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

[cruisin_woodward]

By the way to get back on topic again :-)

Looks like the stand alone DnP programs will be 3-4 years. What are the clinical hours?

I think the clinical hours are different for every program...this is a sore spot for most people on this site, b/c it is really not that impressive for a practice (not clinical) degree. I really think that both the MSN and the DNP need more clinical hours, and it is something that needs to be addressed. The program I will be attending will have 1000 clinical hours. I think that 2000 seems like a reasonable amount. I know that they (the powers that be) are going on the expectation that the nursing backround covers a lot of the clinical time, however, I agreed with that notion until I saw that there are programs where you get your RN, and then go right into NP...you never even have to practice as an RN. I think that the entrance criteria should be more standard. Minimum one year in the environment that you plan to specialize in. Now, I know for ACNP, and peds, and neonatal, my school requires one year minimum...well I'm not sure how it equals out, but it's a minimum number of hours you must have in that field as an RN. Critical care is the same way...I'd give you numbers, but I don't have them, I just know that people were told that when they went for their interviews...it didn't pertain to me, b/c I had 3 years experience in critical care... So anyway, I got off topic...The 1000 hours are spread out over 4 semesters...

I feel very strongly, that the accredidation committees need to get some regulations and guidelines with all of the programs...I am new to this, and I must say that it really surprised me.

[JDCitizen]

Kind of makes you wonder who is in charge and what/who are they listening to.

One day maybe those powers will say and I am adding a Southern flair: Y'all this is the minimum and we want your programs framed to this minimum but we also expect you to surpass the minimum.

[physasst]

I think the clinical hours are different for every program...this is a sore spot for most people on this site, b/c it is really not that impressive for a practice (not clinical) degree. I really think that both the MSN and the DNP need more clinical hours, and it is something that needs to be addressed. The program I will be attending will have 1000 clinical hours. I think that 2000 seems like a reasonable amount. I know that they (the powers that be) are going on the expectation that the nursing backround covers a lot of the clinical time, however, I agreed with that notion until I saw that there are programs where you get your RN, and then go right into NP...you never even have to practice as an RN. I think that the entrance criteria should be more standard. Minimum one year in the environment that you plan to specialize in. Now, I know for ACNP, and peds, and neonatal, my school requires one year minimum...well I'm not sure how it equals out, but it's a minimum number of hours you must have in that field as an RN. Critical care is the same way...I'd give you numbers, but I don't have them, I just know that people were told that when they went for their interviews...it didn't pertain to me, b/c I had 3 years experience in critical care... So anyway, I got off topic...The 1000 hours are spread out over 4 semesters...

I feel very strongly, that the accredidation committees need to get some regulations and guidelines with all of the programs...I am new to this, and I must say that it really surprised me.

This was a well worded post.

Others on here continue to try and slam ANYONE who questions the validity, or necessity of the DNP. It's kinda sad, because there have been several physicians on here, and they continue to get mocked as well. Many states do not allow NP's to practice independently. Directing such strongly worded comments to medical students and physicians will not help your cause. This continues to be the problem with some in both the PA and NP communities, where people think that insults, and put-downs advance your interests. Change is happening for both professions, however, it needs to be balanced, carefully thought out, and deliberated. A working knowledge of not only your goals, but the political atmosphere, environment, and careful language must be used. For example, I had lunch when I was in DC last week with a congressional aide, we exchanged pleasantries, and then began to talk about cycling (a HUGE pastime of mine, that and triathlons), and in the period of an hour, by carefully listening, and reading between the lines, I learned more about the congressman and his health policy views, all by talking about cycling. I guess, what I'm trying to say...is polish......you need polish. Something, regrettably, I have not practiced here either.

I myself, want to apologize to anyone on this board whom I have offended. That was never my intent. I merely have several policy related concerns about the DNP. I actually only came to this board to inquire about any interest in the residency that we are putting together, so again, to anyone to whom I came off a bit strong, my deepest apologies. I think of NP's as colleagues, and would really like to see us work together.

Oh, and BTW..you might want to watch the HOR pretty closely over the next four weeks. There's a pretty big health care reform related bill, (the first of three in a row actually) coming out. Obama wants all three to through the house, committees, and senate by the end of June for his signature.

