KurtDNP

I am a DNP-prepared nurse practitioner, having completed both brick and mortar as well as online programs at state universities. I saw no innate advantage in one format over the other, although I prefer online as I think my time is typically utilized more efficiently when not locked into real-time live lectures. I've also matriculated through both full-time and part-time programs. There were no appreciable quality differences. I started with an Associate RN degree, got my BSN, then my MSN, followed by a Post-Masters Certificate and finally the DNP. Admittedly biased by the skewed sample of my personal experience, I tend to think nursing education should continue to offer family-oriented, nontraditional, step-wise entrance/advancement options that cater to people at all stages of life. I hope we continue to offer part-time and distance/online options. I know of no studies providing reasonable evidence to support the one-size-fits-all approach to disciplinary entrance and advancement academically that mark other health-related disciplines. I see no evidence of correlation between nursing's flexibility and lack of consistent quality. I hope, therefore, nursing maintains this flexibility. Notwithstanding, there is indeed a need for quality standardization in terms of clinical hours, documentation of clinical experience and the like across academic programs nationally. I appreciate the unique purpose of the practice doctorate in nursing (DNP), for example, but wish more CLINICAL experiences were included for those in clinical tracks (like NPs, CRNAs, CNMs and CNSs). I wish NP programs required extra courses like gross anatomy, medical biochemistry and procedure workshops relevant to basic clinical skills every advanced clinician should know well. Perhaps the MSN could lead to a generalist advanced practice nurse with primary and acute care training across the lifespan. Then the specialty aspect can be added during the doctoral leg (along with the quality improvement and translational evidence-based practice skills the DNP degree was designed to offer). Finally, some sort of optional post-graduate clinical internship, fellowship or clerkship (preferably with other advanced practitioners) could be available (with some government-funded sponsorship IMO) for those wanting to achieve practice autonomy faster or for sub-specialization. Anyway, that's kind of how I see things right now. If nothing else, it is clear that most of us believe there is room for improvement in NP education. Hopefully by continuing these sort of discussions, real changes that are substantive and impactful will follow. Blessings... Kurt

Back2SchoolRN, you've articulated it well. I suspect/hope these are growing pangs. As more and more clinically practicing, doctoral-prepared advanced practice nurses (APNs) take leadership roles within the profession, particularly DNP-prepared leaders, the uniqueness that defines nursing as a discipline will be increasingly understood, interwoven, and even reinvented. As such, the evolution of clinical competence based on that uniqueness will be advanced without compromising individual nurse-patient relationships on the IOM alter of systems/cohort/population-based care (a foundation of DNP curricula). The latter, while important, cannot continue to supersede the main focus of APN clinicians: the holistic nurse-patient relationship; at least not for the clinician DNP students. The CNS, BTW, like NPs, CNMs, and CRNAs, is going to be a DNP-level certification as well (for the one who inquired--AFAIK). Kurt

@IcySageNurse, I agree with you when you say the DNP is not about improving clinical skills (defined as individual point of care health and disease management). Nursing practice is more than just clinical practice and the DNP was designed with that in mind. That is why I suggested we still need a clinically-focused doctorate. I believe you are incorrect if your view limits the DNP to being only "about making money while increasing political clout of the NP lobbyists." While it is likely true that the DNP will (eventually) lead to higher earning power (for colleges of nursing too) as well as increase political clout (and know-how and not just for NP lobbyists), the primary focus is to create experts at improving healthcare quality using the best available evidence to impact populations. I do believe this is not only a noble goal, but a goal that nursing is probably the most suitable discipline to be champions of. My point, however, is that most clinically-focused nurses (NPs, CRNAs, CNSs, CNMs) are not particularly interested in becoming quality improvement experts but would rather spend most of that time improving their clinical skills. Again, I do believe some QI leadership should be taught to every doctorally trained nurse, but for the clinician who does not intend to practice population-based advance nursing, more clinical and less QI content (especially with regards to required practice hours) are in order.

