HELP DNP vs FNP

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Can anyone explain the advantages of going ahead and getting my DNP? What can I do clinically with a DNP and not with a FNP? Pay differences? Open my own clinic?

THANKS

My objections largely come from what I believe to be a deficient NP education on all levels when compared to PAs and MDs. This is compounded by the increasing numbers of people, especially those with no nursing background, who are now being pushed through NP schools both on the masters and doctorate level. If I felt this tract produced superior clinicians I would be supportive but I do not. I'm guessing the old outcome studies we are so fond of will not hold up over the next decade.

Since I have concerns about the quality of NP education in general it is increasingly concerning that the latest trend is to have more nurses educated on a doctorate level without an increase in our true clinical acumen for those who are becoming NPs. I feel the medical model is superior and think all the additional nursing fluff makes us look silly to physicians and physicians are the standard I strive to emulate in my practice. I do not believe the DNP is a superior preparation for a clinician, not that it isn't valuable on other levels, but in my experience we need more NPs who are more skilled with regard to diagnosing and prescribing. If we truly had something comparable to the MD I'd be all over calling us Dr but until then I'm not a fan. It will be interesting to see the comparisons of Masters vs. DNP outcomes.

I respectfully, but 100% disagree with you on most of your points. If you think the MD/PA model is superior, then someone needs to go that route. I do not desire to be a physician.

Increased clinical hours and taking tests doesn't make you an expert clinician. If you think physician residency programs don't push people through that shouldn't practice, I can tell you now that I have seen it more times than I can count. They are very reluctant to reject a resident out of a program just like the medical profession revokes the licenses of physicians of fewer than 150 a year NATIONALLY.

While I agree the program are not standardized and there are many substandard programs, it all boils down to how much work are you willing to put into your own education? How far are you willing to compromise on a program? If you want to go to the for-profit school that only requires a BSN and a check, then those graduates shouldn't complain that they can't find a job.

PA's and MD's doesn't know what it is like to spend 12 hours with a patient. They write orders, but they have no idea of what steps it takes to get from Point A to Point B...they just know the end result they are looking for and order more things. That doesn't appeal to me in the least.

You are very incorrect that the DNP program does not increase expertise..just like anything else it depends on where you go. The three programs that I am looking at now all have a clinical component. Approximately 1000 hours on average.

If the PA system is so superior, then why in most states must they still be supervised by a physician and NP's in many states can engage in independent practice?

The PA program requires more hours because you don't have to have any prior medical education, training, or experience. You are trying to cram all of that plus diagnostics in three years. Their last 1 1/2 years is purely spent in clinical hours. You would be shocked at how often that includes just sitting around watching the attending.

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Specializes in Family Nurse Practitioner.
While I agree the program are not standardized and there are many substandard programs, it all boils down to how much work are you willing to put into your own education? How far are you willing to compromise on a program? If you want to go to the for-profit school that only requires a BSN and a check, then those graduates shouldn't complain that they can't find a job.

PA's and MD's doesn't know what it is like to spend 12 hours with a patient. They write orders, but they have no idea of what steps it takes to get from Point A to Point B...they just know the end result they are looking for and order more things. That doesn't appeal to me in the least.

You are very incorrect that the DNP program does not increase expertise..just like anything else it depends on where you go. The three programs that I am looking at now all have a clinical component. Approximately 1000 hours on average.

If the PA system is so superior, then why in most states must they still be supervised by a physician and NP's in many states can engage in independent practice?

The PA program requires more hours because you don't have to have any prior medical education, training, or experience. You are trying to cram all of that plus diagnostics in three years. Their last 1 1/2 years is purely spent in clinical hours. You would be shocked at how often that includes just sitting around watching the attending.

You can disagree with my opinion and insinuate that I should have gone to medical school but that doesn't negate my points that APRN programs are inconsistent and if the number of graduates increase as predicted the outcomes will likely become less favorable for NPs. I'm probably not "very incorrect" that the DNP doesn't increase skills if as you mention it is dependent on the schools. That PA students need more clinical hours due to no previous medical experience or spending 12 hours with a patient is an exceptional experience unique to APRNs especially in light of the number of direct entry NP programs that don't require any nursing experience at all really doesn't pan out.

Maybe it is just the schools I am familiar with but the DNP "clinical component" hours were actually spent working on the capstone project and frankly I have been subjected to a dozen of them from 2 different schools and none were especially advanced or earth shattering. Again for a APRN who will be prescribing I'd continue to assert there is a need for more pharm related hours.

