Doctoral degree to become an NP???

n_g · Dec 4, 2007

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.

I know how difficult it is because I live with one after watching her go through medical school and now residency.

Medical education is not simply about rote memorization. It's about applying what you learned to what you see and hear. That's why it's intellectually challenging. It's also a grueling, physical process. Hours are very long. Even as a med student, you will log more than 6000 clinical hours by the time you graduate. For a 3 year residency, you will log more than 11,000 clinical hours by the time you finish. Why so many hours? Because you need to constantly be a the hospital to see as many variety of cases as possible. It's not like if patients with specific illnesses come at scheduled times. It's unpredictable. That's why trying to equate the training of a DNP with an MD to many is ridiculous to those are familiar with the training programs.

prairienp · Dec 4, 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.
Nursing education has it all wrong.
quote]
I am trying to figure out the "boon" in nursing education? If there is such a "boon" for academia one would come to the conclusion academia is the place to be in the future. Yet, academia is struggling with finding faculty. In reality, NPs don't want to leave practice to teach when they take a pay cut, often a significant pay cut. If the DNP degree is really a "boon" for academia maybe academic salaries will match those in practice.

ready4crna? · Dec 4, 2007

The DNP would be a boon for academia in the sense of increased tuition money brought into individual schools. I do not want one, but will be forced to obtain it due to eventual licensure issues surrounding the whole mess. It truly adds nothing to my practice in it's current format, and good luck obtaining respect with it in an academic setting outside of nursing.

As usual, the AACN (American Association of Colleges of Nursing) has continued to excel in their pursuit of marginalizing and generally ruining the overall educational process of nurses. Eerily similar to JCAHO IMHO.

Miss Mab · Dec 5, 2007

[quote=prairienp;2528901

I am trying to figure out the "boon" in nursing education? If there is such a "boon" for academia one would come to the conclusion academia is the place to be in the future. Yet, academia is struggling with finding faculty. In reality, NPs don't want to leave practice to teach when they take a pay cut, often a significant pay cut. If the DNP degree is really a "boon" for academia maybe academic salaries will match those in practice.

Perhaps I can help clarify.

I simply stated it would be a boon for academia, that is, the collective of higher education and its institutions. The poster above pointed out the first and most obvious such benefit. I pointedly did not express this development to bestow any such blessings for "nursing education."

Creating a new doctoral degree and then having the added bonus of engaging in the advocacy for its requirement for a great many professionals? Are you kiddin' me? Darn right the Ivory Tower is going to be the place to be for all the doctorally prepared RN's. At least for the forseeable future. This is the best career development for this crowd since its inception. What will really be interesting is the first BSN-MSN--DNP racers who in a few years will then be teaching practicing NP's without benefit of much clinical experience themselves. Oh, this will be interesting...

I understand the current nursing faculty shortage and the monetary reasons behind it. I live in California. Some shifts we are making more than the doc, much less the NP. I know they don't wanna go back to teach for less than even that. It's a shame it's the way it is. This new wrinkle most certainly won't help. (Somehow I have a feeling those qualified to teach the burgeoning DNP's will do okay but MSN need not apply for obvious reasons)

Where's the uproar about transferring much needed resources amidst a "shortage"? And to something that can't even be proven a necessity? Yeah, I keep complaining to my dentist about a painful abcess but he only wants to talk about bleaching my teeth.

So no, this development does nothing beneficial for "nursing education". What a double whammy for undergrad ed. Too few MSN's able to do it and now most, even if they are willing, will be too focused on their own newly undertaken educational pursuits, if history is any guide regarding licensure and reimbursement, to consider investing in nursing's future teaching our beginning students.

"Miss" "Mab"

amzyRN · Dec 6, 2007

I know how difficult it is because I live with one after watching her go through medical school and now residency.
Medical education is not simply about rote memorization. It's about applying what you learned to what you see and hear. That's why it's intellectually challenging. It's also a grueling, physical process. Hours are very long. Even as a med student, you will log more than 6000 clinical hours by the time you graduate. For a 3 year residency, you will log more than 11,000 clinical hours by the time you finish. Why so many hours? Because you need to constantly be a the hospital to see as many variety of cases as possible. It's not like if patients with specific illnesses come at scheduled times. It's unpredictable. That's why trying to equate the training of a DNP with an MD to many is ridiculous to those are familiar with the training programs.

