating the child, adult, and geri specialities (and eliminating the psych CNS entirely). The graduate programs are all switching over and, starting next year, ANCC is only offering a family psych NP certification, in line with the LACE model (and those of us who went to a lot of trouble to pursue education and expertise in a particular age group are getting kicked to the curb).

edmia, BSN, RN · Dec 27, 2013

Well this is true except for CRNAs who are trained to provide care to all ages and surgeries. The APRN consensus model is supposed to provide some continuity between training of all APRNs. http://www.aacn.nche.edu/education-resources/aPRNReport.pdf An APRN would have to be in school for decade or more to learn every possible speciality. With the consensus model APRNs get similar background training in pharmacology pathophysiology etc. then move onto their specialty training. This would be similar to the medical model of teaching physicians.[/quote']
Thank you for that link. This is what I was thinking about, a base model of preparation with post-graduate specialty. The CNP described in the consensus model is better than all these fragmented tracks we have now.
Sent from my iPhone using allnurses.com

matthewandrew, NP · Dec 27, 2013

Well I would expect these advanced nurses (as they should now) to complete residencies as well in their chosen specialities. I don't see why MD/DO programs are able to prepare clinicians to practice in every specialty (with residency of course) but the profession of nursing can't.

And please do not get upset. I understand these may seem crazy ideas (but wasn't the APRN model a bold idea 50 years ago in the US)? Right now, not every country in the world have NPs because some people say it's a ridiculous idea. I know all NPs are living proof of the capabilities and potential of all nurses (with the proper education and preparation).

Please, this is only a bold idea I'm putting up for discussion. I post this in the spirit of improving and modernizing our beloved profession.

allnurses Guide · Dec 28, 2013

Well I would expect these advanced nurses (as they should now) to complete residencies as well in their chosen specialities. I don't see why MD/DO programs are able to prepare clinicians to practice in every specialty (with residency of course) but the profession of nursing can't.
And please do not get upset. I understand these may seem crazy ideas (but wasn't the APRN model a bold idea 50 years ago in the US)? Right now, not every country in the world have NPs because some people say it's a ridiculous idea. I know all NPs are living proof of the capabilities and potential of all nurses (with the proper education and preparation).
Please, this is only a bold idea I'm putting up for discussion. I post this in the spirit of improving and modernizing our beloved profession.

1. You cannot lump CRNAs into any of this. CRNAs are trained to provide care to every age group and surgery type. CRNAs are the oldest APN specialty dating back well into the 1800s or approximately 150 years.

2. Nurses are trained as generalists. APRNs are trained as specialists. Physicians are trained to enter residency with general overall knowledge, but are not qualified for any speciality until they finish residency training.

3. The Consensus Model is supposed to train all APRNs with a similar background before moving to speciality training. This isn't a new idea that you have come up with it is something that educators and nursing associations have been working with for several years now.

manusko · Dec 28, 2013

Well I would expect these advanced nurses (as they should now) to complete residencies as well in their chosen specialities. I don't see why MD/DO programs are able to prepare clinicians to practice in every specialty (with residency of course) but the profession of nursing can't.
And please do not get upset. I understand these may seem crazy ideas (but wasn't the APRN model a bold idea 50 years ago in the US)? Right now, not every country in the world have NPs because some people say it's a ridiculous idea. I know all NPs are living proof of the capabilities and potential of all nurses (with the proper education and preparation).
Please, this is only a bold idea I'm putting up for discussion. I post this in the spirit of improving and modernizing our beloved profession.

These MD/DO programs prepare them to be competent in every area? No, they apply for specialties after medical school. They aren't ready for the OR, dermatology clinic, OB/GYN practice etc....

nomadcrna, DNP, CRNA, NP · Dec 30, 2013

FNPs do solo ER coverage in many states. No other NP can do this. The studies back up their safe care.The ANCC has stated that ER is a specialty in the consensus model. Meaning any NP can get additional training

You are not an NP so I'm not sure how you are able to judge whether or not a certain type of NP can work in a specialty.

The reality is that there is absolutely no difference between PAs and NPs n clinical practice. The initials mean squat, it is all the person..

I do agree with the concept of a base FNP for all specialties, including CRNA.politics and money has seen to that not happening.

That's a very interesting idea! Thank you for the response. I think FNP is the closest "generalist" APRN we have. I guess I'm just not a big fan of FNPs not being eligible to practice in acute care (except maybe in fast track ED). It differs with PA and MDs being able to practice in whatever setting and practice they choose after graduating. I think the DNP can be so much more. (Think of DO programs without OMM). Just a thought.

nomadcrna, DNP, CRNA, NP · Dec 30, 2013

Not really as the NP does not get the generalist training before specializing. Except the FNP to a Certain degree.

Well this is true except for CRNAs who are trained to provide care to all ages and surgeries. The APRN consensus model is supposed to provide some continuity between training of all APRNs. http://www.aacn.nche.edu/education-resources/aPRNReport.pdf An APRN would have to be in school for decade or more to learn every possible speciality. With the consensus model APRNs get similar background training in pharmacology, pathophysiology etc. then move onto their specialty training. This would be similar to the medical model of teaching physicians.