DNP (doctor of nursing practice) vs. DO/MD

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Well I hope so. I'm holding out for something I'll really enjoy. Private practice is OK, but I really loved the health department during my rotations. I am sort of stalling hoping the HD has an opening, since that is where I really want to be. The physicians there are really awesome. They love public health and love to teach and mentor other people who love public health. I have no idea what the pay scale is there, but I'd take 65K to be able to work there, no question. Keep your fingers crossed that one of their NPs hits the lotto or something!
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While no one likes to see bad outcomes, it's cases like this that the American people will see more and more in the future with NP's, CRNA's, and midwives. These stories will hopefully galvanize the politicians to change the laws, lawyers to file more malpractice lawsuits against these groups, and insurance execs to raise their malpractice premiums.

Midwife Charged in Virginia With Involuntary Manslaughter

ALEXANDRIA, Va.-- A grand jury in Virginia has indicted a midwife who has delivered more than 1,200 babies on manslaughter charges in the death of a baby, MyFoxDC.com reports.
 
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emedpa said:
you shouldn't have a problem finding a good job at 80k. look on the nhsc site. most of those jobs pay well(and provide loan repayment) and you work as part of a primary care team in a small office setting. and most folks who work long term at an nhsc site care about what they are doing and are willing to share with others/teach. good luck.
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hey, what's a physician associate as you wrote in your signature?
Never heard of it....are you from the US or is it a foreign thing?
 
figured someone would point that out...

as if the victim is any less of a victim 27 years later...

anyway, the subject matter wasn't the point of the post...

anyone can google search (and post a link to) bad midlevel outcomes...

as we all know on SDN, one midlevel anecdote applies to all midlevels right :sleep:

i yahoo'd 'anesthesiologist negligence' and it was one of the first that popped up, that's all...(I learned that yahoo is very scientific when I took nursing statistics don't you know!!)
 
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Taurus said:
While no one likes to see bad outcomes, it's cases like this that the American people will see more and more in the future with NP's, CRNA's, and midwives. These stories will hopefully galvanize the politicians to change the laws, lawyers to file more malpractice lawsuits against these groups, and insurance execs to raise their malpractice premiums.

Midwife Charged in Virginia With Involuntary Manslaughter

ALEXANDRIA, Va.-- A grand jury in Virginia has indicted a midwife who has delivered more than 1,200 babies on manslaughter charges in the death of a baby, MyFoxDC.com reports.
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Has it historically worked against physicians?
 
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Taurus said:
While no one likes to see bad outcomes, it's cases like this that the American people will see more and more in the future with NP's, CRNA's, and midwives. These stories will hopefully galvanize the politicians to change the laws, lawyers to file more malpractice lawsuits against these groups, and insurance execs to raise their malpractice premiums.

Midwife Charged in Virginia With Involuntary Manslaughter

ALEXANDRIA, Va.-- A grand jury in Virginia has indicted a midwife who has delivered more than 1,200 babies on manslaughter charges in the death of a baby, MyFoxDC.com reports.
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To clarify, the woman in this lawsuit is a Certified Professional Midwife (CPM) not a Certified Nurse Midwife (CNM). CPMs are not nurses; they have their own separate, independent training and regulation. While this situation is unfortunate, it has nothing to do with nursing or certified nurse midwives per se.
 
medium rare said:
To clarify, the woman in this lawsuit is a Certified Professional Midwife (CPM) not a Certified Nurse Midwife (CNM). CPMs are not nurses; they have their own separate, independent training and regulation. While this situation is unfortunate, it has nothing to do with nursing or certified nurse midwives per se.
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I think Taurus' point is still very valid. As mid-level practitioners, and in particular, NP's, CNM's, and CRNA's beg for fully-independent practice, they are going to have to put on their big boy/big girl pants and realize that the malpractice risk now falls squarely on them - not a supervising or "collaborating" physician, but on THEM. And the number of lawsuits as well as malpractice rates will be on the upswing as adverse events become more common.
 
agree w/ jwk...

but i'll ask for hard data, as is often asked for on these boards from the nursing staff, by physicians...

please show the actual number of malpractice cases, settlements, or whatever data applies to one's argument...

for every CNM, CRNA, or any other APN malpractice anectotally cited, we can all find a doc related anecdote as well...

it's just a pissing match otherwise...

