Doctoral degree to become an NP???

CraigB-RN, MSN, RN · Nov 25, 2007

It's interesting how the thread has changed since it started, and how the programs have already mutated from the first one.

I still find it interesting that many years ago, when the NP thing started, the argument was that you didn't need the education of an MD to treat 80% of the patients. Now we seem to be saying we were wrong.

It will be interesting how things work out over the next couple of years. I figure If i'm going to change my mind and finish the NP, I better do it now, before I get stuck doing another 3 years of school.

jjjoy, LPN · Nov 29, 2007

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.

Of those who go to nursing school, very few also already have the qualifications for medical school. For those who do have that choice, the time investment in education may factor in to their decision to pursue nursing over medicine. Isn't that why schools have rolled out more Accelerated BSN programs? Those who had already earned bachelor's were discouraged to go back for an RN degree because that meant at least another 2 years in school, assuming all pre-reqs were already - and possibly not even earning a BSN - meaning even more time to "higher" nursing goals.

So now, there are 12 or 18 month RN/BSN accelerated programs for those who qualify. Becoming an NP requires additional eduation on top of that. How much? Is two years reasonable? So for someone with a bachelors' degree (4yrs), it will be at least another 3 years to practice, even without any additional changes to requirements. And that doesn't seem unreasonable given that one would hope that an NP has at least 3 years of nursing education, not counting non-nursing coursework. So it seems no matter how you slice it, if you already have pre-med coursework and a bachelor's becoming an NP vs a general practitioner MD isn't nearly as wide an educational gap as for those who don't have such qualifications already.

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.

I agree. On that same token, though, another year or two education isn't really that much. If one want to be an NP, one must put in the time. And yes, anyone can take and succeed in math and science courses. The question is whether or not one thinks it's worth their time and effort given their objectives. Those who want to apply to med school have to take such courses. At this point, pre-nursing students don't have as many math and science requirements - which for some is reason enough to choose nursing over medicine. By the way, that's not my view. I enjoyed and excelled in my science and math classes and had more than was required for nursing school.

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.

Interesting observations and questions. They merit their own thread! Much nursing today IS more about "medicine" than "nursing." It's the nursing assistants and personal care aides that do the bulk of the most basic nursing care (caring for physical and psychological comfort) while licensed nurses are an instrument for the practice of medicine (administering medications, watching out for adverse effects, applying medical interventions when necessary). Nursing assistants still don't need a lot of education but RNs now require about 3 years of training to qualify. Well, that's my perspective thus far... and this is going way off on a tangent... so I'll stop. Thanks for the interesting post!

jjjoy, LPN · Nov 29, 2007

I still find it interesting that many years ago, when the NP thing started, the argument was that you didn't need the education of an MD to treat 80% of the patients. Now we seem to be saying we were wrong.

At this point, MDs also have residency requirements beyond finishing school so that right there adds several more years. Someone mentioned some possible GP-only programs that are shorter. Makes sense. One doesn't need 6-8 years of post-bachelaureate training to deal with basic health issues. But at least 3 years seems reasonable.

Ideally, the NP candidate already has a good deal of health care experience. He or she already recognizes and knows how to handle many various health issues, and so NP training would be filling in the gaps and making sure that the students have the latest and most complete information available and to learn the new formal role of diagnostician and prescriber (versus the informal role they've played when second-guessing another's practice). For this person, three years of training does sound like overkill. However, for someone who has comes to an NP program with minimal nursing practice - or even nursing practice in an unrelated field (eg from mother/baby nursing to geriatric NP) - three years doesn't sound totally unreasonable to me.

amzyRN · Nov 29, 2007

But the programs I've looked at aren't just 3 years, but 4 years (at USF for example). I think the majority of them are 4 years beyond the RN and undergraduate degree. The BSN and many BA degrees take 5 years. That's at least 8 years training. Plus there's the expense of school, having to take time off work. I think it's a lot of training and to not expand scope of practice or salary of NP, seems unfair to me.