[JDCitizen]

For your review:

To doctorate or not to doctorate, is that the question?

by David Mittman - March 17, 2009

Provided by Clinician1

As a PA or NP there are many situations we do not like, but choose to accept. Over the last five or six years one of those events is that many of the other health professionals that we work with are acquiring doctorates. Pharmacists, physical therapists, OTs and I believe audiologists, all will have the doctorate as their entry level educational requirement over the next few years. Then there are optometrists, chiropractors, podiatrists, psychologists and others who have had them for a number of years. That’s a whole bunch of doctors who are not “doctors”. That’s fine for those professions but it does put us NPs and PAs in a bit of a bind.

We NPs and PAs were always able to get doctorates in other areas; public health, education, and more. NPs also had nursing sciences. Those doctorates suited us well until the last few years when organized graduate nursing decided that they would institute the DNP degree and that degree would be required of all NEW NPs by 2015.

Keep in mind that you do not have to be an NP to get a DNP. It means Doctor of Nursing Practice, Not Doctor of Nurse Practitioners. But on with the story. So the doctorate creeps into the NP world and with it comes the inevitable value that people put on your degree and what they all “think” it represents. It also puts stress on the PA educational world for parity. Here it goes again.

When it comes to wanting to be recognized as professionals on the same practice level as those professions that have instituted a doctorate, the doctorate is a good move. If we as PAs and NPs can write “orders” to other professionals who are doctorally trained, and we are not, it will become a bone of contention in the future. Sooner or later the other professions will ask why these NPs and PAs who are not trained at their doctorate level are making the decisions that these professions should be making. In other words, “How can you expect me, a DOCTOR of Pharmacy to take orders from these mere assistants and nurses?” So, yes, doctorates will have to be earned by some of us to keep up the status quo. Unfortunate but true. But back to the DNP. What is sad is that the DNP is not standardized, and in many educational programs it is not a clinical doctorate. It will cost NPs who are currently in practice $30-50,000 to acquire. and many, not all, but many of these programs will not make the NPs who enter them better clinicians. They will learn how to be better leaders and how to better impact the healthcare system. If they devote those new skills to making a difference, they will make nursing and patient care stronger, but in most cases will have not recieved the clinical eduction they expected. That’s the sad part.

What is also very sad to me personally as a PA who also loves the NP profession, is that both our professions have finally convinced people that our dream was accurate. For 35 years I have looked people in the eye and told them “You don’t have to be a doctor to provide high quality healthcare”. Then NPs and PAs went out and

over the last thirty years proved what we all believed to be the truth, in fact, we proved it beyond the shadow of a doubt. So now that we have proven that you DO NOT have to be a “Doctor”, advanced practice nursing leadership (NOT most NPs) have now said “You DO need to be a doctor to provide primary care”. I understand the politics behind the decision but I wish it was done in a different way. It really undercuts what we have been saying for 30 years. On the other hand, 30 years ago many of the other healthcare professions were not at the doctorate level, and I understand that also. The question is, could we have done it better and could we have

done it together?

I would have liked to see PAs and NPs team up and as many PAs do now (for no formal graduate credit) enter postgraduate residency programs. These programs are usually from one to two years in length and you learn on a resident level in a medical specialty while getting paid. At the end of your training you are very marketable

and also know the specialty you trained in just about as well as a fourth year resident. Not bad. That is where I would like us to go for our doctorates if we want to practice clinically. Maybe now is the time to establish some joint postgraduate residencies and make that happen.

So, do I believe in the doctorate? Yes. I think PAs and NPs will be forced to have them. Do I think they are necessary-not really. If we are going to go into these programs let’s make sure they prepare us clinically at the doctorate level so that we can assume the responsibility we want as compared to the other “doctors” in our

healthcare system. To do it any other way might get us the title, but clearly will not make us the best clinicians we can be.

So little word play:

I myself do not believe in the doctorate at this time....Yes I also believe PAs and NPs will be forced to have them. But at this time I really don't think they are necessary I think the MSN programs could have been, should have been strengthened overall both didactically and clinically. I do believe that if doctorate programs are going to mandated these (all) programs need to make sure they prepare us clinically at the doctorate level so that we can assume the responsibility we want as compared to the other “doctors” in our healthcare system. To do it any other way will only get us the title, but clearly will not make us the best clinicians we can be and worse may very well damage the career fieild as a whole.

