Is there a CLINICAL DNP?

[PG2018]

I've been in conversation lately regarding the DNP, and I've read the position papers published by the AACN, et al. However, I do not believe they typical curricula are of merit. With the purpose of achieving "parity" amongst physicians (which will never happen), pharmacists, physical therapists, and others I don't understand how courses in research translation and application fit that purpose.

If we examine the curricula of any university's medical school, pharmacy school, and physical therapy (DPT) program we'll see that the years are filled with courses of a scientific nature and clinical training. I've never believed that RN prereqs and experience as a RN are a substitute for provider education, yet we accept that as such and take only a few "-ologies" while in NP academic preparation.

Having said that, is there such an animal as a CLINICAL doctorate for nurses? Not a PhD. Not a DNP focusing on research and policy. Not an EdD focusing on adult instruction. But rather a clinically-oriented doctorate.

I realize no NP's scope of practice or reimbursement will change due to an earned doctorate, but I think this encourages dialogue and fact sharing. I would likely enroll in a doctoral program if I could find one that offers instruction in something I want to know.

[anh06005, MSN, APRN, NP]

I am enhancing my education whether I get credit for it or not. I just wish there were other classes to take to show others that I am bettering myself as a clinician in better understanding the disease processes and medications I am prescribing. I do look up things I do not understand. I do have plenty of "a-ha" moments where stuff finally clicks.

As a PP said I wish I had more x-ray experience. More 12-lead EKG experience (I can interpret a rhythm with the best of them but some of the subtle things you pick up on 12-leads I have no idea about). I know some of this will come with time and further studying on my own but I wish I could have more formal training. Perhaps more time to spend with ortho doing joint injections? With general surgery doing minor office procedures (since the clinics I was in for school didn't do these things often).

Basically I've ranted to try to say that I didn't ONLY mean I wanted to "get credit for" furthering my knowledge. I'd love the experience of formal education as well (and yes I have done a few things on Coursera also).

Not all of us agree about all of this but I know there are more than a few of us who would love an experience like it!

[anh06005, MSN, APRN, NP]

There are many different careers that carry the title Dr. This does not mean they need to think like a medical doctor. The same with nursing. The DNP is a Doctor of Nursing Practice, not a Dr of Medical Practice. We have too many providers now all prescription happy and focused on pharmacology and disease management. The role of nursing is geared more toward wellness, prevention and healing - not curing.

That's the difference. We need less science and more spirit. We need less chemicals and more caring and nurturing. The future of nursing lies in our ability to see the difference between curing and healing, and focus on the most optimum outcome for the patient. And sometimes - more often than not - that involves less med management and fewer diagnostic studies. The future of nursing will only change when we have the courage to claim our place in the healthcare profession as total care providers, body mind and soul. The very foundation it was built upon.

I'm sorry but I think most APRN set themselves up for frustration when they continue to beat the same drum of competing with a medical doctor or a PA. We are not the same.

And if you haven't grasped that this far into your education, then maybe perhaps your the one that is "doing it wrong".

This is exactly what I love about nursing. As a nurse I understand more about patients and what they deal with. As a previous home health nurse I completely understand what they may be dealing with at home. BUT given that APRN's often work in the same capacity as physicians I would hope we could have some extra scientific knowledge as they do. I still want to focus on the whole being of my patients. I still want to take that extra time to explain to them how a medicine works, what it's for, and how they can best manage their diseases on their own.

When a patient with colon cancer, on chemo, and renal impairment comes in with a complaint it's better to understand what all is going on SCIENTIFICALLY so I can provide the best care I can.

I do not want to stray from nursing and what nursing is about. I enjoy science, though, and loved that nurses were more compassionate which is why I became one. I don't think this takes away from the fact that to properly diagnose and treat having a better scientific background would likely help us all understand what is going on with the patient and how to care for them to the best of our abilities.

