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 had more clinical experience than most of my instructors. they didn't want to hear what i had to say about what was going on in the real world. i went back to school so i could function at an advanced role. i naivelly thought that the fnp program would teach me more about medicine, disease and illness, and how to take care of sick people. wrong!!!! more nursing theory, nursing research, etc, etc. more semester hours of fluff that you won't use in practice than in pharmacology of pathophysiology. but, if you speak out or say anything to disagree with the instructors, watch out. most of them aren't even actually practicing but think they know what it is like in the real world. now, they think that more school, ie the dnp is what is needed. sounds like job security for a bunch of instructors. all of these forces is the reason why nursing is not respected by the medical community. i had the respect of the physician i worked with because of my experience (25 years in critical care), caring, compassion, and how i took care of his patients. not because of a master's degree or doctorate. but sadly, experience doesn't mean anything. and to those of you returning to school, who want to graduate, just keep your mouth shut, jump throught the hoops, and repeat back what they teach verbatim, regardless of whether it is true in the real world of health care. the nurses of the future will be highly educated, but will they be able to take care of sick people, make the family happy, take an increased patient load (because of the nursing shortage) and do all of the tasks that we do everyday that could be provided by a cna? i don't mind cleaning up blood, vomit or poop, but i resent the fact that education is valued so much over experience. oh, and before anyone thinks i am against education, i don't. i can spit out a paper like they require and had a 4.0 grade point in my bsn program. but, when i returned to the bedside, it was my experience that mattered to the patient and my compassion, not what grade i made on a paper about the dorothea orem nursing model. thanks.

i am confused by several of your statements. the faculty in your np program are unwilling to discuss what they are teaching? the faculty have told you your experience is not worthwhile? although i was never a great fan of nursing theory i do consider the content very worthwhile and helps in the provision of healthcare. theory is very minor part of the np curriculum and necessary in the development of your disquisition. it is my understanding that all np faculty practice at least part-time, i know that it is an expectation of the nonpf. the accreditation process (assuming your program is accredited) would frown heavily on the fact that the np faculty are not practicing. most importantly, if this np program is so bad why did you apply?

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most importantly, if this np program is so bad why did you apply?

i doubt lit went into her program thinking it was a poor program. i certainly can't say what kind of research she did on the program or how it compares to other programs.

so perhaps the better question is to ask how common such unsatisfactory programs are. is that an exception or the norm? are strong, clinically robust programs, as yours sounds to be, exceptions or the norm?

a related question is how are such programs regulated to determine the minimal standards of that level of education and to ensure those standards are met. another question would be how should potential np students evaluate the programs they are considering to ensure it meets their needs? no school is going to say "we require lots of fluff nursing theory courses and only minimally focus on concrete medical practice that you'll need to be a good advanced practice nurse."

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I doubt Lit went into her program thinking it was a poor program. I certainly can't say what kind of research she did on the program or how it compares to other programs.

So perhaps the better question is to ask how common such unsatisfactory programs are. Is that an exception or the norm? Are strong, clinically robust programs, as yours sounds to be, exceptions or the norm?

A related question is how are such programs regulated to determine the minimal standards of that level of education and to ensure those standards are met. Another question would be how should potential NP students evaluate the programs they are considering to ensure it meets their needs? No school is going to say "we require lots of fluff nursing theory courses and only minimally focus on concrete medical practice that you'll need to be a good advanced practice nurse."

No, but every program publishes its curriculum -- how much effort does it take to read over the course descriptions of the courses required to graduate? Do people take advantage of the interview process to ask tough questions and do their best to evaluate the school while the school is evaluating them? Do they ask to meet with current students in the specialty track they are considering? Do they look (hard) at several schools in order to decide which one is the best choice for them?

