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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....

When I said fluff earlier, it was not aimed at the ENTIRE courseload an NP student is required to learn. I think I made that pretty clear. The courses you listed would be the meat and potatoes required to Dx, Tx and Rx. Of course they are not useless, you cannot be an NP without them. I do think, however, that the academic mentality of adding the extra year for DNP will find it irresistible to shove more preachy banter into the curriculum. How many of you "tweaked" your answers for your nursing ethics classes because you knew it was what the professor wanted to hear? How many of you let a big "sigh" out when you had to study for that research methods test? How many of us find that what it taught in the classroom barely resembles real world nursing? How many of us have had clinical instructors tell us that this is how it is done in the hospital (vs the textbook). Some DNP programs have a capstone project in the final year, do they not? What really put this into perspective was when I had to do an essay for my Pharmacology class. I went looking thru books in the pharmacy section of the library and realized how even a basic understanding of Chemistry would have un-garbled some of what I was attempting to read. I quickly headed back to the Pharmacology books in the nursing section, r/t deficent knowledge of chemistry AEB by failed attempt to decipher the language of chemistry. We as nurses are relentlessly beat over the head to be "critical thinkers." It isn't enough to carry out a medical order, we need to know why. It isn't enough that we administer an IV drug w/o knowing what extravasation is. Fine. This is actually a good thing and I agree wholeheartedly. So why is it that NP's can prescribe w/o having taken one single course in Chemistry, even in high school? We are all about EBP, yet the NP programs don't explore that evidence base when it comes to the pharmacotherapy classes. If DNP is to be the norm in the future, how about taking this opportunity to give it some objective credentials? You know, the answers to which mathematics gives the single (or at least really narrowed down), irrefutable rationale? No more of this interpretive qualitative filler which may change precipitously when someone else does a better funded study than you. If it is to come to pass, then maybe an entrance requirement should be a full year of intro chem? It can be further expounded upon in a bio/organic chem class that should be offered as part of the DNP curriculum. How would this not give a deeper understanding of your prescribing powers? I would feel better knowing the deeper "why" than doing a yearlong capstone project on, let's say, patient coping in the outpatient vs inpatient setting, evidence to show teaching...yada yada. If anything, it would open the floodgates and allow more NPs to prescribe narcotics (I don't know how drug schedules work in the states...yet). Does getting that private practice you have always wanted look a little closer now? If this DNP took the time to beef up its grads with hard science vs: a capstone project, more research based snoozer classes, or emergent theories courses which helped some RN get a journal published, then it would be worth this new standard as entry to practice. The way I see it, it can only enhance the care of patients from a safety point of view. Think I don't know what I am talking about? Then why not ask your patients? Talk to them about the drug(s) you are prescribing to them. Then ask them if they are comfortable that you took a class called, "scholarly inquiry for nursing practice" or "advanced research methods" instead of Organic Chemistry or advanced microbiology (with lab requirement)? DNP is not a research based terminal degree, so schools should stop this pseudoattempt at making its graduates reasearchers on top of being clinicians. Leave the research to the PHds, that is why they chose that degree. People choose NP for a great balance of one on one care and technical skills and knowledge; at least that was why I looked into it. Recognize DNPs as the expert based clinicians that they are and give them even more hard science to positively enrich their Dx-ing and RX-ing judgments. I think that a patient would be more grateful that you fully understand their what osmolality is beyond " X = refer to nephrology" versus the A+ you got in Emergent Nursing Theory.

Shalom! Best wages are in Alberta, period. They pay double for overtime, start higher than BC and Ontario, and have the lowest income tax structure of any province. Also, you only pay one tax there. It is so good that Ontario keeps losing their new graduates to the west. Working conditions are debatable in every province. You'll have good and bad places. However, Ontario nurses are highly stressed and overworked and understaffed. This was so much so that my friend's mother wound up coming home to Manitoba for cancer palliative care because of the waitlisting d/t lack of open beds. No nurses = no beds. I went to a recruiting fair about a month ago. Provinces like BC and Alberta were offering relocation cost bonuses from $3000 to $5000. Not once did I hear of these offered from Ontario based hospitals. If I stay in Canada, I will definitely head to Calgary. I was thinking of Toronto b/c that is where a lot of my friends are, but man the money is too good and friends don't pay the bills (or loans, dammit).

