Doctoral degree to become an NP???

markdanurse · May 28, 2006

Has anyone else heard the following?:

Columbia School of Nursing will introduce a four-year "doctor of nursing practice" doctoral program that teaches much broader skills, such as evaluating clinical studies and setting up independent practices. As they gain these new skills, nurse practitioners are branching out beyond primary care to fill a growing need for personnel in many areas of medicine, including specialties such as long-term care providers for the elderly.

I think this is an absurd idea for nurse practitioners. A 4 year doctoral degree to become a nurse practitioner? This will actually be a REQUIREMENT to become an NP by the year 2015 if certain nursing interest groups get their way. WHY is there such a big push for this if nurse practitioners really aren't planning on competing with physicians like the special interest groups claim? The degree will teach NP's how to set up INDEPENDENT PRACTICES...how is this not competing with physicians? NP's having a doctoral degree may want to be referred to as "Doctor"...how is this not competing with physicians? I think this requirement may very well hurt the profession as a whole by doing the following: Decreasing the number of NP applicants, creating friction between physicians and NP's due to title use and physicians viewing NP's as competition, and create more role confusion for the public regarding nursing and the concept of the nurse practitioner.

Let's look at this idea folks. One goes to school for his or her BSN (Typically 4 to 5 years). Then one goes to school 4 more years for the Doctorate of Nursing Practice Degree. That's 8 to 9 years. Then he or she gets a position starting at $60,000 - $70,000 a year, if he or she is lucky (I have met NP's starting out as new gaduates making $54,000/year). No residency will be required like traditional medical school, but you can bet the universities offering such a program will charge you quite a pretty penny for the doctoral degree. (Just look at schools offering the PharmD, the DPT, the Aud.D, etc. These programs ARE EXPENSIVE, costly, and time consuming.) Then, to make things more fun, NP's will have to go against the grain of the medical profession (the AMA, including specialty groups of MD's and DO's) to fight for priveleges to practice independently in states unaccepting of the NP as an independent provider. Then there will be fights about getting empaneled by insurance companies for direct reimbursement for services provided. This will not be a smooth transition...this will be a war! The AMA is a powerful entity, both politically and socially.

Now don't get me wrong. I WANT to become an NP. But I want to get mine in 30 months as opposed to 4 years. I DO NOT want to be a doctor. I do NOT want to be called "doctor". I especially do not want to be a "doctor nurse". If I wanted to spend all that time in school, like the new degree proposes, I would GO to medical school. This way I would get a well respected MEDICAL DEGREE in the same amount of time, complete my residency, and then start out making $130,000/year (on average) instead of $60 - 70,000 a year. Oh, and I wouldn't have to worry about "physician collaboration", independent practice restrictions, being reimbursed by insurance companies, prescriptive privileges, or public confusion about my role in the healthcare system. And don't fool yourselves, many other intelligent people will see things my way too, which will lead to LESS NP's, which is a BAD thing for the profession.

Nursing isn't ready for this idea right now. There are too many other issues nursing needs to worry about first. What do you think about this issue?

brownrice · May 28, 2006

I have not researched this issue at all, however, I am suspect of the forces that drive certain action in higher education....consider that universities are really a big business--don't get confused and think there just so super altruistic--NOT. They are out to gain recognition and make a profit. The entities swirling around them are even more profit hungry--the entrance exam testing centers, the book publishers, companies financing ed loans, etc, etc. If they examine how to increase profit, it can be done very simply by requiring more education.

I agree with you that this idea of the doctoral degree for nurses is absurd. Did the pharmacists and PT's really need it too? I don't think so.

So, if I were forced to research this issue (which I wouldn't waste my time on otherwise) I would bet that at the root of it lies some lobbying from someone who stands to make a profit or gain recognition for their ego. Or, the AMA.

Medicine is so screwed up in the US already--quality of life v. healthcare dollars spent is abismal. So, these "bright" people are thinking, let's make it even tougher to find a provider to go out into rural areas to deliver healthcare, let's make them go to school for at least twice as long--what a fabulous idea! It ought to discourage quite a few that can't afford it. On top of that, let's confuse the public and give them the title of "doctor".