OT but I love your name. :)

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Elkpark these are clinical specialists using their title in clinical settings. Please read my post more closely before attempting o correct me. The DNP is not currently viewed as this by many, hence what I said previously.

wtbcrna a very well written post and I think it highlights the disorganization within the profession. My concern, and the concerns of many I speak with who look down on the DNP, is that it seems to only exist to put money into the pockets of schools. It qualifies the holder for virtually nothing that an MSN doesn't already qualify the holder for, and can be earned in shady, disreputable online schools. Would you have surgery performed by someone who earned his or her degree online? Why on earth does a nurse holding an MSN need two extra years to earn a DNP, but three-year bridge BSN-DNP programs exist? Can anyone be expected to take that seriously?Dramatics aside, it breeds disrespect for the DNP as a clinical degree, as a doctoral degree, and for the profession as a whole. If the educational process involved in earning the degree can be standardized at the highest levels and clearly defined (you need look no further than these forums to understand that even many nurses have no idea what the DNP is or what is meant to be) then it stands to further our profession greatly. The critics, like myself, need to see that happen before jumping on the bandwagon and being sniggered at by the rest of the medical field.

Elkpark has a tremendous amount of experience and was right in correcting you because you needed to be corrected.

Do not say that "most" nurses do not know what a DNP entails because that isn't true. It's been around long enough to where most nurses know what it is, it's physicians that are not familiar. MSN/DNP/PhD nurses only make up 3% of the nursing profession.

You are very incorrect that it doesn't qualify you for anything that the MSN doesn't qualify you for as it depends, does the job you are applying for require it? Have you ever looked for jobs that required a doctorate? I am wagering you have not. Most say, "earned doctorate", they do not specify PhD or DNP, however, if you were working for a college or university, a PhD may qualify you for a tenure track while a DNP will not.

Before you jump up and down and try to say, "Ah ha! Even the universities think it's inferior or else they would consider them the same!"

Not so fast.

Do you even know what the difference is? PhD have high levels of education in RESEARCH. Guess what brings money INTO a university? Research grants. Who is the best qualified to write for those grants and get approval? The PhD.

The whole PURPOSE of the DNP is for nurses desiring advanced education in the area of nursing PRACTICE not RESEARCH. If you think there isn't any difference between the MSN and a DNP advanced practice nurse, would you claim there is no difference between an ADN and a BSN-prepared RN? After all, they are doing the same job. Most hospitals don't pay any more for it.

I felt like I was far more well-rounded after I finished my BSN in a RN-BSN program. I am currently applying for a post-masters program and I went back and looked at my admissions essay that I wrote for my MSN program that I just finished and I was shocked I got accepted I thought the writing was so bad. You don't realize you improve that much but the truth of the matter, it happens so gradually sometimes you don't even realize how much you have grown as a student until you go back and review work you have previously done.

The reason that a DNP program takes two years and three year BSN-DNP programs exist is because the university either designs the MSN to complement the DNP or it doesn't.

You have to understand that you have nurses that have finished a MSN 20 years ago going back for a DNP. The BSN to dnp programs are designed to include all of the critical components had you completed the degrees separately and these programs are more recently designed.

The top nursing programs in the country are offering the DNP.

With change comes education and that starts with our profession. This is a forum where people can come to ask questions and many start here and then continue research elsewhere because it provides more immediate answers from those that have "been there, done that" and are in various stages of their careers, in management, administration, education, advanced practice, etc. You get a cross-section of opinions, some good, some bad, but all still valuable.

As long as we have people like you in the profession that think nothing of openly bashing any advancements because those advancements are newer and still evolving, I'm shocked that we are not all still wearing white and getting cups of coffee for physicians. I for one plan to be part of the solution, rather than being part of the problem.

It takes very little effort to complain but it takes a visionary to be part of the change and a desire to move forward. That my dear, is how our profession progresses.

If you have an issue with the DNP programs, then I suggest you start writing letters to the organizations that accredit them. I am sure they would love to hear from you.

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To jlmPMHNPstudent, RN,

You seem to have very strong opinions about DNPs and online educationalprograms. Do you have any evidence to back up your claims? Also, your profile indicates that you have 1 year of RN experience. Your user name indicates thatyou are a psych NP student. I would be interested in knowing what sort of NP grad program accepts an RN, without a BSN, into a grad program. Are you also unhappy with the standards of your own school too? Maybe you are just an aspiring psych NP. What experience could you possibly have to judge the merits of NP programs? Please present some sound evidence to back up your bold claims.They actually teach you how to do this, as well as critical thinking skills, in grad school, mainly in those fluff courses”.

