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.
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.
I agree 100% with your post. DNP should be CLINICAL practice only with more advanced courses of anatomy, pathology, pathophysiology, pharmacology and Microbiology. Those on DNP should think like doctors and act like doctors. They should consider themself as residents. Paperwork and stupid assignments are not helpfull at all. Amen!
I also 100% agree that, for the already practicing Advanced Practice Nurse, there needs to be a doctoral option that is truly clinically focused in the way the a medical doctorate is. The post-master's DNP, although an alternative to the post-masters PhD, is primarily policy and leadership focused. If an NP wants to practice in clinic as a primary care provider for 100% of their time for the rest of their career, let's say, in family medicine, for example, the DNP is simply not needed to advance their knowledge base or clinical proficiency. If a DNP truly produced better clinicians than an MSN degree it would be required for Full Practice Authority (FPA) and we have not seen that be the case. MSN NPs are truly good providers, safe and proficient in their fields and that is why we have been given FPA in many states.
If we truly want to elevate our Clinical Professionals (and especially if there is a push to make a Doctorate of Nursing the exit degree for NPs) we truly need to have an option among the doctoral degrees of a truly clinically focused terminal degree. I mean, yes, we (of the "clinical bent") could just go to medical school for a terminal degree if we are so determined to have a clinically focused doctorate... but many of us want to remain in the nursing field.
We need to show that our programs can produce consistently clinically proficient medical providers. Like it or not, NPs are working within and pushing for independence among what has been defined for centuries as medicine (not nursing). If we want to be able to practice at the highest level of clinical practice and colleague supported independence, it would be appropriate to have a Doctorate of Nursing program that mirrors the model of medical schools which has shown a consistent output of great clinical providers. This is done through extensive and rigorous didactic and supervised clinical learning experiences.
I personally would love to have the option of just being in primary care for the rest of my career AND have a terminal degree that supports my clinical pursuits as a primary care provider, not as a future policy maker or clinic manager, etc. That's not to say classes with policy or leadership focus should not be included in the "clinical doctorate" for NPs but I would much rather spend the additional 500+ clinical practice hours on a deeper dive into clinical specifics, in a fellowship, and/or in an ambulatory care specialty and not just a quasi-PhD research project.
It would be great to have a program that went into greater depth on all areas related to primary care (or acute care respectively for ACNPs) such as biochem, advanced kinetics and physiology, endocrine, cardiology, neurobiology, advanced application of differential dx's (the horses AND the zebras), advanced clinical nutrition & even maybe some alternative modalities like chiropractic (osteopathic) procedures, clinical herbalism and clinical acupuncture.
We COULD be so well-rounded as Doctoral Nurses with such potential to truly lead our field into peer-supported and colleague supportive professional advances within our passions toward primary care. Medical doctors typically spend so much money on medical school it is not always in their best interests to pursue Primary Care and get paid so much less than if they specialize. On the other hand, Advanced Practice Nurses (specifically in Primary Care) could, like another peer said in their post, really take the lead in the area of Primary Care. Primary Care Clinical Specialization could easily be where we could go with a clinically focused nursing doctorate for NPs. The PhD and the DNP are truly great options for so many NPs. They have their purposes and real strengths. And on the other hand, in my opinion, a Doctorate of Clinical Nursing Practice could elevate our terminal degree options as Nurse Practitioners who have a deep passion for primary care and/or primarily clinically-focused practice (acute/specialty). It could dramatically change the landscape of our future independence, satisfaction in our careers as PCPs and improve cohesiveness with clinical colleagues and our "non-NP" counterparts (physicians).
If a DNP truly produced better clinicians than an MSN degree it would be required for Full Practice Authority (FPA) and we have not seen that be the case.
Clarification, that should read: "If a DNP truly produced better clinicians than the MSN degree, a DNP would be required for Full Practice Authority (FPA) ...".
LaLuna12
22 Posts
I agree 100% with your post. DNP should be CLINICAL practice only with more advanced courses of anatomy, pathology, pathophysiology, pharmacology and Microbiology. Those on DNP should think like doctors and act like doctors. They should consider themself as residents. Paperwork and stupid assignments are not helpfull at all. Amen!