ProgressiveThinking

As stated in the thread title, is 75k worth it for a DNP? I ALMOST started a DNP program at a top 10 school nearly 3 years ago as a new grad CRNA, but deferred because I wanted to work, pay down loans, and save money. As I shop through DNP programs I find myself interested in bigger named schools, e.g. UCLA, Johns Hopkins, Yale, etc. These programs all run ~70-85k, and it makes me wonder if paying $$ for the name is worth it. I'm a co-owner of an anesthesia group that contracts with both CRNAs and MDs for multiple facilities, so getting a DNP will not lead to me earning anymore money. If anything, it's a bad investment financially (unless I somehow used it to become a hospital system CEO). Ultimately, I'd be doing it for self-satisfaction which is why I'm drawn to doing it at a bigger named school. HOWEVER, I sometimes wonder if I should get over going to a a more expensive school for the name. We have a local private school that offers a post-master's DNP for 20k. There's also DNAP programs that are geared towards CRNAs that allow you to take 1 class per semester at a low cost, namely University of Missouri. Although, as somebody who lives in California, I would feel weird saying I graduated from a school in Missouri. I just wouldn't be proud to say that I graduated from any of these schools, but at the end of the day a DNP is a DNP. I guess my question is, how important is school prestige for the DNP? Is ~75k worth it for a name?

Minimum amount of questions here for LVN, RN, and CRNA. Case closed.

I became a CRNA and never looked back. I love it. WAY different from bedside nursing. Being a provider is much more satisfying. However, I will say that nursing as a career is pretty good IF and only IF you look at it like a career. If you plan on staying in med/surg, giving people baths and passing out narcotics and antiemetics for the rest of your career (or working in nursing homes for that matter), of course you're going to hate nursing. Those are burnout jobs that thankless. I did both. Once I got to the ICU I felt a little more respected, and my job satisfaction went up. I am VERY VERY thankful to those who make their careers out of working in med/surg and SNFs. It just wasn't for me though. With nursing you can go into IT, anesthesia, NP, dialysis, ER, ICU, management, admin, med/surg, tele, infection control, education, teaching, etc. The list goes on. If you don't like your job then find one you do like. There's A LOT of opportunity out there.

I hope it's the Medical Center's OR, but likely it'll be the Heart and Surgical Hospital.

Oh yeah, and when I was there the anesthesia group was considering no longer allowing SRNAs to rotate through the main medical center's OR. With CRNAs no longer being able to rotate there or one of the other outpatient surgical sites, SRNAs were essentially limited to 1 of the outpatient sites for ALL of LLU. I hope this is no longer the case though, because for what you pay at LLU you would hope that the education would be top notch without any limitations. This isn't to say that if you go to LLU you won't become a good CRNA. By all means you can and there are some very solid providers that have graduated from the program, and some even practice independently. Just don't go to the LLU expecting to get great experience at LLUMC. It just ain't happening. Work hard and learn everything you can in your outrotations:-ARMC, VA, Navy, NAPA, Ohio (optional, but great). If they do allow you to rotate to the main OR (I did), be prepared to deal with people whose intensions are to make you feel second class as a SRNA.

Well, I've rotated through LLU, and I have to say that it was the worst rotation I had. VERY INCREDIBLY anti-CRNA and extremely medically directed. The CRNAs aren't even allowed to push induction drugs, place CVLs or A-lines at the facility. I repeat, at their own facility. The anesthesia group is fairly anti-CRNA, and it was vocalized when I rotated through. The SRNAs I worked with varied in quality, with most being okay. The majority of the good experience they receive comes from their out-rotations, namely ARMC which is TWUs primary California clinical site (hence the suggestion for TWU). I would rank programs as followed: 1) Kaiser (only downside is they have too many rotations so as soon as they get their bearings at a place it's onto the next rotation), but they consistently produce solid graduates. 2)TWU (ARMC is hands down the greatest site for SRNAs in SoCal, but you get worked long hours like staff for free, but come out prepared. Their students were the strongest clinically-LLU, Kaiser and USC rotate here). 3) and 4) LLU and USC come in at a tie. USC rotates to sites where there are no CRNAs and are forced to follow MDAs all day who don't let them do anything (anesthesia can be political like that), and for some, it really showed. LLU's main downside is that it's affiliated with a medical center with an anesthesia residency that has anti-CRNA sentiments. Residents obviously get preference for big cases, and as a SRNA you won't even be pushing induction drugs. It was a fairly demeaning rotation honestly. One of the MDs told me that CRNAs are basically technicians who don't do any real thinking. CRNAs even got pulled out of one of their outpatient centers so that residents could get more experience that was more similar to private practice. ALSO, for the cost and the length of the program, you might as well go to medical school. FWIW though LLU does have a pretty solid heart rotation up in NAPA, or at least they used to. If I wanted to be a CRNA and ABSOLUTELY HAD TO stay in the IE, I would go to LLU, but I would strongly consider making other options work.

