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

[amzyRN]

I think that the DNP should expand scope of practice and increase salary of NPs and also include more training in advanced biological science. I am not entirely against a DNP if it did those things listed above. I also don't think it should be required. I think that nursing curriculum could include more advanced training in biological science and still be a humanistic field. I think one of the reasons that people would still go the nursing route is that even 4 years of graduate school is still less than medical training b/c of the internship and residency requirement. If med school was shorter (and probably could be) people may start pursuing that route. Also, medical training could expand it's scope to include a more holistic approach to healing, etc...like nursing (at least in theory) which may make it more appealing. As it stands med school is a very intense and lengthly program (that I think could be revised) and thus nursing is more appealing to me at this point. Also, I like than nursing has acknowledged that a human being is an irreducible whole. Med school still seems reductionistic in my opinion. Nursing still seems to be an expanding and evolving field with unique modes of training and I like that. My only qualm is that it could include a more in depth and thorough look at biological science (at the undergraduate level, since that's all I know about thus far). Mentioned above, if the DNP curriculum included more biological science and not required to practice as an NP, I wouldn't have a problem with it,

J

J

[core0]

Now I am confused, while searching the PA Forum I found this:

3. Finally the doctorate for PAs. The PA doctorate is inevitable. I am aware of three programs that have had clinical doctorates ready for at least three years but have not put them into play for political reasons. Now that there is a DScPA these will programs will inevitably proliferate. The concern is that now that there will be four levels of educational credential for a PA (or 5 if you count certificate programs), will outside or internal agencies try to define the PA profession by educational level instead of competency. This is the primary objection even to naming the masters as the preferred degree. The students that LESH trains are as able to take care of patients as anyone. Their lack of a doctorate or masters does not stop them from becoming excellent clinicians.

The doctorate for PAs is fine. We need increased research by PAs so this can only be beneficial. Where it would not be beneficial is to let it be the start of mandating degrees for PAs. It may already be too late, but going away from clinical competence as a standard is to lose what it means to be a PA.

David Carpenter, PA-C

You have to put it in perspective. The original post was a call for independence and doctorate for PAs. Essentially I was against all this.

The issue that I addressed here is one of a "PA doctorate" vs a PA having a doctorate. There are quite a few PAs that have done the DHSc from Nova for example or a PhD. Unitl the army program started there was no PA specific doctorate. The reason that programs have held off starting this was that they were concerned that the doctorate would become the defacto terminal degree for PAs as opposed to the Masters as it is now. So yes I think that it is inevitable that more programs will develop clinical doctorates for PAs. These will continue to be post graduate programs. It is unlikely that regular PA programs will move toward the doctorate unless someone such as Medicare or NCCPA requires it for licensure or billing (as happened with NPs). Hence my concern for degree mandates instead of relying on clinical competence.

David Carpenter, PA-C

[markdanurse]

David,

This is what I like about the PA profession versus the NP profession. Your profession does not knock the educational levels of the members of your profession and is not demanding a single entry level requirement to practice. I like the fact that there are certificate, associate, bachelor, and master degree PA programs. All of them have their use. For example, a military corpsman with 20 years of experience will have a huge array of medical knowledge and thus a certificate or associate level PA would fit nicely for him. Why should he have to go to school for 6 to 7 years to get a Master's degree in PA Studies when he has so much life experience? Why not have a bachelor degree PA school available for those who want their first bachelor degree to be in PA studies? Why not have master degree PA programs available for those who already have a bachelor degree in another area? You don't see the PA profession demanding that all schools go to a DScPA degree like you see nursing do. Even if it did, I don't think there would be a movement to change every single program to a doctoral level.

Bottom line is, regardless of your previous academic experience, PA school is HARD. You either perform, or you're out. It matters not at what educational level you enter into PA school, it will be at least 2 years of pure academic rigor. Dummies generally don't graduate.

The only thing that has changed educationally is the prerequisite requirements to go into these schools. I am not impressed by a PA student having a bachelor degree in psychology, elementary education, or business. Most of the classes in those degrees do not apply to what you must know in PA school anyway. In fact, when I applied back in the day to a Bachelor of Medical Science PA program at a local private university, students were accepted in over me into the program even though I was an LPN who worked almost daily with PA's at an inner city ER. (And yes, I had a 3.9 GPA and all the classes the school required.) After my interview, I received a letter of rejection a few months later. When I called the school to ask about the rejection letter, I was told the other students were more qualified academically. Again, only 6 seats out of 90 were given to students who applied with no degree or an associate degree. I did not agree that a school teacher, business major, or psychology major was more prepared for PA school than a practicing nurse to enter into a BMS PA program. I also felt the practice of accepting people into a bachelor's program when they already had bachelor degrees or higher cheapened the process, as there were plenty of seats in the MMS program to apply for. The point I'm trying to make here is that more is not better. Often times, more is simply just, well... more. I knew I had the intelligence, background, and muster to hold my own with any of those students who did get accepted.

