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its been a while since my last post but i have a choice to make and hoped the input of other advanced practice nurses might help. I find myself having to choose between to jobs. the first is a critical care nurse practitioner in a pulmonary intensivist group. i would have my own assignment of about 5 patients daily. there are morning rounds, then we present patients to the attending, then early afternoon we do consults and procedures (lines, spinal taps and intubations mostly) and have family rounds after that. I would have a decent amount of autonomy. The group is very pro NP. there is a lot of opportunity for education as the group does a lot of research and seminars The second position is a neurosurgical position. i would round mostly on patients in the icu, some clinic and would see new consults. i would also get some OR time which would be new to me. I wouldn't have as many procedures but I would be trained for ventriculostomy placement (also new to me) Ive been an ICU NP for a couple years now and really like it, but the thought adding OR time and ventriculostomy placement to my skill set is really appealing, not to mention its a very focused specialty. Any thoughts?

Actually, they do. If you read my statement, I specifically say "ARNP" and not CRNA. The reason for this is that the DNP requires a minimum of 1000 clinical hours. CRNA programs typically already meet this requirement (above and beyond), but ARNP programs are usually between 500 and 1000. I agree that fluff courses don't do much to help nursing practice and think DNP programs would be better served with classes that refine our clinical skills. DNP programs could trim fat by getting rid of some of the research oriented stuff. Instead of some capstone project, a Doctor of nursing PRACTICE should do something that proves their practice skill. Thats why I like the idea of a clinical portfolio. For an ACNP it could include things like central line or chest tube placement.

ACNP covers age 13 and on. i found a couple links talking about this, but ill try to find more if i can. I actually remember covering this in school quite clearly however. http://www.slu.edu/x30733.xml http://nkuonline.nku.edu/graduate/msnursing/acute.php On that note, do you have a source for 18 and up?

There are also pediatric ACNP programs in existence. If you were going to go back to school to get the FNP degree solely for the purpose of being able to see children (below 13 yr), then you could just as easily earn a pediatric ACNP degree. If you intend to work in an ICU, then I personally would not bother with the FNP or pediatric stuff. The ANCP scope includes people down to 13 years old. You typically will not have people working in an adult ICU floating over to the pedes ICU. MDs, ARNPs, and RNs all go through different, specialized training to work in pediatrics. Employers know this and are unlikely to expect applicants to have dual certification. (ER is a little different in that you don't know whats coming in. However, many hospitals, especially Level 1 trauma facilities, have a separate Pedes ER) If you do plan on working in an ICU or ER, I urge you to go ACNP. With increasing frequency, I am finding that ARNP jobs in this area are specifically asking for this certification (versus FNP). For my job, it came down to the fact that our intensivist base their practice model off of the Society of Critical Care Medecine (SCCM). SCCM is basically the authority for ICU practice standards in this country. I am a member of SCCM and one of their requirements for non-physician members is that they posses at least a masters degree and ACNP or CRNA certification.

Of all the DNP programs I've looked into, the one I like the most is Columbia University. The really do emphasize the clinical aspect in their program. They require the completion of clinical portfolio instead of thesis or other more academic approach. I hope that DNP programs for nurse practitioners eventually evolve to make this a requirement. It probably does not make sense for a non nurse practitioner DNP student to meet this requirement however. EVERY DNP program (for ARNPs) does serve to improve the nurses clinical skills above what they learned in their masters by virtue requiring more clinical hours be completed. Some programs, of course, will provide a better experience. (true of any school, including medicine). Are these additional clinical hours enough to warrant the title "doctor"? That is certainly a matter for debate. There is no question that MDs spend more time studying before being "let loose", but I it is unrealistic to expect nursing to evolve the DNP program to exactly mimic osteopathic or allopathic models. As nurses, we begin our clinical training during our undergraduate The whole concept of an advance practice nurse is based on that fact; the idea being to expand on this knowledge. This is a historical truth. Future DNP programs will likely continue this tradition. Given that nursing and medicine will not have identical educational paths, at what point should DNPs be considered worthy of the title "doctor"? Should they need more clinical hours? Do they need to prove their competency after boards some how? Are DNPs not considered experts in their field now?

