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

The purpose of the DNP is not to replace MDs or to make a super NP. There are many practical reasons for require a doctorate. Most of health care is already requiring one. Nursing needs to be on the same level. My reasons for getting my doctorate are simply for personal satisfaction. I agree about the on line program, but there is still a large clinical component if it is BSN to DNP. For MSN to DNP, the clinical component is research based. I am going BSN to DNP and will have 1000 hours of clinical time. None if my classes are on line. Many are with the PhD students. Many are with the Masters students. I'm on my I phone, so I can't get too far into it, but I plan on being a critical care NP. I will still sit fir the ACNP boards. I really think people are making way too much of this. It is just a natural progression. It needs some tweaking, but it's still new!! Give it a chance.

What practical reasons? And no, natural progression is not a "practical" reason. Personal satisfaction IS important, but why not make it optional then? I'm really surprised that you will only get 1000 clinical hours. That seems like a small number even in a master's program, let alone a doctoral level program. I know that I got well over 2000 hours of clinicals.

As I have said before, there are only two substantive reasons to ever change the entry level degree for a health profession...

1. Enhances, or improves quality of patient care, proven by objective data (shorter hospital stays, improved M&M stats, more efficient management of disease states-less testing, better outcomes)

2. Enhances or improves patients ACCESS to care. again, proven by objective data (lower wait times, patients able to establish with and see providers, etc.)

There are so many issues with it from a policy perspective that I have raised here in other posts, that have not been adequately addressed yet.

I would just like to see some actual, concrete data.

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Specializes in Vents, Telemetry, Home Care, Home infusion.
and just what are those "professional issues" that you speak of? hmmm?

physical therapy and pharmacy both have doctoral degrees true, but neither profession has made a mandate that all pt's and rph's need to have a doctorate, so it is not quite as similar as you would have us think.

the articles below state the "professional issues" i eluded to more eloquently than i can state after working 14hrs. karen

american physical therapy association: "dpt degree faqs

what is the difference between a professional (entry-level) dpt program and a professional (entry-level) mpt program?

the length of the majority of dpt programs has been extended beyond the traditional two-year masters program. based on a recent informal survey, accredited and transitioning dpt programs have augmented the breadth and depth of content in a typical two- or three-year professional (entry-level) mpt program. the specific augmented content areas include, among others, differential diagnosis, pharmacology, radiology/imaging, health care management, prevention/wellness/health promotion, histology, and pathology. in addition, the final or culminating clinical education experience is typically extended beyond the average of 15 weeks; some are 1 year in length.

:up:

what is the rationale for having professional (entry-level) dpt programs?

the rationale for awarding the dpt is based on at least four factors, among others:

1) the level of practice inherent to the patient/client management model in the guide to physical therapist practice requires considerable breadth and depth in educational preparation, a breadth and depth not easily acquired within the time constraints of the typical mpt program;

2) societal expectations that the fully autonomous healthcare practitioner with a scope of practice consistent with the guide to physical therapist practice be a clinical doctor;

3) the realization of the profession's goals in the coming decades, including direct access, "physician status" for reimbursement purposes, and clinical competence consistent with the preferred outcomes of evidence-based practice, will require that practitioners possess the clinical doctorate (consistent with medicine, osteopathy, dentistry, veterinary medicine, optometry, and podiatry); and

4) many existing professional (entry-level) mpt programs already meet the requirements for the clinical doctorate; in such cases, the graduate of a professional (entry-level) mpt program is denied the degree most appropriate to the program of study.

doctor of pharmacy - wikipedia, the free encyclopedia

in the united states, the pharmd. (doctor of pharmacy) degree is a professional degree that prepares the graduate for pharmacy practice. [1]

traditionally in the united states, the bachelor's degree in pharmacy was the first-professional degree for pharmacy practice. however, in 1990, the american association of colleges of pharmacy (aacp) mandated that a doctor of pharmacy degree would be the new first-professional degree.

chronicle of higher education: credential creep

the ideal doctorate

there is considerable agreement on how the goals of the new degree programs should ideally differ from the goals of bachelor's or master's education. doctoral graduates not only should be competent in their basic discipline, but also should be able to develop and evaluate new therapies and carry out clinical research. they should be able to assume a leadership role in their profession and help set policy. says creighton's ms. coppard, "they should be able to reason through problems analytically and ethically."