NANDA Dx's are such hokey it's not even funny. NO ONE USES THEM OUTSIDE THE FRIGGIN CLASSROOM!!!!!!!!!!! It's just more useless fluff to sell textbooks and give something profs can use to recharge their egos. Most nurses use DARP or narrative, so right there NDX's are rendered moot. Not being able to use medical Dx's to support an NDx just makes it look even less credible. I mean, wow, do I really feel dumbed down when I have to make these things for a care plan. I wouldn't even think of saying an NDx to a doctor; the last thing I need is a doctor looking at me like, "oh, how cute, trying to play doctor are we?" I know my boundaries in practice. I wish the "academics" would take their heads outta their glutes and remember where they came from.

It is the paradoxical effect of more is less. More requirements for NP = less applicants to grad school. I am guessing people with ambition apply to NP grad school. These people, motivated people whom should have a good grasp of foresight, will see that "three is weak" and "four gets you so much more." I've got to start trademarking these catchphrases. How about this one: "the PE of DNP."

Visit US World and Weekly news. I paid a pretty penny to get their "Best American Grad Schools 2008" issue mailed up to Canada. Top 3 schools for NP year after year: -UCSF -U of Washington -U Penn If I were to choose a school, it would be UCSF. They have the most breadth of options available for NP practice. Couple that with the fact that they are a grad school solely committed to Human health (medicine, nursing, dentistry, Life sciences), the name alone is enough reason to get a Masters from them. I agree, though, it would be nice if we had a professor rating for schools.

Troop demoralization that begins in the school setting before getting that BSN in your hand. It is funny to see how the nurse instructors who were complete bullies to powerless students relegated to "gossip queens" towards their RN counterparts. I guess it is hard to say stuff to your face when they no longer control your grades. I have every intention of looking up those instructors post graduation and embarassing them in front of their students; hopefully breaking them down to tears. I've said it before. Why would I want to stay the long term in a profession where bullying, politicking, backstabbing, and blatant disregard for student emotional well being is commonplace? C'mon, we all know how high and mighty some nursing specialties think they are over others. We hear it, we see it, we receive and or give it. United we stand, divided we....um......well that's all we seem to do at times.

How about professionalism extended to the clinical instructor/student dynamic? I find that clinical instructors can be angelic to evil incarnate. Yet, professors and other staff prefer to take the ostrich approach and hope these whiny students graduate before making too big an issue of it; then repeat. There are no prerequisites other than RN to fill these jobs. As a soon to be nurse, how can I be a part of a culture that allows the abuse shown to students in the clinical setting? Most schools are purely subjective in their grading, so unless you have been taking notes on the side and recording abusive behavior, you are at their mercy. The clinical leaders are always on their side; it is like talking to a brick wall when you try to tell your side of the story. This is the ugly side of nursing that is never spoken of in the academic setting for fear of retribution from the professors. I have realized that nurses are just as petty and egotistically charged as the next cardiologist, MBA, JD, Psych PhD, et al. Unfortunately, empirical grading (read: objective) is not part of nurse clinical teaching and are subject to the whims of whomever is there no matter how much of a bully they prove themselves to be. I must say, this is not who I wish to become should I wish to advance my career. The abject lack of professionalism from some clinical instructors and two clinical leaders (so far) has sealed the deal for me; I have rejected MSN/DNP/PhD because I find too many of these people are too concerned with image of their respective schools and a profession as a whole. They will, at the student's expense, do whatever it takes to show the world how we are just as educated and critically thinking as our MD counterparts. They purposely eviscerate our GPAs to show the world how "tough" nursing school is and boy, don't you ever forget it. Want to strategize how to keep nurses in the profession when they graduate? Treat them with the respect you would receive from them. Why would I stay in a culture that purposely demoralizes their troops? Nursing on the whole needs to stop this juggernaut of promoting image at the expense of its future generations. It is hard to keep nurses when not even their own faculty respected their decision to pursue nursing, AEB the thousands of horror stories told about student clinical experience.

