Doctor of Nursing Practice (DNP): My Personal Pro's and Con's

[Cold Stethoscope]

AbeFrohman said:

There is nothing wrong with an associate degree PA. All associate degree PA programs require minimum 4,000 hours of prior, high level experience (nurse, emt, rt) and most are in the 10,000 range. So might say they are better than master prepared PAs. Also they have the class and clinical requirements as a masters degree PA (minimum 2,000 hours of clinical) minus a research project. They still take research though.

I think in California you need 2000 hours of clinical experience. In Florida I don't know if there is any specific requirement, though one school that offers the AS in PA wants you to have a few hundred hours of some kind of experience (such as, as a volunteer) before they'll really consider your application. I don't know whether their program has a capstone course. As long as you pass the PANCE with a good score, I'm not sure that it matters which type of degree you have -- or a certificate.

I wonder, though, whether the physician community is as critical of PAs as it is of NPs.

[CraigB-RN, MSN, RN]

A Gross Simplification

The thing that PA programs have going for themselves is the PA part of it is the same, no matter if it's a AS,BS, or MS. The curriculum is standardized. We as a group can't even decide what a DNP program really is. There are now DNP programs for management and education. Have nothing to do with being an NP. Every other profesion that I've looked at at least has a base standard for their doctoral level. Everything from Biology, Chemistry, Engineering, And health care PT and OT and PharmD. Only nurses have stepped into this nebulous area called a "practice Doctorate".

The physician community isn't up in arms over the PA's because (simplified version) they aren't competition. They as a group aren't trying to go at it alone. The fight that the APN community is having is because nurses have felt for years that they need to be autonomous. The nurse union doesn't feel that they need to be beholding to an MD. As a group PA's are content were they are at. They are making plenty of $$, and get to do what they want. They also don't have the same limitations that we as nurses have placed on ourselves. If a PA want's to change specialties, they just find someone to hire and train them. Don't have to go back to school and get another degree or certificate.

I enjoyed the article. My problem with the DNP is it being the entry level to APN. As a natural progression and specialization, I have no problems with it. Like the Doctoral PA programs. They aren't entry level they are progression and specialization. I think the comments that are made about the clinical component have to do with the perceived issue of lack of quality clinical in APN programs today. Unfortunately this is somewhat of a smoke screen. I've seen MD residents skate through their residencies and never real learn what they are supposed to, and I've seen RN's doing informal clinical as they are working though NP school adding many uncounted hours of clinical. Hell I've seen ICU nurses who have taken their whole career as a clinical and know as much as the residents do even before going to ACNP program.

DNP is something that is here to stay. And like Juan said there are a lot of things that still have to be determined.

[Cold Stethoscope]

CraigB — great post. The only quibble I have is that some PAs really would like to be more independent, and one MD student blamed their lack of independence on the successful efforts of nursing lobbyists to keep PAs directly under a physician's supervision.

That conspiratorial idea is a bit far fetched, given the lack of success nursing lobbyists have had in doing much of use for nurses themselves.

[CraigB-RN, MSN, RN]

Well being married to a PA and teaching clinical skills to PA students. I have a prejudice I admit. Yes there are PAs that would like to be more independent, just like there are NPs who are happy the way things are.

[zenman]

Cold Stethoscope said:

To be honest, I'm not sure how much useful knowledge an MBA, in most cases, would confer. An accounting degree — maybe. An MBA is more of a checkoff item if your applying for a corporate management position, but I think corporate managers for the past ten years or so have gotten over the idea that having an MBA necessarily makes one a good manager.

You can get a roughly equivalent education from books.

I'll disagree. An MBA might not guarantee that you're a good manager but it provides you with much needed business info and skills, even if you plan on hiring a practice manager, accounting person, etc.. My MBA program was not boring as another poster mentioned. I chose an executive MBA program as I wanted to be taught by practicing professionals and not by a bunch of theory experts. To get into my program you had to be 30 years old (one 29 yr old got in because he owned his own company) and have business experience. Imagine how much I learned from participating with all my classmates vs a bunch of 20 yr olds who never did anything. Even the dean of our business school was a well-known consultant, and incidentally, a member of the London Circle of Magicians!