I'm not trying to criticize any individual and I know that people's lives are complicated, but I see far too often on this board that people are looking for the quickest, easiest graduate program, or they simply sign up for the graduate program closest to their home because they feel (for v. good reasons, I know) that they can't travel someplace else to go to school. Well, if you just sign up for whatever is closest and/or easiest for you without any real scrutiny, don't be surprised when you wind up unhappy with the program. I have personally known any number of nurses who put less time and effort into selecting a graduate program than they would shopping for a new refrigerator!! Caveat emptor applies just as much to higher education as it does to any other kind of financial transaction.

Whatever grad program you go to, you're going to put in enough blood, sweat, tears, and $$$ by the time you're done that you really owe it to yourself to make sure it's a program you want to be in, that is going to give you what you really want, not just "the path of least resistance." :)

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I have to agree with PrairieNP. In all of the NP programs that I researched, the NP faculty were currently practicing. That being said, I did only research well-known, reputable programs. I would be curious to know what kind of a program Lit attended and if the program was accredited. Joy also brought up some valid points. It seems that there needs to be uniformity in NP education.

Having only graduated from my BSN program a year and half ago, it really surprises me when people talk about the focus on nursing theory in current nursing education. We really never covered any nursing theory. We talked briefly about Florence Nightingale's role in the development of sanitation, handwashing, etc. Other than that, I really have no other examples of what nursing theory really is. Perhaps they snuck it into the curriculum and I just didn't realize it was nursing theory?? I found all of the papers that I wrote in my undergraduate program to be applicable to clinical practice.

As to how potential NP students should evaluate programs, I can give examples of what I looked for. First, I think it is very important to make sure that the program is accredited. I reviewed the course descriptions to get a general idea of what to expect. My program seems to be very clinically-based. There is one advanced practice nursing theory and research course, but it is only 3 credits. All of the other courses are clinically-based. I noted that about 800 clinical hours are required, which is very good for an NP program. I took a look at the profiles and bios of the nursing faculty. I did look at their experience, but also their education and if they earned degrees from reputable universities. I also payed attention to their research interests, since I am interested in doing a master's thesis. Also, I took note of the fact that some courses are taught by faculty outside of nursing. I took this to be a good sign, since I think it is best to learn pharmacology from the experts in pharmacology (i.e.- professors in the college of pharmacy). I am enrolled in the FNP program, but my courses on childbearing will be taught by faculty in the CNM division and those on pediatrics will be taught by the PNPs. I asked a lot of questions during my interview and I talked to students who were currently in the program.

I agree with Elkpark. Some people try to find the easiest route to getting a degree and don't want to put in the hard work. Graduate education is supposed to be difficult and challenging.

I apologize if this was off-topic, but I hope that it helps someone who is trying to evaluate a program.

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Prairienp and elkpark, I agree that everyone needs to critically evaluate their educational choices. I can see wanting to discourage folks from just blaming all their problems on something outside of themselves. On the other hand, from what I've seen on these boards, it ISN'T uncommon for nursing programs to be light on the clinical preparation and heavy on the nursing theory. Thus, going to such a program doesn't necessarily mean that a person would've found obvious red flags had they just put a little bit more effort into it. Certainly, many people will do just fine with an education from schools that aren't the best of the best.

I don't know how closely Lit's experience and perception of her program mirrors that of other students, or if her school was particularly weak in it's clinical education. I suspect, though, that it's rather common and not just an indication that she "didn't do her homework."

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I understand what you are saying. My situation is unique because I am a university professor and I need the doctorate. I don't think it should be a REQUIREMENT for nurse practitioners or CRNA's. Unfortunately though, at least in my area, they are turning out some nurse practitioners who haven't been exposed to very much in their educational experience. I think that the doctoral degree, with more clinical hours will eliminate some of this problem. I think it should be the individual's choice though, not mandated.

As far as income goes- who goes into this for the money? The PhD's I teach with have years of education and certainly aren't making the money. Its a decision to rise to the top of your profession, which isn't always about the almighty dollar. We need to get away from not getting education because it doesn't pay as well- it is really about making yourself the best you can be at what you do. I'm not asking others to do it, just explaining what went into my decision. For me it had the most to do with the desire to attain a tenure track position at a university. I don't use the title doctor in practice- it would be confusing and deceiving to the patient.

