I don't understand bsn to dnp programs

Jules A, MSN · May 19, 2017

Kudos for being so thoughtful. I have seen many posts where the person is actually enrolled before they even realize what the curriculum entails, future positions they will be eligible for or expected wages...shaking my head.

If you are interested in the medical model pursue PA school. Just my opinion and one that is not shared by all but at this time nursing is overrun with nursing fluff classes, holistic blather supporting this is our special attribute and absolutely no requirements for actual nursing experience before 500 clinical hours gives the ability to prescribe medication. The numbers of NP is expected to flood the market in upcoming years and historically NPs are lousy at negotiating and I'd guarantee the rates will plummet due to both of these factors. I'm hoping things change with our education but suspect the barn door is already open.

https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-national-projections2013-2025.pdf

This thread discussed some of the issues of direct entry programs.

https://allnurses.com/nurse-practitioners-np/brave-or-just-1100340.html

direw0lf, BSN · May 19, 2017

Thank you, Jules A for your reply and providing the 2 resources for more information.

That is the issue, that I do like the nursing model. Nursing classes were a challenge for me at first, different from the science classes I took before, but I feel like I have a good understanding of the nursing model and critical thinking involved. But I would sacrifice that for PA to have a better education, if I can't safely practice as an NP because they expect you to learn as an RN first then just give you lots of what you called fluff!

When I asked my teachers, or in clinical I asked a PA also, what is the difference between PA and NP, the #1 answer was "NP's have more autonomy, PA's are under a physician always." That sounded great, that as an NP I could chose to be under a physician or not (depending on the state laws), but now I'm finding out the real differences, I don't think I'll be prepared in a BSN to DNP program, even while working as an RN while in school.

I'm still reading through that thread though! Thanks again.

llg, PhD, RN · May 19, 2017

Schools are not identical. They target different types of students and prepare them for different types of jobs. This is particularly true at the graduate level (and that is not just true in nursing ... That's the way education is in all fields at the graduate level.)

So ... you need to do your research and decide which best fits your educational needs and preferences. You seem to be doing that and I commend you for that.

Most DNP programs include graduate level courses in physical assessment, physiology and pharmacology. Those courses are supposed to provide all of the students (regardless of specialty) a foundation of knowledge upon which to build expertise through clinical practice and other educational strategies (self-study, continuing education, etc.) It's not like undergrad, in which all of the content is presented to the student in a classroom. It's common in graduate school for the students to "go and get" the information/knowledge related to their specific interests rather than to "be given" that knowledge.

Taking a quick glance at the Univ. of South Florida website ... I see that they do this. In the BSN-DNP program, those courses are listed under the requirements for the MSN -- but the material on the BSN-DNP program say they are taken as part of that program, too.

Maybe a graduate program in nursing is not for you ... but maybe if you explore the nature of graduate education a little more and look at the curricula of different schools, you will find a program that suits your needs.

Good luck.

pro-student · May 19, 2017

I am really surprised though at the curriculum of many bsn-dnp programs because you can specialize in mental health, but the lectures are more about research, theory, ..and for example USF (university of South fl) or Maryville university, don't have ANY lectures with focus on the speciality, but you are required to have so many clinical hours for that specialty. Those two schools do not require any RN clinical experience before applying (neither does Duke uni, but they don't have a mental health specialty, and I'm sure there's more universities like that )

I'm not sure you're information is accurate. For one, USF does not have a PMHNP program at all. You may also be getting the MSN-DNP and BSN-DNP programs confused. All NP programs must include, at a minimum, Adv. Health Assessment, Adv. Pathophysiology, and Adv. Pharmacology regardless of specialty. In addition, they must also include both didactic (what you're calling lecture) and clinical coursework in the area of specialty. Most PMHNP programs include between 3-5 semesters of courses on advanced practices psychiatric nursing and well as a separate course in psychopharmacology. Maryville's PMHNP program includes a psychopharmacology and mental health assessment course as three semesters of psychiatric diagnosis and management course and clinicals. Post-MSN programs will be more like you are describing since students will already be APNs.