J

n_g · Dec 1, 2007

After seeing what medical students and residents have to go through, there are very few people in nursing who could make it through to the end. You may say I'm wrong, but why don't you first closely shadow a resident for a few months. See what times he comes in and leaves, how much studying he has to do when not in the hospital, and the nature of the work itself. Can most nurses put up with this for years? I really, really doubt it.

Medical training is very rigorous and stressful process. The endproduct for those who make it are competent clinicians. The public understands this. That's why if the nursing profession presents a degree that is very watered down the public will never put DNP's and MD's on the same level.

What do you suppose is the message that an online DNP degree sends to the public? We're already shooting ourselves in the foot.

amzyRN · Dec 2, 2007

After seeing what medical students and residents have to go through, there are very few people in nursing who could make it through to the end. You may say I'm wrong, but why don't you first closely shadow a resident for a few months. See what times he comes in and leaves, how much studying he has to do when not in the hospital, and the nature of the work itself. Can most nurses put up with this for years? I really, really doubt it.
Medical training is very rigorous and stressful process. The endproduct for those who make it are competent clinicians. The public understands this. That's why if the nursing profession presents a degree that is very watered down the public will never put DNP's and MD's on the same level.
What do you suppose is the message that an online DNP degree sends to the public? We're already shooting ourselves in the foot.

First and foremost, your use of the pronoun "he" to refer to doctors/resident is sexist, since is excludes "she", so please try to use gender neutral language. Second, I absolutely think that if anyone has the passion and inspiration to go to med school, they can do it. Why would a nurse be any different than the general population? Why wouldn't anyone, if they wanted to, study anything that inspired them. To say that nurses couldn't handle it a demeaning characterization. How do you know this as fact? Have you tried to go to med school and failed? And you assume that because you cannot handle something that others cannot? And, at the end of med school and residency, after learning all of that detail, do you think that makes a better clinician? And can you prove it? For example, research indicates that NPs are equal to MDs in general practice, how do you explain this? Maybe nursing just figured out how to do things more efficiently.

At any rate, I really value your thoughts,

J

SN2bExpAt · Dec 2, 2007

And, at the end of med school and residency, after learning all of that detail, do you think that makes a better clinician? And can you prove it? For example, research indicates that NPs are equal to MDs in general practice, how do you explain this? Maybe nursing just figured out how to do things more efficiently.
J

Proof? How many clinical hours do med students put in prior to finishing a residency? Around 6000 hours or so?

NP programs? 500-700 ish hours?

Research indicates that two fields can equally Dx strep throat? A broken arm? Prescribe Humalin R for diabetes? Drain a boil/furuncle? Suture a gash?

Internists are considered primary care providers. They work general internal medicine. If they were considered to be on par, hospitals would put NPs on rounds instead of the docs, right?

I am not trying to be rude, but implying that both professions have equal knowledge, even GPs, is kind of insane.

amzyRN · Dec 2, 2007

Proof? How many clinical hours do med students put in prior to finishing a residency? Around 6000 hours or so?
NP programs? 500-700 ish hours?
Research indicates that two fields can equally Dx strep throat? A broken arm? Prescribe Humalin R for diabetes? Drain a boil/furuncle? Suture a gash?
Internists are considered primary care providers. They work general internal medicine. If they were considered to be on par, hospitals would put NPs on rounds instead of the docs, right?
I am not trying to be rude, but implying that both professions have equal knowledge, even GPs, is kind of insane.

I don't think that I said they have = medical knowledge, but that in practice, NPs and gen. practitioners provide equally sufficient care, i.e., the MD in practice isn't better than the NP, for primary care issues.

j

core0 · Dec 2, 2007

I don't think that I said they have = medical knowledge, but that in practice, NPs and gen. practitioners provide equally sufficient care, i.e., the MD in practice isn't better than the NP, for primary care issues.
j

Actually the answer to this is we don't know. There is only one study that compared BC/BE physicians to NPs. That study showed one difference but had too many flaws to be valid. The follow up study which should have been able to show actual endpoints that were different foundered on a lack of patient follow up. If I remember it was published in a third or fourth tier journal and rightly discarded.

