Doctoral degree to become an NP???

core0 · Sep 6, 2007

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

The state BONs are working on a national nursing compact. The thought is that any nursing license in one state in good standing would be valid in another state. They are fairly far along for RNs. They also would like to extend this to NPs. Whether this can be achieved is another story. One of the problems of extending NP practice to other states is the wide variance in NP practice acts and scope of practice.

Scope of practice is governed by the NPs certification and the state BON. There are a variety of interpretation and several states require additional training or supervision before the NP can prescribe. In the National BON white paper pharmacology was identified as a perceived weakness by some BONs in the NP educational model. The DNP requires additional coursework in Pharmacology, Pathophys and disease process such that along with the clinicals they would meet the requirements for all states but Maine.

Also inherent in this is full independent practice by NPs without any required supervision or collaboration with physicians. There are a variety of reasons that the DNP is not popular with the physicians. One is the perceived use of doctor in a medical setting which has been argued at length here. The other is independence which has economic and political undertones. The primary driving force that I have seen here is the Anesthesia/CRNA battle over supervision. This has translated into blanket opposition by anesthesia over any changes in nursing practice acts that consider promoting nursing independence (as seen in the recent attempts to change the Texas practice acts).

Its a very complicated political play and I think the BONs are somewhat naive in thinking that they can use this to end run around physician involvement in states where it occurs. The heavy NP involvement in In-store clinics is exacerbating this whole situation in some states.

David Carpenter, PA-C

jjjoy, LPN · Sep 6, 2007

The way I see it "DNP" is more about mirroring the move of PT programs that now offer only doctoral degrees. Pharmacy programs have granted "doctoral" degrees for some time. Such programs are generally three years to four years from entry to graduation and are usually entered after having already earned a bachelor's degree.

If advanced practice nurses are to have the kind of autonomy that is being pushed for, then three years of additional education seems only fair. How much more advanced can one's practice be with just a year or two extra of education? And how can APNs expect to be taken seriously if their training was substantially shorter than that of other mid-level providers?

CraigB-RN, MSN, RN · Sep 7, 2007

I just read an article about job disatisfaction in pharmacist and others who have gone the degree creap already. I'll have to go out and find the reference so I can post it.

It basicly focused on how nothing improved after the "docterate" level was optained. Personlly I think it's an attempt at a quick fix for a problem that is much bigger and more complex than that.

prairienp · Sep 7, 2007

the way i see it "dnp" is more about mirroring the move of pt programs that now offer only doctoral degrees. pharmacy programs have granted "doctoral" degrees for some time. such programs are generally three years to four years from entry to graduation and are usually entered after having already earned a bachelor's degree.
if advanced practice nurses are to have the kind of autonomy that is being pushed for, then three years of additional education seems only fair. how much more advanced can one's practice be with just a year or two extra of education? and how can apns expect to be taken seriously if their training was substantially shorter than that of other mid-level providers?

the pharm d program has 2 years of pre-reqs, application to pharm d program, attend school for 4 years and are given a bs degree during the process followed by the pharm d at the end of 4 years. this is a 6 year total process. there a few who enter these programs with a bs already, i would say it is the same % who enter bs nursing program.

a year or two of extra education will make a significant difference. one of the differences is the dnp places advanced practice nurses at the same table as the other professionals.

HealthyRN · Sep 9, 2007

the pharm d program has 2 years of pre-reqs, application to pharm d program, attend school for 4 years and are given a bs degree during the process followed by the pharm d at the end of 4 years. this is a 6 year total process. there a few who enter these programs with a bs already, i would say it is the same % who enter bs nursing program.
a year or two of extra education will make a significant difference. one of the differences is the dnp places advanced practice nurses at the same table as the other professionals.

i have researched pharmd programs extensively and this information is not the norm. the majority of people who enter pharmd programs already have a bachelor's degree. i'm not sure what program you are looking at, but most programs do not award a bs degree in the process, unless it is an accelerated pharmd program. there are accelerated programs that follow the timeline that you mentioned (6 years), but this would require the student to apply to the program and be accepted directly out of high school or before beginning university coursework. then, it would require 2 years of pre-reqs and you would start the pharmd coursework during the 3rd year of college. a bs degree would be awarded if you were in the accelerated program. the accelerated programs only accept top students and are much harder to get into than the traditional programs. many programs may say that you only need to complete the pre-reqs and a bachelor's degree is not required, but so do some medical schools. however, the vast majority of students are going to need a bachelor's degree to be accepted. regardless, the coursework for the pharmd is 4 years.

llg, PhD, RN · Sep 9, 2007

An interesting side note to this discussion:

Within the last few weeks, 2 higher education coalitions -- one representing universities in North America and the other representing universities in Europe -- have met and issued statements calling for clarifying and strengthening the role of Master's Degrees in general. These groups are not nursing-focused: they cross all disciplines.

