Where is the DNP at in terms of being required?

[foreverLaur]

I heard that the DNP was going to be required for all nurse practitioners by 2015. However, I don't know how factual that is. When my aunt was in nursing school, they said the exact same thing about all RNs being required to have bachelor degrees, but that obviously STILL hasn't happened and that was 30 some years ago.

I am graduating in March with my BA and planning to enter a 2nd degree accelerated BSN program. My plan is to become a Physician Assistant, but PAs aren't used at all in the area where I am from. If I end up staying here or plans change, I may consider an NP program because I still have a lot of prerequisites left for PA and it might not be feasible depending on where my life is. Anyways - I have done a lot of thinking and I would be happier with PA, but if the cards fell in such a way that I ended up going NP, I would not regret the decision and I would be happy with my career.

My question, however, is when (if ever) will a DNP be required? If a DNP becomes standard, I will, with 100% certainty, NOT become a nurse practitioner. I have looked at several DNP programs and they are A JOKE. They are a combination of a M.Ed, MBA, and MPH. Where is the science? Where is the clinical hands on patient care experience? Even the AMA things it is a such.

The Board Chair of the American Medical Association even said:

"We have the deepest respect for nurses, and the AMA wholeheartedly believes that each member of the health care team plays a critical role in ensuring patients get the best possible care. But it's an undeniable fact that a nurse with a graduate degree does not have the same education and training as a physician who has completed medical school and residency training, and it's misleading for nurses to introduce themselves to patients as a doctor, (Make Room for Dr. Nurse, April 2). While standards for the Doctor of Nursing Practice (DNP) are presently being devised, nursing organizations currently recommend DNP students complete just 1,000 hours of "practical experience" after obtaining a Bachelor's degree. Physicians complete more than 12 times that amount during their graduate education. In addition to the two years of clinical rotations physicians fulfill during their four years of medical school, they also complete three or more years of full-time medical residency training.

The DNP program with the one-year residency training mentioned in the article is far from the norm. While one DNP graduate may complete a two-year program including a one-year residency, another can complete the program entirely online and without any patient care experience."

Yikes!! If I get a doctorate degree, I expect to have a lot of hardcore science and at least a few thousand hours of full-time patient care experience. I expect a lot of hands-on learning. Yet in every DNP program I have seen, there is NONE! If I am going to spend that much time in school to get a doctorate degree, I might as well go to medical school. I don't want to go to medical school. I want to get a masters degree and be an excellent mid-level practitioner who provides the highest level of care to my patients. A practice doctorate degree for nurses is a joke.... it doesn't make nurses even close to be equivalent to doctors. They will always and forever be mid-level practitioners. So, what is the point of a doctorate?

I wouldn't be so against the DNP if it was modeled somewhat after the MD/DO or even PA programs that are taught more on the medical model and use science, hands-on learning, and patient care experience. But they don't. Check out the curriculum for the DNP program at Case Western: http://fpb.case.edu/DNP/curriculum.shtm

I'm not against nurses or nurse practitioners. I highly respect the nursing profession and health care wouldn't function without them. I am just against the nurse practitioner program being a doctorate level degree. Is this going to happen? When will it happen? What is the purpose if it doesn't make us better care providers to patients? How do people in favor of the DNP react to the AMA being a against it?

[foreverLaur]

On a related note, at a DNP info session that I attended recently, the director of the program mentioned Mary Mundinger's role in the push for the DNP, and said she had heard or read somewhere that Mundinger's NP students at Columbia School of Nursing had somehow been able to take the Medical Board Exams (that MD's take) and passed them. Has anyone else heard that? Interesting.

The day that nurses take and pass the medical boards is the day that the sky cracks and falls down.

What you are referring to is Mundinger trying to get the NBME to design an optional DNP board exam, that would be based off of USMLE Step 3, but that effort was shot down earlier this year before it could ever be truly developed.

(thank you to the people on SDN who provided me with this information)

[Winnie04]

Aaaah, I see. I thought it sounded a little out there!

[AtomicWoman]

None of the doctors who are anti-DNP feel that the program is taking over their jobs. They just fear of patient safety.