[Cold Stethoscope]

I'm familiar with the Executive MBA program at the University of Chicago by proxy. My friend completed the program, and her classmates were mostly executives from large eastern and midwestern companies. What a school like that gives you is a recognized, prestigious name that might open some doors; a network of people in mid- to upper-management in large corporations; and some useful knowledge, especially if you have no formal business education. (She already had a business degree from Cornell.) All in all, it's not clear to me what the gain was in the end in terms of her actual career.

I also know someone who was an engineer, went through one of the top entrepreneurial MBA programs (Babson), and wound up going back into engineering. She eventually moved into a management role, but I think should could have done the same without the MBA, as many of her peers did.

I dated a woman while she was getting her MBA at Northeastern (her employer paid for it). She was super-smart. I don't think she was very challenged. (She wound up going on for her CPA certification.)

I know a superstar in marketing who got her MBA at Sloan (MIT) and wound up making a killing when her company went public, but I'm not sure that her degree made her much more super than she already was.

Those are my anecdotes.

"Was Earning that Harvard MBA Worth It?" (NYT, 2006)

Maybe so, but at the cost of losing a couple of years of salary and a huge tuition bill, if you're paying.

I would certainly look askance at an on-line MBA program.

[Cold Stethoscope]

By the way, now there are not only combined MD/MPH programs. Now there are also combined MD/MBA programs.

[apocatastasis]

I'm a new NP, received my Master's 3 months ago. I have no complaints about the clinical portion of my MSN program. But we would have been well-served with MORE than 700 clinical hours. I would love, and willingly pay for, a doctoral program that would provide me with additional didactic and clinical training in psychotherapy, neuroscience, and psychopharmacology. You know, USEFUL stuff that we're supposed to know.

Would the DNP provide those experiences? Absolutely not, because this clinical/practice doctorate is neither clinical nor practical.

I've looked at curricula from schools all across the U.S. I can't help but see the DNP, quite frankly, as an inferiority complex-driven grab for money and power that embodies everything that is WRONG with nursing education.

Forgive me if I'm overly cynical, but these wounds are too fresh. I've already yawned my way through more hours of health policy, systems, and research than I care to count. I've already witnessed the most egregious and childish stereotyping of minorities in the name of a semester of "cultural competency." I've already written far too many forty page papers on the history of dryer lint and the ethical concerns surrounding Florence Nightingale's lighting farts on fire with a match, formatted in APA format and referenced.

And they're telling me I have to do it AGAIN? NO. THANKS.

When AACN gets its act together, it can find me over here... actually taking care of patients. (Now there's a concept they've never heard of.)

[SweettartRN]

I wish the lie of the DNP requirement would cease. This panic of being done with NP school by 2015 in order to avoid a change, is simply an unnecessary panic of something that, so far, isn't happening, and probably won't happen for years to come.

With all of the changes set to take place with the new healthcare laws being in place, and doctors threatening to leave private practice because of it, the need for APN's is going to grow exponentially, and currently supply will not be able to keep up with demand.

[BCRNA]

Where exactly are programs offering a doctoral level PA programs? The last I heard the PA profession has publically commented (through there national association) that they are strongly against a doctoral PA program. There are some bridge programs that give PAs some credit to a MD program. Just curious if they changed there stance.Also, most clinicians do not actually know how to read and critique research articles. Their skills end at reading the conclusion section and skipping the methods all together. Not disparaging clinicians, but most programs do not teach true evidence based practices. It isnt enough to just read a review article or take someone elses word. How many clinicians could truly critique research studies or even explain the appropriate uses of ANOVA, logistic regression, or chi square?

[AbeFrohman, BSN, RN]

The army offers a DSc in PA studies that coincides with a EM or Ortho residency. Other branches have the residencies in place and are working to implement the DSc. This was done mainly to allow for promotion as you can get stuck in a rut if you only have a masters degree. The AAPA is still against a doctorate. There is only one bridge which is for PA to DO at LECOM that is 3 years. Not even much of a bridge and is equivalent to other 3 year programs direct towards primary care where they just cut out the summer off and a couple of electives.

As far as evidence based practice goes, both my NP and CRNA program went into plenty of detail on this. Problem is, no one cares or uses it so it becomes lost after graduation.

[SE_BSN_RN, BSN]

All these differences in the levels of nursing just confuses me. Ugh! I thought the DNP was the "terminal degree" in nursing. What's the difference between the PhD and DNP? They aren't the same?

And why is it so complicated? An MD is either an MD or DO, not this and this and this.....why isn't nursing the same?