Well my point is that I wanted to discuss with people with experience is how is that possible? I have actually thought about going for a PA instead, because in the PA ciricculum the emphasis IS on patho, disease tx, etc..isn't that what DNP focus should be on too?? Did I miss the boat in understanding that the DNP is to specialize in an area and have certain autonomy, or under a physician, for diagnosing and treatment? But how with no lecture background in your speciality?

If you're interested in the medical model, then PA school is a better option for you. However, PA school will include very little focus on psychiatry and you would likely want to consider doing a fellowship if that is where you want to practice. A PMHNP program will include significantly more content and clinical practice in mental health and will prepare you to do both psychotherapy as well as diagnosis and medication management. Again, any accredited PMHNP program will include both clinical and didactic courses specific to your specialty as well as the three Ps (adv. physical assessment, adv. pharm, and adv. patho).

direw0lf, BSN · May 19, 2017

Thanks llg and Pro_student for your input and comments.

Pro, it's not easy to find info about USF (imo) but I did speak to someone who said there is a PMHNP and I'm visiting the campus in August. This is the only info I could find on their website:

USF Health || College of Nursing | Programs of Study

Maybe my understanding is incorrect.

For Maryville I thought that the classes such as "advanced pathophysiology" (which I am kind of bragging here to say it's the same book I had in my BSN patho class!) or pharmacology were general, to all the specialties. I guess I had expected to see a curriculum more like "Advanced Psych 1, II, III, etc"

I just want to be prepared. Three physicians in my clinical in the last year were very negative about the education NP's are receiving.

llg I'll give a lot of thought about the different approach to education between undergrad and grad levels!

llg, PhD, RN · May 19, 2017

I am certainly not going to defend every nursing school out there. There are some very bad ones.

But physicians rarely have a good understanding of nursing -- and often judge nurses and nursing from a medical perspective rather than a nursing one. In other words, if it doesn't fit with "what a physician would do" ... then it must be bad because everything "not physician" is viewed as inferior.

So gather lots of perspectives and understand them well before choosing a career path for yourself.

pro-student · May 19, 2017

Thanks llg and Pro_student for your input and comments.
Pro, it's not easy to find info about USF (imo) but I did speak to someone who said there is a PMHNP and I'm visiting the campus in August. This is the only info I could find on their website:
USF Health || College of Nursing | Programs of Study
Maybe my understanding is incorrect.
For Maryville I thought that the classes such as "advanced pathophysiology" (which I am kind of bragging here to say it's the same book I had in my BSN patho class!) or pharmacology were general, to all the specialties. I guess I had expected to see a curriculum more like "Advanced Psych 1, II, III, etc"
I just want to be prepared. Three physicians in my clinical in the last year were very negative about the education NP's are receiving.
llg I'll give a lot of thought about the different approach to education between undergrad and grad levels!

The url for USF you posted was for residency programs which would be post-certification and is why some are in areas in which there is no APN certification (e.g. - trauma, dermatology, orthopedics, endocrinology). Here is a link to the specialties they offer for the BSN-DNP program.

BS to DNP - Doctor of Nursing Practice | USF Health

Also, just to make clear, all NP programs will include the 3 Ps (Avd. patho, adv. pharm., and adv. physical assessment) which are often the same or very similar regardless of specialty. They will also include, in addition, generally 3-5 semesters of both "lecture" and clinical in the specific specialty you are enrolled in. So, for instance, Maryville requires you to take the 3Ps plus Psychiatric Diagnosis and Mangagement I, II, and III each with a clinical in addition to Psychopharmacology. Similarly, an AGNP student would take the same 3Ps plus Diagnosis and Management of Adults/Older Adults I, II, and III.