i have been outspoken about solo APN practice...As a patient I demand (their) collaboration and hands on supervision by physicians...

but inflammatory links are just that...
 
jwk said:
I think Taurus' point is still very valid. As mid-level practitioners, and in particular, NP's, CNM's, and CRNA's beg for fully-independent practice, they are going to have to put on their big boy/big girl pants and realize that the malpractice risk now falls squarely on them - not a supervising or "collaborating" physician, but on THEM. And the number of lawsuits as well as malpractice rates will be on the upswing as adverse events become more common.
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I understand that things are different across the country regarding midlevels, but it reads like you're ranting against the 1990s. NPs have known all of this for years. In many states our liability already ends with us. It can actually be one of our selling points - the PA who makes a truly awful error is going to get the supervising MD dragged into court. The NP who makes an error is, depending on the state, an independent practitioner.

And as others have pointed out, we currently lack any real evidence about whether any of the branches of midlevels working within their scope of practice make more mistakes or get sued more often than physicians. It would be interesting if we did know, because we could probably learn something and either grant more independence or change how we train midlevels. Since we don't, this discussion tends to turn into a lot of handwaving.
 
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atkinsje said:
Physicians Associate = Physicians Assistant.

Same thing different name.
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going by the Webster definition, an assistant is not really an associate.
sounds like somebody's got an inferiority complex...:rolleyes:
 
plauto said:
going by the Webster definition, an assistant is not really an associate.
sounds like somebody's got an inferiority complex...:rolleyes:
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IIRC they all used to be physicians associates, then at some point the name was changed. There is currently a push to go back to the associate name.
 
atkinsje said:
IIRC they all used to be physicians associates, then at some point the name was changed. There is currently a push to go back to the associate name
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A physician associate is a physician who works in a group practice and still hasn't made partner yet. There are thousands of physician offices called "XXXX Physician Associates."

This is equivalent to law associates at a law firm. You don't call a paralegal a "law associate."

Way to bastardize the English language by calling someone who is not on the same career track as the physician (nor share the same degree) an "associate."
 
womp said:
A physician associate is a physician who works in a group practice and still hasn't made partner yet. There are thousands of physician offices called "XXXX Physician Associates."

This is equivalent to law associates at a law firm. You don't call a paralegal a "law associate."

Way to bastardize the English language by calling someone who is not on the same career track as the physician (nor share the same degree) an "associate."
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Not sure if this little rant is aimed at me, if it is go bitch at these people instead (they may actually care). I was simply answering a question.

Taken from here.
Assistant v. associate
Yale may have joined the majority of PA programs a decade ago in offering a master’s degree, but it has remained resolutely independent when it comes to the name of the Yale program—for reasons that run deeper than mere tradition. In the early days, more than half the PA programs nationally were called physician associate programs, but as time went on, the preferred term became physician assistant, which is the term used by the American Medical Association (AMA).
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chimichanga said:
agree w/ jwk...

but i'll ask for hard data, as is often asked for on these boards from the nursing staff, by physicians...

please show the actual number of malpractice cases, settlements, or whatever data applies to one's argument...

for every CNM, CRNA, or any other APN malpractice anectotally cited, we can all find a doc related anecdote as well...

it's just a pissing match otherwise...

i have been outspoken about solo APN practice...As a patient I demand (their) collaboration and hands on supervision by physicians...

but inflammatory links are just that...
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You're a funny guy. Want to make an appointment to discuss this issue? Oh wait, I might can fit you in say in a couple months.:laugh:
 
zenman said:
You're a funny guy. Want to make an appointment to discuss this issue? Oh wait, I might can fit you in say in a couple months.:laugh:
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It's my right as a pt, and as a long time RN, I know what I have seen at work...I want physician supervision with NPs...

I live in a big city...I have many options for my health care, and I choose a collaborative model...
 
chimichanga said:
It's my right as a pt, and as a long time RN, I know what I have seen at work...I want physician supervision with NPs...

I live in a big city...I have many options for my health care, and I choose a collaborative model...
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I agree. I personally would rather have their supervising nearby. Also Zenman-Do you believe in NP independence....just a question.
 
