Doctoral degree to become an NP???

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The American Association of Colleges of Nursing (AACN) is calling for the requirement of doctorate in nursing for advanced practice nurses, such as nurse practitioners, nurse midwives, clinical nurse specialists, and nurse anesthetists. This new degree will be called a Doctor of Nursing Practice and, if the AACN has its way, will become the entry level for advanced nursing practice.

AACN Position Statement on the Practice Doctorate in Nursing

I hope a doctorate isn't needed-that's ridiculous-unless you want to teach or do research. To be a Nurse Practioner I think you should have several years as BSN graduate working in your specialty are-some hospitals are even instituting "residency" programs for nurses. Then get your master's and APRN..Didn't they learn anything by the RN/DiplomaGrad/BSN debaucle? Too much book learning-not enough clinical experiences doesn't make you a good NP!

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I hope a doctorate isn't needed-that's ridiculous-unless you want to teach or do research. To be a Nurse Practioner I think you should have several years as BSN graduate working in your specialty are-some hospitals are even instituting "residency" programs for nurses. Then get your master's and APRN..Didn't they learn anything by the RN/DiplomaGrad/BSN debaucle? Too much book learning-not enough clinical experiences doesn't make you a good NP!

In reality, the research supports the + outcomes of those with little to no experience as rns before becoming nurse practitioners. The success is based on the individual regardless of educational pursuit. I am wondering if you have the same thoughts about PT? OT? Speech? Pharmacy? Or is it only nurses that need more "real" practice before they see patients?

One additional thought, a doctorate will not make a good teacher, again it is the individual who makes the role.

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In reality, the research supports the + outcomes of those with little to no experience as rns before becoming nurse practitioners. The success is based on the individual regardless of educational pursuit. I am wondering if you have the same thoughts about PT? OT? Speech? Pharmacy? Or is it only nurses that need more "real" practice before they see patients?

One additional thought, a doctorate will not make a good teacher, again it is the individual who makes the role.

I would be curious to see this reasearch? The concept of direct entry NP's seems to be poorly studied if at all and there is little data on factors relating to success as a nurse practitioner vis a vis background or experience. The other professions do not claim to build off a previous background as the original nurse practitioner design did. In addition the other practitoners are not providers in the true sense of the word. While there are states where they have pseudo independent practice it is very narrow.

David Carpenter, PA-C

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Yes Dave, I agree. Prairnp- Could you please give us the source of your research , I'd like to read it. Yes, I think practicing skills at a basic level in any profession makes you a better advanced practitioner-that's why we have internships, clinical practicuums etc. They only prepare a student for a general experience in a field-not a specialty practitioner. Sorry, the argument that an RN with no clinical experience in their speciality is on par with one who jus has "book Learning" is illogical and possibly dangerous!

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Specializes in ICU, ER, HH, NICU, now FNP.

What might be interesting - if I could find the data is to list out the number of clinical hours for the following:

PT Doctorate - All undergrad and graduate clinical hours combined.

OT Doctorate - All undergrad and graduate clinical hours combined.

PharmD - All undergrad and graduate clinical hours combined.

DNP - - All undergrad and graduate clinical hours combined.

And to compare the DE NP number of clinical hours with a PA's programs number of total clinical hours.

I would bet that the DE NP program adds up to about the same hours as the PA program by the time an RN has gone UG to grad. Or maybe they don't. It may also be state dependant to some degree. Food for thought - hmmm?

You can't know what you don't know until find out that you don't know it - and by then it's usually too late!

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what might be interesting - if i could find the data is to list out the number of clinical hours for the following:

assumption for this bachelors = 128 hours, semester hours = 1 hour x 16 weeks. credit for clinical hours is subtracted from didactic hours so credit isn't given twice.

pt doctorate

bachelor's 128 hours = 2048

dpt 90 hours = 1440

total didactic 3488

clinicals 1500

ot doctorate - all undergrad and graduate clinical hours combined.

undergrad 60 hours

dot 120 approx for total of 160-180 (there are direct entry programs and those which require a prior bachelors) = 2500 approx.

clinical 1200 hours approx

pharmd - all undergrad and graduate clinical hours combined.