[Jules A, MSN]

What if that's not the goal? (Who said it is the goal?) Again, is there some evidence that the current generations of advanced practice nurses (excluding the occasional, individual "bad apple" to be found in any profession) are providing substandard, inferior, unsafe care, that would justify the need to dramatically revamp advanced practice education in nursing?

While I will happily agree that there are too many low-quality graduate programs "out there" in nursing, the diploma mills that have sprung up like mushrooms after a spring rain, and would love to see a much smaller number of programs that were all of good quality (and I feel the same way about prelicensure nursing programs, for that matter -- far too many of them, and far too many poor quality programs), IMO, that is a different discussion than completely reworking the basic educational model.

There is always going to be "more" to know. I know any number of physicians, experts in their field, who feel frustrated about how much more there is to know, and how much better a job they could do if only they knew everything. But it ain't going to happen. People who feel they want/need further knowledge and education are free and welcome to seek that out. But there is always a tension between "nice to know" and "need to know." As with prelicensure nursing programs, the goal of the advanced practice educational program is to get you "in the door" and started practicing (at a novice, entry level), not to turn out a finished, perfect mature clinician. It is the responsibility of each individual nurse to continue to grow and develop professionally throughout our careers.

I agree with most of what you are saying, really I do, and most of my complaints are geared strictly toward NPs and what I think would be a positive addition to the curriculum. As NPs, we are being thrust into being the PCP or in my case the attending and the need to be heavier in medicine and lighter in brow wiping would be an excellent DNP tract imo.

Edited to add: I forgot to answer your initial question it is my goal to be on par with MDs and the OP said we are aiming for parity with MDs, lol. :)

[Jules A, MSN]

I do not want to stray from nursing and what nursing is about. I enjoy science, though, and loved that nurses were more compassionate which is why I became one. I don't think this takes away from the fact that to properly diagnose and treat having a better scientific background would likely help us all understand what is going on with the patient and how to care for them to the best of our abilities.

Very well said and I also value considering the entire person in a holistic manner however my main focus based on the job I was hired to do is to be a safe, skilled prescriber. I feel it is worthwhile to be able to function to the standards of a MD and require an excellent income in the process.

Unfortunately rather than appreciate my efforts to support our profession it seems easy for others to become self-righteous, call me a pill pusher and insist that I must be selling out for the almighty dollar. It is counterproductive.

[PG2018]

If you think the diagnosis and treatment of illness is all memorization then you're not doing it right. There are countless giants in business. I'm quite the opposite of you. I don't see why a course or degree is necessary to integrate new research into practice trends. Having said that, what about integrating research is holistic?

I realized I didn't finish my thought.

There are countless giants in business who lack business preparation. Having said that, I don't think the practitioner needs such prep work, through DNP or otherwise, in order to run an efficient, prosperous practice. So again the DNP lacks useful substance.

This is actually a fairly recent find for me and one of my favorite new sites:

Modern Medicine | Medical Articles | Journal Database | Medical Economics

[PG2018]

I disagree. Name an APRN who is hired to provide "caring and nurturing." Rather, we're hired to cycle through as many patients an hour as is reimbursable, provide quality outcomes, order studies and prescribe chemicals.

There are many different careers that carry the title Dr. This does not mean they need to think like a medical doctor. The same with nursing. The DNP is a Doctor of Nursing Practice, not a Dr of Medical Practice. We have too many providers now all prescription happy and focused on pharmacology and disease management. The role of nursing is geared more toward wellness, prevention and healing - not curing.

That's the difference. We need less science and more spirit. We need less chemicals and more caring and nurturing. The future of nursing lies in our ability to see the difference between curing and healing, and focus on the most optimum outcome for the patient. And sometimes - more often than not - that involves less med management and fewer diagnostic studies. The future of nursing will only change when we have the courage to claim our place in the healthcare profession as total care providers, body mind and soul. The very foundation it was built upon.

I'm sorry but I think most APRN set themselves up for frustration when they continue to beat the same drum of competing with a medical doctor or a PA. We are not the same.

And if you haven't grasped that this far into your education, then maybe perhaps your the one that is "doing it wrong".