Many academics outside of the health care field are concerned about the proliferation of "professional doctorates" that muddy the waters about what different levels of education involve, who accredits all these programs, the standards in place to guide their development, etc.

(The Chronicle of Higher Education is a good source of information about what's happening in higher education for those of you would would like to read about the educational world outside of nursing.)

It will be interesting to watch all of this unfold.

prairienp · Sep 9, 2007

i have researched pharmd programs extensively and this information is not the norm. the majority of people who enter pharmd programs already have a bachelor's degree. i'm not sure what program you are looking at, but most programs do not award a bs degree in the process, unless it is an accelerated pharmd program. there are accelerated programs that follow the timeline that you mentioned (6 years), but this would require the student to apply to the program and be accepted directly out of high school or before beginning university coursework. then, it would require 2 years of pre-reqs and you would start the pharmd coursework during the 3rd year of college. a bs degree would be awarded if you were in the accelerated program. the accelerated programs only accept top students and are much harder to get into than the traditional programs. many programs may say that you only need to complete the pre-reqs and a bachelor's degree is not required, but so do some medical schools. however, the vast majority of students are going to need a bachelor's degree to be accepted. regardless, the coursework for the pharmd is 4 years.

i did check some programs out as you seemed so sure. i went to several of the big 10 and big 12 schools pharm d. programs web sites, they all require two years of pre-req before competitive admission into the 4 year professional program. there is no mention of an accelerated program or a bs requirement. i didn’t find any information on if a bs is awarded during the process, i know one program where i was a faculty member did offer the bs during the pharm d. process. maybe the big 10 and big 12 schools are different from the rest of the us? do you think all the programs in the big 10 and big 12 are accelerated? which schools that you know of require a bs for admission to the pharm d. curriculum?

jjjoy, LPN · Sep 9, 2007

From Wikipedia:

Traditionally in the United States, the bachelor's degree in pharmacy was the first-professional degree for pharmacy practice. However, in 1990, the American Association of Colleges of Pharmacy (AACP) mandated that a doctorate in pharmacy would be the new first-professional degree. As of the year 2000, all pharmacy schools in the U.S. have discontinued the B.S.Pharm. (Bachelor of Science in Pharmacy) degree program.

Many top level schools look favorably upon applicants who first complete a bachelor's degree. For those students who desire a more accelerated pace, it takes a minimum of six academic years, which can be completed in five calendar years, after high school graduation to complete the Pharm. D. program. However, it is quite common for pharmacy students, like medical students, to take eight years to complete the degree which includes 4 years of university in addition to 4 years of graduate school.

from Univ of Minn

In 2007, 75% of admitted students possess a Bachelor's degree, and less than 2% complete the prerequisites in two years.

From Ohio State

The faculty at Ohio State recently voted to require a Bachelors Degree for entry into the PharmD program, beginning Autumn Quarter 2007.... Previously, the Bachelors Degree was suggested for entering students and the vast majority of those accepted had completed a bachelors degree, but beginning in autumn 2007 it will be formally required.

from USC

A Bachelor's degree is not required, but highly recommended. Candidates who have received or will receive a Baccalaureate degree or who have completed units in excess of the minimum required will be considered more favorably than applicants who have fulfilled only minimum requirements.

from UNC

The doctor of pharmacy, commonly called the PharmD, is the professional degree for pharmacists. It is neither an undergraduate degree nor a graduate degree but rather a degree similar to a doctor of medicine (MD) or doctor of dental surgery (DDS). This means that you are not required to complete an undergraduate degree program before being admitted to a PharmD program (although many of our students have). After earning a doctor of pharmacy degree and successfully passing a licensure exam, you are eligible to practice as a pharmacist.

From Butler Univ

The Doctor of Pharmacy (Pharm.D.) curriculum offers a rigorous mix of classroom, laboratory, and experiential learning. The six year program consists of two years of pre-pharmacy course work and four years of professional training and clinical rotations.

......very interesting!!!!! Lots of changes in educational preparation across the board - as llg noted. Who can keep up?!