2 years undergrad 64 hours

4 years phard 110 hours

approximately 174 semester hours = 2784

clinical hours = 40 credits = 40 hours x 10 months = 1600 hours

dnp - - all undergrad and graduate clinical hours combined.

bsn 60 pre req and 42 nursing = 1632

clinical 300

dnp (this is really tough to find good numbers. i will use the rutgers msn to dnp numbers. i will note that the numbers quoted below do not seem to reflect the aacn statement that 1000 clinical hours beyond the anp hours are necessary for the dnp). i will also note that nonpf has issued a statement they they do not want a set number of hours.

msn 27 hours = 432

clinical 500 hours

dnp 35 hours = 1225

clinical hours 500 hours

ms anp total didactic hours 2032

ms anp total clinical hours 800

dnp total didactic hours 3289

dnp total clinical hours 1300

pa program

there is no real relationship between the number of semester hours and the number of hours spent in class. pa school is generally m-f 8-5. for a typical program this would be 40 credits. however most pa programs credit 16-18 credits for tuition purposes.

the average pa program is 26 months (20-36 months) with approximately 1650 hours of didactic time and 2050 hours of clinical time. the minimum hours to get into a pa program is 60 hours, but the majority are masters programs requiring a bachelors 104 of 135.

didactic 960-2048 + 1650 = 2810-3700 (the majority will have 3900)

clinical 2050 hours

the dnp and pa totals ignore any clinical hours gained through work experience. this is less of a factor for dot and dpt.

ok so here are the totals. i will note that these are selected individual programs that seem to be representative your number may vary.

degree didactic hrs clinical hours

dpt 3488 1500

dot 2500 1200

pharmd 2784 1600

dnp 3289 1300

pa 3700 2050

for comparison

md

bachelors - 2048 hours

ms i-ii 2500 hours

ms iii-iv 4-5000 clinical hours

residency (assume fp with an average of 60 hours of week for 48 weeks per year) = 5760

so total is 5000 didactic hours and around 8000 clinical hours. clinical hours for surgeons would be around 25,000 (assuming the program adheres to residency rules).

i would bet that the de np program adds up to about the same hours as the pa program by the time an rn has gone ug to grad. or maybe they don't. it may also be state dependant to some degree. food for thought - hmmm?

so yes the total hours of the dnp are close to the pa if they adhere to the aanc standards. otherwise they are less, but np's concentrate in one area as opposed to the pa approach. for example the dnp hours at 1000 (discounting the rn hours) are similar to a pa who did all their electives in fp and if they followed the aanc recommendations, would have greater hours in fp.

david carpenter, pa-c

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Specializes in ICU, ER, HH, NICU, now FNP.

And sometimes - different backgrounds bring a different perspective to the table - in a lot of GOOD ways.

I wasn't wanting to compare SEMESTER hours - I was talking more like clock hours in clinical. Most degree plans in terms of semester hours are a wash - we all know that a BS takes a certain amount, an MS takes another amout - it is the difference in actual CLINICAL clock hours I was wondering about. That info is a little harder to come by because it varies so much.

IE: My MS program required 720 clock hours of clinical - that didnt count class time, lab time or have anything to do with semester hours. That was strictly the clinical time required in the MS program. That of course would be in addition the AS+BSN or BSN program clinical clock hours as well as in addition the 2 (and in most cases - more - I and many of my classmates had over 10 years exp) years of required field experience as an RN prior to entry into clinical courses.

Lets not make this a PA vs NP or an NP vs DNP discussion, there are planty of other threads for that. The subjective pros and cons of requiring NP's to have a DNP to enter practice (not stay in practice) in the future can be weighed here in discussion without a trump factor.

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And sometimes - different backgrounds bring a different perspective to the table - in a lot of GOOD ways.

I wasn't wanting to compare SEMESTER hours - I was talking more like clock hours in clinical. Most degree plans in terms of semester hours are a wash - we all know that a BS takes a certain amount, an MS takes another amout - it is the difference in actual CLINICAL clock hours I was wondering about. That info is a little harder to come by because it varies so much.

IE: My MS program required 720 clock hours of clinical - that didnt count class time, lab time or have anything to do with semester hours. That was strictly the clinical time required in the MS program. That of course would be in addition the AS+BSN or BSN program clinical clock hours as well as in addition the 2 (and in most cases - more - I and many of my classmates had over 10 years exp) years of required field experience as an RN prior to entry into clinical courses.

Lets not make this a PA vs NP or an NP vs DNP discussion, there are planty of other threads for that. The subjective pros and cons of requiring NP's to have a DNP to enter practice (not stay in practice) in the future can be weighed here in discussion without a trump factor.

I think that you have to look at didactic hours also. If you don't have the knowledge base to build on then how do you get benefit from clinical hours. The old version of medical education was essentially experientally based. The Flexner report showed this to be bad practice and changed medical education to the current model.

That being said, the real problem that I see is there are three competing visions of the DNP.

1. AACN - use the current masters NP and add advanced pharmacology, advanced patho/phys and advanced disease process. This is the only area to call for specific clinical hours - they call for a minimum of 1000 hours (I am unsure if this is total hours or above the base NP hours.