One of the main problems I see with the DNP (as it currently is) being the base education for NPs (and then relying on paid residencies for increased clinical expertise) is that current DNP curricula still "wastes" valuable hours (typically 500+ hours not counting study and class time) focused on quality improvement (QI) instead of point-of-care clinical health and disease management. Again, QI is very important, but not what most NPs are interested in. Thus, it would make sense to teach us about it without the crux of our time and energies being spent on actually doing a QI project when we know full well that we will likely never do it again (QI leadership). I am glad that I now have a much better understanding of QI and its significance on cohorts as well as on hospital, local, state, national, and international systems. However, I truly have little interest in actually conducting, directing, or significantly participating in the leadership of QI programs. I would much rather improve my clinical skills--especially the relevant clinical sciences such as A&P, patho, and micro. I would benefit more from increased exposure to other specialties such as cardiology, ortho, radiology, rheumatology, nephrology, oncology, ophthalmology, otorhinolaryngology, or even surgery. I also think some of the QI classes could be condensed in a clinically focused version of the DNP to make room for the increased clinical content.

I don't know why I am only NOW seeing this. Oh, I do...school!! I am an NP in the ER. Neither FNP nor ACNP (or ANP) train you for the ER. The best route, IMO, is FNP+ACNP outside of the new (but not yet established) ER NP certification coming soon. They do normally want RN ER experience but most will rarely hire new NPs irregardless of RN experience because being an NP in the ER is truly a very different beast than RN practice. ER RN practice clearly gives you some good background but not enough to be up and running in the fast-paced ever-changing environment of the ER. Make sure you get as many clinical hours as possible in the ER (if your program allows it). So the best options of becoming an ER NP IMHO and in order of best to worst: #1. ER NP tract (best option, currently at the University of South Alabama, for example, you end up with ACNP and FNP; soon there will be an actual ER NP board certification) #2. FNP (get as many ER clinical hours--and urgent care--as allowed/possible) #3. ANP (get as many ER clinical hours--and urgent care--as allowed/possible)--pediatrics not part of training so you'll be limited to adults-only positions #4. ACNP (get as many ER clinical hours--and urgent care--as allowed/possible)--pediatrics not part of training so you'll be limited to adults-only positions

By the way, DNPACNP=Doctor of Nursing Practice As A Clinical Nurse Practitioner

I'm not dogmatic about this, but I suspect having a third doctoral option that is truly clinical would be beneficial. As a currently practicing MSN-prepared NP, currently enrolled in (and near the end of my matriculation though) a DNP program, I can say that the DNP curriculum is not "fluff" like some of my post-ADN BSN classes were. The DNP curriculum focuses on quality improvement (QI), an extremely important aspect of nursing practice to be sure, but not really what most advanced practice nursing clinicians are interested in. To that extent, DNP-prepared NPs are no more clinically advanced with respect to management and treatment of individual patients than MSN-prepared NPs. The DNP prepares the clinician for wider evidence-based application of clinical knowledge to systems, populations, and cohorts. One day, the surgeon general of the United States will likely be a DNP-prepared NP, CNS, CNM, or CRNA (for example). While doctoral-level QI expertise is extremely important, so is doctoral-level clinical expertise that is founded on the holistic values of nursing. As both a natural and social science with more emphasis on the social than medical and osteopathic practitioners, nursing clinicians bring a unique perspective that adds to the overall quality of healthcare in a way that no other discipline does. Allopathic and osteopathic practitioners, with regards to doctoral-prepared clinicians in disciplines with relatively wide scopes of practice and subspecialties (as opposed to podiatrists, chiropractors, psychologists, doctors of optometry, etc.), also offer unique perspectives that are beneficial to overall healthcare. The addition of nursing to that mix improves access, options, perspectives, and innovation and should, therefore, not be seen as competition but, rather, complimentary. Having said that, the current doctoral options (research as PhD or practice as DNP) do not satisfy the needs of the advanced practice nurse who is interested in further advancing clinical expertise and less interested (or totally disinterested) in practice on the population or systems level where QI is the emphasis. Perhaps postgraduate internships/clerkships/residencies (or whatever we want to call them) are the solution but I would venture to guess that most NPs interested in a clinical doctorate would prefer at least a little more anatomy and physiology, microbiology, pathophysiology, health management, disease management, and training in clinical procedures. Some QI training (as recommended by the Institute of Medicine) would remain but not as the central focus. Then post-graduate rotations can further and optionally augment clinical expertise, particularly with regards to subspecialization. So, perhaps there will be another movement in the coming years (or decades) to add a clinical doctorate so that nurses have three pathways to scholarship and expertise within the values of the discipline: the research doctorate (PhD), the practice doctorate (DNP), and a clinical doctorate (I don't know, DRNP, DCN, DCNP, DNPc, DNPAACNP, just kidding). What do you think?