in pharmacy, graduates of a doctoral program should be more "involved with patient care and collaborative practice with other health-care professionals," says jeffrey w. wadelin, associate executive director of the accreditation council for pharmacy education

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Specializes in ER; CCT.
The purpose of the DNP is not to replace MDs or to make a super NP. There are many practical reasons for require a doctorate. Most of health care is already requiring one. Nursing needs to be on the same level. My reasons for getting my doctorate are simply for personal satisfaction. I agree about the on line program, but there is still a large clinical component if it is BSN to DNP. For MSN to DNP, the clinical component is research based. I am going BSN to DNP and will have 1000 hours of clinical time. None if my classes are on line. Many are with the PhD students. Many are with the Masters students. I'm on my I phone, so I can't get too far into it, but I plan on being a critical care NP. I will still sit fir the ACNP boards. I really think people are making way too much of this. It is just a natural progression. It needs some tweaking, but it's still new!! Give it a chance.

Hey congrats on your DNP matriculation. I look forward to starting my DNP program this fall, too. I too am sensing an intense form of behavior from others on this post that just makes me feel that many are threatened by the natural progression of advanced practice nursing. It's funny, those most threatened often fail to remember that our medicine counterparts did not start at the clinical doctorate level either. Perhaps they are a bit apprehensive as they are still searching for evidence that supported physician's movement from an apprenticeship gig through the full evolution towards doctorate prepared medical education. Nonetheless, in the current economical climate, those who can do it better or the same for cheaper should be feared since now both physicians and NP's will both be clinically based doctors providing care in overlapping markets.

Although not all nurses agree with the decision, I do, however, find it amusing that such distain for nursing's decision to move to the DNP as the minimal credential for entry level is coming from those who are not even nurses. The ignorance related to what nursing is and what in means to us as well as our clients is underpinned by the extremely disrespectful, inflammatory statements, as just one of many examples, made regarding Florence Nightingales influence on the profession and what she truly did for patients first, and the profession second. It takes all kinds in this world, for sure, and makes me smile when such things are posted on this site, dedicated and exclusively for the advancement of nursing.

It is very curious indeed how some, will go out of their way, to visit a board that celebrates nursing and its development and take the time to make such reckless, inflammatory and ignorant statements where these statements would be more than welcomed on other boards. They are, however, correct in stating that they have absolutely no real impact on nursing, nursing future or the autonomy in which advance practice nursing is headed. If they did, the NP movement would have died 35 years ago in Colorado. If they did, 23 states and climbing would not have independent practice for NP's. If they did, all states would have prohibitions on the utility by DNPs of the title "doctor." If they did, the AMA's overt resolutions to stymie advance nursing practice would have had a negative impact on NP scope of practice which it did not in any state. If they did, there would not be prescription privileges for advance practice nurses in all states. And if they did, the decision for DNP as the terminal degree and minimum entry into practice would not have been made.

Some ask, "Where's the proof that NP's are just as good or can provide competent care with equivalent outcomes as physicians?" To me, countless study after study documenting this very fact means very little. What I want to know is what evidence exists to suggest that physicians can provide equivalent and comparable care to that of nurse practitioners. I'd really like to see that. Perhaps then, we can have a healthy debate on how to properly critique a research study.

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Well, the "truth and transparency" act is before congress now, and if it passes, and it looks likely too, than it will be illegal for ANY NP or nurse (recognizing some of the older doctoral degrees in nursing) to call themselves "doctors" in the clinical setting.

You actually want to see a study showing that physicians can provide care that compares to an NP?....wow, that sort of arrogance is rarely ever seen. You've never even practiced medicine on any level, as my understanding is that you are still a student, and you think NP's can provide superior care? That sort of naivete, shows your lack of understanding of the complexities of medicine. I am a PA with almost 20 years of total experience, and there are still things I don't know. I can see almost every patient that presents to an ED or primary care office, but there are some patients that require higher levels of care.