Why shouldn't a really bright diploma or ADN RN with many years of experience be able to go to school for two more years and become an NP? Why does it HAVE to be an MSN (or soon a DNP) to gain entry into the profession? Again, too many hoops, too much nonsense.

But thank goodness the PA profession gets it. I have met some certificate and associate degree PA's in my career who could do circles around their supervising physicians. I find it sad that the NP profession does not grasp the same concept. Competence is more important than credit hours.

Mark

[core0]

david,

this is what i like about the pa profession versus the np profession. your profession does not knock the educational levels of the members of your profession and is not demanding a single entry level requirement to practice. i like the fact that there are certificate, associate, bachelor, and master degree pa programs. all of them have their use. for example, a military corpsman with 20 years of experience will have a huge array of medical knowledge and thus a certificate or associate level pa would fit nicely for him. why should he have to go to school for 6 to 7 years to get a master's degree in pa studies when he has so much life experience? why not have a bachelor degree pa school available for those who want their first bachelor degree to be in pa studies? why not have master degree pa programs available for those who already have a bachelor degree in another area? you don't see the pa profession demanding that all schools go to a dscpa degree like you see nursing do. even if it did, i don't think there would be a movement to change every single program to a doctoral level.

its possible just not likely. there are essentially two organizations that could mandate degrees. nccpa could require a specific degree to be certified and arc-pa could require a school offer a specific degree to be accredited. fortunately both of these organizations recognize that a specific degree does not enhance competency. instead nccpa has done extensive research on what pas need to know and be tested on and arc-pa uses this blueprint to tell the programs what they need to teach. fortunately there has also been increased emphasis on transparency for the student. for example all programs must publish their pass rates.

bottom line is, regardless of your previous academic experience, pa school is hard. you either perform, or you're out. it matters not at what educational level you enter into pa school, it will be at least 2 years of pure academic rigor. dummies generally don't graduate.

the only thing that has changed educationally is the prerequisite requirements to go into these schools. i am not impressed by a pa student having a bachelor degree in psychology, elementary education, or business. most of the classes in those degrees do not apply to what you must know in pa school anyway. in fact, when i applied back in the day to a bachelor of medical science pa program at a local private university, students were accepted in over me into the program even though i was an lpn who worked almost daily with pa's at an inner city er. (and yes, i had a 3.9 gpa and all the classes the school required.) after my interview, i received a letter of rejection a few months later. when i called the school to ask about the rejection letter, i was told the other students were more qualified academically. again, only 6 seats out of 90 were given to students who applied with no degree or an associate degree. i did not agree that a school teacher, business major, or psychology major was more prepared for pa school than a practicing nurse to enter into a bms pa program. i also felt the practice of accepting people into a bachelor's program when they already had bachelor degrees or higher cheapened the process, as there were plenty of seats in the mms program to apply for. the point i'm trying to make here is that more is not better. often times, more is simply just, well... more. i knew i had the intelligence, background, and muster to hold my own with any of those students who did get accepted.

what you have stumbled on is what i feel is the greatest problem with pa educational programs. there is no transparency among programs on who gets accepted. you can look at caspa data for the programs that use the service and get a general idea of whether you are competitive but not for individual programs. the next step will be to require programs to publish data on their admissions. it will allow students to know where they stand in the admissions process. if you look at med school to use an example all the programs publish extensive statistics on their classes which allow students to apply in a more selective manner. this would also require a change in the way students approach pa school. i see too many schools that only apply to one local school. you have to treat this as you would any major life changing decision. it may involve some sacrifice.

the number in the class pretty much tells me which program it was. yours is not the only complaint about that particular program. there are a very few programs (fortunately), that preferentially take students without medical experience on the grounds that the students are easier to teach (mold). not my particular brand of vodka but thats the beauty of pa school, as long as they cover the required material and have decent passing rates they can conduct their program however they want.

why shouldn't a really bright diploma or adn rn with many years of experience be able to go to school for two more years and become an np? why does it have to be an msn (or soon a dnp) to gain entry into the profession? again, too many hoops, too much nonsense.

but thank goodness the pa profession gets it. i have met some certificate and associate degree pa's in my career who could do circles around their supervising physicians. i find it sad that the np profession does not grasp the same concept. competence is more important than credit hours.

mark

one of the things that i found interesting about dr. musinger's comments on the dnp was the concept of moving toward a single certification standard. that is the weakest part of the current np situation in my opinion. an accreditation organization essentially exists to protect the public not to promote the profession. with many of the current certification organizations it is unclear which function they are preforming.

as far as competency based education, for nps that train left the station long ago.

david carpenter, pa-c

[amzyRN]

I am aware of the DrPASc. It's a pilot program by the military for PA's.

You have to keep several things in mind. If the scope and pay does not increase with longer training, then why force students to spend an extra two years of time and money pursuing it? Just so that people can stroke their personal egos? Do you think that the docs care if you have a DNP or DrPASc? They will treat you the same as if you have a NP or PA. Neither the docs, Medicare, the insurance companies, and the hospital credentialing committees will care because you're still not a board-certified physician.