Makati2008 said:
I agree. I personally would rather have their supervising nearby. Also Zenman-Do you believe in NP independence....just a question.
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I have total independence here in New Mexico. I like it because I hate any additional paperwork or hassles. But, I'm also the type to ask whenever I feel I need to, as I did today via telemed. I had a patient being weaned off depakote and on 500 mg by a physician no longer here and the patient was also on max Lamictal. The patient started having major mood changes with SI. I wanted to jack the depakote back to 1,500 for a couple weeks and keep the Lamictal where it was at. The other physician agreed with my plan. I don't know crap but I work hard at it.
 
zenman said:
I have total independence here in New Mexico. I like it because I hate any additional paperwork or hassles. But, I'm also the type to ask whenever I feel I need to, as I did today via telemed. I had a patient being weaned off depakote and on 500 mg by a physician no longer here and the patient was also on max Lamictal. The patient started having major mood changes with SI. I wanted to jack the depakote back to 1,500 for a couple weeks and keep the Lamictal where it was at. Theother physician agreed with my plan. I don't know crap but I work hard at it.
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So although you are wiling to call a SP, do you not see the danger in having a MLP with total independence and how that can go bad quickly, and especially with younger NPs with less experience? Honestly being in med. school now I can say without reservation that the training is not there for this(you will hear it referred to as the glass ceiling)! As MLP we learn only the very tip of the iceburg when it comes to medicine.
 
I've been lurking in this thread and a few others re: the fierce debate about DNPs and MLPs in general. I agree with a lot of what is being said: I don't think most NPs can safely function independently; this isn't because they are lesser beings but just because their training is shorter and less intense. I believe that some NPs with a lot of experience (10+ years maybe) and dedication could be at that level in a primary care setting, but definitely not right after graduating from school. New grad NPs should be getting instruction and guidance from their collaborating physician / other more experienced NPs and PAs, just like a first-year resident would get from their attending.

However, where I disagree with people is when they crap all over the DNP degree. Nothing about the DNP necessitates the need for NP independent practice. As it stands, the DNP does not offer any different scope of practice in any state as compared to a MSN-prepared NP. Would I ever get an DNP? Not unless there are changes that make it more of a clinical degree, rather than a blended clinical / administrative / whatever you want it to be degree; at this point I'd rather just get an MPH. However, to blame the DNP for NP independence is to conflate two separate issues: the former is just degree inflation (hardly a new thing) and the ladder is a political issue.

Also, I think that physicians need to read the writing on the wall and realize that MLPs are going to take over primary care in many ways (though not completely). Rather than fight this inevitable change tooth and nail, I think it would be better for everyone if physicians worked with and advised nursing organizations on ways to improve NP training so that they are better prepared clinicians.

So there is my two cents.
 
Makati2008 said:
So although you are wiling to call a SP, do you not see the danger in having a MLP with total independence and how that can go bad quickly, and especially with younger NPs with less experience? Honestly being in med. school now I can say without reservation that the training is not there for this(you will hear it referred to as the glass ceiling)! As MLP we learn only the very tip of the iceburg when it comes to medicine.
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I do agree that NP training does need to be more standardized to account for the varying experiences of nurses. But you have to remember that short, intensive training has been well proven in the military, for use in places few physicians would want to be.

Do I want to learn medicine at a great depth? No, I'd throw up if I had to do bio chem. I lean more to studying the human condition and reactions/responses to life. I look through the other end of the microscope so to speak. Kinda hard to explain but that's basically it.
 
chrish0204 said:
I think that physicians need to read the writing on the wall and realize that MLPs are going to take over primary care in many ways (though not completely). Rather than fight this inevitable change tooth and nail, I think it would be better for everyone if physicians worked with and advised nursing organizations on ways to improve NP training so that they are better prepared clinicians.
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NPs aren't going to be able to "take over primary care" for the forseeable future, as there simply aren't enough of them to go around. Furthermore, the cost of training NPs exceeds the cost of training physicians when you consider the far fewer number of work-years contributed by NPs vs. physicians using current workforce data.

http://medicinesocialjustice.blogspot.com/2009/01/ten-biggest-myths-regarding-primary.html

The best thing physicians can do, and are doing, is to advocate for payment reform that encourages and rewards effective team-based care.
 
Taurus said:
While no one likes to see bad outcomes, it's cases like this that the American people will see more and more in the future with NP's, CRNA's, and midwives. These stories will hopefully galvanize the politicians to change the laws, lawyers to file more malpractice lawsuits against these groups, and insurance execs to raise their malpractice premiums.

