2015 DNP

zoidberg, BSN, RN · Jan 24, 2012

well said.

ccso962 · Jan 24, 2012

well said.

Thanks! Now if we could just get the powers that be in nursing education and DNP curriculum design (and the advancement of nursing as a profession in general) as a coordinated group to feel the same way we might actually start to get somewhere.

I completely understand that there are plenty of professionals that do feel this way, but we have to stop putting grease on the "squeaky wheels" and instead replace them with new wheels that work the right way.

As always my two cents worth.

psychonaut · Jan 26, 2012

The powers-to-be in academia are leaning heavily on the state BONs to secure DNP dominance and the destruction of the MSN-educated NP. The Consesus Model is an early move in this war. SInce the original backlash in nursing against the Mundinger point of view, they have gone stealth.

If you want to oppose this, it must be done at the state level. Involvement in state BONs is the only way to make sure you don't get railroaded. These are (in general) folks who likewise wish to eliminate the ADN as an entry-to-practice. Some good noise-making by our ADNs (and economic realities) has forstalled that from happening for four deades; similar action will be needed from MSNs who oppose the DNP as entry-to-practice for NPs.

zoidberg, BSN, RN · Jan 27, 2012

I think the DNP issue is part of a large group of issues facing NP's and nursing, and IMO the DNP is the least urgent. who cares what the degree is, it just needs to be standardized. Here is what needs to happen: (not holding my breath...)

1) only have one organizational body, which should be democratic so governing bodies know what nurses face in real life, in real time. This would prevent things like this DNP issue. In an ideal world, nursing as a community, NP's in practice, would decide when and how to modify the education, credencialing system, and degree outlines in nursing. They would be better poised to interact with government if there was only one body as well.

2) come up with standard NP types, and have standardized national testing for each NP specialty. Variation between states is a nightmare, each state having a BON is crazy, we need to consolidate.

3) Update minimum educational requirements. PA education is superior in diagnosis and basic science. NP education needs to include gross anatomy, basic physiology & pathophysiology of each body system, and include some clinical biochem, genetics, etc... not to the point of having a separate class for each body system like med school, but NP's would benefit from more heavy clinical science based courses. RN experience is not regulated, and years of practice does not always mean knowledge. And as said in so many places on AN, clinical experience/rotations in NP programs is lacking.

i can dream...

zoidberg, BSN, RN · Jan 28, 2012

pa has the advantage of being like rns in that it is a general lisencure and like rns pas can work in any field they can get hired into./quote]
biggest issue! we need a general license for np's!
it wont ever happen, but it would be nice to have a med school type system with a general np education (current fnp on steroids) then have a residency type system to specialize. and the scope of practice would be easier to manage from there as well.

red5 · Feb 19, 2012

i agree with benm93...... what you dont need is more nursing theory...you are right pmfb-rn about Np and pricing themselves right out of the market. The DNP is a monster created by the ivory tower of high education and the boards where the higher ed's sit......nothing more. When was the last time you heard a master NP, walking out of a patients room stating, "damn, if only for a DNP, I could treat this"? You dont.IMHO: OMG the DNP students have the ego thing really bad already..........sad

