SN2bExpAt

You know this question is coming. Why would I bother with 4 years of extra nursing school when in that same amount of time I can get a medical degree that has unlimited diversity potential? You already need to take chem and org chem to be considered for admissions into CRNA schools. Some medical schools allow our A and P as substitutes for Biology, so that just leaves Physics as the differing pre req. With the current and NON abating nursing shortages we face, I am puzzled as to why you damn yanks keep making it more difficult for nurses to want to get into the profession. Seriously, 8-9 years to become a neutered prescriber? There are only 2 winners with this DNP nonsense: PA and medical schools. This "keeping up with the jones" inferiority complex driven mentality just erodes my want to stay long term in the nursing profession. The whole "look at me, I'm special too!" attitude is borderline juvenile and makes non ivory tower nurses shake our heads in shame.

BINGO!!! I was fortunate enough to witness an autopsy in my medicine clinical rotation. The pathologist was excellent about teaching my group as she cut and dissected each organ. The patient was a 285 lb female 25 year old heavy smoker who died of a pulmonary artery clot. And when I say clot, I mean this thing was the width of a child's finger and at least 15 cm long. If she had cut into her leg, I am sure there would have been more. I never would have imagined clots being that big considering all my nursing A&P comes out of a textbook and little else. I also got to see what a uterus looks like in a non-pregnant woman (size of a walnut), the circle of willis, substantia nigra, the enormity of the human liver, and much more that will stick in my brain for years to come. I learned more about putting it all together and "critical thinking" in that 1 1/2 hours than I have in weeks of medicine/nursing theory classes. I dunno, maybe I am just jaded from all the holier than EVERYONE ELSE, INCLUDING DOCTORS attitude the majority of my nursing faculty seems to share. My medicine prof described iatrogenic as caused by doctors. If you look it up, iatrogenic means secondary problems caused by health care workers. This could mean an incompetent physiotherapist to a nurse giving the wrong medication, as well as doctors. What I am saying is if this Dr Mundinger-esque attitude is prevalent in nursing grad schools, then I want no part of it. I was once of the attitude that 500-700 hours of clinical experience was no biggie, I can gain the rest experientially as I go along. But it seems as though egotistically charged nurses (with ZERO foundation, btw) could be a part of that experience and quite frankly, I have had more than enough verbal abuse from nursing instructors who think they are as smart as doctors because they are hoping the students won't clue in to their SEVERE A&P, immunology, pathology, organic and biochemistry, knowledge deficits. My medicine instructor is so rigid in her rightness that she will make up answers before she admits to making a mistake (and we have caught her plenty of times). Would I be comfortable letting a seasoned NP Dx pneumonia? Sure. She/He has years of experience in a collaborative care setting. If you are asking me to choose between a newly minted IM MD/DO grad and a newly minted ACNP grad, I'll take the grad with 10,000+ clinical hours under their belts, tyvm. I don't **** around when it comes to my health care provision.

So, um, I am guessing by the non response that the Chem requirements aren't all that important then? High school will suffice? Where's a Biff Tannen emoticon when you need one???

CRNA schools highly recommend a chemistry course(s) prior to entering their programs. However, these schools never seem to specify a preference(s). Some recommend Organic Chem, others BioChem. That would infer at least two full chem courses, since you cannot take the two aforementioned w/o a year 1 intro chem course. This is frustrating. I would hate to handicap myself if 6 credit hours of 1st year University chem is insufficient. Then again, no one CRNA school has stated specifically that you need Chemistry, only that it is highly recommended. What gives here? Is Intro enough or do I also need to tack on Organic and Biochem? How complex is the chemistry in CRNA programs? BioChem isn't even a required course for Medical School, they teach it to you once you are accepted. How is it for CRNA students? Those of you in school or graduates, did you find that Organic and Biochem were necessary to succeed in your courses? Was Intro chem and physics enough, or not? I would hate to come in unprepared. I was reading U Miami's webpage (nursing) and they will kick you out of the CRNA program if you get less than a B-. That got the gears rolling to make sure I cover all the pre reqs if I want to apply. Question: how does a B- translate on a 4.0 GPA scale?

