2015 DNP

[BabyLady]

I am wondering if anyone has heard any updates.

Everything I keep seeing online from the AACN is "recommendation", "strongly encouraged", "highly suggested".

I have yet to see anything, that says, "Look, either you graduate and pass your boards by January 1, 2015 or you can put the MSN you have in back of the closet and start working on your DNP, because the MSN isn't good enough anymore to sit for national certification."

There are many of us, including myself, that will be finishing probably in 2013 or 2014...now, we would all like to think that we would pass our certification the first go-round, but we all know that may or may not happen for some of us.

Example: You graduate in June 2014 with your MSN and it is January, 2015, you still cannot pass your certification exam...does that mean you have to go back to school or you cannot practice?

I have seen some colleges that have completely phased out MSN programs but I have seen MANY that have not...that makes me wonder if it is not going to be a "go" like they are claiming that it is.

I would love to hear from those that keep up with this sort of thing...that may have more insight.

[dqbanrn]

Of all the DNP programs I've looked into, the one I like the most is Columbia University. The really do emphasize the clinical aspect in their program. They require the completion of clinical portfolio instead of thesis or other more academic approach. I hope that DNP programs for nurse practitioners eventually evolve to make this a requirement. It probably does not make sense for a non nurse practitioner DNP student to meet this requirement however.

EVERY DNP program (for ARNPs) does serve to improve the nurses clinical skills above what they learned in their masters by virtue requiring more clinical hours be completed. Some programs, of course, will provide a better experience. (true of any school, including medicine). Are these additional clinical hours enough to warrant the title "doctor"? That is certainly a matter for debate.

There is no question that MDs spend more time studying before being "let loose", but I it is unrealistic to expect nursing to evolve the DNP program to exactly mimic osteopathic or allopathic models. As nurses, we begin our clinical training during our undergraduate The whole concept of an advance practice nurse is based on that fact; the idea being to expand on this knowledge. This is a historical truth. Future DNP programs will likely continue this tradition.

Given that nursing and medicine will not have identical educational paths, at what point should DNPs be considered worthy of the title "doctor"? Should they need more clinical hours? Do they need to prove their competency after boards some how? Are DNPs not considered experts in their field now?

[PMFB-RN, RN]

EVERY DNP program (for ARNPs) does serve to improve the nurses clinical skills above what they learned in their masters by virtue requiring more clinical hours be completed.

*** Except they don't. At least not all of them. The CRNA program based here at my hospital and where my best friend in a student went from MSN to DNP without adding a single clinical hour or experience. Students to the DNP portion first, part time. It is all classroom and paper writing and research. Then the enter the exact same CRNA program as the previous MSN students did with exact same classes and clinicals as the previous MSN students. The CRNA programs are already loaded down with a lot of fluff and this program just added to it.

[dqbanrn]

Actually, they do. If you read my statement, I specifically say "ARNP" and not CRNA. The reason for this is that the DNP requires a minimum of 1000 clinical hours. CRNA programs typically already meet this requirement (above and beyond), but ARNP programs are usually between 500 and 1000.

I agree that fluff courses don't do much to help nursing practice and think DNP programs would be better served with classes that refine our clinical skills.

DNP programs could trim fat by getting rid of some of the research oriented stuff. Instead of some capstone project, a Doctor of nursing PRACTICE should do something that proves their practice skill. Thats why I like the idea of a clinical portfolio. For an ACNP it could include things like central line or chest tube placement.

[zenman]

DNP programs could trim fat by getting rid of some of the research oriented stuff. Instead of some capstone project, a Doctor of nursing PRACTICE should do something that proves their practice skill. Thats why I like the idea of a clinical portfolio. For an ACNP it could include things like central line or chest tube placement.

Research increases the chances my patients improve...just saying.

[dissent]

Given that nursing and medicine will not have identical educational paths, at what point should DNPs be considered worthy of the title "doctor"? Should they need more clinical hours? Do they need to prove their competency after boards some how? Are DNPs not considered experts in their field now?

I'd say similar clinical hours and similar education in path, pharm and physiology

Research increases the chances my patients improve...just saying.

Sure but having 12 hours of useless research fluff and only 4 hours of pathophysiology isn't doing your patient any favors.

[JeanettePNP, MSN, RN, NP]

You do not need to be a DNP to learn new skills. You can pick up skills on the job as an NP. I don't think there's anything that's within the scope of practice for a DNP that's not for an NP. Maybe some hospitals will start requiring DNP if you're going to head a department, or if you want to teach, but clinically I don't see the advantage of a DNP.

[prairienp]

You do not need to be a DNP to learn new skills. You can pick up skills on the job as an NP. I don't think there's anything that's within the scope of practice for a DNP that's not for an NP. Maybe some hospitals will start requiring DNP if you're going to head a department, or if you want to teach, but clinically I don't see the advantage of a DNP.

Same argument historically used when the diploma nurse transitioned to the BS, when the certified NP transitioned to the BS, big uproar, when we went to the MS in 1992, same song different dance, now the DNP. The most vocal always seems to be those who already have the degree and can't see why additional education will make a difference. Keep seeing the same theme, research "fluff".