Obviously, you haven't met my primary care physician. Nor have you read some of the angry comments by doctors that pop up on the New York Times website.

Aside from that, yes, I would like to see the DNP evolving. And it will. Right now, we're in a transition phase where the vast majority of DNP students already have an MSN, with all the clinical courses, advanced pharmacology courses, etc. the MSN required. PTs went through the same thing when most DPT students were MSTs. Many schools developed an MST-to-DPT transition program that ran in tandem with their new DPT programs. Now students with a BS in PT go for their DPT. Nursing will develop along similar lines, too. The DNP will become even more clinically-focused and applied science-focused, with the phase-out of the MSN for NPs. (I'm not sure that the MSN itself will disappear, but I think the MSN as prep for NP will.) How long will that process take? Who knows. But it will happen.

[AtomicWoman]

(thank you to the people on SDN who provided me with this information)

The people on SDN are the MOST frightened of the idea of NPs having any autonomy.

[foreverLaur]

The people on SDN are the MOST frightened of the idea of NPs having any autonomy.

No, they are just the most verbal. There wil never come a time when physicians will be phased out and nurses will rule the world. Nobody fears for that because it simply won't happen. How many clinical hours do you get from a MSN? In order to be as qualified as a primary care physician, I am assuming that a MSN + DNP gives you over 24,000 clinical hours like MDs have, right?

[core0]

No, they are just the most verbal. There wil never come a time when physicians will be phased out and nurses will rule the world. Nobody fears for that because it simply won't happen. How many clinical hours do you get from a MSN? In order to be as qualified as a primary care physician, I am assuming that a MSN + DNP gives you over 24,000 clinical hours like MDs have, right?

Just out of curiosity where are you getting that number for clinical hours. I would challenge any specialty outside of maybe CVS or Neurosurgery to come near that.

David Carpenter, PA-C

[foreverLaur]

Even if you cut that number in half, the NP curriculum still doesn't come close. I believe the letter the AMA issued said 12,000 for MDs versus 1,000 for DNPs.

[core0]

Even if you cut that number in half, the NP curriculum still doesn't come close. I believe the letter the AMA issued said 12,000 for MDs versus 1,000 for DNPs.

I would believe 12k. A three year residency will average around 9000 hours plus another 1700 hours for medical school. Lots less than 24k.

David Carpenter, PA-C

[springing]

I realize that this is a bit of thread necromancy, but I would just like to note that if you're going to count residency as part of a physician's clinical training hours, you should count years as an RN as training hours for NPs.

In Canada, you cannot become an NP without two years working as an RN. So figure 37.5 hours a week, 4 weeks a month, 11 months out of the year, times two: 3300 hours. Say you're doing ASU's BSN-DNP, that's 1000 clinical hours training to be an NP. This is not counting the hours you spend in clinicals in your ASN or BSN program.

I also want to note that unlike MDs, almost all of which learn things they will never, ever use in their training (i.e. opthamology, dermatology, etc), NP training is specialized for exactly what they want to do. Of course, this makes it difficult for NPs to catch those "zebras" that come out of nowhere and they were never trained to watch for, but that is why NPs work under the supervision of a doctor...most of the time.

I am fully opposed to ANY person becoming an NP without at least 2 years of work as an RN, and I am also opposed to any NP opening their own clinic without at least 5-10 years of experience working supervised with MDs. This brave new world of NP autonomy is going to crash quickly if inexperienced NPs start making colossal mistakes and get hit with malpractice lawsuits. If NPs grab too much, too fast, too soon, they will end up with less than what they started with.

[foreverLaur]

I realize that this is a bit of thread necromancy, but I would just like to note that if you're going to count residency as part of a physician's clinical training hours, you should count years as an RN as training hours for NPs.

In Canada, you cannot become an NP without two years working as an RN. So figure 37.5 hours a week, 4 weeks a month, 11 months out of the year, times two: 3300 hours. Say you're doing ASU's BSN-DNP, that's 1000 clinical hours training to be an NP. This is not counting the hours you spend in clinicals in your ASN or BSN program.

