Masters Vs DNP

allnurses Guide · Nov 20, 2013

It is 2015, here's the link:
http://www.aacn.nche.edu/dnp/faqs
So does anyone else think that this shift from Masters to DNP's is a little out of whack? Funny this should come up in the newsletter because I was just randomly looking at Univ. of Maryland's graduate programs and they've now moved all of their advanced practice degrees to DNP.
I'm just a lowly student starting RN clinicals this Spring, so I'm a long way off, but this doesn't make a lot of sense to me for a number of reasons. The argument being made is that nurses work with other professionals that require doctoral level education (i.e. physicians, pharmacists, physical therapists, etc.), and therefore nurses are not up-to-snuff. With the exception of physical therapists, however, nurse practitioners are not getting paid nearly the amount as the other professionals and those with doctorates will still get paid the same amount as those with Masters. There's no evidence that care provided by nurses with doctorates is any better than those with a Masters degree.
Also, it just seems to add confusion to an already confusing system. An NP with a DNP wants to be called 'doctor', but so does the physician.
Here is a good article calling some of this into question as well: http://www.nytimes.com/2011/10/02/health/policy/02docs.html?pagewanted=all

The move to a Doctorate level education isn't because of degree matching with other professions. It is often used as an example to show that other professions are moving in that same direction.

How is a nurse introducing themselves as, "I am Dr. X your Nurse" that confusing. Most the nurses I know with Doctorates, including myself, don't even use the title Doctor unless it is in formal correspondence or academia. A lot of nurses still prefer to use our first names when dealing with patients no matter our degree or APRN title. I think using our first name helps us quickly build a personal rapport with patients.

[h=4]"WHY MOVE TO THE DNP?[/h]

The changing demands of this nation's complex healthcare environment require the highest level of scientific knowledge and practice expertise to assure quality patient outcomes. The Institute of Medicine, Joint Commission, Robert Wood Johnson Foundation, and other authorities have called for reconceptualizing educational programs that prepare today’s health professionals.
Some of the many factors building momentum for change in nursing education at the graduate level include: the rapid expansion of knowledge underlying practice; increased complexity of patient care; national concerns about the quality of care and patient safety; shortages of nursing personnel which demands a higher level of preparation for leaders who can design and assess care; shortages of doctorally-prepared nursing faculty; and increasing educational expectations for the preparation of other members of the healthcare team.
In a 2005 report titled Advancing the Nation's Health Needs: NIH Research Training Programs, the National Academy of Sciences called for nursing to develop a non-research clinical doctorate to prepare expert practitioners who can also serve as clinical faculty. AACN's work to advance the DNP is consistent with this call to action.
Nursing is moving in the direction of other health professions in the transition to the DNP. Medicine (MD), Dentistry (DDS), Pharmacy (PharmD), Psychology (PsyD), Physical Therapy (DPT), and Audiology (AudD) all offer practice doctorates."
http://www.aacn.nche.edu/media-relations/fact-sheets/dnp

photogwest · Nov 21, 2013

I'm not sure what you mean by saying that the move to DNP is not about degree matching when bullet #3 and #4 in your list clearly makes that case.

But aside from that, the other points aren't very convincing to me either. And I submit to you that my opinion may change as I get more advanced in my nursing career (this will be a second career for me). As an aspiring nurse, I have a high view of nursing and the field, but this just doesn't seem like the right direction. There's a lot of talk about complexity and scientific knowledge and expertise above, but what are the big picture goals here? Here is an excerpt from the article I referenced earlier:

Some health care economists say the push for clinical doctorates across health professions could be misguided. They argue that anything requiring students to spend more time and money getting trained will invariably result in longer waits and increased costs for patients, because fewer students will meet the increased requirements and those who do will eventually demand higher compensation.

“Everyone’s talking about improving patients’ access to care, bending the cost curve and creating team-based care,” said Erin Fraher, an assistant professor of surgery and family medicine at the University of North Carolina School of Medicine. “Where’s the evidence that moving to doctorates in pharmacy, physical therapy and nursing achieves any of these?”

By all means, we should have DNP degrees - if only to fill spots in academia. But this shift in philosophy for graduate level education for nursing practitioners seems counterproductive. Sure its great to think that we'll have more brilliant nurses out there, but at what cost? And besides the added cost and time, what is there to gain by making it a doctoral program, rather than a masters level program? And again, what is the evidence that patient care and costs will actually benefit from the changes?