I suspect that there will be a lot of resistance from students about moving the PA degree to the DrPASc. Furthermore, the docs have strong say in PA matters. Docs sit on the PA governing boards and PA's are covered by the boards of medicines. If docs feel threatened, they won't let the DrPASc become the standard.

As others have pointed out on other boards, medical schools have increased their enrollment by +20%. Interestingly, this occurred after the DNP was introduced. Yet the number of residency slots remain the same. What does this mean? In the near future, medical graduates, especially from lower-tiered schools may not get a residency. The number of students affected could be in the hundreds or higher. If this happens, the medical organizations will find a way for them to utilize their training. These non-residency medical graduates will compete with NP's and PA's for midlevel positions. This is how the medical organizations are responding to the threat that the nurses have put forward with their claims of equivalence with the DNP. This is something that everyone should watch out for.

This presumes that the MD would be preferred, but w/r/t scope of practice NP/PA may function just as well as the MD except the MD costs more, even without the residency. Just my opinion, and could be wrong. Interesting that I saw that line of reasoning almost in a panic on the student doctor forum, that the DNP would compete for residency programs with MDs and that was very bad, etc. I think that if a new independently practicing mid-level practitioner created by a doctorate program with a residency and advanced science training is not a bad idea necessarily. I think eventually primary care docs won't exist anymore but maybe that's not bad either. We'll just have to see. thanks,

J

[core0]

This presumes that the MD would be preferred, but w/r/t scope of practice NP/PA may function just as well as the MD except the MD costs more, even without the residency. Just my opinion, and could be wrong. Interesting that I saw that line of reasoning almost in a panic on the student doctor forum, that the DNP would compete for residency programs with MDs and that was very bad, etc. I think that if a new independently practicing mid-level practitioner created by a doctorate program with a residency and advanced science training is not a bad idea necessarily. I think eventually primary care docs won't exist anymore but maybe that's not bad either. We'll just have to see. thanks,

J

You have to look at the different scenarios. There is little that a NP/PA can do that could not be done with a physician that only had an internship. However, the BOMs are moving away from this for a number of reasons. Most states require a residency for FMGs and at least an internship for non FMGs. There is a paper that will hopefully be published later this year that shows that non-residency trained physicians are much more likely to have bad acts reported to the national practitioner data bank. Anectdotally this has most boards looking at making residency mandatory for all practicing physicians.

Another way to look at it is what will change with "independence". Most independent practices are in FP or Peds. This will not change. A BE/BC physician still has substantial advantage over anyone else in contracting with insurance companies. This will not change unless this is also mandated which is more unlikely than practice acts changing. These are also the practices that have the lowest reimbursement.

There is no way that any NPP will get independent privileges in a practice that is procedurally bases such as GI or cards. Even derm will be a difficult nut to crack if Florida is any example.

Basically it comes down to whether physicians want to give up FP or not. In the same argument about residencies there was discussion about the number of new MD and DO graduates. It is possible that more residencies and fellowships will open up but the existing physicians will oppose this. More likely the ones that cannot get into specialty practice will be forced into primary care forcing out FMGs (and to some extent DOs in MD residencies). So most likely there will be more MDs doing primary care (although this does not change the number of primary care physicians produces since they will mostly displace FMGs). This will be the competition for independent NPs.

Right now until the practice acts and Medicare is changed there is no advantage to the DNP. Given the forces arrayed against any changes it is unlikely that the changes will happen anytime soon.

David Carpenter, PA-C

[bnrn03]

I don't think it will fly right away. They have been trying to make a BSN entry level for a while now and they can't b/c of the shortage. There is a shortage of NP's too.

[CraigB-RN, MSN, RN]

Actually I think it is happening as we type. But through a backdoor. More and more schools are dropping their MSN programs for dnp programs. I don't see the states making it mandatory anytime soon, but it's going to be come harder and harder to find MSN/NP programs

[amzyRN]

UCSF in California doesn't plan on having a DNP program anytime soon. At least that's what they say. They are I believe the 2nd best program in the US, first in their ANP program. They did say they'd adjust their masters programs. I emailed one person affiliated with the ANP program at UCSF and she said that the market will dictate the success or failure of the DNP.

J

[emmycRN]

This is only going to apply to those that do not become FNP, CNM ect byt 2015 right? Every one else will be "Granfathered" in? For Gods sake. I work for two of the best FNP's in my area and neither of them even have their BSNs!

This is a little scary! Not even a BSN??? :confused:

[sirI, MSN, APRN, NP]

This is a little scary! Not even a BSN??? :confused:

Yes, there are many NPs practicing w/o BSN/MSN. They were "grandfathered" in once MSN became mandatory. They did a 4 year, full time preceptorship with a board certified physician (in the RNs specialty selection) and after completion of that, passed national certification examination.

That's how I became NP in the beginning. ADN grad, preceptorship, national certification boards. (added MSN/post grad FNP later).

[emmycRN]

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.

How much studying HE does, how many hours HE puts in?! Not only are you misinformed (about what it takes to be a nurse or NP) but it seems sexist as well!