First off, the public is protected from unqualified providers through state law. The states require that NPs pass a National certification test for licensure along with completing an approved educational program that is ‘Nationally accredited' as well as a given number of clinical practice hours with approved preceptors (among other requirements). Who accredits these programs? The CCNE (a branch ofthe AACN) and the Department of Education. The accreditation process is no small feat. You can find the basic highlights by following the link to the following document.

http://www.aacn.nche.edu/ccne-accreditation/Standards-Amended-2013.pdf

The format that the education is delivered has little merit as long as it meets thestringent criteria needed for accreditation. And after all, this is the 21stcentury. We need to be innovative in the way we educate the new generation.Informatics is where it's at. Online education is here to stay, like it or not,and it is proven to be effective. What difference does it make if you listen tolectures online verses wasting precious time driving across town then lugging a back pack into a crowded lecture room and listening to a lecture next to some annoying dude crunching on potato chips? I am an adult learner and take responsibility and initiative in my own learning. I don't need someone to take roll call.

In my program, one of those substandard BSN-DNP online programs, we spend 8 weeks ona beautiful brick and mortar” campus suturing, reading x-rays, doing biopsies, doing check off skills on assessments and protocols, doing live competency exams, listening to lectures in person, engaging in group activities, and delivering tons of presentations so that we can demonstrate we have mastery of the material. We are also required to complete well above the minimum requirements with qualified preceptors in our community learning our trade. This is where the real bread and butter comes in in my opinion. These preceptors also get to decide if your skills are up to snuff. We have a great student-faculty ratio (1 faculty: 2 students), so we get lots of individual attention. Yes it is expensive, but these are the qualities I am paying for.The director of our program is the founder of the American Association of Nurse Practitioners. I would love to hear you debate her with your opinions of the merits of online education.

I agree that the DNP is misunderstood, until one actually does the research. There has been some unfortunate rumor started that DNPs are bred to be equal to MDs. That could not be further from the truth. The DNP is a practice doctorate, just as the MD, the dentist, the attorney, and others are. This is opposed to the research doctorate or PhD. PhDs generate new knowledge whereas practice doctorates implement that new knowledge into practice and into systems. Until the DNP, no one is at the top of the food chain doing this for nursing because the PhDs are tied up generating the new knowledge. The DNP education focuses on elements that are very well described by the AACN's essentials. The elements are very consistent. The schools design their programs to meet the essentials. This document prescribes the minimal educational requirements for all levels of nursing education.

American Association of Colleges of Nursing | CCNE Standards & Professional Nursing Guidelines

There is sound reasoning behind the DNP. The educational requirements are being raised for all levels of nursing education and this is driven by the IOM and NIH as well as a slew of other National healthcare organizations. Nursing has not been well represented at the decision making table. The DNP was designed to prepare nurses to sit at the table of these decision makers and stakeholders and design the policies that affect nurses and the quality of patient care delivered.

The DNP education does vary somewhat in relation to the specialty chosen. For example, ANP, GNP,FNP, PNP, MSN ed, CNS….etc. Maybe that's why people think the requirements are inconsistent. However, the essentials of the DNP portion are consistent.

I find it hard to believe that so many nurses are belittling the efforts of those trying to improve the profession and give nursing a stronger voice and better representation. This is where all those fluffcourses” come in handy (economics, roles, epidemiology, leadership,organizational and management courses, quality and safety, lots of research andresearch translation, EBP, healthcare policy and law, informatics, and advancedbiostatistics …among others.). I can assure you, there is nothing fluffy”about these courses. For those of you that want a more in depth medical education, go to medical school! Or take continuing ed and attend conferences and workshops.

I would like to stress that the NPs with a master's degree are not given ample credit and titling for the master's degree on steroids” they have achieved. They are well on their way to having a doctorate and are not being recognized for it. The DNP provides a way for those that want to go a little farther to achieve the recognition they deserve. It does not mean they are substandard to the DNP anymore than an ADN/diploma is substandard to the BSN in the role that they play. The DNP just expands the role to include more skills that can affect healthcare onthe macro level.

Nurses everywhere, patients, and even conditions for the opposing MDs will benefit from what DNPs are trained to do, despite all the criticism. It is so comforting to know that we have so much support from our nursing colleagues as we aim to support them in their causes ( sarcastic smirk :-/). What a way to bite the hand that feeds you! No one is forcing anyone to get their DNP. Please don't thwart the efforts of those that want to improve healthcare delivery in America on a higher level and advocate for nursing!

As for all you eyerollers”, you are entitled to your opinions. Unfortunately for you, the only vote you're going to get in this matter is the eye rolling until you go out and advance your education so that you can sit at the table with the decision makers. If you want to change what you are unhappy about this is the productive and effective way of going about it. Get the higher education, then you can get a job with the accrediting bodies and decide what schools live up to the standards. And, you could also influence the policies that direct who can be addressed as doctors”.

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I agree! Also the BSN-DNP is 90+ credit hours. Not everyone can get it done in three years.

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Specializes in Internal Medicine.