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Do yourselves a favor and go to Kaiser, Texas Wesleyan, or USC if you're looking at California schools.

I did this exact thing because I thought my stats weren't competitive, and surprisingly, every single director replied to my email. Most said different things, but the recurring response was "Just apply. A lot of it depends on how competitive the cohort is from the application cycle you apply for, and more important than anything else is how you interview."

I was just accepted to a DNP program at a public research university that's ranked top 10 for public schools, and is nationally ranked as well. I currently work as a staff CRNA at this particular university's hospital, so I'm getting a pretty nice discount. These are the only 2 reasons I'm pursuing the DNP: 1) Large discount in a program that created a cohort to cater to CRNAs who work for the university, and 2) Doing it at a school that is locally respected with a name I'd be proud to say that I graduated from. I can't help but think about how I'm going to be wasting time and money pursuing this, and I've done A LOT of thinking about whether or not the DNP is really what I want. I'm still not sure, but I'm doing it for the aforementioned reasons. I'm happy to have the opportunity to pursue a doctorate, particularly because of my negative past with academics when I was younger. I also know that I will never be content if I don't obtain a terminal degree, especially as more new grad CRNAs come out graduating with a DNP. It's just my personality. However, I can't help but think that my doctorate won't be respected in the medical community. The curriculum is very lackluster, and I guess my point is that if you pursue a post-master's DNP you can't go into it expecting to become a better clinician, or expecting more respect from our physician colleagues. They'll never respect it. It's a turf war thing. I DO believe that the DNP curriculum will better prepare me function in the board room later on in my career, and it will help provide me with the tools to convince those in the C-suites to expand CRNA services......or at least I keep telling myself that to justify spending more money on another degree LOL

I mostly agree with this, but I'm a little on the fence about USC. I currently work with a lot their grads and a lot of their SRNAs rotated to my main clinical site when I was a SRNA. What some of their SRNAs told me is they're forced to start a different rotation every month and most of the sites are heavily supervised where CRNAs are either limited or they don't even have CRNAs. Just when they get comfortable and people start trusting them and allowing them to do things they have to go to a different site. I definitely agree with every other school listed, mainly Kaiser. Their students were pretty good. I was fortunate enough to rotate to a military hospital for a month, and they had some very very strong CRNAs. Only downside was at this particular place the military anesthesia residents got all of the bigger cases, but the CRNAs were very very independent.

I graduated from the largest program in the country. I was fortunate enough to be placed at a site with one of the busiest trauma centers in the state that didn’t have anesthesia residents. I specifically chose the site because I worked there in the ICU. We took overnight call and the CRNAs supervised 2 SRNAs at the same time. We were on the schedule and basically used as staff. The place was apolitical. CRNAs, SRNAs, and MDs all worked together and I learned so much. I was there for 12 months, and did 4 months worth out specialty outrotations, which I actually preferred. We had a ton of autonomy. When I graduated, I felt ready for independent practice and felt very prepared for neuraxial, and moderately prepared for peripheral nerve blocks. Granted, some of the newer blocks I never got to learn. It was a grind, but now that I’m practicing, the transition to practicing as a CRNA has been fairly easy for me, So I wouldn’t have done any other program. We had students rotate from both big name programs, and another program that’s known for producing independent practitioners. It was evident when they rotated to our site that they weren’t used to the autonomy that we were allowed, and weren’t clinically the strongest. I can’t speak to other big name programs, but mine was the best experience I could have had. I think it’s unfair to group all big programs together. I was fortunate because I knew people in the program, so I did research and knew what I was getting myself into. my advice would be to do your research and talk to alumni or current SRNAs on their clinical and didactic experience and then go from there. Don’t pay attention to the US News rankings.

