psychonaut

One dichotomy that has occurred to me is your embrace of DE and your Humanist style (is that fair to say of a shaman? Absolutely no mockery intended, serious). You of all people have to appreciate how much different it is to learn in someone's physical presence vs via technology. I took one of the first on-line courses available at my U in 1998 or so (a psych class, believe it or not). I have taken many since. I loved my on-line English lit course so much I took the second semester, just for the joy of reading and participating with that professor. SO I am in NO way opposed to DE, I love it and feel it even has a place in nursing ed at the UG and Grad levels. I am in a DE NP program now, and I don't think the format translates well. Our brief visits each semester are like manna from heaven to me. Discussing clinical cases IN PERSON with my peers and professors is just a whole 'nother beast. Of course, all of my clinical is in person, and while I can read and write all day about patho and pharm etc it just strikes me as more challenging and real when done with another person, asking and answering questions... I try and know when to fish or cut bait. If DE is firmly entrenched in NP education, than I want to be part of making it as good as it can be. I know your feelings regarding standardized exams, and since I am getting into the education side of things myself I appreciate non-standard educational methods (mixed PBL/case studies with hands-on elements is my current passion), but we NEED objective, standardized judgements to make some level of rational decision regarding the competence of our students (and ourselves). That means exams with no looking up the answers, no "group input," just the student and a pencil and paper (or the electronic equivalent).

I love going 'round with zenman here and SDN, he's a fixture and has the experience to back it up. I too can disagree, but I have a feeling he'll be the one I hunt down for help when I finally lose my marbles. I have the distinct idea that a world-traveling psych NP shaman is a dude I'd enjoy partying with.

Trolling in its finest sense. Short, nonsensical posts, with subtle "bait" to incite the desired response. Make no mistake, I appreciate good trolling, even when I am the target. How can I best react to the hook in my mouth? Froth with fury at your mis-characterizations, or mock your (clearly tongue-in-cheek) pseudo-intellectual vocabulary? So, in plain language, devoid of any emotionalism: my intent is to oppose any requirement for the DNP as entry level to the Nurse Practitioner profession. My focus will be at the state level, with my state's board of nursing, but will extend to the national level as needed. I will make my state legislators aware of my opinions and rationale on this subject. I will never oppose your right to practice, nor oppose you setting yourself up as an expert in your area of interest. I'm also well over the whole "calling yourself Doctor" (non) issue, you can call yourself whatever you want. Being a nurse makes you my peer. Being a NP makes you my colleague. Having a DNP makes you, at very best, an NP with additional experience in some specific content area.

More than anything else, understand what a differential diagnosis is. This was something that tripped up many of my colleagues, regardless of years of RN experience. This is a new skill set for RNs. Pathology, physical diagnosis, pharmacology...these are not conceptually different (just different in terms of breadth and depth at our new level). Learning to make a differential, then narrow it down based on history, signs and symptoms, labs, is a new thing. Having it clear at a conceptual level will serve you well in NP school.

No, you are not. You are NPs with additional coursework in systems leadership, research utilization, health policy, etc. I support your right to exist. Your extra coursework no more makes you my leader than my extra coursework as a BSN makes me the leader of the RN profession. I know NPs with PhDs. They are NPs with additional mastery of theory, research design, and generation of new knowledge. They are not my leaders either. Whatever the focus of your final project, I would be happy to consult you (as an expert) in that area. My willingness to consult you on general patient management issues would be based solely on your acumen as a Nurse Practitioner, NOT your DNP. You have the same respect I offer automatically for all my fellow nursing professionals. Beyond that, my respect is afforded on many things, but none of them is the letters after your name (beyond "RN"). ...and drown those of us not in your boat, right?

Deferential respect: "they paid obeisance to the prince". A gesture expressing deferential respect, such as a bow or curtsy. "Bow to your Sensei!" =]

I just made the decision to renew my AANP membership. Part of it is the benefit angle, i.e. I can renew at student rate, discount on my cert (if I do AANP instead of/along with ANCC), etc. My hesitation was that my $$ goes to de-facto support of AANP's push for the DNP as entry to NP practice. However, I also think I may be able to stir up a 5th comumn within the org to oppose this, along with efforts at the State level. We'll see.

Legally, I don't know, but as a condition of employment? And working with the sure knowledge the "clinic" will NOT back you up if you deviate form said algorithm? I would definitely be wary.

I will say it again and again: in the end, it is the State Board of Nursing who will decide what degree is needed to be a NP in your state. That is where this battle can be fought (for those of us who oppose the DNP-as-NP-entry-to-practice) and won. This is where the assault on ADNs has been successfully resisted for many decades. The DNP can absolutely exist as far as I am concerned, as a "terminal degree" for those grad-degree nurses who don't want to go the PhD route. There is absolutely NO rationale for the current iterations of the DNP to be the mandatory entry point to advance practice nursing. It should be an option, something to bolster an academic or administrative resume, NOT a de-facto requirement. Beware the Consensus Model, and other nationally "recommended" alterations to State Nurse Practice Acts. Buried within are the assaults on the ADN RN and the MSN NP.

Check your state practice act first.

Tough call, and clearly a far cry from someone wanting narcotics. I like your invitation to provide you with some supportive evidence. This is the example of going out of your way for a colleague moreso than just giving it would be. Even a small study with shaky foundations would give you some theoretical basis to work from. In those times when I've wanted to propose an unconventional dosing or whatever to a new provider, I always come prepared knowing I'm asking for an "off-label" use and having evidence and rationale to offer them (and not an attitude, like with the "MD" comment).

My very uneducated information is that providers in these clinics are limited to very strict treatment algorithms...am I misinformed?

The powers-to-be in academia are leaning heavily on the state BONs to secure DNP dominance and the destruction of the MSN-educated NP. The Consesus Model is an early move in this war. SInce the original backlash in nursing against the Mundinger point of view, they have gone stealth. If you want to oppose this, it must be done at the state level. Involvement in state BONs is the only way to make sure you don't get railroaded. These are (in general) folks who likewise wish to eliminate the ADN as an entry-to-practice. Some good noise-making by our ADNs (and economic realities) has forstalled that from happening for four deades; similar action will be needed from MSNs who oppose the DNP as entry-to-practice for NPs.

That is a very good start, and to be emulated.

This is probable the single best indictment of online NP education that I have seen. I'm not singling you out by any means. As a matter of fact, if your school actually describes the tests in this manner, good for them, at least they are being honest. Graduate level clinical education based on an "open book" system is a sad, sad thing. I've heard of schools where the testing is much stricter (going to a proctored testing center, web cams on while testing, et. al), but I think the method above is closer to the norm.