If these people who are all for the four year degree truly cared about quality of healthcare, they could figure out how to provide healthcare to the 45+million uninsured in this country. Much better use of their political struggles in my opinion.

platon20 · May 30, 2006

NPs ALREADY HAVE INDEPENDENT PRACTICE!

Why would we want to get a doctorate just for that?

Doctorate for nurses makes very little sense.

If htey are going to make the training that long, you might as well go to medical school.

texas-rn-fnp · May 30, 2006

I am in FNP program through ISU.

I was forwarded a document through the school that said by 2015 the NP program will be a 3 year grad program that gives you a DNS. There are supposed to be a few schools out there like this already, but all schools are supposed to be changing to this by 2015. The NP program will be grounded in FP and then you will have to do a post grad didactic and residency if you want a specialty. Yes, this is becoming closer to a medical degree. Yes, NPs are going to be more competative with docs.

RE: salary. It is VERY dependant on location. I am now living between Sacramento and SF. I have seen job postings for FP docs out here for only $118-125k. In contrast, most FNP postings in San Antonio advertise for $85k. I have even seen some for up to $125k in SA. That is a major difference, especially considering the cost of living difference. Sadly, I know new RN grads in New England that can't even get a job. Location is a major determinant of salary and cost of living.

texas-rn-fnp · May 30, 2006

I have not researched this issue at all, however, I am suspect of the forces that drive certain action in higher education....consider that universities are really a big business--don't get confused and think there just so super altruistic--NOT. They are out to gain recognition and make a profit. The entities swirling around them are even more profit hungry--the entrance exam testing centers, the book publishers, companies financing ed loans, etc, etc. If they examine how to increase profit, it can be done very simply by requiring more education.
I agree with you that this idea of the doctoral degree for nurses is absurd. Did the pharmacists and PT's really need it too? I don't think so.
So, if I were forced to research this issue (which I wouldn't waste my time on otherwise) I would bet that at the root of it lies some lobbying from someone who stands to make a profit or gain recognition for their ego. Or, the AMA.
Medicine is so screwed up in the US already--quality of life v. healthcare dollars spent is abismal. So, these "bright" people are thinking, let's make it even tougher to find a provider to go out into rural areas to deliver healthcare, let's make them go to school for at least twice as long--what a fabulous idea! It ought to discourage quite a few that can't afford it. On top of that, let's confuse the public and give them the title of "doctor".
If these people who are all for the four year degree truly cared about quality of healthcare, they could figure out how to provide healthcare to the 45+million uninsured in this country. Much better use of their political struggles in my opinion.

The system is already messed up. We obviously know how many nurses we are short, then the system is not conducive to bringing in new nurses. Just look at how most NP programs are leaving you on your own to try and find a preceptor. Then most of the potential preceptors either are not interested in being one or they only take med students. This is a school responsability.

jer_sd · May 30, 2006

when i read the vision paper i was supportive of this new change.

look at many of the doctorial programs now are 6-8 years (you can still get into med school with 2 years college same with optometry, chiropractic, pharmacy... not common but possible) looking at current nurse education 4 years for a bsn and many np programs are 3 years in length and many are in excess of the 36 credit hour minimum for a masters. if they increase the clinical portion to one year rather than 500 hours (fte equivalent of 3 months) i feel np graduates will be better prepared to function in a team environment. i finished two np programs and both were lacking in clinical exposure for my employers expectations of me. so you spend an extra 6-12 months in clinical time to develop skills not that bad of a change in education.

the fact they also are thinking about residencies for that clinical year is an exciting idea for me. pharmacy, optometry, physical therapy, md/do all have residencies i have only been able to find 6 residencies/fellowships for nps with an internet search.

even with a dnp we will still be nurses. we approach patient in a different manner than md/do with overlap in skills and functions. i am not a replacement for a physician instead i offer services that compliment other health care providers to provide patient care. i believe nps should be independent providers legally but no provider practices alone in the current health care environment. rather we should be held accountable for our actions and stop functioning as an extension of a physician.

just my opinion....

jeremy

platon20 · May 30, 2006

Even DNPs cant come out and say directly that they compete against doctors.