Never have I ever met a physician who cared so much about the nursing admissions process to comment that one should pursue advanced practice after 3 years. Also, a lot of the basic mistakes that you mentioned that BSN-DNP nurse made is learned at the bedside with ICU being one of the prime areas to learn this stuff. I never experienced lateral violence or anti-intellectualism at the bedside. We were encouraged to take courses that would help us grow clinically, and our hospital would pay for it. If anything, there was an unspoken competition about who could get more "certifications," and who was capable of taking care of the sickest of the sick, e.g. crashing trauma, septic patient on multiple vasopressors about to code, etc. This bedside experience is something I still use today and fall back on when anesthetizing sick patients. Granted, I worked in unionized California hospitals where nurses had nurse-to-patient ratios and were paid 100k+, which may have attracted a different demographic to the field than a hospital in a state without ratios that pays 25/hour would. If anything, working in a nursing home as a LVN passing medications for 30+ patients taught me time management. Working in med-surg allowed to learn to quickly sift through information, analyze it and respond accordingly. Working in step-down prepared me to work in the ICU. My ICU experience nicely prepared me for anesthesia school and my current practice is a culmination of all of my experience and education. Sure, you might not need this type of experience as a FNP practicing in primary care, but would I rather have a FNP with 10+ years of cardiothoracic and ER experience be my PCP, or a brand new BSN-DNP without any prior experience be my PCP if they graduated from the same program? I would personally choose the former. I think the beauty of nursing is that people can advance their education and change their specialty rather easily. I don't think that creating more barriers for people to improve their situation and learn more is the answer. I do however think that the quality of programs and their curriculum should be examined and beefed up academically as long as its relevant to their specialty. Use the extra months and credits to give CRNAs more regional/cardiothoracic/US/TEE, FNPs more clinical hours and specialty rotations, nurse leaders more admin rotations that are relevant , etc. Better this than doing an irrelevant capstone project.

I think that's more of an example that DNP programs should require experience for admission, or that hospitals shouldn't hire people into a role where they're expected to establish clinical guidelines without any clinical experience. It sounds like her undergrad nursing program failed her as well. It also sounds like her DNP program's pharmacology course failed her as well. Perhaps the quality of the courses already given, since MSN and BSN-DNP programs are required to have pharm, patho, and physical assessment courses as part of their curriculum, should be evaluated. I don't know that one nurses mishap means we should add calculus and physics to a nursing leadership degree though. I definitely agree with you when you say that DNP curriculum is watered down needs revamping, though.

I'm a MS prepared CRNA as well, and I completely agree that the DNP lacks application to most advanced practice nurses. While I don't necessarily think that a non-APRN who wants to obtain a degree with a specialization in say, leadership should have to repeat any hard sciences, I do wish that an BSN-DNP FNP or BSN - DNAP (CRNA) would add additional clinical hours (mainly for NPs though since CRNAs have a minimum of 2000 clinical hours), or applicable courses that can actually be applied to clinical practice, e.g. extra regional anesthesia, cardiothoracic anesthesia, or transesophageal echocardiography, etc. instead of fluff courses that require bogus capstone projects. The post-master's DNP program that I'm pursuing will have zero application to anesthesia, but I'm doing it because it's a hybrid program (not completely online) at a big name institution and I'm hoping it will open more doors for me in the future through networking. The problem with making a post-master's DNP more difficult, especially for working professionals is less people will apply, and at the end of the day these programs exist to make the institution money, unfortunately. This is especially applicable to individuals like me who went to a CRNA program that was heavy in the chem/biochem/o-chem, patho, pharm and graduated with 3000+ clinical hours. I think a good idea would be to add more hard sciences to BSN-DNP programs, and have post-master's programs that will help an APRN improve clinically.

Thank you very much for the elaborate response. You have effectively dissuaded from me pursuing a PhD. The truth is I'm still a little jaded from CRNA school and your description exhausted me. I applied to my employers DNP program which is new, but has both a leadership and education focus and the school is highly ranked. A lot of people in the CRNA community choose to pursue a DNAP degree for more of an anesthesia focus, but I like how broad the DNP is should I ever choose to pursue administration or education with ability to teach people other than CRNAs. Thanks again!

Hello, I'm currently browsing through DNP and PhD programs. I want a doctorate mostly for personal reasons. I know that it likely won't make me anymore money as a CRNA, but I know I'll never be satisfied if I don't have a terminal degree for my field. I like the accessibility and cost of some DNP programs. I'm currently looking at a DNP program through my employer (academic institution) that would take 2 years and cost 40k with our discount. It's a little pricier than I like, but the school is nationally ranked and a top 10 public school nationwide. Going to a place like this could potentially open up more doors for me if I decide to teach or go into admin later on (which isn't too common for CRNAs). However, I can't help but yearn for a PhD as I think it holds more clout. Looking at the curriculum of most PhDs, it seems that they're longer, cost more (although funding can be available), and a lot more research is required. Having said all of this, I was wondering why you chose a PhD program instead of a DNP program or vice versa. Any input is appreciated!