[PG2018]

We're aware of what the current training model is for. Instead, many of us are insisting that we providers (later generations) receive more, entry level training. I really don't care about the title of doctor, and I couldn't care less if the janitor has a PhD in industrial hygiene and presents himself to patients as "doctor" or if the receptionist has a DBA and also introduces herself as "doctor" or the phlebotomist has a doctorate in cytotechnology. I'm questioning, originally, if a clinical doctorate exists for nurses, and no the DNP is not that as I understand it.

Basically, I made this thread asking if anyone knew of a DNP with clinical coursework, i.e. the stuff that trains clinicians to do the jobs for which patients come and see us. The DNP is "practice focused" as many say, yet it exists to translate research into policy to be made a practice pattern. EVERY provider hits the books, journals, websites, and/or apps to find the latest nugget that will help solve the most recent problem...or to learn that something extra that he realizes he or she does not know. We will continue to do that, doctorate or not, and that will enhance our practice. It is, however, quite efficient to have subject matter experts present "need to know" material in distilled fashion, i.e. class. For example, I would love to have had some courses in neuroscience and neurology. Instead they were tucked away in other subjects at the expense of breadth.

ETA: The political entities that push nursing tout the DNP as a method of adding parity to other doctoral-prepared health professions. I don't believe our present DNP does that - at all. I know we, as APRNs, will likely never achieve parity with physicians because we lack the scientist-clinician education, and we lack mandatory residency training. I'm ok with a degree of this because there would be no point in having midlevels, and I am a midlevel provider providing total psychiatric care. I have a collaborating physician but do not turn to the phone every time I am stumped. Having said that, I merely implore nursedom to throw us dogs a bone and give the students that follow the enhanced scientist-clinician training, and increased training hours, they will need to do the job in an ever evolving healthcare system. Psychiatry, for example, will some day become an interventional field, and present research is revolving around brain imaging and no longer trimonoamine hypotheses. This means in coming decades we'll likely diagnose differently and treat differently. Yes, in-service and CME will teach us how to do this, but for the love of Pete it'd be really nice if every PMHNP left school knowing brain parts and basics of imaging likewise understand both the physiology and pathophysiology to be able to interpret all of the labs we draw. I see a lot of APRNs look at a CBC and not have a clue what any of the differentials mean. Instead, they generally fall on WBC, Plt, RBC, and for some the H&H. As an example I was taught what anemia was in the undergraduate level, and despite taking the same assessment and patho courses at the graduate level, I was never taught the diagnostic criteria of anemia. In MSN studies, I never had any focus, even in patho, on brain function or what simple parts were. Who knows what a hippocampus is? I had to learn it myself, and it's not as if I went to a fly by night school. I received my master's from a top university medical center.

What if that's not the goal? (Who said it is the goal?) Again, is there some evidence that the current generations of advanced practice nurses (excluding the occasional, individual "bad apple" to be found in any profession) are providing substandard, inferior, unsafe care, that would justify the need to dramatically revamp advanced practice education in nursing?

While I will happily agree that there are too many low-quality graduate programs "out there" in nursing, the diploma mills that have sprung up like mushrooms after a spring rain, and would love to see a much smaller number of programs that were all of good quality (and I feel the same way about prelicensure nursing programs, for that matter -- far too many of them, and far too many poor quality programs), IMO, that is a different discussion than completely reworking the basic educational model.

There is always going to be "more" to know. I know any number of physicians, experts in their field, who feel frustrated about how much more there is to know, and how much better a job they could do if only they knew everything. But it ain't going to happen. People who feel they want/need further knowledge and education are free and welcome to seek that out. But there is always a tension between "nice to know" and "need to know." As with prelicensure nursing programs, the goal of the advanced practice educational program is to get you "in the door" and started practicing (at a novice, entry level), not to turn out a finished, perfect mature clinician. It is the responsibility of each individual nurse to continue to grow and develop professionally throughout our careers.