For one thing, it would still be a battle since much of this is economic. More importantly, however, is why would nursing do this? What's the point? People should then just go get allopathic or osteopathic training. Nursing offers a unique perspective and approach that should never be lost. I don't want to see DNPs go the way of DOs and seemingly lose the discipline-specific values, skills, and offerings that uniquely add to the healthcare landscape. BTW, if NPs are midlevels, what are staff nurses? We need to use another term or simply say NPs, PAs, CRNAs, CNMs, CNSs, etc...

The following is by no means exhaustive and is what I've gleaned from my personal observations, education, and reading. The term model is not speaking of some specific step-by-step process but, rather, a philosophical paradigm that undergirds the values, assumptions, approach, and practice of a discipline. Thus, I will attempt to differentiate the medical model from the nursing model (where "model" refers to the fundamental underlying approach). Mind you, as society changes, so do disciplines. Some of these are less true now than 30 or 40 years ago but I still think my fundamental points are reasonably accurate. Medical model TRADITIONALLY TENDS to emphasize empiricism (cause & effect; objective facts relatively separable from the patient), reductionism (reduces the patient to a disease, body part, problem that can be fixed), paternalism (physician over patient, physician over other providers--hence phrases like "physician's ORDERS") Strengths: Aggressive and in-depth treatment of specific disease processes, keen awareness of objective anomalies, often motivates patients through authority (could be a weakness too) Weaknesses: Can easily miss the whole-person complexity of humans, less sensitive to subjective evidence Nursing model TRADITIONALLY TENDS to emphasize esthetics (experiential knowledge), holism (the interconnected nature of human realities a.k.a. mind-body-etc...), partnerism ([i made that word up but I'm sure there's a legitimate term out there] nurses partner with patients to help them reach self-actualization, doing only for them what they can't do for themselves) Strengths: The HUMAN in human being is validated, empirical evidence is utilized but with the purposeful consideration of the subjective reality that is a legitimate part of the human experience, patients feel like partners and not subjects or children (unless they are...indeed...children) Weaknesses: Can easily miss more complex physiological anomalies, risk being overly sensitive to subjective evidence

