Doctoral degree to become an NP???

[VickyRN]

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

[psycharnp]

Trivial knowledge that helps 0% when it comes to diagnosing a patient you say?

Well as a practicing NP. I remember taking two research classes, roles and issues, Leadership, management, Pathophysiology (1,100 individual pathologies in a semester with exhaustive testing over randomly selected pathologies in terms of diagnostics, differential diagnosis, and treatment methods at various disease states). I remember the advanced health assessment rated sent in to the Medical School for rating by the same standards and individuals who rate the Medical Students. Then there is the pharmacology class again thought, and graded by the medical school. Additional pharmacology classes thought and graded by the NP school. More useless knowledge I suppose???

Of course prior to entry into the actual specialty field the masters level classes that are required such as roles and issues, two research classes, and all the theory and prevention I could stand. Many other required classes both before and after being accepted into my chosen specialty. All of which, I do indeed find useful on a daily basis in real world practice.

Now you are right about one thing here: you don’t use nursing theory to make a medical diagnosis, and that is an excellent point. However medically diagnosing is only one of many crucially important aspects of being a nurse practitioner. Lets remember we ARE NOT PHYSICIANS, OR PHYSICIAN LOOKALIKES; RATHER WE ARE NURSES!!!!!!!

WE CANNOT REPLACE PHYSICIAN, NOR CAN PHYSICIANS REPLACE US!

Let me give you a clear and historically accurate example of the necessity of nursing and nursing theory in real world application.

From the eleventh century until 1800’s the physicians, were ever increasing their knowledge of surgical techniques. By 1855 when Nightingale arrived at Scutari and began utilizing research-statistics and utilization of her theoretical model of nursing leading to her implementing change which resulted in a decline in mortality rate.

Prior to nightingales application of nursing theory the absolute best the physicians could accomplish was 42.7%. By using NURSING THEORY (FLUFF according to you, not me) she dropped mortality to 2.2% and she accomplished this in only 6 months. The physicians had tried for more than 600 years and could not do better than 42.7% mortality using the medical model.

If it were your future kids you refer to, would you prefer they go under the knife with 42.7% chance of dyeing post operatively (medical models very best), or 2.2 percent chance of dying post operatively (nursing theory in action giving us entirely the standard we utilize to this today).

Another flawed notion is this additional year you write about. Try three additional years minimum.

As far as that chat with your kids (medical school or DNP school) which shall they choose….Good luck!!!!!!

My grades, and course content are more than adequate for Medical School. I am also very well connected to the decision makers at the University politically. I estimate my chances of getting into the DNP program this year at just under 10% based on number of seats (15 total seats per year for all specialties combined) VS. the number of applicants.

Unless your kids are genius or better, (and I sincerely hope they are) they will not be making that big decision: “medical school or DNP school”. Medical school has considerably more applicants than seats available, just like DNP School, and like DNP school, a combination of ability, grades, integrity, and political pull are absolutely necessary to successfully gain entrance.

In short: make up your mind, do you want to be a physician or a nurse? I chose the nursing rout myself. Once you really do make up your mind, then I urge you to follow the advice of a great physician and personal hero of mine (John Benjamin Murphy M.D.), which follows:

It is the purpose of every man’s life to do something worthy of the recognition and appreciation of his fellow men. . . . By their superior intellectual qualifications, their fidelity to purpose and above all their indefatigable labor the few become leaders.

The Journal of the American Medical Association, Chicago, 1911, 57: 1.

Gender neutral replace man/men with person/persons

[amzyRN]

I'm still not convinced that the curriculum proposed for the DNP will yield a better NP. I am not convinced that extra research and other classes such as these

http://www.son.jhmi.edu/academics/academic_programs/doctoral/dnp/plan/

are going to improve the quality of care NPs provide. But, as a rational person, I recognize that I can be wrong. I think that we will, as one wise person stated a few posts ago, have to wait and see. And I love the theory of nursing as being more holistic and humanistic, but the drive toward more research and evidence based practice is making it more and more reductionistic, like medicine, in my opinion. Anyway, no offense intended, just wanting to give an honest opinion,

J

[prairienp]

I'm still not convinced that the curriculum proposed for the DNP will yield a better NP. I am not convinced that extra research and other classes such as these

http://www.son.jhmi.edu/academics/academic_programs/doctoral/dnp/plan/

are going to improve the quality of care NPs provide. But, as a rational person, I recognize that I can be wrong. I think that we will, as one wise person stated a few posts ago, have to wait and see. And I love the theory of nursing as being more holistic and humanistic, but the drive toward more research and evidence based practice is making it more and more reductionistic, like medicine, in my opinion. Anyway, no offense intended, just wanting to give an honest opinion,

J

Thanks for the link. I found the plan of study for the post masters DNP very appropriate. These experienced NPs need course work that will enable them to have the resources to manifest change in the role of the NP. Policy, econ, EBP are essential to understanding our scope of practice issues. The capstone project could be inquiry into a specialty area like policy or clinical, depending on the desire of the student. I would say Hopkins got this one right.