sixty3dayswithSarah, BSN, CNA, RN · Oct 24, 2012

Seriously, Dr. Tammy knows her stuff.... I like that you tell it like it is and dont sugar coat it. I live 20 minutes from Boston, and I am an unemployed BSN RN? with 12 years experience, so I am being forced into the DNP thing so that I can find a job. The hospitals that everyone thinks are so great are laying off seasoned, well I was lightly salted, and replacing with all new grad's (NO OFFENSE TO NEW GRADS) TO SAVE MONEY. I envy you, I think that if we lived closer we would make a great team,you can see the somatic patients and Ill take the mentally ill ones ;)I have spent over $1,000 on applications fee;s gre scores, transcripts etc.... to apply to 7 schools, I took your advice, I did the research on the cost, OMG, I may as well go and get my D.O., its closer, cheaper, easier to get into.... This hurdle is ridiculous, schools know that this is happening and they are clamping down on it- whats the damn point to spending an additional 45k to be called Dr RN, it sounds nuts.... Side bar, I considered doing the whole army reserves scholarship deal, they give you 20k to start, pay for everything in school and give you $2088 per month, they repealed dont ask dont tell so Im not to concerned their, but when something seems to good to be true, it is, I can see myself now counselling dismembered solders suffering from PTSD trapped on an island with on coconuts to eat, BUT, I got my DNP. Oh, Oh, and what is up with all of these schools that where literally nobodies, scrambling to find students, now thinking their sh1t dont stink? I was talking to a school in Mississippi last year, first year they had the DNP, they loved me accepted me during my phone interview. But I decided to go to Brandman instead, who didnt let me know I was accepted until after school started! So I called that school in Mississippi, I am a polite man, I asked to speak with Ms.-------------- and some person who completed a Windows computer class was sassing me (as I googled to see if she was actually Dr,) she was awarded an honorary Doctorate, so she just gets to cut the whole line, and this time, they where not so nice... Like all things that appear to be a good idea (selling on Amazon, selling on Ebay, coloring your hair yourself) this DNP is nothing more than an economy boosting mechanism taking advantage of people when they are at their desperate point- no politics, but what he hell is up with Barak lowering student Loans, I depend on the refund to feed my two kids, this semester instead of my normal, I received a third, looks like we are on a Raman diet tonight!

OH, lastly, MD's have sticks up their pants, all of em, PA need to step off that high horse and realize they are still lower on the totem pole than us, I looked over the curriculum's, the DNP portion of the BSN-DNP track is nothing more than busy work, and has nothing to do with patient care. I could see if it was more clinical, more relevant education, but advanced ethical decision making- im 34, my ethics are not changing and neither is anyone elses for that matter they are ingrained in our brains. So I suggested to a school over the phone, is it possible to add a post msn grad certificate, "Oh No, the DNP is very important studies we dont mess with that" right,, because my advanced billing course will make me understand bipolor disorder better. Here is my analogy..... Its kind of like watching CNN Headline News..... First they have the slit screen with a person in the studio talking to Christian Amapor (the Persian Matrix) who is getting ready to board a Somalian Pirate ship or riding a scud missle to afganistan- she is the bravest woman in the world, I swear next she will be broacasting live from Terhan"Helllllllllllloooooooooo, I am Chrrrristiaaaan Ammmamapore, and I am coming to you live as I stand topless in Terhan.. back to CNN, so they have the ticker at the toptelling me a story about some family ice fishing, then on both sides of the screen they have the terror alert, time, date, militatry time, their favorite colors, when they last went to the facilities, and without fail, Ill be reading the ticker at the bottom of the screen "All American MUST Evacuate Their Homes In The Cities Of" (commercial) "The best part of waking up---- how much crap can you fit on one screen, I cant do it, I cant watch cable news, my heads going to blow up! Thats how I feel about the DNP and its changes.

TY

Again, Dr, your awesome!

sixty3dayswithSarah, BSN, CNA, RN · Oct 24, 2012

I know, their poop dont stink, and its even the faculty who have been "grandfathered" in and given honorary doctorates, Id love to see them churn out a 15 page paper about nursing Theory-AGAIN SINCE its imperative to a patients health that I know the theorist bla....... I really love your "Damn, If only for a " line, that works well. And if you read the curriculum, for the dnp, what the hell does it matter if I understand nursing innovations over the past 50 years, its irreverent! You might like my other post I just went off on a tirade... you should check it out

"Damn, if only I had a DNP I'd know how to properly punctuate this sentence!"