But does more training=better practitioner? I don't think there's any research to prove it either way. And by the way, I wasn't saying DNP=MD. Infact, I think the DNP stinks, and that a MSN, NP is sufficient to diagnose and treat common chronic and acute illnesses. Thanks for your thoughts,

J

silas2642 · Dec 7, 2007

But does more training=better practitioner? I don't think there's any research to prove it either way. And by the way, I wasn't saying DNP=MD. Infact, I think the DNP stinks, and that a MSN, NP is sufficient to diagnose and treat common chronic and acute illnesses. Thanks for your thoughts,
J

Yes, I think that it would be safe to say that when good, seasoned physicians who are capable instructors train junior pracitioners, this leads to better clinicians. Is this supported by research? Maybe not anything that I can quote, but in the world of medicine, it is generally accepted that medical students know far less than residents, residents know less than fellows, and fellows generally know less than the attendings of their specialties. Yes, there are always exceptions, but this is the case in the vast, vast majority of cases and it has been this way for thousands of years and is backed by common sense-- the more you know, the better clinician you are going to be. We are taught that at the foundation of professionalism is knowledge-- without a solid knowledge base you cannot help your patients.

The problem that a lot of physicians see with the outlier nurses who want to see DNP's be equal to doctors is that they don't seem to know how complicated medicine really is-- basic pharm classes that you learn in nursing school and in NP school are just the tip of the tip of the iceberg and disease is just so much more complicated than that. There are so many complicated path that looks like you run of the mill every day illness and can be easily misdiagnosed unless you know what to look for. NP's need someone to fall back on in times where they get stuck and need a greater knowledgebase, i.e. a physician.

core0 · Dec 7, 2007

But does more training=better practitioner? I don't think there's any research to prove it either way. And by the way, I wasn't saying DNP=MD. Infact, I think the DNP stinks, and that a MSN, NP is sufficient to diagnose and treat common chronic and acute illnesses. Thanks for your thoughts,
J

The issue is that one organization felt that the MSN in its current form lacked enough training (the BONs), particularly in Pharmacology. Another organization jumped on the band wagon for their own reasons (NONPF). The Canadians looked at this exact same problem and their solution was another pharm and pathophys class and 200 hours additional clinicals. So instead of inventing another degree the "issue" could have been solved with two additional classes and more clinicals (classes and clinicals that some NP programs are already doing). The problem really comes down to lack of standards. There are no standards on what needs to be taught just general guidelines and hourly requirements. The way that nursing chose to impose new standards was through a new degree.

David Carpenter, PA-C

amzyRN · Dec 7, 2007

Yes, I think that it would be safe to say that when good, seasoned physicians who are capable instructors train junior pracitioners, this leads to better clinicians. Is this supported by research? Maybe not anything that I can quote, but in the world of medicine, it is generally accepted that medical students know far less than residents, residents know less than fellows, and fellows generally know less than the attendings of their specialties. Yes, there are always exceptions, but this is the case in the vast, vast majority of cases and it has been this way for thousands of years and is backed by common sense-- the more you know, the better clinician you are going to be. We are taught that at the foundation of professionalism is knowledge-- without a solid knowledge base you cannot help your patients.
The problem that a lot of physicians see with the outlier nurses who want to see DNP's be equal to doctors is that they don't seem to know how complicated medicine really is-- basic pharm classes that you learn in nursing school and in NP school are just the tip of the tip of the iceberg and disease is just so much more complicated than that. There are so many complicated path that looks like you run of the mill every day illness and can be easily misdiagnosed unless you know what to look for. NP's need someone to fall back on in times where they get stuck and need a greater knowledgebase, i.e. a physician.

This is just a hypothesis that I have, because I have a degree in molec. and cell biology from Berkeley, and I know how deep the rabbit hole goes, with respect to how drugs affect the cells, how the brain works, etc. and it goes even beyond what physicians and other doctoral trained clinicians know. I'm not saying that I know the tip of the tip of the ice berg, but I know how complicated things get, because I've had a taste as an undergrad. But, I also know, from personal experience that knowledge that is learned must be used. In the every day world, I doubt docs are going to go into the depth that they were trained in, like from the beginning of the given signal transduction pathway that was tweeked outward to cause it's affect. It's just too complex, there's too much, and still the body is somewhat unpredictable. Knowledge that is not used gets shelved in the back of our minds and docs shelve that stuff too. But medical schools feel it's necessary to do all that work in all that depth and still turns out physicians that make mistakes and that forget. So, in general, I believe that more training should make a better clinician. And yes, docs do have more breadth of knowledge, I would hope they wouldn't forget it that fast, but some do. NPs know just enough, plus the hands on generalist stuff and grasping general ideas on the job as an RN, to do their job very well. NPs treat a small number of common, acute, stable chronic illnesses, and they are good at that. In that small area they can do that very well, probably just as good as an MD. If a person wants to do that type of thing, diagnose common, acute, stable chronic illnesses, instead of going to med school and residency for 7 to 8 years, why not go to NP school, if you can forgo all the the rest. But, if someone has the passion and determination and love of learning all of the details, then they should go down that path. In short, many docs end up not using much of the grueling details that they learned and rely on ref books just like the rest. And by the way, anything can be learned with enough dedication and love of what one is learning.