[sirI, MSN, APRN, NP]

This was a well worded post.

Others on here continue to try and slam ANYONE who questions the validity, or necessity of the DNP. It's kinda sad, because there have been several physicians on here, and they continue to get mocked as well. Many states do not allow NP's to practice independently. Directing such strongly worded comments to medical students and physicians will not help your cause. This continues to be the problem with some in both the PA and NP communities, where people think that insults, and put-downs advance your interests. Change is happening for both professions, however, it needs to be balanced, carefully thought out, and deliberated. A working knowledge of not only your goals, but the political atmosphere, environment, and careful language must be used. For example, I had lunch when I was in DC last week with a congressional aide, we exchanged pleasantries, and then began to talk about cycling (a HUGE pastime of mine, that and triathlons), and in the period of an hour, by carefully listening, and reading between the lines, I learned more about the congressman and his health policy views, all by talking about cycling. I guess, what I'm trying to say...is polish......you need polish. Something, regrettably, I have not practiced here either.

I myself, want to apologize to anyone on this board whom I have offended. That was never my intent. I merely have several policy related concerns about the DNP. I actually only came to this board to inquire about any interest in the residency that we are putting together, so again, to anyone to whom I came off a bit strong, my deepest apologies. I think of NP's as colleagues, and would really like to see us work together.

Oh, and BTW..you might want to watch the HOR pretty closely over the next four weeks. There's a pretty big health care reform related bill, (the first of three in a row actually) coming out. Obama wants all three to through the house, committees, and senate by the end of June for his signature.

Thank you, physasst. Very nice post.

[physasst]

For your review:

So little word play:

I myself do not believe in the doctorate at this time....Yes I also believe PAs and NPs will be forced to have them. But at this time I really don't think they are necessary I think the MSN programs could have been, should have been strengthened overall both didactically and clinically. I do believe that if doctorate programs are going to mandated these (all) programs need to make sure they prepare us clinically at the doctorate level so that we can assume the responsibility we want as compared to the other "doctors" in our healthcare system. To do it any other way will only get us the title, but clearly will not make us the best clinicians we can be and worse may very well damage the career fieild as a whole.

Dave Mittman is one of the most respected clinicians, in both PA and NP circles. I don't know him really well, as he is not really active in the AAPA anymore, but he was a founder of the ACC, The Clinical Advisor Journal, as well as many other projects. He's a pretty bright guy, and his assessment, as usual, is spot on.

[core0]

Dave Mittman is one of the most respected clinicians, in both PA and NP circles. I don't know him really well, as he is not really active in the AAPA anymore, but he was a founder of the ACC, The Clinical Advisor Journal, as well as many other projects. He's a pretty bright guy, and his assessment, as usual, is spot on.

While I respect Mr. Mittman he has an agenda. This Clinician 1 post is part of that agenda. The AAPA and most practicing PAs disagree with this assessment on where the PA profession is going.

David Carpenter, PA-C

[prairienp]

while i respect mr. mittman he has an agenda. this clinician 1 post is part of that agenda. the aapa and most practicing pas disagree with this assessment on where the pa profession is going.

david carpenter, pa-c

tell us more on how the aapa and "most" practicing pas disagree with the assessment. i have read the pa forum and sdn and those pas would "mostly" agree with your premise. does the pa profession have a position? seems as if these same pas on the pa forum and sdn don't care much for the aapa leadership either. thus, i am wondering if the majority of pas really do disagree with mittman's position. although i do not always agree with his position, i do read and respect his "agenda". in fact, i also look at your posts the same way.

[physasst]

tell us more on how the aapa and "most" practicing pas disagree with the assessment. i have read the pa forum and sdn and those pas would "mostly" agree with your premise. does the pa profession have a position? seems as if these same pas on the pa forum and sdn don't care much for the aapa leadership either. thus, i am wondering if the majority of pas really do disagree with mittman's position. although i do not always agree with his position, i do read and respect his "agenda". in fact, i also look at your posts the same way.

i would say, that i disagree with parts of mr mittman's assertions as well. i don't believe that we will be "forced" to have them. i agree with him that the dnp was poorly planned and is not being executed well. i also agree with him that joint residencies are becoming more necessary (although i believe, mine and dave's reasons differ for this). the aapa cannot even agree on a base degree (which i also agree with, i was an associates degree graduate as a pa, and i went on to finish my master's much later), and i'm sure as mr carpenter would agree, sitting in the hod and listening to the degree debate concerning a master's minimum requirement is one of them more mind numbing experiences one can have.

i think that david is correct, i think that most pa's and the aapa would disagree with the assertion that we will all be "forced" to have doctorates.

