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 date of 2015 still stands, although some schools have already requested (& I think been denied) extensions. You will be grandfathered in, and will not need to get your DNP. if you choose to however, it is a two year full time comittment... 3-4 years part time. It would not be a post masters certificate, it would be a doctoral degree... Hope this helps!

The 2015 date is simply what two organizations wish. There is no DNP requirement for any certifying organization either now or proposed. Similarly neither of the two nursing accrediting agencies mandate the DNP. If you look at the MSN history there were still bachelors NP programs in existence until 2006. For that matter there was never a mandate by any accrediting agency. Medicare required it as part of the 1986 medicare billing changes. States gradually changed their rules in response.

David Carpenter, PA-C

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The 2015 date is a suggestion. This is not a done deal. Unless you are going to teach, this degree offers nothing more than fluff classes.

I'm taking a DNP course as an elective and it looks to be very practical for real life business and financial planning for health care. I've just started it yesterday so we'll see.

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In attempting to scroll through all 80+ pages of this topic, I was trying to find out if there have been any changes in making the transition in 2015. I looked at the AACN website and it still says 2015, but I have a hard time believing that's really going to happen - but now I'm feeling pressured to get it done ASAP to avoid having to pursue a DNP.

ALSO, I'm wondering how post master's programs would work for people who already have an MSN and want to pursue getting a post master's certificate. I'm about to graduate with a generalist entry master's degree and I really *DO NOT* want to have to go back to school (after having spent 2 years in grad school pursuing this degree) and spend another 3-4 years getting a DNP, especially as I don't think it's necessary and would most likely be extremely costly.

If you do a search of several university advanced practice degree programs, several have already phased out the MSN degree program for NPs. So while you think it might not happen, it is already in the process of happening. If you have your MSN before 2015, you will be grandfathered in, to my understanding.

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If you do a search of several university advanced practice degree programs, several have already phased out the MSN degree program for NPs. So while you think it might not happen, it is already in the process of happening. If you have your MSN before 2015, you will be grandfathered in, to my understanding.

Many programs have moved to the DNP, however, many have not. For various reasons some programs may not be able to offer the DNP.

Consider this historically. The push for an MSN requirement started in the early seventies. By 1979 approximately 1/3 of the NP programs were certificate programs and even into the mid to late 80's around 20% were certificate programs. By 2005 all but 2 programs were Masters. There were two primary change drivers. One was the decision by the ANCC to require a Masters for certification. The direct result of this was the creation of the AANP certification program which allowed all graduates certification. The real driver was the ability of the ANA to tie educational degree to reimbursement for the CNS in the Omnibus Billing act of 1989. Even then there were still a significant number of non-masters NP programs until Medicare drove the final nail in the coffin with the Balanced Budget Act of 1997. This was essentially an exchange. The right to bill directly in return for disenfranchising NPs that did not have a Masters. One thing to remember is that none of the three agencies that accredit nursing schools with NP programs have ever required a Masters as part of an NP program.

If you look at the current forces, there are some of the same issues. NONPF wants to move the profession toward the DNP. A significant number of nursing programs also would like this probably out of a wish for increased revenue and academic power. There are a number of programs that will see a decrease in revenue and some programs that are unable to offer a doctorate. These are essentially the same issues that played out in the mid 80's to mid 90's. There has been no movement to change the certification standards, or for that matter uniformity on what they should be. To make it more confusing there are schools that are offering the DNP degree to students with neither a CNS or NP certification.

There will be a period of shake out, but unless either the certification agencies or Medicare mandates the DNP its unlikely to become a requirement. In this scenario its possible but unlikely that one of the certifying agencies will mandate this since the same situation will develop in the one will continue to certify non-DNPs as a business move.