Example: I had a patient last week who came in with nausea and vomiting, simple right? NOT. Patient had a diagnosis of SC ca of the lung with mets to the liver and kidney. They also complained of a headache, a careful neuro exam revealed loss of stereognosis on the left and weakness in the right hand. Labs showed a sodium of 119. Creatinine was 3.5. Hemoglobin= 9.5 Labs otherwise normal. SO, I proceed with a head CT, as his index surveillance scan was 5 months ago at his initial diagnosis. 12mm right parietal lesion noted with vasogenic edema. I was in a small ED with NO phsyician present....I stabilized him, started fluids and sodium replacement, and gave him decadron. THEN I transferred him.

Do you honestly think that an NP at the receiving facility could provide complete care for him with no physician involved, and that his outcome would be better with an NP?

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Specializes in CT ICU, OR, Orthopedic.
What practical reasons? And no, natural progression is not a "practical" reason. Personal satisfaction IS important, but why not make it optional then? I'm really surprised that you will only get 1000 clinical hours. That seems like a small number even in a master's program, let alone a doctoral level program. I know that I got well over 2000 hours of clinicals.

As I have said before, there are only two substantive reasons to ever change the entry level degree for a health profession...

1. Enhances, or improves quality of patient care, proven by objective data (shorter hospital stays, improved M&M stats, more efficient management of disease states-less testing, better outcomes)

2. Enhances or improves patients ACCESS to care. again, proven by objective data (lower wait times, patients able to establish with and see providers, etc.)

There are so many issues with it from a policy perspective that I have raised here in other posts, that have not been adequately addressed yet.

I would just like to see some actual, concrete data.

You are a PA, so I am curious as to why you are so concerned about our entry level requirements? I am not going to get into a debate about PA vs NP, because I feel they are collegues, not enemies. All APNs are going to DNP for entry level. I work with some excellent CRNAs that are diploma nurses, but I do not think that CRNAs should be able to graduate with an associate degree and practice. As far as clinical time goes, you got 2000 hours of clinical, because it is not required that you work in health care before starting PA school. I guess you could say I have over 6000 hours of clinical time (3years) as a CT ICU nurse, and 14 years in the OR as a surgical technologist FA. There lies the much debated difference in clinical time. No, I am not diagnosing per se, but I still have quite a bit of experience. Your posts make me wonder why you feel so threatened. It doesn't even affect you, and it does not compromise patient care, it improves it.

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You are a PA, so I am curious as to why you are so concerned about our entry level requirements? I am not going to get into a debate about PA vs NP, because I feel they are collegues, not enemies. All APNs are going to DNP for entry level. I work with some excellent CRNAs that are diploma nurses, but I do not think that CRNAs should be able to graduate with an associate degree and practice. As far as clinical time goes, you got 2000 hours of clinical, because it is not required that you work in health care before starting PA school. I guess you could say I have over 6000 hours of clinical time (3years) as a CT ICU nurse, and 14 years in the OR as a surgical technologist FA. There lies the much debated difference in clinical time. No, I am not diagnosing per se, but I still have quite a bit of experience. Your posts make me wonder why you feel so threatened. It doesn't even affect you, and it does not compromise patient care, it improves it.

I am concerned, because about 50% of my time now is spent in health policy, on both the national and state levels, and a primary focus of my research and committee time is spent discussion ACCESS to primary care issues. I am very concerned that increasing the time, and monetary requirements to become an NP will hurt access to primary care. NP's will graduate with higher student loan debt, and will, if we use medical students as an example, migrate to better paying jobs. Evidence suggests that this is likely to happen, and I am concerned that we will be limiting an already short primary care provider pool even further.

BTW- your example of PA schools is completely false. EVERY school that I am aware of requires prior HCE. My school for example required a minimum of 4000 hours of HCE....the average of my class was 10,000 hours. The average age in my class was 32. Contrarily, there are NP programs that require NO PRIOR experience, and are RN/NP programs combined. I know they exist, because I just hired one for our group.

I agree that PA's and NP's should be colleagues, I am a member of the ACC, and I encourage all members of both professions to join, together we can accomplish much. My concerns are not based on my work as a PA, but rather on my work as a policy wonk.

BTW-...just for clarification...there is NO SUBSTANTIVE EVIDENCE that the DNP degree will improve patient care. There may be in the future, but there is none now.

