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.

[Jules A, MSN]

It is a done deal now but didn't we already have enough programs, titles and confusion?

In our history of developing and granting doctoral degrees, we have offered the Doctor of Nursing Science (DNS or DNSc) degree, the Doctor of Science in Nursing (DSN) degree, the Doctor of Education (EdD) degree, and the Nursing Doctorate (ND)”

Practice drives knowledge development in nursing. In fact, practice is the essence of the discipline of nursing. Therefore, advanced graduate education that does not address inquiry that reflects clinical practice, is likely to train researchers whose research progress may not readily advance nursing science.”

From: Meleis, Afaf I.; Dracup, Kathleen September 2005, The case against the DNP: History, timing, substance and marginalization. Online Journal of Issues in Nursing;2005, Vol. 10 Issue 3, p73

[ThePTNurseGuy, DNP, NP]

hey PsychGuy, could you email me back? my email is [email protected]

[zinaptl]

@sadiemae1123 Do you feel like there were enough classes in your DNP program to help you diagnose and treat patients? I heard the MSN route sets you up to diagnose and treat more so than a DNP route which is focused on evidenced based research and leadership. I notice a lot of DNP programs that I have found don't offer advanced patho or pharm or courses on how to diagnose etc. 

[HOPEforRNs, ADN, BSN, MSN]

6 minutes ago, zinaptl said:

@sadiemae1123 Do you feel like there were enough classes in your DNP program to help you diagnose and treat patients? I heard the MSN route sets you up to diagnose and treat more so than a DNP route which is focused on evidenced based research and leadership. I notice a lot of DNP programs that I have found don't offer advanced patho or pharm or courses on how to diagnose etc. 

The DNP was created to turn nurse practitioners into experts at translating evidence into practice. It does not contain any hard science and will not improve your actual ability to treat individual patients but instead improve your ability to translate the research into your practice. It's unfortunately a degree filled with a bunch of fluff. It was well-intentioned but very poorly executed. 

[zinaptl]

@HOPEforRNs Ideally I'd still like to focus on the medical side of it all once I become an FNP. I am brand new BSN grad and I work on tele right now. I absolutely love the medical side of it and knowing how to respond, giving medications etc. I just don't know if DNP will set me up for that but at the same time MSN is saturated and the degree no longer holds the value that it once did. 

[HOPEforRNs, ADN, BSN, MSN]

4 minutes ago, zinaptl said:

@HOPEforRNs Ideally I'd still like to focus on the medical side of it all once I become an FNP. I am brand new BSN grad and I work on tele right now. I absolutely love the medical side of it and knowing how to respond, giving medications etc. I just don't know if DNP will set me up for that but at the same time MSN is saturated and the degree no longer holds the value that it once did. 

The DNP is largely useless letters you'll be required to get because nursing is a game of alphabet soup. The fancier your letters, the better you are. It's ridiculous but it's the reality. I would honestly get a few years under your belt and then do a BSN to DNP program. 

[DrCOVID, DNP]

If you read and comprehended the AACN content about the DNP, you wouldn't be posting paradoxical questions.

DNP essentials: 

Essential III: Clinical Scholarship and Analytical Methods for Evidence-Based Practice

Essential VII: Clinical Prevention and Population Health for Improving the Nation’s Health

Essential VIII: Advanced Nursing Practice

Appendix A:

I. Advanced Health/Physical Assessment

III. Advanced Pharmacology

Those sure happen in clinic right? You think NPs and MDs are supposed to have parity when they were never meant to. Like asking, "why is an apple not an orange?"

I guess I understand why we post stuff like this, because our "JOBS" are similar. 

We are mincing words here, like practice and clinical are supposed to be two different worlds...

 

[Ellen NP, MSN, NP]

Nevertheless, what we really need as NP's is more clinical training. If you want to teach, write, develop policies or do research, a DNP may well advance your career. If you want to have a 100% clinical practice, you need more clinical training hours. The 'old' MSN programs had real research and leadership coursework. We translated research into practice through rigorous 12-18 month projects. We had more clinical training hours. WE had performance exams with mock patients before we could advance to the next course. Those programs have been replaced by others with fewer clinical hours and less rigorous prerequisites for entry into the programs. The DNP programs are bringing back that work that we had in the early MSN programs into their curricula. When the DNP was first planned, the idea was to add a few additional courses to our already rigorous curricula to meet a doctoral standard. Today, a post MSN DNP can easily take several more years of study.  