[prairienp]

i would say, that i disagree with parts of mr mittman's assertions as well. i don't believe that we will be "forced" to have them. i agree with him that the dnp was poorly planned and is not being executed well.

i think that david is correct, i think that most pa's and the aapa would disagree with the assertion that we will all be "forced" to have doctorates.

i was part of the dnp planning and part of the execution. the planning was started in the late 90s, debated between various np organizations for years. where is dave saying "poorly" planned? he is saying the process could have been better, i agree. i can say the same thing about virtually anything i have done in the past 50 years. those in the early dnp planning stages were targeting adv practice nurses, especially the nps. others (nurses and non-nurse administrators) added their thoughts and found that this may be a way to help with the critical faculty shortage of doctoral prepared nurses. the dnps i know sought the education level because they found the curriculum attractive.

take a look at the beginning stages of the np and pa, do you define that as poorly planned? poorly executed? we had a md from duke who wanted to start a np program for non-nurses, was denied and had the fortitude to start his own program accepting military medics to become pas. i suspect the planning and execution would be considered "poor" if using the same criteria you are applying to the dnp program. i would not say the duke program was poorly planned, rather they were a developing program accepting changes to improve the program as they progressed.

the dnp program is here to stay, we can be critical of the steps, fight the change, sit back or we can make the process better. i know i will do my best to improve the process, the optimal outcome is a better health care provider, i believe this to be most important goal of the dnp.

[physasst]

i was part of the dnp planning and part of the execution. the planning was started in the late 90s, debated between various np organizations for years. where is dave saying "poorly" planned? he is saying the process could have been better, i agree. i can say the same thing about virtually anything i have done in the past 50 years. those in the early dnp planning stages were targeting adv practice nurses, especially the nps. others (nurses and non-nurse administrators) added their thoughts and found that this may be a way to help with the critical faculty shortage of doctoral prepared nurses. the dnps i know sought the education level because they found the curriculum attractive.

take a look at the beginning stages of the np and pa, do you define that as poorly planned? poorly executed? we had a md from duke who wanted to start a np program for non-nurses, was denied and had the fortitude to start his own program accepting military medics to become pas. i suspect the planning and execution would be considered "poor" if using the same criteria you are applying to the dnp program. i would not say the duke program was poorly planned, rather they were a developing program accepting changes to improve the program as they progressed.

the dnp program is here to stay, we can be critical of the steps, fight the change, sit back or we can make the process better. i know i will do my best to improve the process, the optimal outcome is a better health care provider, i believe this to be most important goal of the dnp.

when i refer to poorly planned, i mean that it could have been executed better, and i am referring to this in his statement:

but back to the dnp. what is sad is that the dnp is not standardized, and in many educational programs it is not a clinical doctorate. it will cost nps who are currently in practice $30-50,000 to acquire. and many, not all, but many of these programs will not make the nps who enter them better clinicians.

and this:

so now that we have proven that you do not have to be a "doctor", advanced practice nursing leadership (not most nps) have now said "you do need to be a doctor to provide primary care". i understand the politics behind the decision but i wish it was done in a different way. it really undercuts what we have been saying for 30 years

so perhaps poorly planned was not the proper language, but i interpret dave's statement to mean that the dnp could have been more uniform, better implemented with a stronger clinical component, now perhaps that is an implementation thing, and not a planning shortfall, so perhaps it is poor implementation. but at any rate, i agree that the programs could be improved. and i would be all for that.

if, i were asked to plan the dnp, it would be along the lines of completing your master's as an np first and always, and then making the dnp an option for those that want to be better clinicians, and it would be a two year program that would consist of at least 3000 clinical hours, and strong residency styled didactic component to complement it, with focuses in the current specialty areas of the np profession.

that would be an outstanding program. if the np profession were to adopt such a stance, and structure their dnp programs uniformly in that kind of format, i would wholeheartedly support the advancement of the degree, and would applaud your efforts at every level.

in short, i would be a fan. but the current iteration is not something that i can put my support behind. and as i said above i do want to work with np's.

