forpath

That Oceania place is a joke! You don't necessarily have to take the MCAT, there's not a single class on "Healthcare as a Team" or "Advanced Medical Theory" and you can't attend online. What gives?

No reciprocity that I know of. And according to many posts on here, there shouldn't be, as you do completely different things as an NP than you would as an MD. You see, NPs practice nursing, MDs practice medicine. Even when you do the same thing for the patient. It would be hard to argue that credit is due for learning/practicing nursing in an MD curriculum, when that is one of the main tenets of promotion of advanced nursing degrees-that they are an alternative to medicine. Unfortunately, you will have to slog through medical education starting from scratch. It will take you 10 years of training to get back to what you are doing now (4 years med school, 3 years internal medicine residency, 3 years hem/onc fellowship). Assuming you get accepted right away. And you'll be ~150K in the hole.

excellent points. it is not a licensing exam, as it is voluntary. i would presume, however, that there is something more that a dnp learns with respect to clinical practice than is learned in fp school. otherwise, there would be no need for a dnp. if one wanted to achieve a doctorate level in nursing, one could pursue a phd, especially as you have stated that there are people looking to the dnps to provide more research. in addition, there must be more that is learned (or supposed to be learned) as half of the experienced nps who took the exam failed it. if it tested only the stuff they learned as nps (both during school and on the job), one would presume all would have passed. keep in mind that this test was, as you stated, designed for these nurses based on their program of study. and as it was the first test offered, one would think that mundinger would have motivation to see the test was fairly constructed. i just have a hard time rectifying the results with respect to clinical capacity. if the dnp is going to be offered, there has to be a standardized assessment of their knowledge. every doctorate level has it, and they should be no different. as i said before, there has to be a metric by which you compare all practitioners, at least on paper, and this metric, in my opinion, should be a knowledge based test. if you cannot pass, you cannot practice. the trouble, however, lies with the fact that there is probably very little difference between what an np does everyday and what a dnp does everyday. you probably cannot stop a licensed np from practicing when he/she cannot pass the dnp exam. so this all goes back to what a lot of people have said, why even have the dnp when there is a phd and an nd already developed? which raises a good question. did nds have licensing exams different from nps?

so would you go so far as to say that the same would be true of any licensing exam, that they are not worthwhile? why take medical boards, the nclex, the bar exam, sit for phd comps, etc? and how do you ensure that every student is getting an equal educational experience if you do not have a standard metric by which you compare them all? if all 50 nurses passed the exam with flying colors, would you still say the test was not worthwhile or would you say "see? dnps are the bomb."? i think it would be a mistake for the test to go away, as it would damage the image of the profession. "we took the test, half of us failed, so we're not taking that test anymore. it's too hard. but hey, bring us your children and other loved ones." and why would you say that it has no meaning to practicing dnps? it was supposed to measure minimal clinical competence of new dnps (who were experienced nps when they took the test, by the way) and mundinger said it was designed specifically for dnps. if one cannot prove minimal competence on paper (which is based on knowledge), then why should one be able to practice? in my opinion, the failures of this test are incompetent to practice until they pass, and even then they are suspect. how should we measure minimal competence of healthcare practitioners? wait until they kill a few and then let the free market take care of it?

They are already starting to take it... From the ABCC website, "The content of the exam is focused on evidence based clinical care. Clinical evidence is applied to practice by many direct care providers; its application is not limited to the medical discipline. The exam is not intended to test graduates from the diverse DNP models of education, but rather to test clinical competency in comprehensive care for the graduate whose doctoral education is focused on direct clinical care." As you all probably know, 45 experienced NPs with DNPs took the test recently...50% passed. Besides the fact that that is a mathematical impossibility, what do you all think of those results in light of the ABCC's description of what the test is supposed to measure? To me, this means that 50% are incompetent to practice as DNPs and should not be allowed to until they pass, just as MDs/DOs are not allowed to practice until they pass theirs. Some have criticized it as being a physician-aimed test, but Mundinger says the test that was administered was designed especially for APNs.

Has there ever been a study that shows that there are worse patient outcomes when a CNA dispenses meds compared to when a nurse does it? And why should the nursing profession feel entitled to influence another profession and say what is and what isn't within the other profession's scope of practice? In this case, the CNA profession. It just seems so arrogant and I know it is just because of money. When a CNA dispenses meds, she is practicing nurse assistancy, but when a nurse dispenses the same meds, it is nursing. They are completely different things. And so what if nurses had more pharmacology than CNAs in school? I can think of like 4 anecdotal experiences where a CNA is a genius and the nurse under whom she worked was a total idiot. Maybe one doesn't need to go through all the years of nursing school to do what a nurse does. Maybe one can do it all with a CNA in much less time, with fewer tests and less stress. In case you all cannot tell, I am being horribly sarcastic and irreverent. It just struck me as ironic that if one were to replace CNA and medication aid with "DNP" and nurse with "physician" in this discussion, many of you would be on the other side of the argument.