Because if they said that, it means they are practicing medicine and not nursing.

State nursing boards have no power to regulate medicine, they only power they have is over the practice of nursing.

So when these new DNP grads come out, they will have to say "I practice nursing, not medicine" or else they could be sued for the unlawful practice of medicine without a license.

platon20 · May 30, 2006

(you can still get into med school with 2 years college

sorry but thats wrong. 99% of med schools require a 4 year bachelors degree. there are a couple of exceptions made to combined undergraduate/medical programs, and some other minor exceptions. so you might find a few people who went to med school with only 3 years of college, but thats the bare minimum.

platon20 · May 30, 2006

The system is already messed up. We obviously know how many nurses we are short, then the system is not conducive to bringing in new nurses. Just look at how most NP programs are leaving you on your own to try and find a preceptor. Then most of the potential preceptors either are not interested in being one or they only take med students. This is a school responsability.

Agree 100%. I dont know why we pay these NP programs tens of thousands of dollars in tuition, and they dont even provide us with clinical preceptors? What the hell are we paying them for?

Its an absolute outrage that after paying that much money you have to set up your own clinicals.

zenman · May 31, 2006

Even DNPs cant come out and say directly that they compete against doctors.

Not entirely true. Even when I practice Zen Shiatsu, I compete against physicians and they can't do a thing about it. For ex, I see clients who are dissatisfied with their physician. So, NPs (and DNPs) will be competing with their own niche in the marketplace. :pumpiron:

markdanurse · Jun 2, 2006

Please understand the point I am making here. Columbia University is setting the precedent here, and the university is making the DNP a four year, NOT a 3 year degree. Other universities WILL follow this precedent, just as all NP programs have that are now at the master's level.

For the nurse that stated NP's practice Nursing and NOT medicine... you can call a rose a "sleeshinfluff" but it's still a rose. By proposing a doctoral degree for NP practice, and teaching how to set up an INDEPENDENT practice at the university level, and by doing 90% + of what a physician does in his or her practice, NP's DO practice medicine and ARE competing with physicians. If too many NP's are pumped out of nursing school to set up independent practice, we will not be received well in the medical community. In some states, NP's are required to be registered with BOTH the state board of nursing and the state medical board, because some states realize NP's really are practicing medicine, not "advanced practice nursing".

Also, this "more is better mentality" is ridiculous. Case in point, an associate degree physical therapy assistant can do EVERYTHING a doctorally prepared P.T. can do EXCEPT do an initial evaluation to formulate a care plan. Functionally they understand the same principles and do the same job. I have worked with both, and I have had a hard time distinguishing between the two. The same thing can be said of the Certified Occupational Therapist Assistant versus the Master's prepared O.T.®, and the Pharmacy Technician (CPhT) versus the doctorally prepared pharmacist (R.Ph.). I used to be a pharmacy technician, and I did everything the pharmacist did except clarify orders with physicians and tell patients how their new prescriptions should be taken. Yes, theoretically the more educated ones know more theory, but how much of that "theory" we have learned in school applied to the positions we have held? A baccalaureate prepared pharmacist can perform just as well as a doctorally prepared one. I have seen associate degreed nurses who can run circles around their bachelor degreed counterparts. I have seen physician assistants outperform physicians in terms of medical knowledge and correct diagnosing in ER's I have worked in. The idea that more is better simply does not hold true. A doctoral degree to become an NP means more money for the universities, a waste of precious time for future NP's, and more confusion to the public about the already confusing NP role in healthcare. How can I say this? Simply put, studies in the journal of the AMA show master degreed NP's having the SAME and in some instances BETTER outcomes than the physicians who partcipated in the study. So a doctoral degree to become an NP will help the profession how exactly?

Guitar_Heroine · Jun 2, 2006

This is interesting to me as it was presented to us in my BSN program not too long ago as a good thing, that it would but nurse practitioners on the same page as other specialties with doctorates like DPT's. But reading these posts... But to spend that much time and money seems a bit ridiculous, even though some of the added requirements could be useful. I'm frustrated. But my quesiton is are "old" NP's going to have to upgrade their credentials or be seen as inferior to people with a DNS even though they have all their clinical experience?