Quote from climberrn
David, I'm sure I'll kick myself but, what does the D in DNP stand for?
Doctorate of Nurse Practitioner. This is an extension of the NP role with extra classes in pathophysiology and pharmacology. There is also a requirement for 1000 hours of clinicals specific to a dedicated nursing practice. This is the theory, I'm not sure how this works in reality. In theory if you entered a DNP peds programs you would do a basic PNP then expand the role or make a more defined role. In this case, 1000 hours of peds critical care would be a pretty good start on this. This would still let you have the basic PNP to fall back on if the job market does not materialize.
In the adult world the common tactic was to do an FNP which would allow you to see essentially any patient. With the advent of the ACNP some hospital credentialling committees are looking at the training of the FNP's and the scope of practice for the FNP and finding that the scope of practice does not cover critically ill patients. In our area they are still allowing FNP's to continue to practice but refusing new FNP's credentialling (they are allowing individuals that can document inpatient experience if their physician goes to bat). We don't have any PNP's doing inpatient medicine in our area so I am not sure how this is going to play out. PNP actually has a similar problem with ACNP. There are now two different ACNP exams with different scope of practice. Similarly there are two PNP exams with different scope of practice. The ANCC is a general certification while the PCNB exam is in either critical care or primary care and it looks like you have to choose. This is an ongoing problem and does not recognize how most private practices operate.
The presence of multiple credentials is very confusing to hospital credentialling committees and there is substantial pressure to use one credential or the other. I would guess they would go with the more restrictive credential. It is also interesting that the FNP requires 1000 hours of clinical practice for recertification. While one could argue that cardiology or rheumatology is an outgrowth of family practice, it is hard to see how an NP working in surgery or critical care can document 1000 hours of clinical practice as an FNP. There are some NP's that argue that these NP's should not be allowed to recertify if they are not practicing in family practice.
Overall it is a very confusing situation and I'm not sure how it is going to play out. While the NP educational programs seem to turing out NP's for academic environments, they seem ill suited to specialty practice which demands both inpatient and outpatient skills (just my opinion).
David Carpenter, PA-C