Who's encouraging him/her to go into medicine? It seemed like a good question to ask of someone who already has one doctoral degree. Clearly this person must have considered medicine as a possibility, and they had an answer as to why they wanted to go into advanced nursing instead of medicine...it is the path of less resistance. Not as long, not as many tests, not as much stress. How stressful med school would have been for the OP is unclear, as he/she feels that the 1st 2 years of chiro school are harder than med school. I found that comment to be interesting. I don't know too many physicians who flunked out of chiropractic school. Besides, based on a lot of comments on this board, the world obviously needs great physicians as well.

I imagine your reasons for pursuing an advanced nursing degree instead of going to med school are very similar to many others---Too long, too many tests, too much stress. Again, just curious--how do you know the first 1.5-2 years of chiro school are harder than med school? And if chiro school was so much harder, then it should be much easier going through med school. You may not even need to study.

Just curious...why not med school? And good luck no matter what you do. It's courageous to leave what one does every day.

As far as I know, a DNP is not eligible to take the USMLE and therefore can never pass it, unless he/she goes on to be enrolled in an accredited medical school.

Sure, if you can get congress to pay for it. And obviously, from an absolute perspective, you do not need nearly as much money to fund DNP residencies as you do medical ones. I do not think ceasing the federal funding of medical residencies if DNPs can not get funding is a viable option, especially in this economic climate. You would not be able to fund the training of a significant number of medical trainees, and then, talk about a physician shortage!!

For all the reasons I mentioned above, I completely agree with you. Unfortunately, it obviously has to be something the nursing community does on its own, including lobbying congress for additional funds for post-graduate training. There is simply no way a DNP could enter a medical residency.

So are you insinuating that DNPs should be admitted into medical residency programs?

I am by no means an expert on this particular test, but it was my understanding that the material for the DNP exam was taken from the Step 3 exam, and then altered by the nursing organization administering the exam so that it would be more applicable to what the DNP candidates were taught. So, I'm not sure it was a straight-forward "medical" test the DNP candidates took. Perhaps you feel anyone could become a great provider in primary care given enough time. Of course they could. How much time is enough? 1 year? 10 years? I presume many people, including myself, would likely prefer that they see someone who is, for the most part, beyond the steepest part of their learning curve before they entrust their care to them. But when you speak of specialties (cardiology, ENT, dermatology, pathology, etc), a residency, and for many of us, a fellowship is the only way to gain a minimal level of competence in that specialty before one has to take care of patients or provide pathologic or radiologic diagnoses. Many specialties cannot be covered in medical school (or DNP school) in sufficient detail and therefore post-graduate training is absolutely "precious". I would submit to you that all recent med school and DNP grads are minimally competent to practice medicine and nursing, respectively. The major difference is, MDs/DOs are forced to undergo additional rigorous training (~60-120 hours/week) in residency/fellowship and then take additional board exams before they are allowed to care for their own specialty patients, whereas DNPs can be simply released on the general populace without supervision in a number of states and with minimal supervision in many others. So yes, in the medical model, a residency does make or break a provider in terms of specialties. Anyway you look at it, there is a steep learning curve following graduation for both professionals, the difference is, in the medical model, there is someone who is intensely looking over the shoulder of the medical graduate. The same can simply not be said about the nursing model in a number of settings. Don't get me wrong, I also feel very strongly that a 3 year family practice residency is not nearly enough training to take care of the exceedingly broad needs of the patients in their panel. If one honestly feels that they know enough to competently practice psychiatry, pediatrics, OB/Gyn, dermatology, internal medicine (including its subspecialties, like endocrine, cards, etc) and some others after only 3 years of residency, then they are way smarter and more confident in their abilities than I am. And if one thinks they can do it after only 4 years of school (MD/DO or DNP), well, you get my point.

Although I am not the original poster, I was lurking on this thread. MDs/DOs are not eligible to take NCLEX (or even a watered-down version of it), and so there would be no statistics available to answer your question.

Thanks, Dave. Sorry.

Perhaps someone could explain to me how these results relate to the discussion. http://www.abcc.dnpcert.org/exam_performance.shtml For comparison, 96% and 85% of 1st time allopathic and osteopathic takers passed in 2007 (latest stats available).