I have been thinking. The theory is that DNPs will be able to bill insurance companies just like docs, right? This would suggest that they are not earning a yearly salary. Mundinger suggests superior care because of the "Noctor" approach, which is adding a caring, holistic approach on top of being Tx'd and Dx'd, correct? I can only assume that a visit to a DNP would be more time consuming due to the assumption that doctors only treat, while Noctors treat AND care. If DNPs can bill per patient, it will not take them very long to realize that treating more patients per day = more billings per day = a fatter Christmas turkey, and then some. I cannot believe people would be so naive to believe that ALL NURSES not take the same opportunity that doctors do in Primary care. Mundinger, in her own words, suggests "superior care." Well, I believe that superior ability can breed superior ambitions. To suggest that DNPs are somehow exempt from a basic human drive, GREED, is foolhardy to say the least. FWIW, wheeling patients thru like a carnival ride was a huge problem in British Columbia. Some docs were seeing up to 50 patients a day. The provincial gov't finally stepped in and capped Family Physicians to seeing 25 patients a day. Will there be this kind of watchdog over DNP's who get a little greedy? They cannot even decide on a standardized, universal curriculum............

Is there going to be a standardization process to ensure consistency? Isn't there something like 190 programs nationwide slated to be offered in the upcoming years? I have a hard time swallowing that someone who attended campus for 4 years is on the same level as someone who did their DNP online. How about the nursing (DNP level) equivalent of the USMLE? AANC, you reading this?

Well, it looks as though DNP entry to practice is coming well before the 2015 proposed "official changeover." Two schools that have scrapped their MSN programs: -UTHSC (Tennesse) -U of Michigan (Flint) Feel free to add to this list.

Proof? How many clinical hours do med students put in prior to finishing a residency? Around 6000 hours or so? NP programs? 500-700 ish hours? Research indicates that two fields can equally Dx strep throat? A broken arm? Prescribe Humalin R for diabetes? Drain a boil/furuncle? Suture a gash? Internists are considered primary care providers. They work general internal medicine. If they were considered to be on par, hospitals would put NPs on rounds instead of the docs, right? I am not trying to be rude, but implying that both professions have equal knowledge, even GPs, is kind of insane.

Are the foreign nurses that Capital Health is recruiting Baccalauraeate prepared? If not, that is one glaring hypocrisy. Or is it that the RNs brought from overseas being settled into Canada as LVN/LPNs? This is the same "better than you" attitude I see the Canadian Medical community taking towards Aussie trained doctors. Canada is willing to accept OZ docs into family or pediatrics, but slam the door in their faces if they want to practice a specialized field (cardiology, neurology, nephrology, et al). I guess the Royal College of Physicians and Surgeons of Canada do not want their cash cow niches being taken up by equal quality trained Aussies. Is that what the CNA is afraid of? The availability, the choice of where nursing grads wish to practice is pretty open right now due to our shortage. This is an attractive selling point getting people to consider nursing as a career. If nursing positions, especially the "higher regarded" ones (ICU, Cardiology/Coronary, ER) are getting eaten up by foreigners, this makes it harder for canadian grads to secure a position they want in their senior practicum and eventual career. Please tell me I am wrong. If keeping the status quo of Canadians in the upper echelons is the driving force behind the miles of red tape foreign nurses have to jump thru, then we are petty indeed. When the care of Canada's sick and needy take a backseat to nursing politics, it makes me a little ashamed that I am represented by these inferiority complex driven nurse "leaders":uhoh3:.