Well, i accepted the job. Time to start looking for a new place to live. Its as an ICU NP. Basically, the job description is a lot like permanent resident for the unit. Ill get to diagnose, write orders, admit, and best of all, do lots of procedures. Trach placement, central line placement, a-line placement, chest tubes and possibly some peg tube. I really like procedures.

Hello, So, today i received a job offer from what is basically my dream job. The pay is what i was expecting, the benefits are good. I'm also excited because I think Im lucky to get the offer. My resume and experience are just border line for this position. (I might not of hired me). Im willing to look past this though. Now, the down side.. its about 200 miles from where I live now. While not a huge move, Ive got some relocation anxiety. I haven't any kids, but I would be leaving other family. I only know a couple people in the new city, literally. Im just hesitant to turn it down because I think it would be difficult to get this on my resume any other way. Anybody have any thoughts..told them i need a couple days to consider.

on the flip side to the no recommendations argument, ive seen that often, when they dont require them, the rest of the standards are quite high, such as GPA, GRE scores and heavily weighted past experience. No matter what school someone applies to, the prospective student should thoroughly do their research. Ask around, locally. Often, many graduates are working in the community and provide real insight to the quality of the program. Don't ever go with just one person's opinion.

I agree that understanding the material is key to passing the exam. I probably did did about 200 questions total.

check ebay for the fitzgerald cds. I bought mine there, the current edition for $150. I later sold it for $160. I actually listed it the day after because i ripped it to my ipod and no longer had use for the actual disc

I listened to my fitzgerald prep course for the ANCC ACNP exam. I listened to it enough times that i could "sing" along with her as she spoke. There were many tidbits that were almost word for word on the exam. However, while studying the cds, i felt that she was leaving a lot out, but when i took the test, i realized she had just focussed the review for what was going to be on the test. Her review is very targeted. Its the only thing i used to study or the exam and I thought the test was kinda easy.

i passed on Feb 23, and sent the paperwork march 21. i checked online yesterday and it said my name and ARNP. When i checked Friday, it still said RN. However, I haven't got any paperwork yet.

i used the fitzgerald review for the ancc acute care exam. i found much of the material she covered was almost word for word on the test. i simply listened to her cd course enough time that i practically had it memorized, like the words to a song. I bought the cd set on ebay for $150, no book and sold it for $160. The cds really were my only study material. For me, the test had way to few clinical questions and too many questions about the appropriate way to interact with your patients

ANCC and AACN both offer certification for ACNP. Check to make sure it is listed as one of the acceptable certification boards in your state for the ACNP. In florida, it was not specifically listed. (though ive heard they will accept it) I did not have any problems getting my registration for the exam through ANCC. They said I would get a letter conforming receipt of my packet and i did. That letter said the process takes 8 weeks. I studied during those 8 weeks and got my ok to test almost 8 weeks to the day. I would take ANCC because it is more widely accepted AND you can get the AACN certification by endorsement, but not the other way around. That means 1 test, 2 certifications. It only works if you take the ANCC one first.

so all those 16000 plus hours produces a practitioner that cost way more to educate, way longer to train, and yet yields outcomes similar to an NP. Show me a study, unbiased or otherwise, where outcomes for an MD are better than that for an NP

as i understand it, the difference in cost between an NP and and MD refers more to the cost of training. Specifically federal dollars which are used to fund many of the residency programs. Further, Medical school tends to cost more. Even if someone believes studies showing nurse practitioners provide equal or better care are biased, I am unaware of any study showing NPs provide inferior care. One strength of nursing education over the medical model is that nurses actually touch patients early on. Typically, most NP students have been involved in patient care for 4 years or more when they begin their NP education.

