Doctoral degree to become an NP???

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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

BBFRN,

Shouldn't most of these courses be covered in a MSN already? I would think that an APN at the Master's level should already be able to utilize research, do research, and have some understanding of computers. These courses would benefit someone in a PhD program but I think the problem is that many DNP programs claim to be more clinically focused. How do these courses contribute to actual clinical knowledge? Why not make the program more like a residency or fellowship with mostly clinical time at the bedside with conferences throughout the week, like real graduate medical education to give real physiologic or pharmacologic knowledge for patient care.

Very well said.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
(Late to the game, so I am catching up. Pardon me if I am covering old things....I may update my responses if I am too far off topic with where the thread is currently focused)

Ironically Ivory Tower PhDs should be against the DNP, as the curriculum seem to be a piece-meal grouping of courses that offer little in regard to advanced clinical training and/or an area of expertise. One of the cornerstones of Ph.D. training is in research, statistics, and mastery in a particular area of knowledge. Based on the curriculum I have seen, the DNP programs seem to be an MPH crossed with an MBA with some Research-Lite training....hardly the rigors of a doctoral program. Even a clinically-based doctorate has a well-developed set of classes and clearly defined clinical training, from what I've read about the great variety of programs....there isn't much cohesiveness in the ultimate training goals of the various programs.

If the purpose of the degree is to teach management.....why not an MBA?

If the purpose of the degree is to be clinical....why not make it similar to the outline in Post #510?

If the purpose of the degree is to better utilize research....why not a Ph.D?

I am all for #2 because *THAT* seems like a great opportunity for training, though then it gets into, "is this practicing medicine or nursing?" which opens up another can of worms.

Fulton & Lyon (2005) wrote an article that addresses some of my concerns, and I think it is a pretty good read (http://www.medscape.com/viewarticle/514545_1, free sign up for access).

Ultimately I think the DNP is going to hurt nursing because it not only is dividing nursing, but it also is drawing a lot of negativity to a really important asset to a treatment team. A Ph.D. in Nursing can practice in addition to teach, so I'm not sure why a DNP is really needed....other than to line the offering Universities' pockets. It reeks of scope creep and degree inflation. When a typical doctoral program is 100-120 credits, I have a hard time seeing 40-60 credits as acceptable.

Support Core 19

Translation and Synthesis of Evidence for Optimal Outcomes

Quantitative Research Methods

Epidemiology and Environmental Health

Legal and Ethical Issues

Clinical Genomics Advanced Seminar

Practice Management

Informatics

Clinical Core 11

Doctor of Nursing Practice I and II

Didactic

Clinical

Didactic and Clinical

Chronic Illness Management

Residency/Seminar 10

Total credits 40

This was pulled from Columbia University's DNP.

Interestingly, I have an ACNP student I'm precepting from a well-respected state university in Michigan that has a reputation for being research-intensive not only in nursing but also in the other health care fields from Medicine to Dentistry and Pharmacy to Psychology. This student had mentioned to me that majority of their faculty continue to resist implementing a DNP program in their institution. They have been offering a PhD in Nursing since 1975.

Two other public universities in the state have started a DNP program, the only ones in existence in Michigan at the current time. Two of my NP colleagues at work attend one program and are able to finish next year after being in the program for two years. This post-master's only option only requires 32 credits of coursework! Surpisingly, these two NP's are the only students in their class who actually work in clinical practice as NP's. Majority of the students in the class are nursing service administrators, clinical instructors, and other types of nursing educators.

The other program that have slated to start its first cohort this fall offers three paths to a DNP. The BSN to DNP requires 78-87 credits, the MSN/NP to DNP option requires 40-44 credits, and the MSN/non-NP to DNP option requires 64-73 credits. The additional clinical component in this newer program are 3 semesters of clinical inquiry practicum (9-19 credits) but the program did not specify what it entails.

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Surpisingly, these two NP's are the only students in their class who actually work in clinical practice as NP's. Majority of the students in the class are nursing service administrators, clinical instructors, and other types of nursing educators.

It actually makes sense....since dnp programs don't really focus on advanced clinical work, I can see why practicing NPs would skip it. Some may argue that the "management"-like courses are beneficial for administrators....but wouldn't an MBA maximize that benefit? If a person wants more "healthcare" related training....then why not an MPH? The MPH is actually the leading degree for practicing professionals in public health.

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.....the MSN/NP to DNP option requires 40-44 credits

At 40ish credits for NP-->DNP....it really does look like a combination of "shortest path" + "degree creep", since an MBA or MPH is at least 40 credits.

I am surprised there isn't more pushback from current NPs, since the DNP may 'force' people to take more classes that may or may not help them to be competitive. Sure people may be grandfathered in.....but that only addresses a small segment of practitioners, leaving everyone following them to deal with the fallout.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
It actually makes sense....since DNP programs don't really focus on advanced clinical work, I can see why practicing NPs would skip it. Some may argue that the "management"-like courses are beneficial for administrators....but wouldn't an MBA maximize that benefit? If a person wants more "healthcare" related training....then why not an MPH? The MPH is actually the leading degree for practicing professionals in public health.