Midwife Charged in Virginia With Involuntary Manslaughter

ALEXANDRIA, Va.-- A grand jury in Virginia has indicted a midwife who has delivered more than 1,200 babies on manslaughter charges in the death of a baby, MyFoxDC.com reports.
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Taurus,

If I read that article correctly, the midwife is NOT a nurse midwife, but little more than a doula and the two aren't even comparable. A "lay midwife" can be certified with little or no formal education, wherease a nurse midwife requires 6+ years of training.

Either way, your article is anecdotal. I could post inummerable articles on agregious physician practices, but that proves nothing. If you want to knock nurse midwives, I suggest you a) know what you are talking about first, and b) use outcomes research rather than anecdotes.
 
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@ Blue Dog: I appreciate the link, though it seems to go against some of the common wisdom on the topic. Also, he asserts that NPs can and do easily transition out of primary care, but I am pretty sure that they would have to go back to school and complete an acute care NP program to do this.

Blue Dog said:
The best thing physicians can do, and are doing, is to advocate for payment reform that encourages and rewards effective team-based care.
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What sort of payment reform are you talking about?
 
sarjasy said:
Taurus,

If I read that article correctly, the midwife is NOT a nurse midwife, but little more than a doula and the two aren't even comparable. A "lay midwife" can be certified with little or no formal education, wherease a nurse midwife requires 6+ years of training.

Either way, your article is anecdotal. I could post inummerable articles on agregious physician practices, but that proves nothing. If you want to knock nurse midwives, I suggest you a) know what you are talking about first, and b) use outcomes research rather than anecdotes.
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She's a CPM, which is about as standardized as CNMW programs. So perhaps you should take some of your own advice and educate yourself.

Agree with you on the anecdotal part however.
 
atkinsje said:
She's a CPM, which is about as standardized as CNMW programs. So perhaps you should take some of your own advice and educate yourself.

Agree with you on the anecdotal part however.
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I honestly don't understand what you are saying. You can be CPM with no real formal education - not even a high-school diploma. A nurse midwife requires 6 years of education, 2 of which are at the master's level. How does an alledged "lack of standardization" in education make them somehow comparable and/or invalidate what I said? How, exactly, do I need to better educate myself on this?
 
sarjasy said:
I honestly don't understand what you are saying. You can be CPM with no real formal education - not even a high-school diploma. A nurse midwife requires 6 years of education, 2 of which are at the master's level. How does an alledged "lack of standardization" in education make them somehow comparable and/or invalidate what I said? How, exactly, do I need to better educate myself on this?
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I am saying that a CPM is more standardized than the picture your painting. A CPM is licensed and has anywhere from 3 to 5 years of accredited schooling (in some cases a masters). There are some CNMW programs that accept ADNs, and with the bridge only takes 3 years making their total time in school 5 years. So yes, the CPM programs (at least the accredited ones that lead to a real CPM which this woman was) is about as standardized as graduate nursing programs are.
 
atkinsje said:
I am saying that a CPM is more standardized than the picture your painting. A CPM is licensed and has anywhere from 3 to 5 years of accredited schooling (in some cases a masters)."
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"The Certified Professional Midwife was developed to provide competency-based certification for midwives who are primarily apprentice-trained in out of hospital birth. The CPM credential allows multiple routes of entry to the profession in order to encourage innovation in education..." Also, "...either through completion of the Portfolio Evaluation Process or through a route determined by NARM as equivalent..." These quotes are from narm.org, who issues the CPM.

You call that standardized? Really? Explain to me how a "Portfolio Evaluatian Process" is, as you say, "more standardized than the picture your painting (sic)." Explain to me how that is as standardized as the curriculum for a certified nurse midwife that requires a master's degree. Maybe I'm missing something -- I admit to not being an expert on this, and maybe there is something I don't know/understand.

Furthermore, you said that CPM curriculum is AS STANDARDIZED as CNMW curriculum. Explain that to me in light of the fact that one can sit for the CPM after merely going through a "porfolio evaluation process."

Regardless, Taurus was using the incompetence of a CRM to bash CNMW's, which is like using the incompetence of a chiropracter to bash orthopedists, revealing his ignorance. That is the point of my post.

atkinsje said:
There are some CNMW programs that accept ADNs, and with the bridge only takes 3 years making their total time in school 5 years. So yes, the CPM programs (at least the accredited ones that lead to a real CPM which this woman was) is about as standardized as graduate nursing programs are.
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I've yet to find a masters-level nursing program that doesn't require a B.S. in something. Those that I've seen that accept an ADN require a bachelor's in something in addition to the ADN. Maybe you have found some that I haven't seen. Please provide a link.
 