I realize this thread is two years old but I just had to comment. I can't speak for anyone else but money was the top priority on my list of reasons to become an NP. As a matter of fact it was about the only reason.

There are other areas of nursing that I prefer but they just don't pay enough.

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Prairienp and elkpark, I agree that everyone needs to critically evaluate their educational choices. I can see wanting to discourage folks from just blaming all their problems on something outside of themselves. On the other hand, from what I've seen on these boards, it ISN'T uncommon for nursing programs to be light on the clinical preparation and heavy on the nursing theory. Thus, going to such a program doesn't necessarily mean that a person would've found obvious red flags had they just put a little bit more effort into it. Certainly, many people will do just fine with an education from schools that aren't the best of the best.

I don't know how closely Lit's experience and perception of her program mirrors that of other students, or if her school was particularly weak in it's clinical education. I suspect, though, that it's rather common and not just an indication that she "didn't do her homework."

I'm not disagreeing with you about the great, ummm, "variety" :uhoh21: among nursing graduate programs -- I'm just saying that's all the more reason why you need to do your homework up front and make sure you're getting into a program you'll be happy with! That's also one of the reasons why nursing is not taken as seriously by the rest of the academy as we might like -- a lot of the programs are heavy on the "fluff." If people stayed away from the mediocre-to-poor quality programs, those programs would have to change their tunes or shut down, but I see so many nurses who enter graduate programs more or less reflexively, because it's the closest to them geographically, or it's the quickest/cheapest/easiest option. I would argue that many of the lower quality programs continue to survive (heck, flourish!) because nurses as a group are not selective enough as "shoppers" and are not demanding quality. It's sort of a conspiracy between the schools and prospective students -- if (many) students want a quick, easy degree and it's easier and cheaper for the schools to offer a mediocre, "fluffy" program than a demanding, rigorous program (which it certainly is!), then don't be surprised if the majority of nursing grad programs are "fluffy." If more students were more informed, vocal, and persnickety about what they wanted from graduate education (and if what they wanted wasn't the quickest, easiest way to put extra letters after their names! :uhoh21:), then the market would adjust.

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I'm not disagreeing with you about the great, ummm, "variety" :uhoh21: among nursing graduate programs -- I'm just saying that's all the more reason why you need to do your homework up front and make sure you're getting into a program you'll be happy with! That's also one of the reasons why nursing is not taken as seriously by the rest of the academy as we might like -- a lot of the programs are heavy on the "fluff." If people stayed away from the mediocre-to-poor quality programs, those programs would have to change their tunes or shut down, but I see so many nurses who enter graduate programs more or less reflexively, because it's the closest to them geographically, or it's the quickest/cheapest/easiest option. I would argue that many of the lower quality programs continue to survive (heck, flourish!) because nurses as a group are not selective enough as "shoppers" and are not demanding quality. It's sort of a conspiracy between the schools and prospective students -- if (many) students want a quick, easy degree and it's easier and cheaper for the schools to offer a mediocre, "fluffy" program than a demanding, rigorous program (which it certainly is!), then don't be surprised if the majority of nursing grad programs are "fluffy." If more students were more informed, vocal, and persnickety about what they wanted from graduate education (and if what they wanted wasn't the quickest, easiest way to put extra letters after their names! :uhoh21:), then the market would adjust.

I would agree with your comments, but I would state that their are considerable barriers for a student to find out about NP programs. There is not a single identifiable curriculum or objectives. The objectives that are published are vague enough to be useless.

There is also a paucity of published data on NP programs. The critical information that a student needs is what percentage of students pass the course, and the percentage of your students that pass the boards. You can glean information about the drop out rate as a whole from some sources but there are no sources that you can find the pass rates. Compare that to the NCLEX where if I am not mistaken every program must publish the pass rates.