All throughout my 2nd year of nursing school I would spend a lot of my free time looking at both Canadian and American schools that offered an NP Masters stream. It is three years in Ontario. You have to complete a Masters then a 1 year certificate program (online, no less) to become a Nurse Practitioner. We like to stuff as much threoretical malarky (thank you whoever said that above) such as Nursing Issues, Leadership, and two research methods classes to distance ourselves from American programs. A lot of trivial knowledge that helps 0% when it comes to diagnosing a patient, which is pure BS. Unfortunately, some Canadians define themselves by saying how unlike the Americans we are. Nursing actually provides a quantifiable basis for this theory, too. All you have to do is compare the Canadian Registered Nurses Exam to the NCLEX. We have a lot more pshychosocial basis vs objective and physiology based testing. I see this pattern spilling into the American nursing landscape, now. Unless that extra year in the DNP proposal is purely clinical and scientific (REAL science, not the qualitative "Anxiety and patient response yada yada" BS research that made me want to hang myself when I was forced to read it), then it will be more useless "fluff" courses that have no practical basis in diagnosing a patient. I see this as another evolution in the dogma of making nursing practice as professionally recognized as, well let's face it, MD's. Canada is no exception, either. We make BSN entry to practice in every province except Manitoba, the last bastion of diploma training. You see, in an effort to make us as "professional appearing" as PT's, OT's, BSc lab techs, we addressed this nation's nursing shortage by cutting those off who could answer the call. We basically shat on all the Diploma nurses coming out of Manitoba. When these students quickly realize that American hospitals pay for their staff to upgrade to BSN, they will not stay here. What I am saying in the above is that this incessant drive to show the world how special we are, usually at the expense of our checkbooks, is driving me to wonder if I want to remain a part of that culture. This drive for recognition is making me seriously reconsider my post BN studies altogether. What do I tell my future kids when they ask me, "nursing school or medical school?" Let's face it, with an equal amount of time to do DNP and medical school, would you have made your university decisions the same way? I am feeling this ever so in my undergrad studies. The kind of people that are so driven to bolster the nurses image to the medical community is making me realize I do not want to turn into one of those types of professors. I am already spitting nails at the 100% useless fluff courses that make up a baccalaureate, why would I want to endure more of the same for another 3 years? Currently it is two, but that is still time wasted in my eyes. Tell me how "Trends in Nursing" or "Nursing Leadership" or "qualitative research methods" will help me diagnose JRA, rheumatic fever, or a simple staph infection? Even if you get something interesting like an autoimmune disorder, you have to refer it to an MD because it falls out of NP scope of practice. As soon as it gets complicated (and interesting) you have to realize your limits and refer the patient elsewhere. I could not live like that, knowing that if I had just spent one more year "elsewhere", I would be recognized as competent to deal with cancer, autoimmune, really cool diagnostic differentials, etc. Unless DNP entry to practice offers that kind of autonomy, people will quickly realize the "alternative" opens up a whole other world where you are limited by your imagination; not by ANA, state, or national legislation which castrates your role as a health care provider. I know, with the combined experience of holier than thou nursing professors, clinical instructors, and now this push for DNP entry to practice, my mind is made up for my pursuit of grad studies and NP is no longer on the radar.

My personality is such that I get as much out of a job/career area as I can, then I move on. To get as much as I can as a BN, I want to get straight into a Critical Care course and do CVICU, telemetry, and possibly Radiology or Cath Lab nurse. I will decide if I want to stay in front line nursing about 4-5 years after graduation.

My reasons. 1) I hit 25 and was seeing all my friends surpass me career wise, possessions wise, and all the other things people with professions acquire. 2) Human health interests me, a lot. I can talk and listen for hours about it (used to be a big exercise freak). Ironically, I never watched medical drama until AFTER I got into nursing school. House rules! 3) Money. Let's get real, if nursing didn't pay well, health care across the continent would be in serious jeopardy. 4) My ticket into the US. To be the best, one has to work with the best people and best technology. Also, the USA is a progressive proponent of continuing education and encourages their nurses to do so. You guys invest in health care (private and public) moreso than your northern neighbours, and it shows. 5) Mother. She is a nurse and makes a very good living at it. She can clock in as much OT as she can handle and her yearly gross (a DN, no less) is more than some newly minted MD residents. If she were putting these kind of hours in as a CRNA, she would have retired in her late 40's. 6) My GPA was brutal in my 1st degree. This is also a great opportunity to be competitive for post nursing school opportunities.