Doctoral degree to become an NP???

Coffeegirly · Jun 29, 2006

I also think you have to research the DNP program. Many of them offer the epidemiology, statistics and the other courses that have been mentioned. However, other programs do stress clinical expertise in the practitioners chosen area.

I would have said these same things many years ago. Why a DNP? It's academic, just another degree.. it's oppressive, it's ivy tower stuff, etc. But as I've been working many years, I've come to slowly change my mind. I do lack knowledge, a lot of it. I practice darned well and yes, my surveys would be better than an MD's....but so? It's all about the patient. Y

The person who made the comment about the docs who laugh at Dr. NP's.... there will always be those. But there will always be many more who will look at us with greater respect and always those that never will. We need to look at who we serve rather than argue amongst ourselves. Nursing is notorious for that. Heck, we can't even decide what the basic level of education should be!! In addition, now we let people go directly from a BSN to MS. Huh? Don't we need years of practice? Because frankly, I don't think a year or two cuts it... but that's just another thread.

So here we are... rather than moving forward, we stagnate and bicker about these issues. Someone wants to make some rules... but not everyone agrees. In most professional groups, a of people get together, study something, come to a concensus, present their decision to the representatives and vote. Decision made. I believe that's been done but we bicker and often can't come to concensus because I think when it comes to these issues, people who graduate from various levels of nursing, for example, thinks their program is best and they should have to change because of this and that.

Change is hard. There are reasons for them. I don't think all change is bad and maybe sometimes we should actually look foro the positives. jmho.

christvs, DNP, RN, NP · Jun 29, 2006

The big deal is not about staying a nurse forever. There are reasons for this argument, and maybe you missed them as they are dispersed throughout these postings. So here's a brief outline for you:
1. Doctoral education is expensive no matter which way you choose to go. NP's don't get paid nearly as much a physicians. Simple cost-benefit analysis here. Heavy student loans have to be paid back, and if you're only making $60-70,000/year as an NP, you DON'T want a heavy student loan burden. And don't expect the schools to charge less for doctoral level education for nurses...they are in this for the money, NOT for the profession.
2. It won't bring any more respect to the profession. Physicians will always see the term "nurse" in your title whether you are a nurse practitioner or a doctor of nursing practice. Nurses seem to have the idea that more education equals more respect. Simply not so. In fact, it is a logical fallacy...just like "more is better". Nurses as a whole need to get rid of the stigma of subservience, inferiority, and inequality attached to the profession of nursing before we get anywhere with this profession. How can this be done? Nurses becoming independent contractors that are NOT attached to the room charge of hospitals with the right to bill the insurance companies for services rendered. You better bet that physicians and the public would treat us better if we weren't just a part of the room charge, but a separate and important group of professionals in the healthcare team necessary for patient care. (My apologies to the Florence Nightingale nurses who disagree.)
3. MSN prepared NP's know more than enough to practice competently, as demonstrated by studies in JAMA showing outcomes equal to and even better in some areas than the physicians managing the same illnesses. There is no evidence to show a doctoral degree is needed to produce a more competent NP, CNS, CNM, or CRNA. Personally, I think this should be a personal choice for NP students...choose either an MSN or DNP...not something that gets shoved down every professional nurse's throat because a group of nurse leaders who probably never worked at the bedside say it will be good for the profession.
4. Now is not the time for this debate. We still have diploma and ADN programs operating. A little more than 50% of all RN's are ADN's. We cannot even bring the minimum requirement for a professional nurse to the BSN level. Just a few years ago, we finally gained consensus to the MSN being the minimum entry requirement to advanced practice nursing, and now we want it to go to a doctoral level??? Why? Let's get nursing as a whole to gain consensus as to the MINIMUM entry requirement for the professional RN instead of messing around with the advanced practice arena.
5. Role confusion. Much of the public still does not know what NP's are and what they can do. Now we are going to require doctoral degrees for minimum entry requirements. So NP's are now "doctor nurses"? Sounds obvious to those of us who are nurses, but what about the public? Seriously people. If you wanted to be a "doctor", it's called "medical school". Being that NP's do 80 - 90% of what physicians do, and call it "advanced practice nursing", NP's that want a doctoral title can go back to medical school to gain that title and not confuse the public.
6. Gaining the DrNP degree will not increase the scope of practice for advanced practice nurses, will not help the group gain enpaneling as providers for insurance companies, and will not allow the group to do anything other than what they already do. So how does it help the group again?
Unless NP's want to enter academia, let's just leave well enough alone.
So that's what the argument is all about, my 25 year old Southern Beauty inquisitor.