I'm suspecting that the students who were not in clinical practice as NP's are hoping that the doctoral degree will allow them to qualify for tenure-track faculty positions in some univeristies offering the DNP as a terminal degree. In fact, if you look at Columbia's faculty directory, some of the faculty who hold DNP's have either Assitant or Associate Professor ranks.

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I'm suspecting that the students who were not in clinical practice as NP's are hoping that the doctoral degree will allow them to qualify for tenure-track faculty positions in some univeristies offering the DNP as a terminal degree. In fact, if you look at Columbia's faculty directory, some of the faculty who hold DNP's have either Assitant or Associate Professor ranks.

If you look at the NONPF documentation this is one of the points. The larger one is to have more "doctorally" prepared Nurses. This is part of their desire to make the BSN the required degree for the bedside RN and to make the MSN commonplace on the floor (the CNL is the "clincal" equivalent to the DNP). One of the rate limiting steps on the BSN (besides academic pay) is the number of MSNs as instructors. The rate limiting step (among many) for MSNs is the doctorally prepared nurses. In the bright glow of the Ivory tower many of these new DNPs will take the lower salary of academia to teach:rolleyes:. Of course this may be the ultimate goal of the direct entry DNP. If the hiring trends are similar to the MEPN these nurses will have a choice between bedside nursing and teaching. I saw a similar pattern with the ND program in Colorado. Of course this leaves those NPs who just want to see patients with an extra 1-2 years of school and more $$$$ of student loans.

David Carpenter, PA-C

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Specializes in ICU.

Now that I approach the end of my FNP/MSN program, I would like to expand into the area of ACNP studies because I crave the hospital experience. I could go for a post-master's program or apply to a DNP program. Problem is, I can't find any DNP schools in my state that offer the ACNP specialty and there are far fewer schools allowing this as an online option.

What are the chances of DNP specialties opening up in the future? It seems there is only a minimum of schools offering a focus in the DNP practice.

Alternatively, does it matter? A terminal degree would offer me the chance to expand into ACNP work?

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Specializes in Critical care, gerontology, hospice.

The chances for DNP expansion are actually very good. You are just starting your career. Wait 2 years and see what's out there, you'll be amazed.

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If you look at the NONPF documentation this is one of the points. The larger one is to have more "doctorally" prepared Nurses. This is part of their desire to make the BSN the required degree for the bedside RN and to make the MSN commonplace on the floor (the CNL is the "clincal" equivalent to the DNP). One of the rate limiting steps on the BSN (besides academic pay) is the number of MSNs as instructors. The rate limiting step (among many) for MSNs is the doctorally prepared nurses. In the bright glow of the Ivory tower many of these new DNPs will take the lower salary of academia to teach:rolleyes:. Of course this may be the ultimate goal of the direct entry DNP. If the hiring trends are similar to the MEPN these nurses will have a choice between bedside nursing and teaching. I saw a similar pattern with the ND program in Colorado. Of course this leaves those NPs who just want to see patients with an extra 1-2 years of school and more $$$$ of student loans.

David Carpenter, PA-C

Could you be more specific as to where NONPF recommends the BSN as the required degree? I was under the impression that NONPF was a NP organization.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
I am surprised there isn't more pushback from current NPs, since the DNP may 'force' people to take more classes that may or may not help them to be competitive. Sure people may be grandfathered in.....but that only addresses a small segment of practitioners, leaving everyone following them to deal with the fallout.

...because the development of the DNP did not result from an exhaustive inventory of issues faced by NP's in actual clinical practice. It was an idea that was born in the minds of a sector of nurses who are involved in educational programs for NP's and Mundinger does get the credit for pioneering the idea as her school had been developing a DrNP program way before AACN jumped in the bandwagon. Now, even NONPF and AANP are involved.

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Could you be more specific as to where NONPF recommends the BSN as the required degree? I was under the impression that NONPF was a NP organization.

The NONPF is an NP organization but it recognizes the need for BSN students to fill the pipeline. As such they are pushing the BSN for the bedside agenda. Look at the ladders here. All of them presuppose that the student has a bachelors (either BSN or BA/BS). They really don't recognize the ADN at all (except as a route to get a BSN):

http://www.nonpf.org/Models1104.pdf

The seamless ladder seem very intersting. In that model they don't even care if the student is a nurse. Bachelors and 4-5 years = DNP.

David Carpenter, PA-C

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Specializes in ICU.
The chances for DNP expansion are actually very good. You are just starting your career. Wait 2 years and see what's out there, you'll be amazed.

Thanks. That's sort of how I envisioned it. I'll give it a couple of years of experience before shocking my husband over yet more education. :D

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