Angeljho

Oh yeah, I know MDs can do fellowships. It's still a form of post graduate training. There are also NP fellowships (although not the same, of course). Still, there are options for NPs to gain post graduate training. I just want to see NP education become more rigorous. There's this huge push for NPs to obtain their DNP degree, but there should be a push for better NP education first. I feel like the image of NPs is becoming increasingly negative with malpractice cases now coming to light. I don't even know if I can support NPs owning their own practices anymore.

DNP is not a clinical degree. It's a nursing practice degree. There's a difference. When you finish NP school at the MSN level, you're expected to be competent to practice. If you want to enhance your skills and knowledge, you can do post graduate training. However, if you're looking to obtain a DNP because you feel it should give you clinical knowledge to improve practice as a provider, then that's a flaw with NP programs at the MSN level, because you should already be competent enough to practice. You can't have two separate degrees (with one being higher than the other) that claim to ready NPs for practice. You're either ready or you're not. Once you become a PA, that's it. Once you become an MD, that's it. Once you become an NP, that's it. As I said, any of these clinicians can do post graduate training (and it's basically required for MDs), but it makes no sense to expect a whole other degree to improve your skills. Instead, you should be asking why you don't feel prepared from an NP Program. CRNA programs have always been more rigorous than NP programs. Their DNPs are still the same content, it's just required. There are DNP programs with NP tracks, but most of these programs still have you do NP coursework like a standard MSN program before you move on to the DNP portion. There is no extra clinical content in the DNP portion. If the DNP were to become a requirement for NP practice, programs would be similar to what I just described. The DNP degree was always meant for advanced practice nurses to tackle healthcare in a different way than directly seeing patients as a clinician. Instead, it trains advanced practice nurses to look at existing research and apply that research to current practice—this is why it's considered a practice degree. You're not improving practice as a provider; you're improving practice on a much larger scale. For instance, if there is a town that has high mortality rates because it lacks true healthcare access, the DNP nurse will work to establish a connection to healthcare. It's still improving practice, and you're doing it on a much larger scale in contrast to providing care to a capped caseload of patients. This is also why the DNP degree is available to nurses who are not APRNs. If you feel that NP education should be stronger—and that's what I feel—then we should be fighting for NP Program educational reform. That's where the issue is. NP programs should parity the rigor of CRNA/PA programs—more clinical hours, more patho/pharm, more basic sciences, more rigorous tests, etc. Leave the DNP degree as it is. It's fulfilling its role.

Yes, the AMA is also going after PAs. I agree that NP education could be more rigorous, but the AMA would still be targeting NPs regardless. CRNA and PA education are both more rigorous, yet the AMA and PPP (Physicians for Patient Protection) are still going after those professions. Why? Because it definitely is about power and control at the end of the day. I am a huge advocate of strengthening NP education, because I think we owe it to our patients to better ourselves by pushing our knowledge to higher standards, but I would never trust or side with physician organizations. With that being said, I do think NP curricula will see a change in the future. Hopefully, they mirror CRNA programs in terms of rigor. I also hope prior experience becomes a definite requirement, because I now see that some people are bypassing working as an RN. That should not be happening.

I don't see the DNP becoming more clinically focused because it's not a degree for only NPs. I think all these different pathways can be confusing, but DNP programs with NP tracks are still two separate pathways combined into one. I'm not sure if DNP programs with NP tracks can change their curriculum, but then it also confuses things for NPs who go back for their DNP degree. I think we should just respect the DNP degree for what it is—a nursing practice degree focused on population health and translational research. I'm currently in a DNP program, and although I wish I was a degree path that offered more clinical sciences, the non-NP students who are nurse managers, CNOs, and nurse educators are loving the program because it's right up their alley.

I am currently in a DNP program, and I'm doing it for two reasons: 1) My own professional development 2) Remain competitive in the far future since schools are pushing out NPs/DNPs like crazy I really wish it was a more clinical focused degree that would further enhance my knowledge in patho, pharm, chem, etc., but nope. Just more research and leadership mumbo jumbo. I think the biggest advantage is that it will open the door for teaching if I want to eventually settle on that. As of right now, the DNP degree is not required, and I doubt it will be in the near future. If it isn't worth the financial investment, don't do it.

I 100% agree. The work I do is very demanding, and I often leave for home after hours (no overtime) and burned out. I love what I do, but I also want to be fairly compensated.

I'm in psych, but at times I also feel the pressure of being fully responsible for someone's care and making clinical decisions. If I'm unsure about anything, I go to the MDs or more experienced NPs for guidance. I'm still under a year since I started practicing, so I'm still learning. I will say this.. most of the stress I endure comes from things like constant prior authorizations or ridiculous bureaucratic busywork that just seems to suck up my time.

Med students and residents (only first and second yr residents) rotate through our clinical site and they're paired with a different provider every day, either MD or NP. Just wondering if this is common and if NPs feel comfortable teaching non-nursing interns.

This is common. I was the first NP at the practice I currently work at and the MDs had no clue what I could and couldn't do. They also didn't know what required close supervision and what didn't. There are still forms (psych evals, HRAs, labs, treatment plans) that are co-signed by an MD because the MDs aren't comfortable with those tasks being completed by NPs "unsupervised."

I work in a psych clinic. I do prescribe docusate, glycopyrrolate, etc, especially for clozapine related side effects. I will also prescribe meds like propranolol if needed. I will NOT prescribe antibiotics or treat anything not psych related or psych side effect related. At my clinic, the psych director challenges all prescribing clinicians to think outside the box. For instance, studies have shown that low vit D is linked to worsening cognition in clients with psychosis. So, I will check vit D levels in respective clients (mostly AA) and prescribe accordingly.

Of course this question depends on practice setting, practice culture, etc, but how do you typically deal with it?

The way I see it, the DNP is a waste of time. There is no incentive to pursuing one other then a feeling of self accomplishment. As a new NP, I'm seen as an attending with a full caseload. Meanwhile, residents are still learning, taking classes, and gaining a far better education that I could only dream of. Seeing these residents motivated me, so I looked more in-depth into DNP programs to see if I could enhance my clinical knowledge in a similar fashion. It turns out that the "practice based" terminal degree was just more fluff policy and research courses. I'm hoping that either the DNP will shift focus and become an actual practice based degree that offers intensive clinical/pharm courses beyond the master's level or a new nursing terminal degree will come into play that does that. The DNP is just another PhD to me. I'm actually thinking of pursuing med school, but that's a whole other topic for another day.

This is an interesting topic. While I do agree that DNPs introducing themselves as Dr. Jane Doe without context could be confusing to patients in the hospital setting, I think the appropriate solution would be to gradually educate the public. I don't think anyone is looking to trick patients, purposely mislead the public, or go on a power trip. I believe in acknowledging and respecting a person's education and title, and I don't believe it would be at the expense of the patient to do that.

Board vitals did help when it came to learning the material in-depth (the explanations for the answers are amazing), but the questions aren't worded the same as the actual exam. The board vitals questions were much harder in my opinion, so it over-prepared me in a way. I mostly used it to understand the content better and target areas that I struggled in. The questions from Psychiatric-Mental Health Nurse Practitioner Certification PracticeIQ were worded more like the actual exam.

As far as review books go, I used Psychiatric-Mental Health Nurse Practitioner Review and Resource Manual, 4th Edition. The other resources I used were: - Boardvitals - Psychiatric-Mental Health Nurse Practitioner Certification PracticeIQ from ANA - PMHNP-BC pocket prep mobile app