The real problem is that most NPs work in collaborative practice with Physicians. It would be difficult to separate the collaboration from the NP work component. The best setup would be to set up a system like the Columbia system but do it in several venues and follow the patients longitudinally to see what the outcomes are. Probably won't happen for a variety of political reasons.

David Carpenter, PA-C

Editorial Team / Admin · Dec 2, 2007

PLEASE stick to the topic, DNP - Doctoral degree to become an NP???

If you wish to discuss other aspects of medicine, start another thread.

Thank you.

CraigB-RN, MSN, RN · Dec 3, 2007

First and foremost, your use of the pronoun "he" to refer to doctors/resident is sexist, since is excludes "she", so please try to use gender neutral language. Second, I absolutely think that if anyone has the passion and inspiration to go to med school, they can do it. Why would a nurse be any different than the general population? Why wouldn't anyone, if they wanted to, study anything that inspired them. To say that nurses couldn't handle it a demeaning characterization. How do you know this as fact? Have you tried to go to med school and failed? And you assume that because you cannot handle something that others cannot? And, at the end of med school and residency, after learning all of that detail, do you think that makes a better clinician? And can you prove it? For example, research indicates that NPs are equal to MDs in general practice, how do you explain this? Maybe nursing just figured out how to do things more efficiently.
At any rate, I really value your thoughts,
J

The old arguments for NP's/PA's in primary care followed the 80/20 rule. 80% if what goes on in primary care clinics doesn't need an MD. Of course to keep that in perspective, those same cold and sore throats and simple fractures are treated in some places without even a midlevel. Independen Duty Medical Tech have been doing that for the past 30 years. It's not rocket science.

I don't see how a DNP is going to improve that. Adding a few more hours of clinical is a good thing and no one is going to fault that. Thier check books might, though.

Doesn't anyone else here remeber the arguments from years back about the establishment of NP's in the first place? Making the DNP the entry level for NP is like stating, oops we made a mistake, the 80/20 rule realy doesn't work. Now for the specialies, yes the DNP could be avalid way to go. But then you no longer meet the critieria set forth inthe establishment of the proffesion in the first place.

With the advent of the DNP nursing seems to want to have their cake and eat it too. The DNP is a something that is here, and it isn't going away. As a proffesion, we need to find ways to support our fellow nurses, and yes I said fellow nurses and not provider or NP, they still maintain a basic nursing licence when all those promises of autonomy, money, increased scope of practice don't come about.

Yes I'm a cynic. After 30 years, i've head all these arguments before,and have yet to see any of the prommises that were made come true. I should know better than to write this kind of stuff at 4am. It's a bit rambling and sure would get me a decent grade in any school I know.

David, How about becoming a ghost writer, You always say thing better than I can. :)

Miss Mab · Dec 3, 2007

Wow--i read the whooooooole thing.

I'm not convinced that the DNP standard isn't simply a boon for academia. That and the ego push--which will not only backfire but serve to backdoor discredit our current highly regarded practicing master's prepared NP's.

I am a second degree BSN RN so,truthfully, I don't have much invested in this career time-wise. One year for BSN and now two+years working. My original thought was to go on for NP.

Nursing on the whole needs to be elevated in so many ways and a push for DNP does nothing to adress core concerns with and within this field. Now I'll need at least four more years to practice at a midlevel?

Don't think I can do it. We talk often about opportunity cost. Why in the world would I do that and yield no benefit in pay/scope or frankly, prestige. Am I in it for ego? No, not really. But I refuse to spend four years on post graduate education only to find myself in a position where I have to explain and defend my practice everyday. Not worth it. I should feel good about such post grad scholarship--not defensive. Why shouldn't reaching the top of your chosen field come with a little pat on the back and prestige? No other career do you need to apologize for being a high achiever.

You know who I think are going to be the big winners in all of this? Med schools and to a lesser extent PA schools. We are going to lose some of the 'best and brightest' in nursing. Can you blame them? Just a little more, or a whole lot less, time and you can openly admit you actually practice medicine without having your chosen profession denigrated by every other ancillary group.

Nursing education has it all wrong.

BTW, what BSN programs only require 300 clinical hours? I thought you had to have 980 or something just to sit for NCLEX and initial licensure. No?