This move seems in-line with much of the misguided (in my opinion) efforts to improve education on the whole in the US. We have such an overemphasis on prestige and graduate level education and white collar work that ridiculous and seemingly arbitrary requirements and hurdles are placed in front of people just so we can appear cutting edge and look like we're doing something important.

1hopefulChik · Nov 21, 2013

This move seems in-line with much of the misguided (in my opinion) efforts to improve education on the whole in the US. We have such an overemphasis on prestige and graduate level education and white collar work that ridiculous and seemingly arbitrary requirements and hurdles are placed in front of people just so we can appear cutting edge and look like we're doing something important.

Hey, photog- I'm a newbie starting UMSON this spring. Maybe we'll get a chance to meet.

I happen to share your skepticism. Most of the curricula I've seen focus on leadership and research- 2 things that do not appear on the surface to do much to make healthcare more affordable nor does it offer APNs more advanced clinical knowledge. Patients are the reasons nurses exist. Patients need us to be clinically strong. Having a really strong clinical skills set offers the greatest benefit to patient, nurse, nursing and the healthcare team alike.

I dare to submit that nursing education has an education gap that needs to be fixed before additional education is proposed. Nurses are mandated to stop in the middle of their education to get clinical experience before going on to the next level, except for nursing informatics.

I think graduate nurses should be trained enough to be able to do acute care, emergency, pediatrics, etc. upon graduation. If nurses cannot graduate with enough clinical knowledge to perform in all non-APN areas, then nursing education is lacking. Other health professions don't require students to stop cold in the middle of the education to get work experience before developing the proficiency to proceed to the next level.

As an older 2nd-career nursing student, the need to interrupt education to go to work is a major barrier to continuing my education. Once you start working, it's hard to go back to school. Plus, how inconvenient to change careers only to have to stop and start in the middle!

allnurses Guide · Nov 21, 2013

I'm not sure what you mean by saying that the move to DNP is not about degree matching when bullet #3 and #4 in your list clearly makes that case.
But aside from that, the other points aren't very convincing to me either. And I submit to you that my opinion may change as I get more advanced in my nursing career (this will be a second career for me). As an aspiring nurse, I have a high view of nursing and the field, but this just doesn't seem like the right direction. There's a lot of talk about complexity and scientific knowledge and expertise above, but what are the big picture goals here? Here is an excerpt from the article I referenced earlier:
Some health care economists say the push for clinical doctorates across health professions could be misguided. They argue that anything requiring students to spend more time and money getting trained will invariably result in longer waits and increased costs for patients, because fewer students will meet the increased requirements and those who do will eventually demand higher compensation.
“Everyone’s talking about improving patients’ access to care, bending the cost curve and creating team-based care,” said Erin Fraher, an assistant professor of surgery and family medicine at the University of North Carolina School of Medicine. “Where’s the evidence that moving to doctorates in pharmacy, physical therapy and nursing achieves any of these?”
By all means, we should have DNP degrees - if only to fill spots in academia. But this shift in philosophy for graduate level education for nursing practitioners seems counterproductive. Sure its great to think that we'll have more brilliant nurses out there, but at what cost? And besides the added cost and time, what is there to gain by making it a doctoral program, rather than a masters level program? And again, what is the evidence that patient care and costs will actually benefit from the changes?
This move seems in-line with much of the misguided (in my opinion) efforts to improve education on the whole in the US. We have such an overemphasis on prestige and graduate level education and white collar work that ridiculous and seemingly arbitrary requirements and hurdles are placed in front of people just so we can appear cutting edge and look like we're doing something important.

Nurses are moving to a Doctorate for a similar reason as other professions in that we are trying to have the degree that matches the credit hours spent. An MSN/APN program already does almost as many credit hours for what DNP/APN needs to graduate. I spent 82 semester hours getting my MSN/CRNA. That is approximately 2x what it would take in other Master degree programs.

Pharmacy was in similar situation when they decided to switch to the PharmD. The DNP is supposed to align the degree with credit hours, make nurses experts in EBP (it takes nearly 17 years to bring research to practice now), and help with the clinical faculty shortage.

I think it is too early to tell if the DNP/DNAP will shorten the time it takes to bring research to practice. It will probably take several years before we will know that.

The article you brought up is opinion piece that seems to be written by a physician.