Blue Dog said:
Some people never let the facts get in the way of a good argument.

No, I just mean that your link doesn't appear to back up your argument (i.e., that the cost of NP training outweighs the cost of MD training). It doesn't mention the relative costs vs. reward of training NPs/PAs/MDs, it only calculates out the SPCs, and it also doesn't factor differences in compensation, which is relevant. Furthermore, it neglects to mention that NPs of a particular specialty (all FNPs and I believe most peds and adult health NPs) must practice in primary care; they can't leave unless they go back to school to complete a program that lets them practice in an acute care setting. It seems like he is grouping all NPs into one category, then saying some of them "leave" for acute care, when in fact NP education almost never prepares someone to work in both acute and primary care.
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chrish0204 said:
Furthermore, it neglects to mention that NPs of a particular specialty (all FNPs and I believe most peds and adult health NPs) must practice in primary care; they can't leave unless they go back to school to complete a program that lets them practice in an acute care setting. It seems like he is grouping all NPs into one category, then saying some of them "leave" for acute care, when in fact NP education almost never prepares someone to work in both acute and primary care.
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many fnp's work in emergency depts without extra training. that doesn't mean they shouldn't get extra training to do this, it just means many of them don't.
our local fnp students rotate through the er for 40 hrs total. many of them then get jobs doing emergency medicine.
 
chrish0204 said:
I just mean that your link doesn't appear to back up your argument (i.e., that the cost of NP training outweighs the cost of MD training).
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Check out the references at the end of the linked article.
 
atkinsje said:
http://fpb.case.edu/MSN/entry.shtm
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That's a bridge program, which is actually pretty common. Usually you show up with your ADN, bridge to a BSN, and then bridge to a masters degree. ADNs entering that program don't enter the MSN program directly - they first go through the classes that BSNs have already taken. It looks like a three semester/six course bridge.
 
Themanatee said:
That's a bridge program, which is actually pretty common. Usually you show up with your ADN, bridge to a BSN, and then bridge to a masters degree. ADNs entering that program don't enter the MSN program directly - they first go through the classes that BSNs have already taken. It looks like a three semester/six course bridge.
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Did you look at the "bridge?" It's 20 hours total. With the average 2 year degree being around 60 hours total. 80 is a bit shy of the average 128 it takes to graduate with a BSN. So yes, this program accepts ADN's and doesn't require them to get a BSN, they take these 6 courses then move right on to MSN curriculum, no degree is awarded (because they don't meet the requirements to get one).
 
atkinsje said:
Did you look at the "bridge?" It's 20 hours total. With the average 2 year degree being around 60 hours total. 80 is a bit shy of the average 128 it takes to graduate with a BSN. So yes, this program accepts ADN's and doesn't require them to get a BSN, they take these 6 courses then move right on to MSN curriculum, no degree is awarded (because they don't meet the requirements to get one).
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First of all, you've yet to seriously defend your claim that the education required for a lay midwife with certification is as consistent as that required for a masters prepared nurse midwife.

Secondly, as others have now pointed out, the program you cite still requires you to be a licensed, registered nurse before pursuing the MSN. Again, how is this "just as standardized" (as you say) as lay midwifery requirements that accept a "portfolio" as sufficient? Don't dodge the question - how is it as standardized?

Finally, what relevance does "standardization" have? Once the minimum requirements are met to become an RN, how does it hurt for schools to add more education on top of it? How does every school's educational requirements looking identical improve outcomes, exactly? In the end, the CNMW is infinitely more prepared than the lay midwife, so trying to compare to two is ridiculous.
 
DogFaceMedic said:
DNP "sounds" better than PA, but that is an attempt at academic prestige/legitimacy. If I have a choice between a newly minted PA or DNP (both without prior experience), I'm going with the PA. As I said on the other post, a CCRN who goes DNP or PA is the best. I know a CCRN going PA, and will be well-ahead of any DNP/NP that I've ever met -- and better than many of the internists who shot-gun labs all day long without reason. But, that's another story.

