So much for DNP being clinical doctorate

@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.

Kurt-NP, I could not agree more abut the utility of a greater clinical focus.

To me, "fluff", "padding", etc., means more post-MSN courses with the same name, focus and content as MSN "core" courses in policy, QI, population health, informatics, statistics, outcomes, on and on.

Even the course names are often the same, in the same schools, but are not considered interchangeable for credit, of course! It's hard to imagine what vast and deep new info will upgrade the MSN-prepared NP's knowledge of health policy or informatics or even QI so much that it takes a semester's worth, or even a year-plus.

It seems more like they couldn't picture an NP wanting to know more about being a PRACTITIONER at the most expert level, or how that might be helpful to practice, without becoming more competition with/overlap with practice of medicine....so they defaulted to "nursing practice" expertise. And I guess that means those "core" topics?

And I have to wonder: At some point, if you are fighting for the right to practice what overlaps considerably with medicine, even though much of it is not medicine....ought you not know enough about the clinical end of things to speak intelligently (not compete with; it's a different field) with medical PhD's, and even serve as a guide to NP clinical practice at a higher level than the MSN-prepared NP?

If not, then you're not entirely in the same field as those MSN-NPs anymore, and nursing needs more definition. Being a guide to public policy, informatics and health care systems--may be useful in guiding the "future of nursing" but it doesn't do much in the exam room or in clinical rounds. Even Health Promotion, Epidemiology, etc., are just part of what the NP considers in daily practice.

I also wonder why the DNP, as the pinnacle of practice, needs more education in "role development. If you are at the top, don't you have the right to define yourself, and isn't that what will be one major DNP task--to define what nursing is, what makes it unique, on the level of nurse-patient or even nurse-population interaction?

Gloria Steinem once responded to a heckler about a pair of boots she was wearing (which apparently resembled combat boots) that the simple fact that she was wearing them made them one example of "women's boots". I'm sure that's a bad paraphrase, but if we send those DNPs out there, once they have that DNP, what they do--not necessarily what they say at conventions, seminars, government meetings--will be the new definitions of nursing practice. They will be the ones with the right to define it, I think. Philosophy and knowledge devlopment will also be PhD stuff, but practice will be what it is,on the ground, and should be led by the DNP.

I would much, much, MUCH prefer to learn more about the clinical area of practice, with supportive content in QI, population management, and those other topics. It seems somehow not only counter-intuitive but just plain weird that nursing PhD's can do research on, say, hypnosis for pain control, but those at the pinnacle of clinical practice should focus their own research more on...informatics, health care systems, and and public policy? Does that mean the nursing lobbyists should best be DNPs?

It would be exciting, to do a clinically-focused doctoral degree "project". (Actually, a study, or research about implementation, management or QI--but research all the same, usually...Yet we're soooo careful not to call it anything like a dissertation or anything PhD-ish. That's weird, too...) A project about health care systems sounds as pleasurable as a root canal, frankly.

Well, I think you are right, and that's my point: Adding that other content defines the DNP role as population management, albeit from multiple angles. It says the clinical knowledge needed is much more limited than the need for political, managerial, administrative, legal, sociological, and similar types of knowledge, and that once you clear the MSN hurdle, it's all about the system.

I realize that evaluating and applying evidence to practice on a national or world-wide scale does require some of that knowledge--a lot, in fact, to do it well, and make it be lasting change. And I am sure many long discussions or even arguments defined the generation of new evidence--pure research--as PhD territory. But there is so little emphasis on higher clinical expertise. "Who you gonna call, when nobody knows what to do?" That used to be the CNS, and should be the DNP, too, as the ultimate resource in his/her specialty area.

Nurses do more than practice demi-medicine; they solve problems and puzzles when the patient has complex, multi-spheric emotional and physical needs, in a way that no other discipline does; I think it's what we do best. Large-scale advocacy is part of that, but doesn't replace it. And the new DNP doesn't seem to be receiving education that adds anything to that competence.