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Specializes in CT ICU, OR, Orthopedic.
I am concerned, because about 50% of my time now is spent in health policy, on both the national and state levels, and a primary focus of my research and committee time is spent discussion ACCESS to primary care issues. I am very concerned that increasing the time, and monetary requirements to become an NP will hurt access to primary care. NP's will graduate with higher student loan debt, and will, if we use medical students as an example, migrate to better paying jobs. Evidence suggests that this is likely to happen, and I am concerned that we will be limiting an already short primary care provider pool even further.

BTW- your example of PA schools is completely false. EVERY school that I am aware of requires prior HCE. My school for example required a minimum of 4000 hours of HCE....the average of my class was 10,000 hours. The average age in my class was 32. Contrarily, there are NP programs that require NO PRIOR experience, and are RN/NP programs combined. I know they exist, because I just hired one for our group.

I agree that PA's and NP's should be colleagues, I am a member of the ACC, and I encourage all members of both professions to join, together we can accomplish much. My concerns are not based on my work as a PA, but rather on my work as a policy wonk.

BTW-...just for clarification...there is NO SUBSTANTIVE EVIDENCE that the DNP degree will improve patient care. There may be in the future, but there is none now.

Thank you for clarifying. Your concerns are genuine, and do make sense. I am not planning on doing primary care, my interest is critical care. Yes, I will graduate owing about $90,000 in loans, and I am no spring chicken so I will likely be paying it off far past retirement.

I still feel that most healthcare is leaning toward practice doctorates. I believe ( but am not positive) that in MI, PT, and audiologists require one. That is my understanding, but would have to check into it. My friend Is being forced to get hers in order to keep up with the competition (job wise).

My neighbor had a Bachelors in construction management, and she never touched a pt till PA school. So I know that at leaste here there are schools with no prior HCE. I would highly disagree with any purely online nursing or RN/NP programs. I think one year minimum experience in the area you want to practice should be a requirement before admission. That is a requirement I think is crucial. I am going to a highly respected school, and am confident that I will come out prepared.

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Thank you for clarifying. Your concerns are genuine, and do make sense. I am not planning on doing primary care, my interest is critical care. Yes, I will graduate owing about $90,000 in loans, and I am no spring chicken so I will likely be paying it off far past retirement.

I still feel that most healthcare is leaning toward practice doctorates. I believe ( but am not positive) that in MI, PT, and audiologists require one. That is my understanding, but would have to check into it. My friend Is being forced to get hers in order to keep up with the competition (job wise).

My neighbor had a Bachelors in construction management, and she never touched a pt till PA school. So I know that at leaste here there are schools with no prior HCE. I would highly disagree with any purely online nursing or RN/NP programs. I think one year minimum experience in the area you want to practice should be a requirement before admission. That is a requirement I think is crucial. I am going to a highly respected school, and am confident that I will come out prepared.

Again, my objective here is not to be confrontational, but rather to answer some policy concerns that I have, and also learn more about it. I can sometimes be a bit brazen, but after being a medic in the military, and then spending years in the ED setting, I tend to be somewhat to the point, even with patients. I also completely and utterly disagree with any online clinical degree completions....nursing, NP, whatever. I feel very, very badly for the patients those providers will be caring for. I'm sure that there are some PA programs out there with minimal HCE requirements, which is why, with my own profession, and I am a young middle aged dinosaur, I am pushing for mandatory PA residencies. At least 12-18 months in length. 2000-3500 extra clinical hours. It is not a popular idea, despite the fact that we actually have a BUNCH of PA residencies. I also am not a supporter of the RN/NP combined programs, but they exist. The NP we hired, well we did so because she also had extensive experience as an EMT.

I wish you luck with the critical care. I did that for awhile, and actually loved it. I think both PA's and NP's can play a big role in that environment.

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Specializes in Education, FP, LNC, Forensics, ED, OB.
Again, my objective here is not to be confrontational, but rather to answer some policy concerns that I have, and also learn more about it. I can sometimes be a bit brazen, but after being a medic in the military, and then spending years in the ED setting, I tend to be somewhat to the point, even with patients. I also completely and utterly disagree with any online clinical degree completions....nursing, NP, whatever. I feel very, very badly for the patients those providers will be caring for. I'm sure that there are some PA programs out there with minimal HCE requirements, which is why, with my own profession, and I am a young middle aged dinosaur, I am pushing for mandatory PA residencies. At least 12-18 months in length. 2000-3500 extra clinical hours. It is not a popular idea, despite the fact that we actually have a BUNCH of PA residencies. I also am not a supporter of the RN/NP combined programs, but they exist. The NP we hired, well we did so because she also had extensive experience as an EMT.

