Actually, a lot of medical students/pre-med students as well.
I've been googling the subject DNP vs. MD and find little from nurses, but a slew of pure hatred for nurses and the DNP.
What gives? I understand the idea- the fear that the DNP will start to deprive the MD from practice, rather than work with the MD.
I found the threads interesting as at no point did any of the med students, not once, show concern that the quality of care provided might be lacking with a DNP.
The med students have this idea that from year 1 of undergrad through completion of a DNP program there are only 600-700 hours required in clinic, and that a DNP takes 2 years or less presuming one already has a BSN.
They also seem to rage in regards to nurses being able to work, and thus get paid, while attending school.
They call the DNP's "Dr. Fakey McNursey", and worse.
Where's the respect? What about the patients?
Why all the hostility? Why do MD's feel they're being pushed away? Is there a history of these new DNP's not providing quality care, or working with MD's? Is it just an ego issue? And why do so many existing NP's dislike the idea of the DNP (beyond what I've read- that additional education isn't apparently needed, some claim)?
(I agree with most every point you make -- except that I need to point out that it's not accurate to say that "all nurses" enter grad school with an "extensive background" in nursing. With the abundance of "direct-entry MSN" programs out there in recent years, many advanced practice nurses did enter graduate study without any background at all in nursing. People are accepted into those programs with a BA/BS in another area and little or no background in healthcare, certainly no experience as an RN. Other people go straight into grad school as soon as they finish their basic, initial nursing education, with little or no nursing experience beyond their student clinicals.)
Please define "many", what percentage are you saying enter Adv practice with a BA/BS in another field without any nursing experience? Is this one of the reasons for hostile reactions by MDs towards the DNP?
Please define "many", what percentage are you saying enter Adv practice with a BA/BS in another field without any nursing experience? Is this one of the reasons for hostile reactions by MDs towards the DNP?
I have no idea what percentage of advanced practice grad students may be in direct-entry programs (which is why I settled on using a bland, general term like "many" rather than any kind of hard figure), but here is a list of schools offering advanced practice specialties in direct-entry programs (i.e., for non-nurse students) -- this is from a quick Google search, so I'm sure it's not even a complete list:
UCSF, CSU-LA, Azusa Pacific U, U Conn, Yale, Georgetown, Emory, U Of Hawaii, UI Chicago, U of So. Maine, Boston College, MGH Institute of Health Professions, Marquette, Northeastern U, Regis College, Simmons College, Grand Valley State U, Columbia U, U of Rochester, East Carolina U, Case Western Reserve U, Ohio State U, U of Cincinnati, Oregon Health & Science U, Thomas Jefferson U, Vanderbilt U, UT Austin, U of Vermont, VA Commonwealth U, Seattle U, and U of Washington.
Also, I know that, while Duke does not have a formal direct-entry MSN program, it does offer an "ABSN-MSN pathway" that is basically the same thing (you go directly from the ABSN into the MSN program), and which offers a wide variety of advanced practice clinical specialty concentrations. I imagine that there are probably other schools out there that do the same thing, that wouldn't turn up on a search or listing of specifically direct-entry MSN programs.
That's a lot of schools that have been turning out advanced practice grads with no previous nursing experience for quite a few years (decades in some cases). Based on that alone, I feel comfortable saying "many" APNs entered advanced practice without any previous nursing experience. I continue to be surprised at how many nurses are (apparently) unaware of the existence of the direct-entry MSN programs -- they've been around now for, again, in some cases, decades. Look around just on this site at how many threads are started by people who are shopping for a direct-entry MSN program in order to become an APN, or asking questions about how to get into a direct-entry program.
I'm not necessarily condemning these programs, or suggesting the graduates are not competent; I'm just reminding folks, since the statement was made that "all" nursing grad students have significant nursing experience/background, that these programs are out there and turning out lots of graduates.
Since these programs and their graduates have been around for a long time without the kind of controversy that has erupted over the DNP discussion, I doubt that they play much of a role in the "hostile reactions" toward the DNP. There have been discussions here about whether or not direct-entry grads have a harder time finding employment than experienced-RN APN grads, but there has not been any open, widespread hostility that I've been aware of ...