Here is why I disagree with that articles opinions: 1. APNs almost always pay for the majority of their training out of their pockets. There is no extra cost to patients for APNs to goto school an extra semester or two. 2. There hasn't been decrease in training/output of APNs as of yet and we are graduating approximately 2,000 DNP students a year nation wide now. 3. There has been shown to be a slight increase in pay (7,688/yr) for DNPs over MSN prepared nurses, but if those nurses are better able to utilize EBP that is small amount for employers to pay. 4. This increase in pay isn't from insurers or CMS which to my knowledge neither insurance companies or CMS have approved higher reimbursement for Doctorate prepared nurses.

I think the physician in that article is more worried about the loss of his/her prestige and potential loss of income if other providers gain more independence.

allnurses Guide · Nov 21, 2013

Hey, photog- I'm a newbie starting UMSON this spring. Maybe we'll get a chance to meet.
I happen to share your skepticism. Most of the curricula I've seen focus on leadership and research- 2 things that do not appear on the surface to do much to make healthcare more affordable nor does it offer APNs more advanced clinical knowledge. Patients are the reasons nurses exist. Patients need us to be clinically strong. Having a really strong clinical skills set offers the greatest benefit to patient, nurse, nursing and the healthcare team alike.
I dare to submit that nursing education has an education gap that needs to be fixed before additional education is proposed. Nurses are mandated to stop in the middle of their education to get clinical experience before going on to the next level, except for nursing informatics.
I think graduate nurses should be trained enough to be able to do acute care, emergency, pediatrics, etc. upon graduation. If nurses cannot graduate with enough clinical knowledge to perform in all non-APN areas, then nursing education is lacking. Other health professions don't require students to stop cold in the middle of the education to get work experience before developing the proficiency to proceed to the next level.
As an older 2nd-career nursing student, the need to interrupt education to go to work is a major barrier to continuing my education. Once you start working, it's hard to go back to school. Plus, how inconvenient to change careers only to have to stop and start in the middle!

1. You cannot improve your practice without utilizing research/EBP. You can have the best skills in the world, but if you fail to evolve your practice over the years those skills will mean nothing as time progresses.

2. Utilizing EBP by all staff has the potential greatest benefit to all patients. It won't be your ability to start an IV or memorize a bunch of medications that will matter the most in the long run, but the ability to incorporate new research into practice to improve patient care, and decrease costs that will make the most differences.

3. Nurses with the exception of CRNAs are not mandated to stop and get clinical education prior to going on to an advanced nursing degree. The AACN actually recommends that nurses should be able to go right from pre-nursing to APN without stopping. Nurse anesthesia advocates getting critical care experience prior to school, because NA schools incorporate that knowledge into their programs.

4. Nursing school is designed to make you competent not proficient. There is no way to make you proficient in every non APN nursing specialty there is by the time you graduate nursing school. It is still recommended that you go through mentorship for several months after graduation so that you can move from a competent novice nurse to an intermediate proficient nurse in a particular nursing speciality.

photogwest · Nov 21, 2013

Nurses are moving to a Doctorate for a similar reason as other professions in that we are trying to have the degree that matches the credit hours spent. An MSN/APN program already does almost as many credit hours for what DNP/APN needs to graduate. I spent 82 semester hours getting my MSN/CRNA. That is approximately 2x what it would take in other Master degree programs.
Pharmacy was in similar situation when they decided to switch to the PharmD. The DNP is supposed to align the degree with credit hours, make nurses experts in EBP (it takes nearly 17 years to bring research to practice now), and help with the clinical faculty shortage.
I think it is too early to tell if the DNP/DNAP will shorten the time it takes to bring research to practice. It will probably take several years before we will know that.
The article you brought up is opinion piece that seems to be written by a physician.
Here is why I disagree with that articles opinions: 1. APNs almost always pay for the majority of their training out of their pockets. There is no extra cost to patients for APNs to goto school an extra semester or two. 2. There hasn't been decrease in training/output of APNs as of yet and we are graduating approximately 2,000 DNP students a year nation wide now. 3. There has been shown to be a slight increase in pay (7,688/yr) for DNPs over MSN prepared nurses, but if those nurses are better able to utilize EBP that is small amount for employers to pay. 4. This increase in pay isn't from insurers or CMS which to my knowledge neither insurance companies or CMS have approved higher reimbursement for Doctorate prepared nurses.
I think the physician in that article is more worried about the loss of his/her prestige and potential loss of income if other providers gain more independence.

Thanks for the response, wtb. I hear what you're saying, but it still seems counter-productive. As 1hopefulChik implied, I think this move makes the distribution of education in nursing too top-heavy. I know EBP is all the rage, I need to read more about it. Speaking as an outsider (for the moment), I don't understand how making APNs doctors is necessarily going to increase the speed of implementation from research to practice. It seems to me that those APNs that would like to focus on research and system design should get their DNP, but those APNs that want to continue with patient-facing work should be able to get NP degrees at the masters level. I see the benefits and purposes of adopting and implementing EPB, but I'm still not convinced making APNs get doctorates will be the magic pill.