I wish you luck with the critical care. I did that for awhile, and actually loved it. I think both PA's and NP's can play a big role in that environment.

I agree with many of your points.

Thank you for your respectful reply...

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Again, my objective here is not to be confrontational, but rather to answer some policy concerns that I have, and also learn more about it. I can sometimes be a bit brazen, but after being a medic in the military, and then spending years in the ED setting, I tend to be somewhat to the point, even with patients. I also completely and utterly disagree with any online clinical degree completions....nursing, NP, whatever. I feel very, very badly for the patients those providers will be caring for. I'm sure that there are some PA programs out there with minimal HCE requirements, which is why, with my own profession, and I am a young middle aged dinosaur, I am pushing for mandatory PA residencies. At least 12-18 months in length. 2000-3500 extra clinical hours. It is not a popular idea, despite the fact that we actually have a BUNCH of PA residencies. I also am not a supporter of the RN/NP combined programs, but they exist. The NP we hired, well we did so because she also had extensive experience as an EMT.

I wish you luck with the critical care. I did that for awhile, and actually loved it. I think both PA's and NP's can play a big role in that environment.

In regard to your statement about HCE, roughly 1/3 of PA programs require HCE, 1/3 of PA programs recommend HCE and 1/3 do not require HCE. The HCE requirement is a geographic variable to a large extent. There are also 4-5 programs concentrated in the NE that are direct entry. Students enter as undergraduates and after three years with summers transition to the PA program if they have met continuing requirements (GPA and pre PA experience). The programs that do not require HCE are statistically different in that they are more likely to be a Masters programs (although that is probably an artifact of the fact that all community college/cert programs require HCE) and have statistically longer clinical and didactic terms.

As far as mandatory residencies, the PA profession looked at specialization and abandoned that model 35 years ago. In my opinion they are not going back. Post grad programs (the correct term) make up and will continue to make up a small percentage of PAs (in my opinion). Instead those of us within PA specialties and PA leadership are working with the physician specialty groups to produce specialty PA training modules with an voluntary PA specialty credential (notice the lack of certification). NCCPA hopes to have this active by 2011.

The PA graduates currently being produced are more than capable of handling primary care duties within a good mentoring physician/PA relationship. If a practice is willing to invest a little sweat equity they can have a PA practicing good specialty medicine within 3-6 months. The issue that we face in the PA profession is a form of early adoptor phenomenon. The early adopters who understand the PA profession already employ PAs and the PAs are unlikely to turn over much as they are happy there. Those who are left do not understand the PA concept or the mentoring needed for new grads or those new to the practice but are hiring for economic or lifestyle issues. This leaves these practices either turning over PAs with dissatisfaction on both sides or competing for a smaller pool of experienced PAs. Once again educational models and mentoring examples are what is needed to overcome this barrier for new grads.

As far as the DNP (to keep Siri happy). My analysis (which I believe is about 20 pages back) is that from an educational policy perspective there were two driving forces. Nursing colleges who wanted to drive out some for profit players and get more tuition dollars and Nursing educators who wanted it for reasons of professional power and prestige (really the same group in the end). If you read the history of the DNP paying particular attention to the NONPF white paper it essentially supports this. The ANA supports it for their own reasons and for the most part NPs that are in practice seem to question its need. The interesting thing is that instead of developing in ways that the NONPF intended its become like every other nursing doctorate (ND, DNsc etc). Its morphed far out of its intended purpose (to provide a clinical doctorate to advanced practice nurses). Since there is no accrediting body for NP programs, colleges are free to issue the degreee to any group they want. Hence you have at least four programs that are issuing the degree to non advance practice nurses. So what does the DNP really mean in the end?