Academic rank inflation is another of my pet-peeves: MPA is appropriate, DNP has little market or clinical value added above NP.
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You show incredible ignorance with this post. The DNP program teaches nurses how to search the literature for best practices and to evaluate the existing evidence. The purpose of the DNP is to mentor nurses into leadership positions to help develop and lead programs that will help vulnerable populations. It has literally NOTHING to do with competing with physicians. Nurses are a vital and useful group and ideally trained for health promotion and prevention. I hope one day when you are ill and need a NURSE you are the last on their list for services. There is no need to bash nurses or compare them to PAs or MDs, both of which serve different and valuable roles.
 
Wirehaired said:
You show incredible ignorance with this post. The DNP program teaches nurses how to search the literature for best practices and to evaluate the existing evidence. The purpose of the DNP is to mentor nurses into leadership positions to help develop and lead programs that will help vulnerable populations. It has literally NOTHING to do with competing with physicians. Nurses are a vital and useful group and ideally trained for health promotion and prevention. I hope one day when you are ill and need a NURSE you are the last on their list for services. There is no need to bash nurses or compare them to PAs or MDs, both of which serve different and valuable roles.
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Too plagiarize another poster:
"Holy resurrected really old post, Batman."

Grow up. Mature people do not have conversations like this. There are serious short-comings with DNP degree inflation and weaknesses in the education process of NP's. Anyone can use UpToDate, but clinical experience is essential in the practice of medicine; for NP curiccula it is 1/2 that of PA education. The suggestion DNP's are better researchers than NP's is baseless. If you read my post accurately -- kind of like the attention to detail required in research -- there is an absence of criticism of RN's, and in fact a recommendation that CCRN's make very good PA's. Not a criticism of RN's, but of the academic self-promoting DNP process.

Your defense of DNP purpose is not credible. It is high-sounding rhetoric, no different than what many NP's, PA's, or MD's study already. This is my educated and experienced opinion.

I suspect you wouldn't have the guts to insult me personally. So there.
 
Wirehaired said:
You show incredible ignorance with this post. The DNP program teaches nurses how to search the literature for best practices and to evaluate the existing evidence. The purpose of the DNP is to mentor nurses into leadership positions to help develop and lead programs that will help vulnerable populations.
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Are you a nurse? You just joined and posted the above. What credentials do you have?


I'd have to say that you have copied this verbage from some DNP program somewhere. The initial thinking behind the DNP 5-10-15 years ago sounded good, however one major problem is that there is NO Standardized curriculum. The result is that aboput 150 DNP programs have been created. Originally, the DNP was to be the terminal degree for Nurse Practitioners, but many DNP programs are admitting people who are not Nurse Practitioners. One of the first DNP programs was Case Western Reserve in Ohio. They took the ND (Nursing Doctorate) program and changed the title, not the course work. In fact, they allowed some ND grads to initially use the DNP title.

NONPF (National Organization of Nurse Practitioner FacultyJ) has standardized curriculum for NP programs such as Family NP's. But no one organization has standardized the requirements for the DNP. The result is a potpourri of programs. Some will give me "credit for my Master's courses, most claim to be different from the nursing PhD but yet most are requiring some "scholarly/capstone project" which is in essence a research project.
As I look at various DNP programs, I get even more confused with the titles of the courses. I teach at New Mexico State University (http://www.nmsu.edu/~nursing/online-doctor-of-nursing.html) which is starting a DNP program and they are accepting Clinical Nurse Specialists and Nurse Practitioners for the post Master's DNP. I work at 2 different clinics and neither of the physicians understood that Clinical Nurse Specialists are not nurse practitioners. Not all DNP degree holders will be nurse practitioners at least in New Mexico.:confused: Some will be CRNAs or CNM (certified nurse midwives) as they are also considered to be APRN's. (Advance Practice Registered Nurses)

I already know how to do lit searches, I get about 7 free journals such as Clinician Reviews, Clinical Advisor, some are for both PA's/NPs. I keep up with best practices & my CEU/CME by attending conferences, the best ones are those with both physicians and NP's both as speakers and attendees. I am required to have 50 hours, 15 of them pharmacology based in New Mexico.

I am not interested in a leadership role, If I was I would have pursued a MSN in Nursing Administration. Or an MBA or MPH.
However, I am busy teaching the next generation of bedside nurses. Is that not a "leadership role"??