I agree with everything you said 100 %. Well put. I'm currently in an MSN program to become an NP and I think the DNP should be a choice, and definitely not forced upon every NP.

-Christine

ErinRNBSN · Jul 9, 2006

I think a ND is a great idea and avenue to promote nurses to a higher level! I am currently completing an MSN for ANP, and would love to go on further. Has anyone heard anything about the AMA requesting that a law go into effect that all APN's are supervised??? I hear this through the grapevine at work. Just wondering if anyone has any news??

alwaysintheknow · Jul 9, 2006

i think a nd is a great idea and avenue to promote nurses to a higher level! i am currently completing an msn for anp, and would love to go on further. has anyone heard anything about the ama requesting that a law go into effect that all apn's are supervised??? i hear this through the grapevine at work. just wondering if anyone has any news??

i saw this coming..........

american medical association house of delegates

http://216.239.51.104/search?q=cache:qx2sq5opb6kj:www.ama-assn.org/ama1/pub/upload/mm/471/211a06.doc+ama+resolution+211&hl=en&gl=us&ct=clnk& cd=6

i say this is going to be a big issue in the coming years now that docs know about the dnp and see this as direct competition and a threat to them. i guess the forum of public opinion will decide. the cat is out of the bag.

alwaysintheknow · Jul 9, 2006

Has anyone else heard the following?:
Columbia School of Nursing will introduce a four-year "doctor of nursing practice" doctoral program that teaches much broader skills, such as evaluating clinical studies and setting up independent practices. As they gain these new skills, nurse practitioners are branching out beyond primary care to fill a growing need for personnel in many areas of medicine, including specialties such as long-term care providers for the elderly.
I think this is an absurd idea for nurse practitioners. A 4 year doctoral degree to become a nurse practitioner? This will actually be a REQUIREMENT to become an NP by the year 2015 if certain nursing interest groups get their way. WHY is there such a big push for this if nurse practitioners really aren't planning on competing with physicians like the special interest groups claim? The degree will teach NP's how to set up INDEPENDENT PRACTICES...how is this not competing with physicians? NP's having a doctoral degree may want to be referred to as "Doctor"...how is this not competing with physicians? I think this requirement may very well hurt the profession as a whole by doing the following: Decreasing the number of NP applicants, creating friction between physicians and NP's due to title use and physicians viewing NP's as competition, and create more role confusion for the public regarding nursing and the concept of the nurse practitioner.
Let's look at this idea folks. One goes to school for his or her BSN (Typically 4 to 5 years). Then one goes to school 4 more years for the Doctorate of Nursing Practice Degree. That's 8 to 9 years. Then he or she gets a position starting at $60,000 - $70,000 a year, if he or she is lucky (I have met NP's starting out as new gaduates making $54,000/year). No residency will be required like traditional medical school, but you can bet the universities offering such a program will charge you quite a pretty penny for the doctoral degree. (Just look at schools offering the PharmD, the DPT, the Aud.D, etc. These programs ARE EXPENSIVE, costly, and time consuming.) Then, to make things more fun, NP's will have to go against the grain of the medical profession (the AMA, including specialty groups of MD's and DO's) to fight for priveleges to practice independently in states unaccepting of the NP as an independent provider. Then there will be fights about getting empaneled by insurance companies for direct reimbursement for services provided. This will not be a smooth transition...this will be a war! The AMA is a powerful entity, both politically and socially.
Now don't get me wrong. I WANT to become an NP. But I want to get mine in 30 months as opposed to 4 years. I DO NOT want to be a doctor. I do NOT want to be called "doctor". I especially do not want to be a "doctor nurse". If I wanted to spend all that time in school, like the new degree proposes, I would GO to medical school. This way I would get a well respected MEDICAL DEGREE in the same amount of time, complete my residency, and then start out making $130,000/year (on average) instead of $60 - 70,000 a year. Oh, and I wouldn't have to worry about "physician collaboration", independent practice restrictions, being reimbursed by insurance companies, prescriptive privileges, or public confusion about my role in the healthcare system. And don't fool yourselves, many other intelligent people will see things my way too, which will lead to LESS NP's, which is a BAD thing for the profession.
Nursing isn't ready for this idea right now. There are too many other issues nursing needs to worry about first. What do you think about this issue?