A note on grandfathering. Its important to understand exactly what this means. In grandfathering, someone who was in a particular position or business is allowed to maintain that business even though its in violation of current rules as long as nothing changes. For example a business that had a sign grandfathered in under old zoning rules would have to take the sign down if the business was substantially changed. Similarly, non-masters NPs were allowed to continue practicing in states where they worked, however, once the rules changes were implemented they are generally prohibited from getting a license in another state unless they met the current license requirements in that state (including Masters). Grandfathering dramatically decreases mobility. Something that is prized more currently than it was in the 70's and 80's.

My thoughts on this for what they are worth.

David Carpenter, PA-C

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Specializes in ER.

I've heard this debate - why would an APN not just go to med school, if that was the case? Would they be called "Nurse, Doctor?" haaa!

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I've heard this debate - why would an APN not just go to med school, if that was the case? Would they be called "Nurse, Doctor?" haaa!

Because nurses believe in nursing theory and not the raw science that you learn in medical school. Medicine and nursing are two very different approaches to the same end goal.

And doctorate degree nurses are simply Dr. XxXX which is why there is a big debate as to whether or not they should be allowed to address themselves as such in the clinical setting since society has decided that doctor = physician.

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I'm taking a DNP course as an elective and it looks to be very practical for real life business and financial planning for health care. I've just started it yesterday so we'll see.

That's great that the course is practical for real life. However, why is it there in a clinical doctorate degree? That's a class I would consider fluff since it doesn't expand your clinical knowledge (ie. treating a patient). My question is, based on looking at many DNP programs, why does a clinical degree have barely any courses that expand clinical knowledge? Or is it really not supposed to be a clinical degree?

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That's great that the course is practical for real life. However, why is it there in a clinical doctorate degree? That's a class I would consider fluff since it doesn't expand your clinical knowledge (ie. treating a patient). My question is, based on looking at many DNP programs, why does a clinical degree have barely any courses that expand clinical knowledge? Or is it really not supposed to be a clinical degree?

We have to look at each school's rationale for the degree. At Rush University it is: "The DNP degree is designed for master's prepared nurses with demonstrated or potential leadership ability who desire to enhance their skills in outcomes management, affecting policy and incorporating data into decision making. The DNP student may already be in a management position or desire to advance to a different leadership role."

Theirs doesn't seem to focus on any further increase in clinical skills, at least by looking at this. But, I can tell you classes which teach you financial concepts are important since you need knowledge of how, when and who pays you and how it will affect your clinical practice and quality of care you provide.

I'll check other schools and see what their focus is.

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University of Arizona:

*Generate and disseminate nursing practice knowledge to stimulate research and improve clinical outcomes;

*Improve health outcomes through scientifically-based advanced practice within your chosen specialty;

*Engage in and lead collaborative practice teams; and

*Influence clinical practice transformation and policy initiatives.

University of Alabama:

Graduates of the DNP program will focus on providing care to populations and communities with an emphasis on improving quality and access to underserved, diverse populations. The three components of the DNP are advanced clinical specialty practice, leadership, and practice inquiry. Graduates will employ abilities and skills in these areas to advocate for reasonable, rational, and data-driven health regulations, standards, and evidence-based practices; sustain collaborative and strategic relationships; promote innovative, effective health-care programs; and form partnerships with diverse groups to address health disparities. In addition, graduates, through additional graduate level nursing education coursework, can choose to prepare for clinical faculty positions to address the critical nursing faculty shortage.

Duke University:

Doctor of Nursing Practice (DNP) program provides skills and tools that enable you to:

*Assess published evidence to inform your practice

*Improve systems of care to influence patient outcomes

*Make changes to enhance quality of care, when needed

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Hmmm... is this lack of focus on clinical skills & medical content to prove that NPs are not just "mini-MDs"? After all, advanced practice nursing isn't just *doing* things traditionally done by physicians (ordering tests, txts, making diagnoses, etc) and certainly it's much more than being an "physician-extender." The content needs to be clearly grounded in Nursing, not Medicine so as not to elicit accusations that NP are in fact practicing medicine and not nursing.