HealthyRN · Sep 9, 2007

i did check some programs out as you seemed so sure. i went to several of the big 10 and big 12 schools pharm d. programs web sites, they all require two years of pre-req before competitive admission into the 4 year professional program. there is no mention of an accelerated program or a bs requirement. i didn't find any information on if a bs is awarded during the process, i know one program where i was a faculty member did offer the bs during the pharm d. process. maybe the big 10 and big 12 schools are different from the rest of the us? do you think all the programs in the big 10 and big 12 are accelerated? which schools that you know of require a bs for admission to the pharm d. curriculum?

as i said, many programs do say that they only require completion of the prereqs before admission into the program and bachelor's degrees aren't required. many medical schools also say the same thing. for example, the university of michigan medical school states that admission requires the completion of 90 semester credits. in other words, you could complete the required courses and apply to medical school without obtaining a bachelor's degree. however, the vast majority of applicants to medical school have a bachelor's degree.

from my research on pharmd programs (and yes, i did look at big 10 universities), it is much the same. from talking with admission counselors, you could apply after completing only the prereqs, but you may be considered more competitive if you first complete the bs degree. also, the majority of people may find it difficult to complete the prereqs in two years and by the time they complete the coursework, they may as well graduate with the bs. other people may not discover an interest in the pharmacy profession until they have been in college for awhile and it may make more sense to get the bs.

i don't know if all universities have "accelerated" pharmd programs, but the ones that i looked at had some form of that. perhaps "accelerated" was the wrong term. ohio state and university of michigan both have programs where incoming freshmen are admitted and guaranteed spots in the pharmd program after completing the two years of prereqs. at least at ohio state, i know that this program did award a bs.

kwagers · Sep 11, 2007

This has been said before, but DNP would be a clinical doctorate, you would not need to get your MSN.
As for why do a DNP instead of an MD? Because the nursing model is different than the medical. I have no interest in becoming a medical doctor. I like the holistic outlook of nursing.

I agree with you whole-heartedly. I am currently in the DNP program at Arizona State University, and I am enjoying it so far! Many people are confused about the fact that you do not need to already have your MSN, as the DNP program track follows similarly to the MSN/NP program. The first 2 years, then sit for your NP in your specialized area, then the 3rd year is focused on the DNP, although the content is a little different in terms of MSN vs. dnp programs. I am finding that, although it is hard, I too, want the holistic approach of nursing vs. the medical doctor or physician's assistant route. Obviously those that don't have the DNP will be grandfathered in before 2015 when it will be the mainstay for those wishing to further their educations/career.

Kristen

core0 · Sep 11, 2007

I agree with you whole-heartedly. I am currently in the DNP program at Arizona State University, and I am enjoying it so far! Many people are confused about the fact that you do not need to already have your MSN, as the DNP program track follows similarly to the MSN/NP program. The first 2 years, then sit for your NP in your specialized area, then the 3rd year is focused on the DNP, although the content is a little different in terms of MSN vs. DNP programs. I am finding that, although it is hard, I too, want the holistic approach of nursing vs. the medical doctor or physician's assistant route. Obviously those that don't have the DNP will be grandfathered in before 2015 when it will be the mainstay for those wishing to further their educations/career.
Kristen

I'm curious how you can sit for your NP without a Masters. The ANCC requires a Masters, Post-Masters or Doctorate from a Nurse Practitioner program. If the program does not grant a Masters how are you eligible to sit for your NP? Also has anyone looked at the ability to bill for Medicare. The current rule states:

" * (4) On or after January 1,2003, nurse practitioners applying for a Medicare billing number for the first time must meet possess a master's degree in nursing and meet the standards for nurse practitioners as defined in paragraphs (1) (i) and (1) (ii)."

So Medicare does not recognize a DNP only a Masters for NPs after 2003. I would interpret this to mean that an NP that did not receive an MSN would not be able to bill Medicare. Some things to think about.

David Carpenter, PA-C

kwagers · Sep 11, 2007

I'm curious how you can sit for your NP without a Masters. The ANCC requires a Masters, Post-Masters or Doctorate from a Nurse Practitioner program. If the program does not grant a Masters how are you eligible to sit for your NP? Also has anyone looked at the ability to bill for Medicare. The current rule states:
" * (4) On or after January 1,2003, nurse practitioners applying for a Medicare billing number for the first time must meet possess a master's degree in nursing and meet the standards for nurse practitioners as defined in paragraphs (1) (i) and (1) (ii)."
So Medicare does not recognize a DNP only a Masters for NPs after 2003. I would interpret this to mean that an NP that did not receive an MSN would not be able to bill Medicare. Some things to think about.
David Carpenter, PA-C

I will have my Master's after 2 years of the 3 year program. I will sit for the boards after the 2 years for my specialty (Mental Health/Psychiatric Family and Child Nurse Practitioner). Then I will finish the DNP program in the 3rd year. Hope that helps make sense of what I originally posted. As for the Medicaid billing, it will be applicable, because I will be Master's certified, as well as DNP certified.