You are right....check ut above link.

Coffeegirly · Jul 9, 2006

It's not nursing that isn't ready for this, it's the AMA that isn't ready for this. They are threatened big time. I can only hope that nurses don't run off afraid which has often been the history because the AMA is so big and powerful. Yet nursing is large but predominantly female. With more and more males entering, let's hope our voice changes more and we all start feeling stronger and more empowered to stand up to this group called the AMA who is clearly threatened by us. No one wants to take anything away from their role. I don't know about you but I respect them. They have expertise and knowledge way beyond mine... I have my own. Why they would think I would be a threat to them is silly. Are they worried about patient satisfaction and $? probably.

That's the reality of it all. It's politics.

brownrice · Jul 9, 2006

Coffegirly:

We don't need more men entering the field of nursing to make our voices heard. The existing base of nurses (who represent the largest group of healthcare professionals in the US) need to become more politically savvy, learn the legislative process, create, fight for, and demand the rights we are due. Nurses as a bunch have historically been a complacent group. I'm all for men entering the nursing profession--that's great. But I believe thinking like this "more men will help" is not right. We create more involved, respected, mature, nurses by requiring a BSN. Until unity and consistency are achieved, can you blame other healthcare professions for thinking nursing has a few problems going on? Nursing doesn't even seem to know what's gioing on with it's OWN profession. What other HEALTH profession allows a range of education from diploma to doctorate?

fuegorama · Jul 9, 2006

Thanks for "knowing some of us" who "are just nurses". I predict in another 5-10 years we will not be required through state statutes to legally collaborate with you on anything, so your "cautiously discussed concerns" will be so much wasted energy as the "golden age" of physician controlled monetary medicine disappears, and cost effective collaborative care given by practitioners with their own expertise replaces most of what you do and what you try to bill for. Your 2 minute assessments of patients and six figure death rate of patients do little to help you "cautiously discussed concerns" with legislators, or the public. Many studies have already proven the safety record of NP's and CRNA's - some of these studies state their safety records exceed those of the MD's and DO's. I guess that upper level chemistry class didn't do much to prevent that patient's unfortunate death. So I guess the MD's and DO's should stop belly aching about their high insurance premiums - they are there for a reason. You are in the twilight of a profession that will greatly change as society, legislators, insurance companies, and individuals realize that you offer only one facet to their health care solution. Perhaps you will play more of a role in research in the future and have even less patient contact. Ah, sort of glad to know you, see yah around, maybe? Snoopd

Wow. Vitriol much?

I hear where this is coming from and encourage you to get your info. correct. The data from the NIH posits that the vast majority of deaths attributed to iatrogenic causes or negligence were system failures. Nurses, as patient advocates share a major chunk of responsibility for these disasters. Frequently these mistakes occurred as direct results of nursing issues/blatant negligence.

Your post, blaming physicians for these deaths, is a perfect view into the public in general and nursing in particular's view of healthcare. People make mistakes, errors occur, but doctors are responsible. (this will be extrapolated in another post)

The medical community is working hard at preventing future iatrogenic injury. I have attended three grand round lectures in the past 6 months where system correction was the focus. Doctors do take responsibility for these problems and we are the agents of change.

This of course would not be possible without nursing. Together we will change the inertia of sloppy practice and prevent unnecessary death and injury.

fuegorama · Jul 9, 2006

Hi. First time posting.

I was a nurse.

I am now finishing my third year of medical school.

I have been watching the evolution of the DNP with interest and a lot of concern.

A significant amount of the noise in the medical world surrounding the proposed elevation of the nurse practitioner to "doctoral status" surrounds ignorance of what exactly is entailed in the training of this professional.