[SN2bExpAt]

Well as a practicing NP. I remember taking two research classes, roles and issues, Leadership, management, Pathophysiology (1,100 individual pathologies in a semester with exhaustive testing over randomly selected pathologies in terms of diagnostics, differential diagnosis, and treatment methods at various disease states). I remember the advanced health assessment rated sent in to the Medical School for rating by the same standards and individuals who rate the Medical Students. Then there is the pharmacology class again thought, and graded by the medical school. Additional pharmacology classes thought and graded by the NP school. More useless knowledge I suppose???

When I said fluff earlier, it was not aimed at the ENTIRE courseload an NP student is required to learn. I think I made that pretty clear. The courses you listed would be the meat and potatoes required to Dx, Tx and Rx. Of course they are not useless, you cannot be an NP without them.

I do think, however, that the academic mentality of adding the extra year for DNP will find it irresistible to shove more preachy banter into the curriculum. How many of you "tweaked" your answers for your nursing ethics classes because you knew it was what the professor wanted to hear? How many of you let a big "sigh" out when you had to study for that research methods test? How many of us find that what it taught in the classroom barely resembles real world nursing? How many of us have had clinical instructors tell us that this is how it is done in the hospital (vs the textbook). Some dnp programs have a capstone project in the final year, do they not?

What really put this into perspective was when I had to do an essay for my Pharmacology class. I went looking thru books in the pharmacy section of the library and realized how even a basic understanding of Chemistry would have un-garbled some of what I was attempting to read. I quickly headed back to the Pharmacology books in the nursing section, r/t deficent knowledge of chemistry AEB by failed attempt to decipher the language of chemistry.

We as nurses are relentlessly beat over the head to be "critical thinkers." It isn't enough to carry out a medical order, we need to know why. It isn't enough that we administer an IV drug w/o knowing what extravasation is. Fine. This is actually a good thing and I agree wholeheartedly.

So why is it that NP's can prescribe w/o having taken one single course in Chemistry, even in high school? We are all about EBP, yet the NP programs don't explore that evidence base when it comes to the pharmacotherapy classes. If DNP is to be the norm in the future, how about taking this opportunity to give it some objective credentials? You know, the answers to which mathematics gives the single (or at least really narrowed down), irrefutable rationale? No more of this interpretive qualitative filler which may change precipitously when someone else does a better funded study than you.

If it is to come to pass, then maybe an entrance requirement should be a full year of intro chem? It can be further expounded upon in a bio/organic chem class that should be offered as part of the DNP curriculum. How would this not give a deeper understanding of your prescribing powers? I would feel better knowing the deeper "why" than doing a yearlong capstone project on, let's say, patient coping in the outpatient vs inpatient setting, evidence to show teaching...yada yada. If anything, it would open the floodgates and allow more NPs to prescribe narcotics (I don't know how drug schedules work in the states...yet). Does getting that private practice you have always wanted look a little closer now?

If this DNP took the time to beef up its grads with hard science vs: a capstone project, more research based snoozer classes, or emergent theories courses which helped some RN get a journal published, then it would be worth this new standard as entry to practice. The way I see it, it can only enhance the care of patients from a safety point of view.

Think I don't know what I am talking about? Then why not ask your patients? Talk to them about the drug(s) you are prescribing to them. Then ask them if they are comfortable that you took a class called, "scholarly inquiry for nursing practice" or "advanced research methods" instead of Organic Chemistry or advanced microbiology (with lab requirement)?

DNP is not a research based terminal degree, so schools should stop this pseudoattempt at making its graduates reasearchers on top of being clinicians. Leave the research to the PHds, that is why they chose that degree. People choose NP for a great balance of one on one care and technical skills and knowledge; at least that was why I looked into it. Recognize DNPs as the expert based clinicians that they are and give them even more hard science to positively enrich their Dx-ing and RX-ing judgments. I think that a patient would be more grateful that you fully understand their what osmolality is beyond " X = refer to nephrology" versus the A+ you got in Emergent Nursing Theory.