Physicians also take many courses that can be argued to have limited clinical application. No singular course makes the difference between NP and DNP. Its joining together of all these that give the student a specific body of knowledge. This body of knowledge then gets applied to their clinical practice, even if the DNP never enters the patients room saying "im going to use informatics on you". Mundingers exam uses retired questions, not rewritten. The pass rate you reference was based off the first time the exam was taken. Unlike med students, there is not a near infinite repository about the exam for the DNP students to reference before testing. Just to be clear, i have stated that i don't think the DNP has evolved enough to merit independent practice (ive said this in several post)

Mundinger's original vision for the DNP was a clinical doctorate. if you review columbia university's curriculum for the DNP, it is more clinical focussed than other DNP programs. She is absolutely pushing for DNP independence, following her model. When NPs wanted independent practice, people complained they were not doctorally prepared, Mundinger responded by developing a clinically focussed doctorate. Then people complained there was not a certification process for DNP, and she responded with a test developed by and using the same questions from USMLE step 3, yet people still complain. There will always be people threatened by or criticizing the advancement of DNP. Not understanding how informatics can be applied to your practice does not attest to its usefulness, rather it demonstrates a lack of knowledge regarding how to apply it. In other words, until you take the class (with the rest of the DNP courses) you simply can not know what you dont know. To say those classes are worthless and will have no affect on clinical practice without having gone through them is statement born in ignorance. (ignorance=lack of knowledge on a particular subject)

a cna can take a 3 week course and call themselves nurses all they want, with the same stipulation they clarify their role in patient care. this is exactly what a DNP does. when people resist something so much it always seems as if they are afraid of it. The DNP is not comming it is here. As an ARNP, i imagine other nurses would relish the chance to advance the profession and since the DNP is still in a nascent stage. this is the best time to shape it into something the profession can be proud of

as stated many times before in this thread the discussion is about the difference between np and dnp. you are off topic. besides, you go to medical school to earn a doctor of medicine and then become a physician. Doctor is an academic title. Nurses are not asking to be called physicians. Physicians have enjoyed a monopoly on the "Dr" title but other people have earned Doctorates in their professions and have earned the right to the title also. Times change I do not assume my patients are too dumb to understand the difference between an NP and MD so i will always be happy to explain to them. Troll= someone who registers with a forum with the sole intent of trying to incite arguments, create controversy and be a general PIA to the forum members.

this guy kinda sounds like a troll.

as of yet, there really is no legal recognition for the DNP, meaning its only the certification that wants to require the DNP. However, you need that certification to have a license. I do think that a DNP prepared nurse would function quite well in many primary care situations, independently. However, I dont think nursing education has evolved to the level medical education has. The DNP is a step in that evolution. As nursing continues to get its @#%$ together, the end result will be an educational paradigm founded on nursing's culture and principles. It will not mirror medicine exactly, because the origins are different. Just as osteopathic is different from allopathic, so will a DNP be differ from either of those. I have no doubt this will eventually happen.

Alaska, Arizona, New Hampshire, New Mexico, Oregon and Washington are among states that have enacted the most expansive NP scopes of practice. In all of these states, the authority of NPs to practice independently includes the authority to prescribe drugs without physician involvement. retrieved from http://www.acnpweb.org/files/public/UCSF_Discussion_2007.pdf

I like the ability to take my classes at starbucks (or where ever). Its a good point that you cant hide at the back of the class, since internet courses tend to have minimums for logging on and participation. As far as the GRE goes, i never had to take it because my undergrad gpa was high enough. It would make more sense to have an entrance exam that is better suited to nursing skills. Perhaps an exams that measures mastery of your BSN skills since the MSN is supposed to be building on that.

while i dont think DNP education has quite reached a level of independent practice, I do envision a day where such is possible. I dont see why nursing cant create residencies and fellowships. Its only natural for nursing to want to evolve its scope as its educational requirements and body of knowledge expand. I must repeat myself in saying that at this time, i dont think nursing education is where it needs to be in order to practice medicine independently.