You're right about the article, a lot of it is just whining from MD's. But I think the concern is valid about costs going up for patients if APNs start demanding more money. As APN's approach the same level of training and knowledge as some MD's, particularly in primary care, it only makes sense for money demands to increase. And why not? If I had my DNP, I'd want more money for my services. Of course, this isn't so much a problem with nursing as it is a concern for medical doctors - hence the New York Times op piece.

Like I said, I'm at step 1 of a (hopefully) very long career in nursing, so I doubt I have the most accurate view of the healthcare landscape. You're obviously someone for me to learn from, so I hope I don't come off as disrespectful. I guess i'm just ranting a bit. I've thought that advanced practice is where I'd eventually want to get, maybe even teaching, and as more financial burdens and requirements stack up, I get concerned that I'll never get there starting a new career in my early 30's.

photogwest · Nov 21, 2013

Hey, photog- I'm a newbie starting UMSON this spring. Maybe we'll get a chance to meet.
I happen to share your skepticism. Most of the curricula I've seen focus on leadership and research- 2 things that do not appear on the surface to do much to make healthcare more affordable nor does it offer APNs more advanced clinical knowledge. Patients are the reasons nurses exist. Patients need us to be clinically strong. Having a really strong clinical skills set offers the greatest benefit to patient, nurse, nursing and the healthcare team alike.
I dare to submit that nursing education has an education gap that needs to be fixed before additional education is proposed. Nurses are mandated to stop in the middle of their education to get clinical experience before going on to the next level, except for nursing informatics.
I think graduate nurses should be trained enough to be able to do acute care, emergency, pediatrics, etc. upon graduation. If nurses cannot graduate with enough clinical knowledge to perform in all non-APN areas, then nursing education is lacking. Other health professions don't require students to stop cold in the middle of the education to get work experience before developing the proficiency to proceed to the next level.
As an older 2nd-career nursing student, the need to interrupt education to go to work is a major barrier to continuing my education. Once you start working, it's hard to go back to school. Plus, how inconvenient to change careers only to have to stop and start in the middle!

Hey 1hC... we probably won't in school at least. I'm doing the RN program @ Frederick Community College due to distance and money constraints. But we should be out in the workforce around the same time. Where do you live/want to work?

allnurses Guide · Nov 21, 2013

Thanks for the response, wtb. I hear what you're saying, but it still seems counter-productive. As 1hopefulChik implied, I think this move makes the distribution of education in nursing too top-heavy. I know EBP is all the rage, I need to read more about it. Speaking as an outsider (for the moment), I don't understand how making APNs doctors is necessarily going to increase the speed of implementation from research to practice. It seems to me that those APNs that would like to focus on research and system design should get their DNP, but those APNs that want to continue with patient-facing work should be able to get NP degrees at the masters level. I see the benefits and purposes of adopting and implementing EPB, but I'm still not convinced making APNs get doctorates will be the magic pill.
You're right about the article, a lot of it is just whining from MD's. But I think the concern is valid about costs going up for patients if APNs start demanding more money. As APN's approach the same level of training and knowledge as some MD's, particularly in primary care, it only makes sense for money demands to increase. And why not? If I had my DNP, I'd want more money for my services. Of course, this isn't so much a problem with nursing as it is a concern for medical doctors - hence the New York Times op piece.
Like I said, I'm at step 1 of a (hopefully) very long career in nursing, so I doubt I have the most accurate view of the healthcare landscape. You're obviously someone for me to learn from, so I hope I don't come off as disrespectful. I guess i'm just ranting a bit. I've thought that advanced practice is where I'd eventually want to get, maybe even teaching, and as more financial burdens and requirements stack up, I get concerned that I'll never get there starting a new career in my early 30's.

Here are some thoughts: If nursing is top heavy because we are now offering a terminal degree then physicians have been top heavy for over a century. You are still going to have the same nurses doing the same jobs, hopefully with more emphasis on EBP, that you did with an MSN but will now have their DNP instead.

EBP/EBM has been around since the early 1990's it isn't some new rage that is out there. Before EBP there was research utilization, but research utilization did not take into account the clinicians expertise or the environment they worked in. EBP is putting the best research to work for you in the environment that you work in. http://www.aana.com/newsandjournal/documents/p269-273.pdf This a good overview on EBP for anyone thinking of becoming an APN. The article is geared towards CRNA and SRNAs, but the overall theme is the same.

