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 think there was a thread about DNP programs that were more science-y based and I remember looking through them but for some reason I didn't save them. It had more assessment and patho versus research, epidemiology, nursing theory.

I think we can all agree that there should be more consistency among all of the degrees as each one IS so different from the others.

I've pondered forensics too. I LOVE that stuff.

[Jules A, MSN]

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.

Hint low dose atypical should assist with the first and second, the TD is likely expected at this stage and I would consider it risk vs benefits. Just in case this wasn't only to prove a point, lol.

[sadiemae1123]

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.

PsychGuy,

There is no provider who is qualified to handle a patient with all those issues alone, regardless of their education and training. He would require a multidisciplinary/team approach.

I work in a psych hospital, and such a patient would be seen by the medical staff - which includes myself, another NP, and an internal medicine physician - the psychiatrist, social work, the psychologist, pharmacy, nursing, outside medical specialist referrals, etc. The only reason a psych NP wouldn't be included is because we can't find any willing to work in our area, not because they have nothing to contribute to the team.

[PG2018]

Hint low dose atypical should assist with the first and second, the TD is likely expected at this stage and I would consider it risk vs benefits. Just in case this wasn't only to prove a point, lol.

I know! LOL. Just making the point for all the readers to see the train wrecks we can get. Of course, healthcare in general is replete with such wreckage.

Reminds me. I found an interesting paper a few months ago covering TD treatments recently. Of course, of the many agents studied, most lacked any significant efficacy, but it was interesting nonetheless:

Cloud, L., Zutshi, D., and Factor, S. (2013). Tardive dyskinesia: Therapeutic options for an increasingly common disorder. Neurotherapeutics (2014)11.

[PG2018]

Sadie, that example was for illustrative purposes. Clearly the person is going to need IM or FP and preferably nephrology.

The only real trickery is in teasing out the dementia v. schizophrenia, treating the Cushing's (any first year NP student can do that), and proper renal dosing which can require a little more study and trial and error.

ETA: Here are 3 links from my "otherwise cool stuff" folder of favorites:

Psychiatric issues in renal failure and dialysis

End-Stage Renal Disease: Symptom Management and Advance Care Planning - American Family Physician

AFP is one of my favorite journals.

Medscape: Medscape Access

PsychGuy,

There is no provider who is qualified to handle a patient with all those issues alone, regardless of their education and training. He would require a multidisciplinary/team approach.

I work in a psych hospital, and such a patient would be seen by the medical staff - which includes myself, another NP, and an internal medicine physician - the psychiatrist, social work, the psychologist, pharmacy, nursing, outside medical specialist referrals, etc. The only reason a psych NP wouldn't be included is because we can't find any willing to work in our area, not because they have nothing to contribute to the team.

[Graduatenurse14]

I'm a year out of nursing school, 6 months into my first RN job and have BS in Education; I taught kids and adults for about 15 years and think that nursing education -at every level- needs to be revamped. We have so many choices of the types of learning environments (public/charter/cyber, private, parochial, Montessori, Waldorf, homeschool, unschool, etc) for children to get the same result- a High School Diploma and nursing education should take a cue. It would be really interesting to see a school truly use evidence-based research from ways adults learn to learning styles to teaching styles to what nurses really need to know, and develop a curriculum and have a BON with the bravery to let them try it.

@PsychGuy, BSN, MSN, RN, EMT-B, APRN, NP,

There are things that I would like to know more about such as reading CT/MRI. I work on a Neuroscience/Neurosurgical unit and see the Neurosurgical residents looking at them and I really want to truly understand what I see on the screen.

Have you looked into auditing courses at a university? I only mention auditing since I'm not sure if individual courses can just be taken and it's much, much cheaper.

Also, I've recently discovered Functional Medicine and the Institute for Functional Medicine. Nurses licensed in the US can become Certified in Functional Medicine and I think for NP's who already function with more autonomy, it can be a great career builder. For fun, I am going to take the online intro course "Functional Medicine: A Systems Approach to Reversing the Epidemic of Chronic Disease. See more at:

https://www.functionalmedicine.org/getstarted/resources/

[Jules A, MSN]

I know! LOL. Just making the point for all the readers to see the train wrecks we can get. Of course, healthcare in general is replete with such wreckage.

Reminds me. I found an interesting paper a few months ago covering TD treatments recently. Of course, of the many agents studied, most lacked any significant efficacy, but it was interesting nonetheless:

Cloud, L., Zutshi, D., and Factor, S. (2013). Tardive dyskinesia: Therapeutic options for an increasingly common disorder. Neurotherapeutics (2014)11.

Good article, thanks. I usually use propranolol and/or klonopin with a fair response. Although I was skeptical a doc I work with did wonders in a case of severe, long term bruxism with cogentin, klonopin and of course restarting an antipsychotic so there might have been a bit of an improvement due to that also. Interestingly enough one of the worst cases of TD I ever saw was actually withdrawal induced, which resolved on its own with restart and a gradual taper, in an adolescent on Geodon.

[HOPEforRNs, ADN, BSN, MSN]

That's great in theory and I certainly don't think we should take that away from nursing. However, especially in primary care, NPs are well on their way towards being THE independent provider. I see a future where NPs run primary care and physicians are only in specialized care. If nurses are going to replace MD/DO primary care physicians, some enhance knowledge in those areas is needed.

We, as nurses, should WANT this enhanced knowledge. We can have a knowledge base that is getting up there with a physician, but we can do it RIGHT because we treat the patient and we look at the whole picture and we are holistic. It's a huge opportunity we're missing out on. Honest, my "3 Ps" at the graduate level as part of a NP program at a well regarded and accredited university were a joke. At the NP program where I work, they are very rigorous. There's a lack of a standard there.

If the DNP focused on all that boring clinical stuff - I wouldn't be interested.

I love what it offers. Anyone can learn body systems. It's all memorization. We learn EKG interpretation in ADN school.

I love the research focus and the broader community focus. To learn how to implement the latest research into practice, and then how to apply it - is great stuff to be a part of.

If I wanted all the specifics of pathophys and disease processes I would of gone to PA school. Nursing is first and foremost a holistic practice, and I hope we NEVER move away from that essence because of "science". There's so much more to a persons overall state of health other than what's going on medically with a specific disease. And nurses fill that gap. Thank goodness. The medically focused providers and caregivers are a dime a dozen. Keep nursing unique.

[Ellen NP, MSN, NP]

It's the PRACTICE doctorate, not clinical and is described as such.

[Ellen NP, MSN, NP]

I specifically tailored my clinical training to include neuropsychobiology, neuropsychopharm, etc. since I work with individuals with complex comorbid medical and psychiatric illnesses. My MSN program was quite good with actual medical didactics but I definitely took it a step further by concentrating my training to prepare me for the role I wanted.

One of the great weaknesses of NP education is lack of standard curricula. Every program is different. Not so withmedical school PA programs, pharmacy, etc.

[PG2018]

This is true. There is NO standardization aside from advanced assessment, physio/patho, pharm. My program had a psychopharmacology, but alas no specialized neuro.

[HOPEforRNs, ADN, BSN, MSN]

This is true. There is NO standardization aside from advanced assessment, physio/patho, pharm. My program had a psychopharmacology, but alas no specialized neuro.

And even the "common" classes like physio vary wildly. I took one as part of a NP program (non-degree student) and I have spoken with professors of this class as a part of a NP program at a completely different school. Not even close.