[core0]

tell us more on how the aapa and "most" practicing pas disagree with the assessment. i have read the pa forum and sdn and those pas would "mostly" agree with your premise. does the pa profession have a position? seems as if these same pas on the pa forum and sdn don't care much for the aapa leadership either. thus, i am wondering if the majority of pas really do disagree with mittman's position. although i do not always agree with his position, i do read and respect his "agenda". in fact, i also look at your posts the same way.

two different issues in the essay. one is the name of the profession. the name is physician assistant. the aapa membership has made it crystal clear that they do not want to change the name of the profession. they have no interest in investing time or money for this.

"hp-3100.1.1

the aapa affirms "physician assistant" as the official title for the pa profession.

[adopted 2000 and reaffirmed 2005]"

the second issue is the degree necessary to practice as a pa. the policy that we have is somewhat schizophrenic on this.

hp-3200.1.0 initial education

hp-3200.1.1

aapa believes competency-based professional education at arc-pa accredited entry level pa programs

followed by life-long learning has been a successful formula for competent pa practice.

[adopted 2007]

hp-3200.1.2

aapa believes the ability of pas to practice and be reimbursed should not be compromised regardless of the

degree awarded upon completion of entry level pa education.

[adopted 2007]

hp-3200.1.3

aapa recognizes that pa education is conducted at the graduate level and supports awarding the masters degree

for new physician assistant graduates.

[adopted 2007]

hp-3200.1.4

aapa recognizes that pa education exists based on unique mission-driven and geographical needs in a variety

of educational institutions and models.

[adopted 2006]

to paraphrase: we believe that pa education is competency based. we also believe that this is graduate education and that new pas should have a masters degree. however, we recognize that in unique situations this may not be possible and that in this event other degrees or certifications are acceptable. in other words we support the masters but we also support those programs that don't give a masters because in the end all pas are trained to the same standard.

further discussion of degrees exists in the pa program faculty section:

hp-3200.7.1

the aapa encourages institutions of higher education that sponsor physician assistant education to establish the

master's degree as the terminal degree for tenure and promotion of physician assistant program faculty.

[adopted 2006]

so ultimately the profession (as represented by aapa) believes that the masters is appropriate and the terminal degree for pas but that other degrees are also acceptable. specifically there is no purpose for a pa practice doctorate either as a terminal degree or initial degree (implied). the practice doctorate was discussed last year and it was felt that current policy dealt with this. a quick perusal of this years resolutions does not show it on the agenda this year either.

as far as most pas agreeing i guess it depends on where you look. there are three primary forums for pas to express themselves. two are interestingly enough named the pa forum. one is a mailing list and the other is the bulletin board (sdn is basically a subset of the bb). both tend to have strong personalities that have definite opinions. the third is the process that the aapa uses to collect opinion and adopt policy - through the state academies, specialty organizations, and congresses.

as far as numbers i would guess that the mailing list has around 4-500 members with less than 100 active members. the other pa forum has around 20k members but i would guess that the number of active practicing pas there is less than 2000 (although this is very much a guess). the hod on the other hand directly or indirectly represents the 35,000 members which are about 40% of those eligible to practice as pas.

as who is more representative this is purely anectdotal. unltimately the number of pas that are actively engaged in policy is small. i would guess that around 10% of pas are active at any level of their national state and specialty organizations. this varies widely state to state and specialty to specialty. for example cvs pas have a more than 90% specialty and aapa membership as well as a very active staff and leadership. the guam pa society on the other hand went inactive as none of the five pas in guam was particulary interested in leadership roles. the difference in discussion is that at the national level the emphasis is more on consensus building. also some issues that are prominent on other forums are not even discussed at national conferences. for example one popular area of discussion on the pa forum is the need for hce in pa students. there are very strong opinions on this, but this has not been discussed as policy at the national level. even at meeting of the educational association its a non-issue. so while the issue may generate strong opinions on the internet, when pas get together its really not even a topic of conversation.

both areas are viewed by aapa leadership but they rarely participate in discussions there as their prefferred mode of discussion is through official channels.

hope this explains my view of what most pas means.

david carpenter, pa-c