[PortlandRN2020, BSN]

On 5/17/2015 at 8:15 PM, HOPEforRNs said:

OP, I'm with you. The rigorous coursework is completely lacking. I'm enrolled in a MSN program right now at a well regarded university and it's a complete joke. It's nothing but useless fluff. Where's the real coursework? When I do actually get to finish a course and say "wow I really learned something valuable" ???

My ideal DNP program would have separate courses (with their associated pharmacology) in:

1. Cardiology (with teaching how to read a 12 lead)

2. Radiology (extensive teaching on reading xrays and CTs/MRIs)

3. Pulmonology

4. Renal

5. Surgery (optional--pick one: general, ortho, etc)

6. Elective (OB-GYn, peds, pain, primary care, etc.)

In addition, I would say add an advanced differential diagnosis course, a course dedicated to the prescribing of controlled substances (since some jurisdictions have a problem with this), a pain management course and an advanced psych course dealing with chemical dependency, and a specific course on when and how to make proper referrals.

I realize this starts to sound similar to medical school but unfortunately, those pushing the DNP are stating that "Dr. Nurse" is equivalent to "Dr. Doctor". So advanced practice nurses need to have some of that material if they are to fill the primary care void.

I feel like the bottom line with the DNP is that it is a back handed way to get more academics, not improve practice. It is an academic wolf in clinical sheep's clothing. That doesn't make it a bad degree, but certainly not what is needed. But, no one will listen because it makes sense. To the powers that be, sensibility and practicality are for fools. Ivory towers for the elite

Couldn’t agree more. 

[DrCOVID, DNP]

On 5/17/2015 at 10:15 PM, HOPEforRNs said:

I'm enrolled in a MSN program right now at a well regarded university and it's a complete joke. It's nothing but useless fluff.

In addition, I would say add an advanced differential diagnosis course, a course dedicated to the prescribing of controlled substances (since some jurisdictions have a problem with this), a pain management course and an advanced psych course dealing with chemical dependency, and a specific course on when and how to make proper referrals.

I realize this starts to sound similar to medical school but unfortunately, those pushing the DNP are stating that "Dr. Nurse" is equivalent to "Dr. Doctor". So advanced practice nurses need to have some of that material if they are to fill the primary care void.

I feel like the bottom line with the DNP is that it is a back handed way to get more academics, not improve practice. It is an academic wolf in clinical sheep's clothing. That doesn't make it a bad degree, but certainly not what is needed. But, no one will listen because it makes sense. To the powers that be, sensibility and practicality are for fools. Ivory towers for the elite

There is so much wrong with this... 

1) If you are in a program you feel is worthless, why stay in it?

2) No nurse worth their dry weight is saying DNP = MD/DO. Only people who have no idea what nursing is and what "doctor" mean say that.

3) A primary idea of the DNP is to bring NURSING's training up to that of OTHER PRACTICE BASED DOCTORATES such as DPT/OT, pharmD, dentist, chiropractor, optometrist. Really gets aggravating that out of ALL THE OTHER CLINCAL DOCTORATES, allnurses here compare ourselves TO MD/DO ONLY. Like really?

4) I went to a reputable expensive private school and had a BSN. I was taught about differential dx, had extra clinical hours, and the program was solid. Could it be better? Well what couldn't? Even most medical schools OMIT nutrition coursework for example and probably don't go into much research which is where we should be getting our information in the first place. I am happy we took a critical look at research (there is a lot of garbage out there) as we are primarily using research to determine best treatments. DON'T forget to treat the patient though!

5) If you specialized in psych, you would learn about drug dependence... I don't think that is something you would treat as a PCP? You know even a physician should refer out for stuff like complicated pain and mental health issues right? You don't see at dentist to have your eyes checked btw...

It totally made sense for ME to get the DNP because a) I didn't want to be in school and training for another 10+ years of my life, b) didn't have an MSN & c) wanted to finish my education, d) have more leverage for jobs, and d) additional CLINICAL time. I spent 1200 hours in PSYCH clinic. Double that of most MSN programs. Years 2 and 3 were spent most of the time doing CLINIC WORK, project and patient hours. I learned a lot about psychiatry and medication doing my capstone.

The argument is beat to death here now, the core issue is lack of curriculum standardization and that if you are an MSN with years of EXP, it's probably not worth getting a DNP right now.

Also, there will be NO grandfathering, since it is a DEGREE, and schools don't just hand those out.

[HOPEforRNs, ADN, BSN, MSN]

5 hours ago, DrCOVID said:

There is so much wrong with this... 

1) If you are in a program you feel is worthless, why stay in it?