Don't you ever wonder how those evidence based guidelines are created? As far as an academic challenge I find the research "fluff" far more difficult as compared to pathophysiology or pharmacology. I see fluff indicating "easy" , not too intellectually challenging. My experience has told me the best way to weed out the weaker students in a nursing program is with a research course, the weaker the student is in research the weaker the student is overall. I have not done the "fluff" study to prove my Hypothesis , only anecdotal experience working with undergraduate and graduate nursing students for 25 + years. Show me a "C" in nursing research and I will show you the weakest student in the group, both academically and clinically.

[PMFB-RN, RN]

Actually, they do. If you read my statement, I specifically say "ARNP" and not CRNA.

*** Yep, the "ARNP" part went right over my head. I withdraw my point. Thanks for setting me strait. I see your point now.

[dissent]

Many use the term fluff because soft sciences add nothing clinically, especially compared to hard science like pathophysiology or pharmacology. When most of a DNP is about learning to read research rather than actually being able to take care of patients, there is a problem- especially when the DNP curriculum is designed to provide care for patients. The DNP isn't a PhD in nursing; it is a clinical doctorate.

As to the research classes showing the weaker students- so does any course. You could use an English literature to show you who are the weaker students but taking English lit (just like taking health policy courses) it's not going to make you a better clinician.

The problem is that most DNP programs just don't have enough clinically relevant courses. Instead they add research/health policy courses which may be interesting but don't prepare you for bedside practice. Let's look at Duke's DNP program. Taking out the research capstone, 33 credits are clinically irrelevant and 33 are clinically useful. That's a problem in my opinion.

Clinically "less useful" courses ( 33 credits)

Research methods, research utilization and applied statistics- 8 credits

Evidence based practice and applied statistics- 7

Data driven healthcare improvement- 3

Health system planning-3

Health system transformation- 3

Epidemiology- 3 credits

Effective leadership- 3

Transforming the nation's health 3

Financial management and budget planning- 3

Clinically useful: 33 credits

Health promotion- 3

Diagnostic reasoning- 4

Managing common acute and chronic problems - 6

Child health care-4

Sexual/reproductive health 4

Elective 12 credits

[bsnanat2]

In this whole debate, I wonder if anyone has run into this problem: I was discussing whether or not to pursue a DNP or MSN for advanced practice and a physcian chimed in that, while MD's in this area are beginning to see the advantage of APRN's over PA's (due to their previous nursing experience), he and some others would not consider a protocol agreement or employment of an APRN with a DNP. This doc (and others he claims) are opposed to what they think the DNP represents. He also mentioned that MD's are just as opposed to PA's having a doctorate as an entry to practice and stated that he has observed no notable benefit of PT's having a practice doctorate. Pharm is the only field that seems to have improved with it he says. What do you all think? Is this an isolated MD opinion?

[linearthinker, DNP, RN]

Dissent:

They are not "clinically less useful courses." They are extremely valuable and assist the NP to improve his/her knowledge base and understanding of health care delivery, and to use that knowledge to assist patients individually as well as communities as a whole. It isn't fluff, and it isn't less useful.

If individual NPs do not feel driven to seek a DNP for themselves, I think that is fine, they should not be forced. However, when they criticize something they clearly do not understand, they debase themselves as well as their colleagues, and that is shameful.

[linearthinker, DNP, RN]

In this whole debate, I wonder if anyone has run into this problem: I was discussing whether or not to pursue a DNP or MSN for advanced practice and a physcian chimed in that, while MD's in this area are beginning to see the advantage of APRN's over PA's (due to their previous nursing experience), he and some others would not consider a protocol agreement or employment of an APRN with a DNP. This doc (and others he claims) are opposed to what they think the DNP represents. He also mentioned that MD's are just as opposed to PA's having a doctorate as an entry to practice and stated that he has observed no notable benefit of PT's having a practice doctorate. Pharm is the only field that seems to have improved with it he says. What do you all think? Is this an isolated MD opinion?

I don't think "isolated" is the correct word, I would say "minority," at least IME. I have not yet had any physician interviewing me voice anything but support and enthusiasm regarding my educational goals. I have had 2 classmates (out of 40) say that they have had negative reactions from physician colleagues. In the interest of honesty, both those instances were extreme to the point that both NPs left their jobs rather than continue to deal with the conflict. In each instance, they has enjoyed positive working relationships until such time as the NPs decided to pursue their higher education.

I did have a negative response from 1 person a few years ago when I first told him of my plans, but he has since changed his tune after learning more about it from me. He was basing his former opinion on slanted pieces he read online and bits of gossip he overheard, etc. He has known me for years and has followed my progress throughout my program, and now says he is impressed with the breadth and depth of what we cover and admits he was wrong. I suspect that that will become more common place as the truth overtakes the rumor mongering.

In the end, individual NPs should do what they feel personally compelled and driven to do and not concern themselves with the uninformed or biased opinions of others. I used to worry about the bias myself. After being in the program (or drinking the kool-aid, as some might say) I am so unspeakably impressed with my faculty, program and peers, that I have no reservations and no regrets.