[PG2018]

Mine too. There is no excuse for us to not know despite our limited training.

Edited to add: I forgot to answer your initial question it is my goal to be on par with MDs and the OP said we are aiming for parity with MDs, lol. :)

[Angeljho, MSN, NP]

PsychGuy, I get what you're asking but as another poster answered, the DNP is the terminal degree for nursing clinical practice. There is no other terminal practice based degree that offers what you're asking because it would NOT be nursing. Think about it, if the courses that many consider "fluff" were removed and more scientific-based courses were added, what would be the difference between medicine and nursing? I do agree that more scientific-based courses make a more competent provider, but there's a reason why people say APRNs practice advanced nursing and PAs/MDs practice medicine.

Anyways, I was just giving you my understanding of it. I do agree with you and feel that the nursing educational model needs to change. I am entering PMHNP school, and I'm expecting to know neurophysiology to the "T." I see a lot of APRNs on here who have complained that they did not feel prepared upon completion of school. I did not know it was to the extent of not knowing what hippocampus is.

[PG2018]

I understand what you're saying. I think DNP is largely a purposeless degree. I've read the position paper on the purpose of the DNP, and it stipulates such a course of study. Again, I only wondered if anyone knew of a program that includes some extra -ologies along with the hugs and fluff. Thanks for the input.

PsychGuy, I get what you're asking but as another poster answered, the DNP is the terminal degree for nursing clinical practice. There is no other terminal practice based degree that offers what you're asking because it would NOT be nursing. Think about it, if the courses that many consider "fluff" were removed and more scientific-based courses were added, what would be the difference between medicine and nursing? I do agree that more scientific-based courses make a more competent provider, but there's a reason why people say APRNs practice advanced nursing and PAs/MDs practice medicine.

Anyways, I was just giving you my understanding of it. I do agree with you and feel that the nursing educational model needs to change. I am entering PMHNP school, and I'm expecting to know neurophysiology to the "T." I see a lot of APRNs on here who have complained that they did not feel prepared upon completion of school. I did not know it was to the extent of not knowing what hippocampus is.

[sadiemae1123]

I think the problem with wanting all the in depth "ology" classes is that it compartmentalizations the knowledge. This is what is done in medical school. But they then have 3 to 5 years of residency to synthesize the knowledge into a cohesive whole that presents the entire patient's medical picture.

NPs, even by prolonging the education into a DNP, don't have that much time for study. You get the three Ps and then, if your program is like mine, have additional coursework in tandem with your clinicals in order to pull that information together to form a diagnosis and treatment plan for the patient.

If you really want to learn more truly in depth knowledge in the sciences then I think a PhD is your best bet. Learning X-rays and EKGs is really a matter of time and taking every extra learning opportunity available. You can learn the basics in the classroom, but I don't think anyone will become a great expert simply by spending more time in the classroom.

The purpose of the DNP is to add to the clinical and didactic content of the MSN by teaching how to read and incorporate research into practice. Something all providers struggle with, since clinical practice routinely lags years behind what research shows to be best practice.

The DNP also gives credit for the work nurses were already doing in the MSN programs. My understanding is that most MSN programs require far more work than a Masters in any other field of study requires. I think this is another reason why there is not a bigger difference in the DNP and MSN programs.

[PG2018]

My MSN was 44 semester hours. Most run from 30-36 in the academic fields; history, English, biology, etc. I just wish the MSN program had devoted more time to the essence of what advanced practice is, i.e. filling the gaps left by physician shortages. Like it or not, that's why PAs and NPs exist, and for that purpose we must be competently educated to do a good job that will become increasingly technological. I do not need a course in advanced community health, nursing theory, or research utilization to become a PMHNP Rather, I needed training in neurobiology, psychopathology, and psychopharmacology, and I got a lite version of that. That level of education is fine for uncomplicated cases, but when comorbid conditions come in, say a demented schizophrenic with TD, Cushing's and ESRD, then the MSN/PMHNP preparation is mostly inadequate.