Last time I checked, you have to get your MSN to be an APRN. It's not my program - it's the curriculum for these programs. It's just not rigorous. 

2) No nurse worth their dry weight is saying DNP = MD/DO. Only people who have no idea what nursing is and what "doctor" mean say that.

If that isn't the goal, why are nurses fighting so hard to be "freed" from physician oversight and have equal practice authority? If NPs don't want physician oversight, then be a physician. Simple as that. 

3) A primary idea of the DNP is to bring NURSING's training up to that of OTHER PRACTICE BASED DOCTORATES such as DPT/OT, pharmD, dentist, chiropractor, optometrist. Really gets aggravating that out of ALL THE OTHER CLINCAL DOCTORATES, allnurses here compare ourselves TO MD/DO ONLY. Like really?

We did this to ourselves. We're trying to do the same job as physicians, especially in primary care, without any physician oversight. If you want the be a primary care provider same as a family medicine doc, then you need the training. The other areas you mentioned.... dentist, chiro, optometrist, pharmD all are 4 year doctorates just like medical school. I could see the argument to align with PT/OT. Although I just looked up a DPT program where I work and it is 118 credit hours. Most BSN-DNP programs are around 72 credit hours. So there's still a huge gap. DPT programs also have a lot more clinical hours (that are actually clinical) and a lot more rigorous science preparation. Nursing is still very "fluffy" in comparison. 

4) I went to a reputable expensive private school and had a BSN. I was taught about differential dx, had extra clinical hours, and the program was solid. Could it be better? Well what couldn't? Even most medical schools OMIT nutrition coursework for example and probably don't go into much research which is where we should be getting our information in the first place. I am happy we took a critical look at research (there is a lot of garbage out there) as we are primarily using research to determine best treatments. DON'T forget to treat the patient though!

This is something that is lacking in both medical and nursing school. It's a huge problem. It needs fixed. 

5) If you specialized in psych, you would learn about drug dependence... I don't think that is something you would treat as a PCP? You know even a physician should refer out for stuff like complicated pain and mental health issues right? You don't see at dentist to have your eyes checked btw...

Those courses would vary based upon your specialty. A psych NP doing a MSN to DNP would see different curriculum than a WHNP doing a MSN to DNP, for example. 

It totally made sense for ME to get the DNP because a) I didn't want to be in school and training for another 10+ years of my life, b) didn't have an MSN & c) wanted to finish my education, d) have more leverage for jobs, and d) additional CLINICAL time. I spent 1200 hours in PSYCH clinic. Double that of most MSN programs. Years 2 and 3 were spent most of the time doing CLINIC WORK, project and patient hours. I learned a lot about psychiatry and medication doing my capstone.

Your program is in the minority. You only need 500 hours to sit for licensing exam as a APRN. 500 hours. That's it. DNP programs add another 500 but none of them are required to be clinical based. Your particular school might add more hours or require more hours in a clinical area, but there is no standardization. A Duke University BSN to DNP graduate would be drastically different than a Walden University BSN-DNP graduate. The diploma mill for profit schools are giving NPs a bad name. There needs to be better standardization. 

Oh and a psychiatrist who has just completed their 4 year residency has around 15,000-20,000 clinical hours. And WAY more didactic and science curriculum. Still not comparable. 

 

[DrCOVID, DNP]

18 hours ago, HOPEforRNs said:

 

I will never forget when I was a couple years into being an RN, one of the MDs asked me what I think a patient's diagnosis was. So I guess all that time he spent in school and residency ensured he was ready and capable? And countless people I have heard now complain about their MDs. Also went to 4 medical "DOCTORS" because I was in chronic pain. And you know what? NONE of them pointed me in the right direction.

The FNPs in my school feel they were not ready. No MSN/DNP is going to say they don't want more training. But once you have a few years and some good mentors under your belt, what does it matter? Seems like you should go to med school and that you don't understand nursing and medicine are not the same. Stop trying to compare them and understand we are governed by different INDEPENDENT boards. The threads here begging for parity are just nonsense. Nursing is NOT medicine.

Everyone on this forum thinks there should be this equality just because we can write an RX. Cuz I need complex physics and o-chem to understand what Benadryl does to the body. Even in psych, most medication actions are theorized and not well understood. The clinical trials done on weight gain for new psych meds don't even control for diet.... I mean come on! At the end of the day, we go by what the patient tells us & it has been shown in literature that a NPs can produce quality outcomes and that is really all that matters anyway. End of this tired subject... and anti-nurse advocates fighting their own field's progression.