Oops! You are correct, ElkPark -- that's an oversight on my part, because there are indeed quite a few MSN programs that accept pre-licensure students. I misspoke in asserting that all grad nursing students have extensive prior training in nursing; it would be far more accurate to say that a sizeable majority do. Even in these direct-entry MSN programs, though, my understanding is that no one just jumps right into the APN role; they either earn the MSN w/initial RN licensure (becoming so-called "generalist MSNs") and then move on to post-master's study for their APN credential if they so choose (e.g., DePaul), or spend time in a "first phase" earning their RN license before moving on to a "second phase" where they earn their MSN and APN credentials together (e.g., UIC's Graduate Entry Program). Either way, though, APN students must still earn an RN license at the least prior to starting on their APN coursework and can work as nurses prior to becoming APNs, so none of them are really starting from scratch in the same sense as a med student (or PT, OT, audiology, etc.).
These fields seem to be cited frequently (along with a wide range of other irrelevancies) by the mandatory-DNP lobby as "proof" that nursing needs to "get with the times" and force a practice doctorate upon its APNs. A large body of evidence vis-a-vis the competence and quality of non-doctoral APNs demonstrates the nonsensical nature of that idea, yet ironically, the same ivory-tower academic types who harp incessantly about "evidence-based practice" have chosen to conveniently ignore any facts that contradict their position on the issue. It's about time someone called them on it, and I for one am truly grateful that the NLN recently weighed in with a contradictory opinion on the AACN's "DNP 2015" push. With any luck, this "DNP 2015" thing will go the way of the mandatory-BSN push -- where it belongs!
Even in these direct-entry MSN programs, though, my understanding is that no one just jumps right into the APN role; they either earn the MSN w/initial RN licensure (becoming so-called "generalist MSNs") and then move on to post-master's study for their APN credential if they so choose (e.g., DePaul), or spend time in a "first phase" earning their RN license before moving on to a "second phase" where they earn their MSN and APN credentials together (e.g., UIC's Graduate Entry Program). Either way, though, APN students must still earn an RN license at the least prior to starting on their APN coursework and can work as nurses prior to becoming APNs, so none of them are really starting from scratch in the same sense as a med student (or PT, OT, audiology, etc.).
I am definitely not trying to be argumentative or highjack this thread, but just want to respond that neither situation was the case in my graduate program (which I attended as a traditional, experienced-RN student -- but shared all my classes with direct-entry students who made up the majority of the student body) -- direct entry students came into the program with no healthcare background at all, they completed an advanced practice specialty MSN in three years, and they did not get licensed as an RN after the first year and work part-time during APN phase of the program. At my school, a well-known and well-respected program, direct-entry students were not eligible to sit the NCLEX until they completed the second year of their program, the first year of the APN phase of the program, and, even after they were licensed, none of the students I was aware of worked as RNs because the program itself was so rigorous and demanding (also because they had absolutely no interest in ever functioning as a "basic," bedside RN and considered themselves much too special and important to do anything like that, but that's another story). One other experienced-RN student and I who worked prn at the university medical center as staff nurses (I did one 8-hour shift a week during the school year and as much as I could get during the school breaks; doing more than that would have imperiled my grades) were the only students I was aware of who worked at all, doing anything, during the program. Direct-entry students in my program were v. definitely "starting from scratch," as you put it, and did "jump(ed) right into the APN role" upon graduation. There are lots of different models "out there" for direct-entry programs -- I would imagine my school is not the only school set up this way ...
I definitely don't consider it "argumentative" when all you're doing is passing along information, ElkPark. As my last post makes clear, I obviously had never heard of any such programs until now...but then, there are tons of things I don't know yet, just like anyone else. For me, this is yet another day where I learned something new, thanks to your input. I was actually a little surprised to find this out at first, but then, I realized that PAs (whose roles tend to be pretty similar to APNs) are generally trained "from scratch" in full-time curricula, so in retrospect, I'm not so surprised after all. :)
Personally, I don't necessarily think doing a program like that would be the best fit for me in any event, as I'd prefer to "earn and learn" on the job, gaining useful experience and paying my APN tuition as I go part-time rather than borrow a large sum (which I would certainly have to do otherwise) to do grad study full-time. But it's good to know that nursing education is sufficiently flexible to offer something that can fit a broad range of needs. Now, if the AACN would only figure out that one size (extra large!) doesn't have to fit all...
From the number of physicians and mid-level providers I have been in contact with both at my job and while considering my career path, there have been two distinct camps.
1. Finances/Job Security
2. Scope of Practice/Knowledge
My thought is there is room for both. The medical system does need fixed and mid-level providers can fill in the gaps and provide excellent, competent medical care. I doubt that anyone on this forum would believe that a DNP is equal to a MD/DO in regards to knowledge. Medical school is intense and the amount of material is extreme. Now many NP/PA/DNP programs are intense and require hardwork, but let us be honest and realize medical school is much more so. But once you get into the field, things level out a bit. The point is that in the current medical system, both physicians and mid-level providers are required to make the system work. I respect both sides and realize it is the person who makes the degree, the degree doesn't make the person.