I also want to note that unlike MDs, almost all of which learn things they will never, ever use in their training (i.e. opthamology, dermatology, etc), NP training is specialized for exactly what they want to do. Of course, this makes it difficult for NPs to catch those "zebras" that come out of nowhere and they were never trained to watch for, but that is why NPs work under the supervision of a doctor...most of the time.

I am fully opposed to ANY person becoming an NP without at least 2 years of work as an RN, and I am also opposed to any NP opening their own clinic without at least 5-10 years of experience working supervised with MDs. This brave new world of NP autonomy is going to crash quickly if inexperienced NPs start making colossal mistakes and get hit with malpractice lawsuits. If NPs grab too much, too fast, too soon, they will end up with less than what they started with.

I disagree. While experience as a RN is valuable, it is not training and practice as an advanced practice nurse. Residency is years of experience that is 100% correlated to a doctors work as an attending physician. You can be a fantastic RN, but that does not always correlate into being a NP. The two are different fields.

Secondly, while a broad medical education is not always directly applicable, it is valuable to have a solid knowledge of the workings of the entire human body, especially if you choose to go into something like family medicine.

Heck, even PAs have more clinical experience in schools than NPs. The PA profession was founded on being a second medical career and most PA students do have substantial valuable experience. Sure there are those that get in without none but there are always a lot of direct entry NPs where you can get through with none either. For example, Cornell has over 2,000 required clinical hours (assuming 40 hrs/week) plus 800 hours of elective clinicals which you can use to specialize just like NPs and heck, not even all NP programs give you 800 clinical hours and PAs get that to specialize PLUS 2,000 more in a broad medical education. How can you even compare?

[llltapp]

I am curious, are you an RN right now ? How many full time years have you worked as a RN ?

An NP takes classes such as Nursing Theory, Nursing Research, Health Policy & Planning, Collaboration & Consultation, Role Development, Teaching & Learning, Legal & Ethical Issues, Inquiry, etc...

I did take Theory, research, policy, Legal and ethical issues. Im not sure where you get collaboration and consultation at. I also took bio, a and p, micro, both under grad and grad stats, chemistry, trig, both under grad and grad physical exam and pathophysiology. Plus my undergrad clinicals and my FNP clinicals.

I know for a fact that MDs and DOs have to take similar classes as well. I feel that sometimes NP programs get too touchy feely with some of this stuff, but make no mistake, they called is advanced nursing, but as a NP told me, its just a name, your practicing medicine, the structure and training is different, but the outcome should be the same.

You comment about being an independent provider... show me someone who is an independent provider... the family doc who refers a patient to cardiology. The cardiologist who does not handle endo issues ? No one is independent, NPs strive for autonomy, but with that autonomy comes responsibility, No one is really independent.

I love how you put that. Its true, there are no independent providers.

Differences between PA's and NP's.... if you have no nursing background and have not been in the field, then for sure, go for your PA. I was thinking about PA after having been a nurse for 16 years! Then I figured, why waste all those years of experience and learning and start from scratch in the PA program.

As an NP, you can open an independent private practice. As a PA, you cannot. If you are only interested in working next to a doctor, physically, then that is for you. As a Family Nurse Practitioner, I had to take all the courses the above poster stated, Advanced Pharmacology, Physical Assessment, Advanced Pathophysiology, blah blah blah. The reason I didn't have to take A AND P was because we had that in our undergrad. A lot of PA's have never set foot in a clinical environment prior to starting the PA program.

As for why doctors think that NP's are not equivalent to them, they are right, we don't have the same education. HOWEVER, I think its funny that the MED school students at my college used the same textbooks in patho and assessment that the NP's do . I would not want to be an MD because I didn't want to make the sacrifice to home and family, have the overhead, and all the call that many docs do.

In my clinical rotations as an NP student, I worked with doctors that said they learned a lot from me. Its a give and take, we all have a place in the healthcare field. MD or NP, the most important thing to know is your own limitations. We all have them.

[Lunah, MSN, RN]

Moved thread to the post-grad forum (vs. the GN forum).