Here's my $0.02 WARNING: These are just MY PERSONAL OPINIONS based on MY PERSONAL EXPERIENCES and MY PERSONAL UNDERSTANDING at I CURRENTLY KNOW IT. OK, here goes... MD or DO Do you have to do or redo the minimal premed classes (1 yr gen bio, 1 yr gen chem, 1 yr physics w/lab, 1 yr org chem)? If so, assuming you want to do family practice or internal medicine without a subspecialty, you're generally looking at: 1-2 years to complete premed classes 4 years of medical school (a few might have year-round intensive classes/clinicals making them a little more than 3 yrs long) 1 year of internship (perhaps) 3 years of residency So, you're looking at a minimum of 7 years to as much as 10 years (not counting subspecialties or fellowships). If you do family practice, you'll generally come out with a ridiculous amount of debt making between $120K to $220K. If you own your own practice and work shrewdly, you can obviously make way more. Most importantly, you'll have the deepest most comprehensive knowledge of physiology, pathophysiology, microbiology, and obviously medicine (the discipline not the generic sense of the word). You'll also have the most autonomy, social respect, professional privileges, and financial rewards relative to other disciplines in healthcare. Top Pros: more in-depth natural science knowledge, more money, more autonomy, more social/professional respect Top Cons: more debt, more difficult to have/raise family during and even after, many many years of schooling, totally rebuilding your knowledge base (very different approach, assumptions, and values relative to nursing) Check out Forum Index - OldPreMeds, Inc. - Powered by FusionBB Post-Masters FNP Typically, you can complete these in 4-5 semesters (1.25 - 2 yrs) full-time or 2.25 to 4 years part-time. If you add the DNP curriculum, you're looking at about 2.5 to 3 years full-time to a maximum of 5 years (typically no more time than this is permitted). You'll graduate with moderate to no extra debt, in a much shorter space of time, making between $60K to $150K (ER NPs typically make between $90K and $150K). If you own your own practice (and you can in most if not all states) and work shrewdly, you can make way more. However, you will have more barriers to practice (although these will get less and less over time). You'll have the most comprehensive nursing knowledge but only a decent amount of medical knowledge (meaning the discipline, not the general sense of the word); and decent but relatively cursory knowledge of physiology, pathophysiology, and microbiology. You'll have more autonomy than undergraduate nurses but less than MDs/DOs, some social respect, unpredictable levels of professional privileges, and generally only moderate financial rewards relative to medicine. Top Pros: more in-depth human science knowledge, potentially really good money relative to years spent in school, more family-friendly (most students are older nontraditional students with family responsibilities), builds on your nursing base Top Cons: practice barriers (legal, social, institutional, regulatory, etc.), less natural science knowledge base, less traditional earning potential relative to MDs and DOs Conclusion I was in the similar predicament and chose the postmasters FNP. I prefer nursing's holistic patient-centered value system and the heavy emphasis on human science. While these are now en vogue even for the medicine disciplines, it has always been fundamental to the nursing discipline. I also love the family-friendly (relatively speaking) life-adaptable nature of nursing education. I'll just have to get the clinical experiences and the deeper natural science understanding after the fact! Those things I crave but not more than what the nursing route gives (not to mention the ability to still maintain family responsibilities). Certainly there are exceptions to almost everything I've written, but they are just that--exceptions. Anyway, I hope this is somewhat helpful. Remember my warning: These are just MY PERSONAL OPINIONS based on MY PERSONAL EXPERIENCES and MY PERSONAL UNDERSTANDING at I CURRENTLY KNOW IT.

Check these documents from ANCC http://www.nursecredentialing.org/PromotionalMaterials/products/CREDBRO11.pdf http://www.nursecredentialing.org/Documents/Brochures/HowtoListYourCredentials.aspx

The Doctor of Nursing Practice (DNP) adds no new clinical content. It is a practice doctorate and not a clinical doctorate per se. Nursing practice incorporates the values and principles of nursing to skillfully assist clients (individuals, families, communities, health systems, nations) progress to their maximum potential. Therefore, DNP education reinforces and expands (advances) nursing knowledge application irregardless of the setting (clinical, administrative, political, etc.). In part, it grew out of a response to 2 landmark papers by the Institute of Medicine (IOM) published in 2000 and 2001 where nursing was essentially urged to take on more leadership in healthcare in general. That healthcare, urged the IOM, should be evidence-based, serviced by a more educated workforce, and streamlined to bring research to practice in a more timely and efficient manner. Given that nursing comprises the largest sector of healthcare professionals, and the most trusted based on consumer surveys year after year, it made and makes sense to enlarge the training on this type of leadership among advanced practice nurses. Furthermore, masters level nursing (MSN) education continued and continues to require increasingly more credit and clinical hours. In fact, MSN programs often have as many or nearly as many credit hours as doctoral programs of other healthcare disciplines. Adding the leadership and evidence-based practice-focused courses to the already credit-packed MSN curriculum clearly justifies making them doctoral instead of unfairly limiting practitioners to MSN level while charging them for and requiring hours worthy of a doctorate. Having said all that, and these are merely just a few of the reasons for the necessity of DNP-level training, it is clear to me that non-clinical advanced practice nurses (meaning those not involved in direct clinical care) should also be included among DNPs. This is not a fluff degree. Sure, more clinical content would be beneficial for those in the clinical tracks. Yet this fact does not detract from the significance of the DNP to nursing practice specifically, and healthcare in general.