David Carpenter, PA-C

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In regard to your statement about HCE, roughly 1/3 of PA programs require HCE, 1/3 of PA programs recommend HCE and 1/3 do not require HCE. The HCE requirement is a geographic variable to a large extent. There are also 4-5 programs concentrated in the NE that are direct entry. Students enter as undergraduates and after three years with summers transition to the PA program if they have met continuing requirements (GPA and pre PA experience). The programs that do not require HCE are statistically different in that they are more likely to be a Masters programs (although that is probably an artifact of the fact that all community college/cert programs require HCE) and have statistically longer clinical and didactic terms.

As far as mandatory residencies, the PA profession looked at specialization and abandoned that model 35 years ago. In my opinion they are not going back. Post grad programs (the correct term) make up and will continue to make up a small percentage of PAs (in my opinion). Instead those of us within PA specialties and PA leadership are working with the physician specialty groups to produce specialty PA training modules with an voluntary PA specialty credential (notice the lack of certification). NCCPA hopes to have this active by 2011.

The PA graduates currently being produced are more than capable of handling primary care duties within a good mentoring physician/PA relationship. If a practice is willing to invest a little sweat equity they can have a PA practicing good specialty medicine within 3-6 months. The issue that we face in the PA profession is a form of early adoptor phenomenon. The early adopters who understand the PA profession already employ PAs and the PAs are unlikely to turn over much as they are happy there. Those who are left do not understand the PA concept or the mentoring needed for new grads or those new to the practice but are hiring for economic or lifestyle issues. This leaves these practices either turning over PAs with dissatisfaction on both sides or competing for a smaller pool of experienced PAs. Once again educational models and mentoring examples are what is needed to overcome this barrier for new grads.

As far as the DNP (to keep Siri happy). My analysis (which I believe is about 20 pages back) is that from an educational policy perspective there were two driving forces. Nursing colleges who wanted to drive out some for profit players and get more tuition dollars and Nursing educators who wanted it for reasons of professional power and prestige (really the same group in the end). If you read the history of the DNP paying particular attention to the NONPF white paper it essentially supports this. The ANA supports it for their own reasons and for the most part NPs that are in practice seem to question its need. The interesting thing is that instead of developing in ways that the NONPF intended its become like every other nursing doctorate (ND, DNsc etc). Its morphed far out of its intended purpose (to provide a clinical doctorate to advanced practice nurses). Since there is no accrediting body for NP programs, colleges are free to issue the degreee to any group they want. Hence you have at least four programs that are issuing the degree to non advance practice nurses. So what does the DNP really mean in the end?

David Carpenter, PA-C

yeah, I'm aware of the push for the specialty credential. Paul Robinson and I, as well as Trimbath were discussing it at the HOD in San Antonio. I've been asked to submit for sitting on the Professional Practice Council, so it looks like we may be seeing each other at the Leadership Summit. The change over time to an increase of programs that do not require HCE, as you have noted, is one of my areas of concern, as all of the programs I deal with require it. I agree with your statements about mentorship, but some physicians have voiced this as a concern as well. They spend months training a new grad at a reduced salary, only to have them leave for greener (read money green) pastures once they have experience. I have heard this numerous times from various physicians. At any rate David, it sounds like you and I are saying the same thing, but perhaps with different phrasing. I know that the AAPA, and NCCPA are likely not going to pursue mandatory residencies, but now with almost 20 years in medicine under my belt, I will still voice my support for that.

PS- I did read the NONPF white paper, which is why I am a little confused.

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Specializes in ER; CCT.
Well, the "truth and transparency" act is before congress now, and if it passes, and it looks likely too, than it will be illegal for ANY NP or nurse (recognizing some of the older doctoral degrees in nursing) to call themselves "doctors" in the clinical setting.

I suppose if there were any truth whatsoever to support this lie, you would have cited and referenced.

You've never even practiced medicine on any level, as my understanding is that you are still a student, and you think NP's can provide superior care? That sort of naivete, shows your lack of understanding of the complexities of medicine.

In the 20 years I have directly cared for, ran buisnesses that have provided care for or directed educational programs that have prepared others to provide care, I have never once nor will I ever practice medicine as I am not licensed to, nor trained, nor have any intentions in practicing medicine.

My naivete, lays and is grounded in the notion that you have absolutely no clue of what I am talking about yet I, nonetheless, attempt to provide education.

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