Don't worry too much about physicians bashing NPs, many always have and some always probably will. Most physicians, however, respect us and treat us as professional colleagues for the most part. There is this common argument that NPs can't possibly do the work of physicians because our training much so much more brief. They love to tout the number of hours of training for various providers. Problem with that argument is that it doesn't hold water. Numerous studies across many specialties and settings have shown that NPs provide care that is as good or better than our physicians counterparts. So really all they are doing is pointing out that it took them much more time in training to be able to provide comparable care.

direw0lf, BSN · May 20, 2017

Thank you again! I really appreciate the time you all took to reply and give a little help!

I read this on clinician1.com:

"a good nurse who wants to be an Advanced Practice Clinician should follow the NP role whereas a person without a nursing background [..] should pursue a PA role. Both will eventually lead to graduation, a certificate, a national board, a license and an opportunity to make a difference in health care in these United States. Both professions, with about two years experience actually become the same type of provider although those from a nursing background are known to document a bit more and particularly of the social status of a patient. "

So I guess it boils down to answering the questions for myself, will I have enough nursing experience to be a good NP if I go straight to NP school after graduation? Will my PCA/extern experience and (future) working as a nurse for 2 years (while in grad school) be enough? I know there are nurses with 10 or 20 years experience going to get their NP's..I could never be as good as they are right from the start but I feel like this is natural..a new PA wouldn't have the same competency as one who's worked 20 years.

Editorial Team / Moderator · May 20, 2017

Another thought: PAs are generalists whereas NPs can really specialize in their education. Something to consider. I know a couple of PAs who did a doctoral post-grad program in emergency medicine at Baylor, but they are kind of rare birds (smart birds, though!!).

chacha82, ADN, BSN · May 20, 2017

If you want to specialize in mental health, why not work for a few years as a Psych RN and then evaluate if you want to get your NP or not? Lots of hospital settings, however, do not hire psych NPs...so you may need to look at state hospitals or other facilities. Before you spend the big $$$ and time on the advanced degree, I would make sure you really like Psych nursing first. Best of luck to you!

KatieMI, BSN, MSN, RN · May 20, 2017

1). PAs (just as primary care physicians) may have as little as one rotation (4 to 6 weeks) dedicated to mental health through the whole training period.

2). What is more importantly, the accents of the training are completely different. PMH/NP programs at least make some efforts to dedicate a little more than a semblance of time to integrative therapies, CAM, communications, community service, etc. In PA programs, there is no time for such frivolities, and in primary care residencies, there is even less of it.

3). While all NP programs must include certain courses in advanced pharm, patho, etc., the level of coursework varies wildly. Where I am, most students who care about their knowledge level simply read both "NP program" books (which are not always that bad, although usually 10 times more wordly than they could be) and basic medical school texts. It is brain-breaking load, but it works for the purpose.

4). NP programs, at the baseline, want your $$$$$ and maybe your Board pass, nothing more. The earlier they got you, the better off they will be, therefore they try to get you in as soon as possible. But this is totally up to YOU to research every program, figure out what it taught there and by whom, know your own learning style, etc., to find a program which will benefit you most. Being a Big Name shouldn't be your deal breaker. Quality of education, placement of alumni, Board pass rate, places of clinical placement, research opportunities (if you like research), number of clinical coursework vs. fluff, front-loaded vs. "spread out" and comparative cost of program should be.

5). Asking physicians about level of nursing education is like asking chemists about nuclear physics. It doesn't matter that they all seem to study kind of the same things; it matters that they have little understading about work each of them do, although there is usually WAY more respect between them than between physicians and NPs (or, as a matter of fact, between physicians and anyone else working in medical field in any capacity).

6). While I am a big proponent of early advanced education in nursing, I still think that for specialties it may be different. Accounting for the fact that employment opportunities are much narrower for PMHNPs than for, say, FNPs or even ACNPs, one must be pretty sure that he or she really likes the field before throwing away those $$$$$ for NP school. I do not speak about 20 years; I speak about 6 to 12 months with these patients in any capacity, just to let yourself know that you won't throw temper tantrum or dive into depression if faced with seeing them 5 days a week.

7). You may be, or may be not as good at anyone else, at any point of your career. It depends solely on you and the efforts you put in your education.