sixty3dayswithSarah, BSN, CNA, RN · Oct 24, 2012

You wanna know something funny, I am prob the only male nurse who works in Reproductive Health, I work for a clinic in India, whose entire client base is North American, bc in the US, not only is everything ten times more expensive, but we have this stupid war with other specialties.... And, speaking from experience, I decided to travel abroad to India and work with a surrogate with my partner, bc this entire country's healthcare is rising in cost, insurance is dropping their coverages so go elsewhere.. In the US, to work with an egg donor, gestational surrogate, an embryologist, and the other 15 people that are their for this amazing procedure IVF- course you get what you pay for here in the US, 30% success for about $18k a month til your pregnant, while in India, my MD has 70% success rate and I paid about $450 usd for that and more, got pregnant the first try.... Im going their to have my teeth fixed too.

ccso962 · Mar 18, 2013

You are essentially saying that primary care physicians are fools for going through so much more education and training (something like a minimum of 15,000 clinical hours versus a minimum of 1,500-3,000).

With absolutely no disrespect meant, this argument is a logical fallacy. It implies, as arguments of this type always do in any number of fields (not just healthcare), that a set number of educational hours, big or small you pick, leads to [fill in the blank] (in this case it is better/worse health care practice).

The problem with this argument is that it takes a variable (in this case educational hours) and places within that variable another meaning that is not implied by the variable. While it is possibly, and probable, that a person with 15,000 clinical hours will see more acute or critical patients than a person with 3,000 hours this is NOT a sure fire thing. The number of hours, in this case the variable, do NOT lead automatically to a better understanding of how to treat patients. It is the variety and type of patient that is seen, and the level of acuity of those patients, that lead to an increased knowledge of patient care. So, it is completely honest to say that I person with 1,500 hours of clinical experience who only sees the highest acuity patients could have more experience with these types of patients than a person who had 10,000 hours of clinical experience and saw mostly low to medium acuity patients. Of course, the other issue here is that while the 10,000 hour student in this example has little to no experience with high acuity patients the 1,500 hour person has little to no experience with anything but high acuity patients; both would be ill-prepared to handle a wide range of patients.

This, and the imposition of the 80 hour work week for residents, is the real reason medical residency last longer. The goal is that, over the longer hours, the resident physician will see a wide variety of patients. If simply having more hours is what made a better physician (and not the patient interaction in these hours) then medical residency programs would double or triple the number of hours that they already offer.

I know that there will be those who say this is essentially saying the same thing, but there is a difference between speaking about the number of hours versus speaking about the patient types encountered. The hours trained argument (whether for health care, plumbing, or ice hockey) always equate out to be fallacious.

This is akin to the argument that somehow the 4 years of undergraduate education as a "pre-med" in the United States makes a better physician than a UK trained physician who goes straight from high school to medical school for 5 years. The truth is, and this hurts a lot of pre-med's feelings, that the UK secondary school system (high school here in the US) is a lot more advanced than we have here. The undergraduate pre-med curriculum here gets US students up the level of UK secondary (high) school leavers. Also, the MD here in the US, and MBChB in the UK are both undergraduate professional education (another thing that always seems to rev up the "physicians" (i.e. sad people with too much time and not enough education on their hands who really have NO medical training) on boards like this).

grahammj · Mar 24, 2013

UNC is slated to start their DNP this fall.

Ellen NP, MSN, NP · Apr 10, 2013

Unfortunately, I know of a number of DNP's and DNP students who cannot yet correctly use the English language. I can say the same about MD/DO students, too, so it's not exclusive to nurses. What happened to learning grammar and spelling in elementary school?

The degree 'DNP' suggests that it is a doctoral degree for NP's but that is not necessarily the case. The initial stands for Doctor of Nursing Practice. There are many programs that focus on nursing education and leadership and do not even offer an NP track.

I can just imagine insurers deciding to pay an NP more for their clinical practice because he/she has a DNP with a leadership focus and no additional clinical training. They don't want to pay us for equal work now. Does anyone think that they will start reading transcripts to see if we have advanced CLINICAL training?

When someone designs a clinical (not a practice) doctorate and does the research to show that the outcomes for patient care by those NP's are better than those of MSN prepared NP's i might be more excited and supportive of the concept.