@Nurse2Long

Great post. One of the things that drives me crazy on these forums is when people belittle the education of others simply based on their perception of it being inferior, with no actual facts to back them up. As far as I know, there is absolutely no research that indicates a decline in the clinical ability of the profession with the advent of on-online for profit education. With states debating all the time to increase scope of practice, and medical lobbies fighting it, you would think the well funded medical lobby would have produced something meaningful by now. Especially with all the generalized backlash towards for profit schools coming from as high up as Congress.

In terms of the DNP, I think the biggest push back you are seeing right now is from current NP's and prospective NP's not seeing any value to the degree. Even at some of the cheapest state online schools, you're looking at $15k for a degree that does nothing to expand your scope of practice, and unless with the government, does nothing to improve your pay. Most individual practices and hospital practices could care less. There is also nothing out there that shows a DNP prepared NP provides statistically significant better quality of care versus an MSN prepared NP. Basically, the cost of the DNP doesn't justify the end result.

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Specializes in Family Nurse Practitioner.

In terms of the DNP, I think the biggest push back you are seeing right now is from current NP's and prospective NP's not seeing any value to the degree. Even at some of the cheapest state online schools, you're looking at $15k for a degree that does nothing to expand your scope of practice, and unless with the government, does nothing to improve your pay. Most individual practices and hospital practices could care less. There is also nothing out there that shows a DNP prepared NP provides statistically significant better quality of care versus an MSN prepared NP. Basically, the cost of the DNP doesn't justify the end result.

This are exactly the problems I have with the DNP for NPs. If it increased our clinical expertise I would be all over it. It doesn't.

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Specializes in Internal Medicine, Geriatric Medicine.
This are exactly the problems I have with the DNP for NPs. If it increased our clinical expertise I would be all over it. It doesn't.

Not only did I increase my clinical expertise, but also my ability to deal with caregivers of people with dementia and other chronic conditions. And in the end, yes, it made a difference: I just took a job where they gave me actual compensation for the DNP.

Oh, and it won't be working with the government....

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Specializes in Internal Medicine.
Not only did I increase my clinical expertise, but also my ability to deal with caregivers of people with dementia and other chronic conditions. And in the end, yes, it made a difference: I just took a job where they gave me actual compensation for the DNP.

Oh, and it won't be working with the government....

I don't doubt that your grew as a provider, but as I said before, there isn't a shred of proof that the DNP creates clinically superior providers to their MSN peers. If one day we come to learn that the DNP does exactly that, then it will probably be worth it.

Right now, all it's doing is hamstringing one of the best things about being an NP. One of our biggest advantages is that we cost less to education and enter the market at a much faster rate than our MD peers, all while still matching them in quality. All the DNP is doing is setting nurses back tens of thousands of dollars and delaying entry to the market, all for a very expensive title. Again, not a shred of proof the DNP makes for better providers.

My guess is your compensation for the DNP isn't enough to cover the outright cost. The hospital a close friend works at where he is contracted under a large national provider group pays an extra $1000 a year for having a DNP versus being an MSN/NP. The competing local hospitals give $1500 extra per year. If you have it, it's a nice bonus, but even in government tiered jobs, the degree is too expensive for the returns.

My local state university offers an MSN-DNP online program, where without buying books or paying for any supplies, the cost of the degree is $19,565. That's on par with what my MSN cost yet it's not going to come with anywhere near the pay raise my BSN->MSN cost.

When the degree offers clinical superiority and expanded clinical practice, that is when it will be worth it.

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Specializes in Anesthesia.

American Association of Colleges of Nursing | Frequently Asked Questions. There is research that shows nurses with higher education do have better outcomes.

We also know that nurses are severely lacking in bringing research into practice or having nurses that are doctoral prepared compared to many of our colleagues.

It is interesting to note one the biggest naysayers for the DNP our nurses themselves.

The simple fact is if you don't want to get a DNP then don't get it. It will likely be decades,if ever, that the DNP will be a national or state requirement to practice for already certified APNs.

The DNP isn't just about getting more clinical hours. You can do that on your own with additional certifications, your work, and/or volunteering.

The DNP is there to develop skills an APN can use throughout their career not just clinical knowledge that will mostly be out of date in a decade.

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Specializes in Internal Medicine.

Again, there isn't a shred of proof indicating a DNP equates into clinical superiority versus NP.

The DNP is a response to other parallel fields like PT and Pharmacy incorporating the Doctoral degree. And also arguably a way to go the state legislatures when wanting greater autonomy and saying "hey look we have doctorates too".

I actually plan on getting a DNP for the sake of having a terminal degree, and think it's fine to have one. I just disagree that it should be a requirement for entry into the field when again, there's no proof DNPs are providing better care.

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