2. The NONPF hours - this seems to have a significant research component and if you look at the current dnp programs they have added research classes such as biostatistics while only marginally increasing clinical hours.

3. The state boards of nursing - they have published a vision paper that does away with the CNS and advocates a basic NP degree with a specific residency in the desired field (combination of 1 and 2?).

Best case scenario, one vision wins out. Worst case scenario, you have competing degrees with different focuses, capabilities and training requirements. An analagous situation would be the ACNP which will soon have two different certifications with different scope of practice.

I agree with you on the variability. This is what makes this hard to research. The information on clinical hours must exist, since there is reference on the NONPF site in the increase in the number of average clinical and didactic hours. However, I have been unable to find this. Reviewing scattered programs it seems that most are nearer 500 hours which is the minimum unlike your program. There are other programs out there that have more hours, but I would imagine that the curve would be left skewed toward the 500 hour mark.

One of the disadvantages that I face when discussing nursing education models is that while I have some contacts in the nursing education community, I am not as dialed in as I am with the PA educators. I also do not as a rule have the same access to nursing education journals. That being said, one of the real questions which you tangentially address is the value of previous experience in clinical practice. You pointed out that you had significant experience as a nurse prior to NP school. However, there are a number of programs that allow direct entry into DNP programs for students without nursing degrees. There has been a lot of discussion about this already, but I was suprised by how little clinical experience there was in the BSN programs that I looked at. To my knowledge there has never been any study if these direct entry student as far a clinical proficency or other attributes.

There a number of problems in studying these students including the fact that there are multiple certifying organizations. Not to start a PA vs. NP thing, but there are similar concerns in our world. The students on the average are getting younger and have less experience. This has been studied, and in the only measureable metric - certification, there is no difference. Interestingly enough there are no real variables including tuition that fall out:

http://www.paeaonline.org/perspective/7022.pdf

As an example - starting next year PA educators should be able to link experience directly to certification exams through the central application process.

I think that this is the question that has been glossed over in the DNP debate. The question - do DE students have the same clinical skills and provide the same patient outcomes as non-DE students needs to be answered. It would be nice if all NP programs published their certification pass rates. You should be able to tease out DE vs non-DE by aggregate scores.

As far as the value of the DNP, from my perspective any program that gives a student additional didactic and clinical training is a good thing. What nursing will have to decide - is this worth the additional barriers to entry that this will entail? The second question is what form will this take. Nursing has a mixed record with regard to minimal degrees - MSN for NP - success, BSN for RN's - not.

David Carpenter, PA-C

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Specializes in ICU, ER, HH, NICU, now FNP.

You make an excellent point about varied standards - but then that has been a problem in nursing all along -

Multiple entry paths + multiple and varied levels of degrees = mass confusion.

Heck even WE have trouble sorting it all out at times.

I agree that programs SHOULD have to publish pass rates - for every ATTEMPT, so that thos who fail and retake the exam are accounted for.

DE programs typically require that the individual complete the RN portion and then while they are taking courses such as patho, adv pharm etc - work as an RN over 2 years before they can be allowed to begin NP clinical courses. I do not think however that this is a requirement in ALL DE programs.

There is also some perception that a DE student has taken "the easy way out" but I would bet that the expectations are much higher of students in the DE programs - those students tend to bring with them prior life experience and education in other fields that can be very valuable. A GOOD DE program accounts for that, still requires RN experience prior to NP clinical and is a rigorous program. Should a 20 year old without any college or life experience be allowed to enter a DE NP program? I'm thinking that is probably not the candidate they are looking for. A few may get in - but if admissions are competitive, those with some type of life experience and background will win out.

It is too bad that so many groups feel the need to define what a nurse of any sort should be and what the education should consist of and yet none of them can agree on anything - that undermines the value of any of the degrees in my opinion.

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Hello everyone I am new to this but I was reading the topic about the doctoral degree and if I am planning to go into that field would it be best if I go ahead and work on getting my doctorate?

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Hello everyone I am new to this but I was reading the topic about the doctoral degree and if I am planning to go into that field would it be best if I go ahead and work on getting my doctorate?

I guess you need to find out when you will graduate and see if you fall under the rule.

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Specializes in CV-ICU, Rehab, Med-Surg, Nursing Home.

Vicky,

So what will this mean exactly for the APN? Will he or she then be called doctor? Will this mean an increase in pay? What is your opinion on this? Is there a way as a nurse to voice opinion in this decision? Will current APN be grand-fathered in? Thanks for your help!! :nurse:

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