Lack of defined educational objectives means that it is very easy to add "fluff" courses to the curriculum. If you listen to this board there seems to be a bimodal distribution of programs. There are programs that are very clinically focused and go beyond the minimum for both didactic and clinical aspects. There are other programs that simply do the minimum in both didactic and clinical coursework. Whether that is because they do not have the resources to do more than the minimum or they choose to do the minimum is the hard thing for the student to figure out.

David Carpenter, PA-C

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I would argue that many of the lower quality programs continue to survive (heck, flourish!) because nurses as a group are not selective enough as "shoppers" and are not demanding quality. If more students were more informed, vocal, and persnickety about what they wanted from graduate education (and if what they wanted wasn't the quickest, easiest way to put extra letters after their names! :uhoh21:), then the market would adjust.

I don't see education as one of those things that can be left purely to market forces if consistent and clear quality offerings are the goal. I don't think we can or should completely leave it up to "market forces" to shut down less than quality programs. Some regulation, preferably from within the nursing community itself, I think is needed to ensure that basic standards are met. That's not just to "protect" students from being suckered into poor programs, but also so that the general public and prospective employees can have confidence in what kind of training an NP graduate has had.

The current state of nursing education isn't going to change overnight and prospective students have to deal with it as it is. However, I do hope that more consistency develops as NP programs continue to expand. If such consistency doesn't come about, then hopefully there'd be some kind of extra designation that higher quality programs would qualify for so that at least the worst of the programs would be easier to identify and avoid - both by prospective students and those looking to hire or be treated by NP graduates.

This doesn't specifically address the original topic of whether a doctoral degree is the way to go for NP education. So I do want to remind folks that when they speak of requiring a doctoral program for NPs, it doesn't mean a PhD - which focuses on research and theory. Instead, it's a title for a professional degree, such as MD and JD. PT programs are now "doctoral" but the coursework and training looks pretty darn similar to the previous "masters" PT programs... and previous "bachelors" PT programs. And with this kind of doctoral degree, you don't need and won't earn a masters along the way.

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Specializes in ED, Cardiac-step down, tele, med surg.

I think if the scope of practice is not broadened then the DNP is somewhat superfluous. If the scope is broadened then the DNP makes sense. I don't want to have to jump through hoops to become an NP just b/c the medical profession is uncomfortable with Masters prepared NPs or b/c the nursing profession wants more esteem. UCSF has the best MS program in the country and if they don't offer one, then I don't think it is essential. Are they going to require that PAs have a doctorate too? If they require a DNP, then I think it is only fair to make all mid-level practitioners get doctorate degrees.

J

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I think if the scope of practice is not broadened then the DNP is somewhat superfluous. If the scope is broadened then the DNP makes sense. I don't want to have to jump through hoops to become an NP just b/c the medical profession is uncomfortable with Masters prepared NPs or b/c the nursing profession wants more esteem. UCSF has the best MS program in the country and if they don't offer one, then I don't think it is essential. Are they going to require that PAs have a doctorate too? If they require a DNP, then I think it is only fair to make all mid-level practitioners get doctorate degrees.

J

We're happy to let you guys soldier on with this one. I would also point out that the major impetus for this is coming from nursing. Particularly NONPF and the state BONs. It will not necessarily broaden the NP scope but plug gaps in the NP educational process (from the BON point of view). Of course implicit in the DNP is independence through the nursing compacts (if you regard that as increased scope of practice). This is also what has the physicians riled up:uhoh3:.

David Carpenter, PA-C

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Specializes in ED, Cardiac-step down, tele, med surg.

I'm not quite sure I understand how the scope of practice would be expanded. Independence through nursing compacts? And what particularly are physicians riled up about? Thanks for elaborating for me, I appreciate it,

J

We're happy to let you guys soldier on with this one. I would also point out that the major impetus for this is coming from nursing. Particularly NONPF and the state BONs. It will not necessarily broaden the NP scope but plug gaps in the NP educational process (from the BON point of view). Of course implicit in the DNP is independence through the nursing compacts (if you regard that as increased scope of practice). This is also what has the physicians riled up:uhoh3:.

David Carpenter, PA-C

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