It seems that some NPs don't agree that this is the way it should be; they see the value in the extra non-clinical knowledge, but don't want it to be the only focus, nor even the strongest. I'm so glad! And I can say there is a LOT more to be learned about health and personality psychology, cultural influences, genetics, toxicology, immunology, nutrition, medications, family dynamics, environmental illnesses, etc., some of which isn't even mentioned in NP school. For the most part, the last mention of some of those topics is ASN/ADN school, though some of it is basic enough that any first-line provider needs to know.

Now that's sad: Nurses have traditionally led the way in holistic care, and I believe that we're dropping the ball by making the practice doctorate about everything BUT the individual, and in keeping the NP scope of actual clinical practice to extremely-limited medical practice. DNP's should know a lot more about the aspects of care that make nursing unique than a nurse at any lower practice level, and how best to offer that unique care.

If we don't, then we may be advocates for our patients, but we're not adding any fresh knowledge or uniquely-nursing perspective into the "health care policy" discussion, either. Why not a deeper dive first into those topics that could improve practitioners' daily practice? We then might have a broader scope of ideas as to what should change than we do now, especially in our own practice, and facts to back them up.

As for the BSN training, again I agree with you that the extra knowledge is very handy in understanding the "big picture", which helps, again, with running the show, guiding change, health advocacy, economics, etc. It helps the nurse understand where to find research and evaluate it, so it can be used, too--though I'd be curious to know how many actually use that part in managing care. Unfortunately, this just shows the old cliche is true--BSNs make easier managers, because they have additional administrative-prep and public health training. They are not more knowledgeable clinicians for being BSNs.

That extra BSN or non-clinical MSN knowledge doesn't contribute much, if anything, to hands-on nursing. When it does, it requires pre-existing knowledge that many of the nurses working under them may have that the BSN/MSN may not. They are leaders, but not greater clinical experts. So it's sad that they CNS is going by the wayside, if the rumors are true. (Are they?)

Why this desperation to distance higher practice as far as possible from the bedside? NOW "Who you gonna call?"

You can't direct a Code Blue from the Boardroom. SOMEbody needs to be the recognized #1 expert clinical resource, and that should be the DNP, as an outgrowth from the junction of NP and CNS.

Those are just my opinions, and they are not the only valid ones, of course.

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

I think many of you are missing the point of what the DNP is trying to accomplish...

I think many of you are missing the point of what the DNP is trying to accomplish...

I know that this is two years down the road from the last post and no one may respond to this, but please, tell me, what is the point of the DNP then?

I am in a post-BSN to DNP program and I realized last month how naive I had been in my thought of what a DNP was. I feel like the kid that just realized that the tooth fairy doesn't really exist.

I will be dropping out of the DNP portion and just finish up the MSN portion and then specialise in something. As soon as the DNP degree becomes a real advanced clinical degree, like all the other healthcare doctoral degrees (DPT, MD, etc.), then I'll reapply.

For me, when I finished my Master's, I went ahead and finished my DNP as I had it in my mind that at some point they might try to require it and I am aging as we speak. Didn't want to go back later in my life when I was tired and trying to slow down..... May not be the greatest reason, but it shows how our mindsets seem to focus depending on age:)

With no actual requirements for additional clinical and didactic knowledge required for the "DNP" it is indeed curious how this one ever got past US regulators and the US Dept of Education. Perhaps it is time for the standards to be made far more stringent.

if you take note of what type of classes are in the DNP (ones that are easy to teach, do not cost much to teach, can all be done online) you can tell its mostly to make colleges money.

it takes time and effort to teach anatomy, physiology, provide labs, clinical placement, etc. But all these policy classes the teachers just throw you a book and have you write papers. No huge time investment on them= they can handle tons of students= tons of students enrolled to make the college money with low out of pocket cost. All slapped together with the word doctor on it.

Plus you don't even get paid more.