[SN2bExpAt]

Oh, I am also not flawed in respect to one additional year. dnp programs are 3 years versus the two required in a masters? I guess I did not make that clear.

If you throw in the 1-2 years of RN experience these programs require prior to admission....

[prairienp]

so why is it that np's can prescribe w/o having taken one single course in chemistry, even in high school? we are all about ebp, yet the np programs don't explore that evidence base when it comes to the pharmacotherapy classes.

if this dnp took the time to beef up its grads with hard science vs: a capstone project, more research based snoozer classes, or emergent theories courses which helped some rn get a journal published, then it would be worth this new standard as entry to practice. the way i see it, it can only enhance the care of patients from a safety point of view.

think i don't know what i am talking about? then why not ask your patients? talk to them about the drug(s) you are prescribing to them. then ask them if they are comfortable that you took a class called, "scholarly inquiry for nursing practice" or "advanced research methods" instead of organic chemistry or advanced microbiology (with lab requirement)?

i

i can't verify, but i suspect the vast majority of nps have had at least one chem course. i am sure most of the np would not consider their research courses "snoozer" classes. my own experience found a strong correlation between success in an undergraduate research course and nclex success. those students who struggled in undergraduate research were the students most likely to have failed the nclex exam. in fact, never did see a student who received an "a" in research fail nclex.

don't under estimate the power of dnp research, i personally prefer the research from an actual clinician as compared to the a non-clinician. the dnp research should be applicable to practice. the entire purpose of the dnp research is to improve practice. why should the research be left to the phds?

[jjjoy, LPN]

Research shouldn't "be left to" PhDs but not all practitioners need the same level of training in research as those people who plan to conduct formal research in their professional life.

Yes, most NPs have had at least one chemistry course as RN programs usually require at least one. There are those nursing programs that require more chemistry (such as a year of chemistry and one term of organic/biochem) but we can't automatically conclude that NPs have had the same degree of education in chemistry (and biochemistry) as MDs (two terms of inorganic chem, two terms of organic chem and a term of biochem - all with lab - these are some of the weeder courses for pre-meds).

Going straight for DNP could possibly take as long as going for MD (only counting years of education and not waitlist time), but that is only for those students who start college with a strong foundation immediately start taking pre-req courses from day one. Most students would need at least an extra year to get up to speed in pre-med coursework (calculus, a year of physics). Pre-nursing courses don't match pre-med coursework so to change from pre-nursing to pre-med would mean additional coursework in classes that are even more competitive than pre-nursing courses. If someone started school with the objective of being eligible for both nursing and med school, that would likely take extra work as well.

Also, NP students have the back up of being able to start work as nurses if anything thwarts their DNP plans. Many NP students work part-time as nurses. NPs also start working and earning sooner out of school than MDs, who usually have several years of supervised residency before they can work independently.

[amzyRN]

Oh, I am also not flawed in respect to one additional year. DNP programs are 3 years versus the two required in a masters? I guess I did not make that clear.

If you throw in the 1-2 years of RN experience these programs require prior to admission....

I think in many programs it's 4 years. For example, at USF (University of San Francisco), the DNP program in 4 years after the BSN. Please send me the link of 3 year programs, b/c so far I haven't found any that short. Thanks much,

J

[amzyRN]

Research shouldn't "be left to" PhDs but not all practitioners need the same level of training in research as those people who plan to conduct formal research in their professional life.

Yes, most NPs have had at least one chemistry course as RN programs usually require at least one. There are those nursing programs that require more chemistry (such as a year of chemistry and one term of organic/biochem) but we can't automatically conclude that NPs have had the same degree of education in chemistry (and biochemistry) as MDs (two terms of inorganic chem, two terms of organic chem and a term of biochem - all with lab - these are some of the weeder courses for pre-meds).

Going straight for DNP could possibly take as long as going for MD (only counting years of education and not waitlist time), but that is only for those students who start college with a strong foundation immediately start taking pre-req courses from day one. Most students would need at least an extra year to get up to speed in pre-med coursework (calculus, a year of physics). Pre-nursing courses don't match pre-med coursework so to change from pre-nursing to pre-med would mean additional coursework in classes that are even more competitive than pre-nursing courses. If someone started school with the objective of being eligible for both nursing and med school, that would likely take extra work as well.