Is BSN entry to practice a proactive measure to keep foreign trained nurses out of Canada? I am seeing two sides here. You have the angels in the sky press release version. This is the version where some nursing prof., whom hasn't had to deal in bedside nursing in over a decade, extolling the virtues of Baccalaureate prepared nurses. In her/his speeching you will hear "critical thinkers" mentioned at least a dozen times. I have personally met a Nursing professor who snubs Diploma nurses. The irony is that most of these older battle axes started in a hospital diploma program and later "upgraded" to BSN. The upgrade was not for personal gain, academic enlightenment, or because they were bored. It was for a chance to get into a management position. Then there is the version I am seeing unfold as I progress thru nursing school. This is the part where Canadians are not so different from our southern neighbours. Our supreme arrogance, looking down on the world like we are so much superior to them. Canada is so damned short of nurses. So what is our magical solution? 1) Make it even harder to recruit foreign nurses and 2) Kick Cdn Dilploma Prepared nurses in the jewels. Manitoba is the last place where DNs are trained and here is where they stay. The rest of Canada does not want them because of a legislated Superiority Complex. I uphold DN's worthiness for many reasons. First, my mom is a DN and she is way smarter than some of the BN's I have worked with, not to mention her work ethic surpasses some of these "superior bred" BSNs. Second, I never stop hearing how the hospital nurses prefer diploma students b/c of their early ingraining of clinical skills. Canadians, if Canada does not want you, look down. By "down" I mean south of our borders. A LOT of american hospitals pay the full tuition for RN-BSN. What is it that the CNA is so afraid of with Diploma Nurses???

Oh boy, lines are gonna be drawn with jackhammers in the near future. /me grabs a bag of popcorn....this is going to get real ugly in the near future.

We already are robotic in the search for EBP based rationale. We are constantly beat over the head with "EBP" in our Nursing Skills labs. We are told not to listen to the "older" nurses if what they show us contradicts what is taught in class. The problem with most evidence in nursing is what you have already mentioned. Qualitative (especially emergent ones) studies can give guidelines at best, it can never be given the title of "proof". Give the parameters and data to five different nurse researchers and you will probably get 2-4 different interpretations. I guess I am too much of a concrete learner to settle for anything less than definitive. I am all for improving patient health outcomes and the keen eyes of nurse researchers to advocate optimal human responses to illness. But man, let the dedicated researchers deal with that, their chosen specialty.

As for reductionist, I would think that 4 years undergrad BN and a few years in practice would help solidify our caring perspective and help us not write off people so quickly. I was watching Mystery Diagnosis on Discovery Health this morning, I had TiVo'd it and finally got around to watching. There was a patient who had edematous ascities post surgery. Then there was the development of tunneling and necrotizing tissue about 2 inches diameter. Her idiot primary care doc kept writing it off as a flu. Most nurses, from their wound care practice and training, would get the red flags going and notify a qualified MD stat. Before commercials were over I, the armchair pathologist, guessed Necrotizing Faciitis. Turns out that is what she had. So yes, some MDs are reductionist morons who cannot see past a lab printout or worse, do not even order one. I guess I am a little biased when I decide post BSN studies because I do not consider myself reductionist. However, I am not comfortable denying myself the opportunity to consider all possible options; which means I want all available classes to r/o self doubt. Seriously, having a case of the "only if's" drives me up the wall to no end. Having a case of the only if's in the grand scope of choosing a terminal career would leave me uncertain, unfulfilled, and uneasy. As an aside on the topic of reductionism, I have a scenario. What if a student went straight from BSN-DNP? This may very well be likely, if not already reality. Without the opportunity to finely polish those human interaction/communication skills, is that any less reductionist than the student who goes from undergrad to Med school? Also, and I could be in error here, I do not remember seeing chemistry as an entry requirement into an NP program. I looked at programs in the US and Canada and I must say, not once did I even see chemistry mentioned on the respective MSN-NP programs. I see Chem and Physics as pre reqs for CRNA, but not NP.

Scroll down to Length of Program UTHSC has already implented DNP as their standard entry to practice as of 2009; guess they got sick of waiting I'll be honest here, I just assumed 3 years because I was thinking to the future and forgetting about current program designs. I found the U Pitt website via Google and some luck, I guess. You are right, currently most people are looking at four years if you follow protocol and go MSN-DNP. My bad.

Oh, I am also not flawed in respect to one additional year. DNP programs are 3 years versus the two required in a masters? I guess I did not make that clear. If you throw in the 1-2 years of RN experience these programs require prior to admission....