Unfortunately as a former insider, I have a pretty good idea. during my nursing career a number of my colleagues went on to obtain their NPs. Several of these were obtained at the 5 semester programs, the RN+NP masters. I recall social gatherings following graduations where they expressed disbelief that they were about to "practice medicine". Every one of them described inadequate training to their proposed job descriptions. A few hundred hours of preceptorship in clinics is not medical training. The title of "doctor" better still "physician" is coveted by most of my nursing friends who aspire to advanced practice. Let's be truthful. The DNP is being touted as an equivalent to the MD/DO.

This may not be the view of many on this board, but the AACN's position paraphrased reads "equivalent to the entry level degree of MD". This is wrong. No buts, no questions, no explanations. It is simply not true. Another year of dissertation, another 500 hours of clinic time, heck another two years is not going to approach the training of a doc.

I was a travel nurse in EDs in the Southwest and East. It was a great job. Good money. Rewarding. Plenty of time off. I had a cute house with a spa and mountain views. Life was sweet.

Work, however, found me always wanting to know a little more. Every interesting medical case found me looking in Harrison's for a dx. I realized that all my nursing anatomy and very basic science simply wasn't enough.

I looked at the NP and spoke with the ones I knew in practice. Without fail they encouraged me to seek a real medical education. So here I am.

Looking from the other side, I can tell you that nurses have very little idea of what goes into a medical student's training. As a nursing student i worked as a paramedic in the ED and picked up 2-4 ambulance shifts a month.

In medical school I cannot imagine having that time. Even without working I have struggled to keep up with the studying. The first two years were memorization boot camp. The third year has seen me in the hospital at times for 120+ hours (there are no work hour restrictions for students) plus preparing for end-of-service exams. It really is life encompassing/consuming.

And I am just beginning! Residency is controlled at 80 hours per week, but there are significant out-of-house demands. I have 3-6years of this training to go provided my scores/interviews/LORs and karma get me a desirable spot.

In a long-winded way, what I am saying is that the AMA and doctors in general view the DNP as cheapening what they have earned. Much more importantly is the patient who is told she is seeing a "doctor" when in fact it will be a person with a fraction of the training and expertise. That little lady with the weak and woozies has a differential diagnosis about three pages long. How many can an NP come up with?

It was said above and it bears repeating. "you can't see what you don't know".

On our diff.page two has hyponatremia about halfway down. What are twenty possible causes of this issue? Better still, how do you fix it? This is medicine. It takes a lot of training and absolute dedication.

I didn't appreciate this when giving that blank faced intern the stink-eye. I don't expect you to. What I would hope to convey is that while the NP and DNP (if the AACN must) have a valuable role in healthcare, it is not a physician equivalent and will never be a replacement.

End of Tome

SharonH, RN · Jul 9, 2006

The DNP is being touted as an equivalent to the MD/DO.
This may not be the view of many on this board, but the AACN's position paraphrased reads "equivalent to the entry level degree of MD".

Oh you are not even in the ballpark. That is not the AACN's position paraphrased or anything else. You need to go back and reread it:

http://www.aacn.nche.edu/DNP/DNPPositionStatement.htm

You have objections, fine, I'm not completely on board myself but at least make sure you are working with the facts.

fuegorama · Jul 9, 2006

Yeah you're right. I won't paraphrase. I'll just quote.

"The first ND program was established as an entry-level practice doctorate analogous to the MD and did not provide specialty preparation."

Out of context? Yep. Is the spirit the same? Yep.

Nowhere in this position statement is the true description of this degree which is preparation as a midlevel clinician. Read-not the practice equivalent of the MD/DO.

This is one of my big issues with the proposal. Nursing must acknowledge the deficits and limitations in its advanced practice training if it desires any kind of supportive or "collaborative" effort with physicians.

Given the myopic focus of the AACN, I doubt this is desired. The mentality seems to be "if we can create this costume shouldn't we wear it?" Just remember it is a costume. You are not that character. You may look like wonder woman. You may even have a cool golden lasso, but you do not have those powers.

Now where is that invisible jet I was promised?

Nodean · Jul 10, 2006

If you are practicing as a masters level FNP or currently in graduate school wouldn't that exempt you from further educational requirements (grandfathered in).