If you work rural, maybe. I took a job in a level 1 and seem to be getting stuck in a trauma, crani, transplant, or AAA on an ASA 4 at least weekly. The other day I did 3 cranis within 10 hours. After a couple of years of this I may need to go onto do some of these bread and butter cases you speak of. I worked in a very busy level 2 MICU (more of a mixed county ICU) that actually took more traumas than our local level 1 (private hospital) and was given a lot of autonomy. I agree with PresG33. It's not always the trauma or unit designation that matters, but rather what you're doing on the unit and how you portray/convey it on your application. With that being said, there are a lot of people that would love to get into a level 1 SICU specifically for school, and if the level 3 doesn't take hearts/ecmo, etc etc, then the level 1 SICU is hands down the safest bet. 20k seems like a lot of money now, but once you're a CRNA that 20k won't seem like much.

Work in the level 1 SICU at the teaching hospital. Not to say that SICU experience at a level 1 would ALWAYS be better experience than the level 3 ICU (sometimes you have more autonomy in these smaller mixed ICUs), but you will likely be exposed to more in the SICU. 20k/year is a drop in the bucket if you really want to be a CRNA.

A tube yes (but even then you can still be exposed), an LMA I'm unsure of. I'm intubating everybody and trying to avoid MAC cases in general unless it's a quick and short case and the patient is low risk.

N95 and goggles on during the entire case if asymptomatic and low risk. If symptomatic and/or high risk then our protocol is to use a papr and gown up.

For any patients who are high risk, symptomatic, or confirmed we're wearing PAPR with droplet precautions along with double gloving. For all other patients we're using N95s and covering it with a surgical mask (to prevent the N95 from becoming soiled in order to reuse), + goggles, double gloves, and yellow gown during intubation. After intubation a surgical mask and goggles only are considered okay. For MAC cases we're being required to wear an N95 mask and observe droplet precautions for the entire case since their airway isn't secured. We're avoiding LMAs, we're performing RSIs (with succinycholine instead of rocuronium-not sure if it's a cost issue) on everybody and avoiding bag mask ventilation. I'm personally using the Glidescope or some other form of video laryngoscopy on everybody just minimize mouth opening and get the tube in quickly, and during emergence from general anesthesia and extubation, I'm putting my N95 and goggles back on and performing deep extubations on all who don't have any contraindications (A technique where we get the patient breathing spontaneously off of the ventilator while still anesthetized with our volatile agent/gas that prevent patients from bucking and coughing everywhere).

I've asked an MD to push drugs where I work because the patient was difficult to mask. It's not that big of a deal. If an MD REALLY wanted to push my drugs I wouldn't care. I know how to push drugs. What IS a big deal is some places limiting CRNAs by not allowing them to push induction drugs. At one of my rotations that was heavily MD ran, me and the CRNA waited 45 minutes for an MD who was stuck in a difficult airway to come in the room to push drugs because the CRNA wasn't allowed to without her in the room per hospital policy. It was a simple case too, which was very different than what I was used to at my primary clinical site. No thank you.

Was this in an ACT? Do you feel like this job prepared you for independent practice? all I keep reading online is "you should do independent practice only and blah blah blah" I joined a similar ACT in a major academic center doing big cases and traumas (the place doesn't limit CRNAs at all with the exception of blocks), and I'm learning so much. For now, I'm very glad I chose this route with hopes to be able to handle anything thrown my way when I go independent later on. In my short time as a CRNA I've already done some VERY high acuity cases on patients with ALL of the comorbidities you could think of. I figured later on down the line I would never say to myself, "man I regret all that big case experience at the level 1 trauma center that I got," but I come on these boards and it seems like wanting to start out in an ACT/major academic center is almost taboo. Sure, I'm not doing blocks, but I figure I could always take a block refresher course. I'll never be able to take a refresher course on doing an emergent open AAA on a crashing patient with COPD, asthma, DM, CKD going into rhabdo, PVD, and PAD on the brink of death.

I would take a motivated person who went to a mill over a lazy person who went to a usnews top 10 school any day of the week.