Why do you all think malpractice rates are so much lower for FNPs than for MDs/DOs performing the same tasks?

Thank you for your post. While I have no background in Orem, Roy, Leininger, etc (I will look into them), I have to wonder: How much of this is used on a daily basis by APNs? That must take a ton of time, upwards of 1 hour to properly counsel a client and his/her entire family. I have seen many posts on this and other sites where APNs are seeing upwards of 55 patients a day. How can one see that many patients and still be "providing counseling to the client and family as a unit in the context of providing holistic and client-centered nursing care." Are there enough hours in the day? And why are they not called patients? What is a client? Second, let's look at the so-called holy grail study of Mundinger et al. from JAMA 2000, which DNPs/APNs point to frequently. That study failed to disprove the null hypothesis-that there is no difference in outcome between NPs and MDs/DOs. APNs like to point to it as proof that they are "just as good, if not better" than MDs/DOs. Leaving aside all the reasons why that study was not the best, why did nurses not OUTperform MDs/DOs? It seems as though the integration of a holistic nursing component with psychology, philosophy, nursing science etc should have run circles around MDs/DOs and all patients in the NP group should have been cured of high blood pressure, diabetes, etc. I can appreciate that patients, sorry clients, often would prefer to be seen by someone who spends more time with him/her. You can't help but feel a personal connection there. But, is satisfaction the most important metric? "This is specifically why APN practice is growing by leaps and bounds as evidenced by consumer satisfaction" is a direct quote from your post. There are many ways in which one can increase patient satisfaction, but may have nothing to do with quality of care and outcome. If one wants to argue that nursing philosophy and implementation add something to clinical care that the allopathic model does not, so be it. But the proof is in the pudding. And studies have shown that patients are less likely to sue a praqctitioner with whom they have a good rapport...regardless of the quality of care.

pinoyNP- Thank you for the time it took for you to respond. I agree, it will likely be up to state legislatures and insurance companies in the end, but as you stated, nursing is fragmented, and not every nurse wants the same thing, as in medicine. But, in the case of CRNAs, were we not seeing a push for specialization in Lousiana when CRNAs were lobbying for pain medicine privileges? People speculated it was because of money, because pain medicine is more lucrative than "regular" anesthesia. On top, there are many people, posters on here included, who feel that when an APN does the "same" thing an MD/DO does, they are practicing nursing and not medicine. If that is the over-arching philosophy of APNs, then what is to say that there will not be a push for nursing specialties? Nursing endocrinology, nursing cardiology, etc. Afterall, an APN in primary care is essentially assuming duties of specialists, as a primary care MD/DO does, when they treat depression, psoriasis, hypertension, etc, albeit in a more limited fashion. Aren't there already APN degrees for specialties? Neonatology, psychiatry? I may be wrong.

How has the AMA abandoned primary care?

The reason I did not put residencies in quotes is because many DNP programs already call their post graduate clinical training residency, or at least that is how they informally refer to it. Thank you for replying.

There is a lot of supposition/presumption on SDN that APNs will eventually try to move into more specialties and create their own residencies for cardiology, endocrinology, dermatology, surgery, etc and function independently in those fields as well. Does anyone see this happening? Has this been one of the "never talk about in public" plans all along of DNPs? It doesn't sound too unreasonable. APNs have functioned highly in midwifery (OB) and anesthesia (CRNA), so it seems "possible" to me. If so, surely they (you) could not consider non-direct patient care oriented specialties like radiology, pathology, etc, could they (you)? How could they justify the "nursing philosophy" in those fields? Just a serious question. No flaming, please.

I agree, but, does the decision making process of an APN only include philosophy and theory? Or does it also include hard data procured from clinical trials and research which then lead to practice guidelines? If so, from where do this data come? From the "physician" side of the street or the "nursing" side of the street? My guess is that the vast majority of an APNs clinical practice knowledge comes from the physician side, while the implementation of that knowledge may have more influence from the nursing side. A low HgbA1c, for lack of a better example, is sought by physicians and nurses alike for diabetics, yes? And what are the separate philosophies? Physicians have "first do no harm" and "the interest of the patient is the only interest that matters". I realize these sound nice and warm and fuzzy and unfortunately, not every physician follows them, but exactly how different are nurses and doctors when it comes to the overriding philosophies on which both professions are based?

One question, which I think relates directly to this topic, is what journals do NPs/DNPs read to stay up on the latest diagnostic/therapeutic advances? The Journal of Advanced Nursing (I flipped through a few month's worth) did not seem, at least to me, to have much practical stuff that would help the busy NP/DNP. Are there others out there that I don't know about? I would love to hear about some.