So what can an NP program include to prove that NPs are grounded in nursing and not medicine? Nursing research, nursing leadership, nursing quality improvement, etc.

Anyway, the clinical practice & medical knowledge part of being an NP should come naturally to a nurse. Nurses are self-directed learners who will utilize all of their resources to bridge any gaps to provide the best patient care possible (so it doesn't really matter if that gap is 10% or 60%). Everyone knows that after a year or so in a job, any significant performance gaps have generally disappeared.

Too cynical?

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So if the DNP degree is designed for NPs who want to go into leadership, management, or run their own practice, why should it be forced upon those who have no desire to do any of that?

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That's great that the course is practical for real life. However, why is it there in a clinical doctorate degree? That's a class I would consider fluff since it doesn't expand your clinical knowledge (ie. treating a patient). My question is, based on looking at many DNP programs, why does a clinical degree have barely any courses that expand clinical knowledge? Or is it really not supposed to be a clinical degree?

Likewise, this is a source of confusion for me regarding what the purpose is for the DNP degree. What role is the DNP expected to fill?

I agree with the shaman, I don't consider the classes being discussed as being "fluff"; i.e. I don't feel them to be without worth or necessarily devoid of content. I would agree that such a knowledge base would be of significant worth to someone in a leadership position in health care delivery.

However, I also agree with those who question the clinical worth of such courses. Which leads us back to the original question, what is the role of the DNP? Is the DNP filling the same role as any other nurse practitioner, with additional knowledge in policy issues?

While members within a profession may have individual variations in roles, we can generally consider a prototypical member of the profession filling a certain role, performing certain duties, etc. So, for example, a prototypical family nurse practitioner (FNP) will be providing patient care in a primary care setting, prescribing meds and obtaining/interpreting test results, diagnosing and treating patients, etc. Yes, we can find many real-world FNPs acting in different roles from this prototype, but in general, that is a (simplistic) snapshot of what a typical FNP will be doing in their day-to-day professional practice.

So, if the above is granted, what is the prototypical DNP doing? The prototypical DNP will be a nurse practitioner, correct? So, is the prototypical DNP providing patient care? If so, is the locale and patient population directly tied to what kind of NP the DNP is (was?)? E.g. is the DNP who was a FNP still working in a primary care setting? Is the DNP/FNP seeing patients in a clinic and/or urgent care type environment? If so, how is their practice changed by the additional knowledge gained by the doctorate? Is this DNP being paid more than their FNP colleagues? If yes, why?

...and on and on and on...

The DNP degree would appear to add little (if any) clinical knowledge to that taught in the MSN-level NP programs. If the DNP comes to be required for all NPs, this is a concern. Why does a clinic FNP need (or even want) 2-4 years worth of hybrid MBA/health promotion coursework? If the NP role is not changing (why would it, it works), but the NP degree requirement is changing, why does this newly required degree consist of coursework largely unrelated to role it's holders are expected to fill?

If the DNP does not become required for NPs, questions still abound regarding what role it's holders are expected to fill. Were I a PhD, I would likewise have questions regarding this degree encroaching into PhD territory. Aside from the policy and leadership courses, DNP programs have a large theory and research component, along with the pseudo-dissertation discussed a couple of pages back. What is that all about?

A doctoral degree with minimal-to-no clinical component; policy, leadership, theory, and research emphasis; required "scholarly project" which seems to entail generation of new clinical instrumentation (along with all of the research and experiment that such a task entails)...all of this sounds like a PhD to me. What am I missing?

DNPs at my school (state U with MSN and PhD programs) are tenure track, and well compensated in that role (per public documents).

I have read the DNP position papers, as well as current textbooks which describe APN roles. I still do not understand what the DNP is, why it is needed, and what role it fills. By this gigantic thread, it seems nobody else does either. What the h3ll is going on within the halls of nursing academia?

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