I don't know that APNs getting their doctorate is going to be a cure all, but why shouldn't nurses get a degree that matches their work or get extra training in utilizing research.

1hopefulChik · Nov 22, 2013

Nurses are moving to a Doctorate for a similar reason as other professions in that we are trying to have the degree that matches the credit hours spent. An MSN/APN program already does almost as many credit hours for what DNP/APN needs to graduate. I spent 82 semester hours getting my MSN/CRNA.

The challenge is that much of the master's and doctorate level education doesn't increase clinical competency in proportion to the time and effort required for completion.

Head knowledge is useful, no doubt. But at least let it be knowledge that makes nurses more valuable to the patients we serve and the health teams on which we participate.

In my mind the crux of the issue isn't whether nurses need more education but rather more of what kind of education. Nurses are expected to gain proficiency and knowledge to work in acute care settings when we should emerge from ADN/BSN with a basic skill set that any graduate should be at least prepared to step into those areas.

I think advanced nursing education is most effective when it makes us better clinicians FIRST.

PA, MDs, PTs, PHarmDs need to keep up with changes in medical therapies and technology. Those changes won't suddenly cease when you get a terminal degree. So, getting another degree is no guarantee you'll be up with the times or ahead of the curve.

1hopefulChik · Nov 22, 2013

The argument being made is that nurses work with other professionals that require doctoral level education (i.e. physicians, pharmacists, physical therapists, etc.), and therefore nurses are not up-to-snuff.

If that's the premise of the argument, then nurses would just be playing copycat and trying to keep up with the Joneses. Perhaps a good reply is that many nurses demonstrate a level of competency and knowledge equal to their peers without a bunch of letters. That says a lot!

I'm not against pieces of paper. I just think it's sad to chase paper to prove things to other people rather than actually gaining practical knowledge needed for the very practical profession that nursing is.

allnurses Guide · Nov 22, 2013

The challenge is that much of the master's and doctorate level education doesn't increase clinical competency in proportion to the time and effort required for completion.
Head knowledge is useful, no doubt. But at least let it be knowledge that makes nurses more valuable to the patients we serve and the health teams on which we participate.
In my mind the crux of the issue isn't whether nurses need more education but rather more of what kind of education. Nurses are expected to gain proficiency and knowledge to work in acute care settings when we should emerge from ADN/BSN with a basic skill set that any graduate should be at least prepared to step into those areas.
I think advanced nursing education is most effective when it makes us better clinicians FIRST.
PA, MDs, PTs, PHarmDs need to keep up with changes in medical therapies and technology. Those changes won't suddenly cease when you get a terminal degree. So, getting another degree is no guarantee you'll be up with the times or ahead of the curve.

Okay, so we teach students to do IVs or health assessments proficiently by the time they graduate and so what are theses students going to do with those skills over their careers that they wouldn't have become proficient in anyways in the first few months of their nursing career. Is that really going to make a difference when in 6-12 months after you graduate you are expected to move from a competent level to a proficient level anyways.

The terminal degree/DNP aligns your degree with the education level you are already nearly getting anyways on the MSN level, and it gives you a formal education on how to keep proficient throughout your career instead just the first couple of years of your career. I think that is worthwhile degree plan.

As a group I work with the most highly trained nurses anywhere (USAF) I have ever seen. All of them have at least a Bachelors degree in nursing and over half the nurses with more than 4 years experience have at least a Masters degree, but hardly a one of them is proficient in the finding and utilization of research/EBP. How can you expect APNs to continue to develop throughout their career if they cannot quickly and efficiently incorporate research into their practices. The majority of what you are taught in nursing/medical school will be out of date within the first 5-10 years of practice. We need to prepare nurses for a career not to just be proficient in a couple of technical skills when they graduate.

By the way nursing and NP school is designed to make you competent not proficient upon graduation. You are expected to go through a mentorship period for at least a few months after graduation.

allnurses Guide · Nov 22, 2013

If that's the premise of the argument, then nurses would just be playing copycat and trying to keep up with the Joneses. Perhaps a good reply is that many nurses demonstrate a level of competency and knowledge equal to their peers without a bunch of letters. That says a lot!
I'm not against pieces of paper. I just think it's sad to chase paper to prove things to other people rather than actually gaining practical knowledge needed for the very practical profession that nursing is.

Hopeful, What is your educational background?