This is what I mentioned before. The current med students, residents, junior attendings, and even premeds, are becoming more and more politically active against any potential encroachment. This is largely been, IMO, due to increased awareness of midlevels (ie. the many NP/DNP articles in the recent months where NPs/DNPs have been quoted saying either that they're equivalent to physicians or, in some cases, that they're better than physicians). I can't imagine a physician at any level of training taking those types of comments lightly. Either way, I think within the next few years, this entire debate will become even more heated than it already is and will likely spill out from anonymous forums into the courts.
I think you are probably right regarding this going to the courts since most of the behavior of physicians in this arena is anti-competitive and frankly illegal.
I think you are probably right regarding this going to the courts since most of the behavior of physicians in this arena is anti-competitive and frankly illegal.
Ha
First of all, it's only anti-competitive if midlevels can do the same job... which they can't. Sorry. They never will be until their training is the same as a physicians. In that case, what's the point of going to NP school? So it wouldn;t be illegal because the jobs could not be the same, by the sheer fact that the training of NPs is significantly shorter.
First of all, it's only anti-competitive if midlevels can do the same job... which they can't. Sorry. They never will be until their training is the same as a physicians. In that case, what's the point of going to NP school? So it wouldn;t be illegal because the jobs could not be the same, by the sheer fact that the training of NPs is significantly shorter.
Ha? First of all, what does that mean? Are you a clown or something? What is only anti-competitive if midlevels can do the same job? Midlevels do a job, you are the one that keeps comparing it to what physicians do, not them. The issue is the anti-competitive behavior of lobbying the government to keep some ridiculous "supervision" clause in the nurse practice acts of a majority of our states. The point in going to NP school is to become a nurse practitioner. It doesn't matter that the training is shorter, it is adequate to be a nurse practitioner and not need a physician "supervisor".
actually it is happening and the accrediting body has set the deadline. whether they will be able to follow through then, i don't know.
when i was in school i would have liked a lot more clinical experience, and more in depth conversations/supervision about psychiatry. my classmates and i felt like we weren't ready to practice yet when we graduated. i think an additional year of more intentive practicum with supervision would be beneficial. but then i also got the same experience when i got my first job and was supervised by a psychiatrist. so, who knows, it will nbe interesting to see if any data is collected about masters v dnp providers and level of care.
the program i went to converted to dnp the year after i graduated and they were promoting it as a systems and management focus, it seemed that the masters part of the program would remain the same, but be augmented with medical systems and management classes--eg: :how to be nurse leaders". i wouldn't be interested in that, but would have liked more in depth clinical experience. for a while i was looking into dnp schools, and seems different schools have different focuses-some are management oriented and others are more clinical, one was more research-to-practice oriented, so could be helpful to talk to the school to determine where their focus is. also, many of the programs are so new you could probably make up your own focus and work with faculty in your area of interest -would show you are a real leader:)
back in the mid 1990's i was a premed student and the physician who ran the per med seminar class i took talked about the issue of how much training a person needs to be a medical provider (medical meaning: np, pa, and md). his sense was that medical schools and residency programs were over training/over educating for providing care. he talked about medical schools that were considering taking a more nursing model-eg: doing specialty training from the beginning of school and not doing as much general medical education. its funny that nursing is feeling they need to go more medical model-more general education, then moving into specialty training. he also suggested that medical schools were still using a 19th century model for education which was probably useful in the 19th century, but with highly specialized medicine and biology we now have, at some point it seems there may need to be a shift in the education of physicians-as there may be just too much knowledge to learn, and specialization- as a necessity dt the amount of information to learn- would occur earlier in training.
maybe nursing and medicine are actually heading in the same direction, but they have different starting points? (eg: trying to figure out how much education and training are needed to have good providers)
i didn't go to med school bc i would never be able to learn all that stuff physicians have to learn, however, i am a psych np and am completely capable of providing great care without having gone to medical school or getting a dnp. if i don't know something, i consult, could be md or np who has a good answer.
but i also agree with other people, its each persons choice as to what they want to learn and how to use their education-if you want all that knowledge-go for it!
I was actually a little surprised to find this out at first, but then, I realized that PAs (whose roles tend to be pretty similar to APNs) are generally trained "from scratch" in full-time curricula, so in retrospect, I'm not so surprised after all. :)
prairienp
315 Posts
Please define "many", what percentage are you saying enter Adv practice with a BA/BS in another field without any nursing experience? Is this one of the reasons for hostile reactions by MDs towards the DNP?