J

jer_sd · Dec 7, 2007

The problem that a lot of physicians see with the outlier nurses who want to see DNP's be equal to doctors is that they don't seem to know how complicated medicine really is-- basic pharm classes that you learn in nursing school and in NP school are just the tip of the tip of the iceberg and disease is just so much more complicated than that. There are so many complicated path that looks like you run of the mill every day illness and can be easily misdiagnosed unless you know what to look for. NP's need someone to fall back on in times where they get stuck and need a greater knowledgebase, i.e. a physician.

This is true for all health care proffesionals. They need to know when to consult or refer to another povider. Physicians fall back on other physicians, physical therapists, dentists, psychologists ect...

If there can be more standard eductonal paths for NPs such as presented in the original concept it will strengthen NPs as clinical providers. If there is an extra year of research, leadership, or advanced nursing theory I do not feel it would be a good move. Similar to ADN vrs BSN, ADN come out of school with fresher clinical skills for hospital employment, many BSN programs have community health/leadership in the senior year with little hospital patient contact which puts them at a disadvantage if they work at a hospital as a new grad. NPs would benifit from additional clinical experience and training I hope new dnp programs don't follow the BSN path.

I have looked at some DNP programs since I hope to practice for many more years. Most that are designed for current NPs are a bridge program, however some that are designed for BSNs look like there is a good improvement. This is a new concept so it will be a while to work out the kinks.

Jeremy

prairienp · Dec 7, 2007

medicine is an art, and it's not something that you can learn online in a matter of months. as emedpa has mentioned, there is a huge problem with these dnp programs because there are no standards among them.

i have always heard nursing was also an art! who is emedpa, i didn't see a post in this thread from a emedpa. based on the name is this a emergency pa?

no standards isn't true, every school has standards they must meet in order to offer a program. what you may mean is that the curriculum has variations in course offerings/expectations from one dnp program to another.

Editorial Team / Admin · Dec 7, 2007

closed for staff review.

edited to add 12-25-07:

thread reopened. please keep the conversation professional w/o personal attacks.

thank you.

markdanurse · Dec 29, 2007

Hello again. I just thought I'd point out something. Being that we are in the world of "evidence based practice", what empirical evidence did the AACN provide in the position paper it sponsored regarding the need for a Doctorate of Nursing Practice for all advanced practice nurses to enter into the field? What research was conducted? Did the AACN send out a survey to currently practicing NP's to ask them about whether or not this DNP degree would be a good idea? Did it send out a survey to physicians, hospital administrators, or allied health professionals asking their opinions? I have read the AACN's DNP paper, and I say to you, the answer is "no". There is absolutely no empirical evidence showing this change is needed or even necessary. Read between the lines of that paper, and here is what you should be reading:

1.) Other professions have a doctoral degree to practice, so we should too. We need to be like other professions such as pharmacists, lawyers, optometrists, etc. They are respected because they are all doctorally prepared, right? Instead of embracing nursing's uniqueness regarding entry into practice, we have adopted the same concept as, "Hey, everyone else is doing drugs, so we should too."

2.) We will produce more doctorally prepared educators by requiring the DNP as an entry level requirement into practice. Never mind that academia cannot pay a PhD educated nurse what she or he is worth right now, and she or he can make much more money working as an APN or nursing administrator than as an educator. Never mind that a DNP prepared educator may not be granted tenure because the degree is not seen as equivalent to a PhD. Also, there is more difficulty in obtaining tenure as a professor in a university's school of nursing than with most other schools within the university. Don't believe what I'm saying here is true? Do your research...there are articles plastered all over the Internet.

3.) We can command more respect from physician's, other healthcare worker's, and patients by claiming all APN's are doctorally educated. I hate to say this, but I have seen plumbers, linesmen, and electricians command a great deal of respect, despite the lack of a college degree. Why? They are EXPERTS in their fields, they can BILL independently for their services, and they do not carry subservient stigmas that nursing as a "profession" has. A doctoral degree does not command automatic respect, especially if it is watered down. (And yes the DNP does not even compare to the MD/DO in terms of level of difficulty and clinical hours.)

We all know medicine is based in intellectual elitism. We all know there will be a group of APN's who get this degree for nothing more than a stroke to their egos. Life is about cost-benefit analysis. People have to live...that requires making money to sustain a lifestyle. I find it amusing that nurses want to get the degree for the "enjoyment of it" or to "enhance their studies". There are really inexpensive ways to enhance one's studies other than a DNP degree...it's called continuing medical education. Requiring people to get into huge student loan debt, and to spend yet even more of their life in school, to make less money than most other practice doctorates currently out there, and see no significant financial or increased scope of practice returns, is absurd.

Critically think this one out using logic, cost-benefit analysis, and research. You'll find that perhaps the DNP really should be just an option, and not a requirement for the APN.

I look forward to your comments. Keep in mind that I do not wish to convey that those who wish to obtain the DNP should not. I do wish to convey that again, it should be a choice and not a requirement.