Also, NP students have the back up of being able to start work as nurses if anything thwarts their DNP plans. Many NP students work part-time as nurses. NPs also start working and earning sooner out of school than MDs, who usually have several years of supervised residency before they can work independently.

There are actually quite a few bioscience majors, like myself, who went into nursing instead of medicine, who have pre-med curriculum under their belts and then some. So for people who have got the science background and can go either way, the DNP requirement, may make the NP option a little less appealing. And pre-med class work isn't impossible to complete. Calculus isn't really that hard. If one wants to put in the time, acing most classes is usually possible. What I liked about nursing was the humanistic and holistic perspective toward healing. I felt medicine was too reductionistic and that human beings could never be reduced to the laws of physics and chemistry. I believed that nursing saw the human condition as something greater than that. The push to make nursing more "scientific" like medicine, via research, research, EBP, etc. may take the creativity out of it. Will we just become robots that have to justify every move based on prior research? The point I'm trying to make is that if nursing is becoming more an more reductionistic, like medicine, then why not just go to med school in the first place. I guess I think a lot of research that is done about human experience (like nursing research) cannot be completely reliable (because human beings are not robots and completely predictable) and therefore I can never completely rely on that data. It would be a guide at best. What is your perspective on this. I mean no offense or want to argue, just learn and clarify my knowledge. Thanks much,

J

[SN2bExpAt]

Scroll down to Length of Program

UTHSC has already implented DNP as their standard entry to practice as of 2009; guess they got sick of waiting

I'll be honest here, I just assumed 3 years because I was thinking to the future and forgetting about current program designs. I found the U Pitt website via Google and some luck, I guess. You are right, currently most people are looking at four years if you follow protocol and go MSN-DNP. My bad.

[SN2bExpAt]

As for reductionist, I would think that 4 years undergrad BN and a few years in practice would help solidify our caring perspective and help us not write off people so quickly.

I was watching Mystery Diagnosis on Discovery Health this morning, I had TiVo'd it and finally got around to watching. There was a patient who had edematous ascities post surgery. Then there was the development of tunneling and necrotizing tissue about 2 inches diameter. Her idiot primary care doc kept writing it off as a flu. Most nurses, from their wound care practice and training, would get the red flags going and notify a qualified MD stat. Before commercials were over I, the armchair pathologist, guessed Necrotizing Faciitis. Turns out that is what she had.

So yes, some MDs are reductionist morons who cannot see past a lab printout or worse, do not even order one. I guess I am a little biased when I decide post BSN studies because I do not consider myself reductionist. However, I am not comfortable denying myself the opportunity to consider all possible options; which means I want all available classes to r/o self doubt. Seriously, having a case of the "only if's" drives me up the wall to no end. Having a case of the only if's in the grand scope of choosing a terminal career would leave me uncertain, unfulfilled, and uneasy.

As an aside on the topic of reductionism, I have a scenario. What if a student went straight from BSN-DNP? This may very well be likely, if not already reality. Without the opportunity to finely polish those human interaction/communication skills, is that any less reductionist than the student who goes from undergrad to Med school?

Also, and I could be in error here, I do not remember seeing chemistry as an entry requirement into an NP program. I looked at programs in the US and Canada and I must say, not once did I even see chemistry mentioned on the respective MSN-NP programs. I see Chem and Physics as pre reqs for CRNA, but not NP.

[SN2bExpAt]

The push to make nursing more "scientific" like medicine, via research, research, EBP, etc. may take the creativity out of it. Will we just become robots that have to justify every move based on prior research? The point I'm trying to make is that if nursing is becoming more an more reductionistic, like medicine, then why not just go to med school in the first place. I guess I think a lot of research that is done about human experience (like nursing research) cannot be completely reliable (because human beings are not robots and completely predictable) and therefore I can never completely rely on that data. It would be a guide at best. What is your perspective on this.

J

We already are robotic in the search for EBP based rationale. We are constantly beat over the head with "EBP" in our Nursing Skills labs. We are told not to listen to the "older" nurses if what they show us contradicts what is taught in class. The problem with most evidence in nursing is what you have already mentioned. Qualitative (especially emergent ones) studies can give guidelines at best, it can never be given the title of "proof". Give the parameters and data to five different nurse researchers and you will probably get 2-4 different interpretations. I guess I am too much of a concrete learner to settle for anything less than definitive. I am all for improving patient health outcomes and the keen eyes of nurse researchers to advocate optimal human responses to illness. But man, let the dedicated researchers deal with that, their chosen specialty.