The "vulnerable populations" I deal with are the elderly on Medicare or the self employed-uninsured/construction workers/field laborers who can not afford anything but the meds on Walmarts $4.00 prescriptions,(Have I got that list memorized!) (Whoa-lets check the sample closet)(What would I do without drug reps??) who don't check their blood glucose often enough because the glucometer strips are too pricey, haven't been to a dentist in over 10 years. Next, you will tell me that you are being educated to be a "change agent". Or similar nonsensical phrasing.

From the essentials for DNP education:


"Most of the current DNP programs are designed to accommodate those APRN's (advanced practice registered nurses) who desire the post-masters course content. Yet the core content ranges across the programs from approximately 25 academic credits to no more then 75 academic credits. In addition some of the programs require additional supervised credits and clinical experiences, similar to residency programs, while others concentrate on leadership, health policy, researched and evidence based practice and informatics dimensions in program development. If the nursing education community moves toward accreditation of DNP programs, there may be more standardization of content. But presently the diversity of requirements is confusing for students and faculty, as well as the public."
http://www.scribd.com/doc/18434234/...ment-and-Implementation-for-Clinical-Practice

If I do pursue this DNP, I am going to spend clinical hours with a dermatologist, that would benefit both me and the patients I see.
 
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womp said:
You don't call a paralegal a "law associate."
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Not the same thing at all, not at all.

As for "career track", I see most if not all of my patients independently. My SP reviews 10% of my charts as is the legal requirement, and that's it. We confer for about 5-10 minutes total each week, and that's because I'm competent enough to deal with the rest on my own. He knows this and it's one of the reasons he hired me. I understand that it's not the same situation for everyone, but in my career it's very much similar.

And no, we don't share the same degree, which is why he is the Physician and I'm the P.A. (Associate, Assistant, whatever). If I was his equal in degree, then I would be called a Physician ... I don't see any PAs striving for that title. Unlike DNPs trying to be called 'Doctor', we are still the P.A.
 
Last edited:
Wirehaired said:
You show incredible ignorance with this post. The DNP program teaches nurses how to search the literature for best practices and to evaluate the existing evidence. The purpose of the DNP is to mentor nurses into leadership positions to help develop and lead programs that will help vulnerable populations. It has literally NOTHING to do with competing with physicians. Nurses are a vital and useful group and ideally trained for health promotion and prevention. I hope one day when you are ill and need a NURSE you are the last on their list for services. There is no need to bash nurses or compare them to PAs or MDs, both of which serve different and valuable roles.
Click to expand...

:laugh:

Superb display of "professionalism" - NOT!

I can guarantee you - one thing I will never NEED is a DNP.
 
Wirehaired said:
] The purpose of the DNP is to mentor nurses into leadership positions to help develop and lead programs that will help vulnerable populations. It has literally NOTHING to do with competing with physicians. [/B] Nurses are a vital and useful group and ideally trained for health promotion and prevention. I hope one day when you are ill and need a NURSE you are the last on their list for services. There is no need to bash nurses or compare them to PAs or MDs, both of which serve different and valuable roles.
Click to expand...

Well that is not what the nursing leadership would have you think. They (esp Mary Mundinger) touted the DNP as degree to compete clinically with physicians. Mundinger is on the record multiple times being quoted saying that DNPs will have essentially equivalent skillsets as physicians.

She even went so far as to have the DNPs at Columbia (where she was the dean) take a watered down version of the USMLE step 3 (MD licensing exam). 50% failed. Interns (ie MDs who have not finished thier training) take that test essentially without studying for it. 95% pass on the first attempt.

Nursing students very often come here and other forums saying that the DNP was not meant to compete with physicians. My response is:
1) how come it is touted as a clinical degree if it doesn't have the clinical hours
2) Why call it a doctorate when it doesn't add much in terms of clinical courses if it wasnt meant to compete...
3) Why does the leadership say it is meant to compete?
 
Instatewaiter said:
Well that is not what the nursing leadership would have you think. They (esp Mary Mundinger) touted the DNP as degree to compete clinically with physicians. Mundinger is on the record multiple times being quoted saying that DNPs will have essentially equivalent skillsets as physicians.

She even went so far as to have the DNPs at Columbia (where she was the dean) take a watered down version of the USMLE step 3 (MD licensing exam). 50% failed. Interns (ie MDs who have not finished thier training) take that test essentially without studying for it. 95% pass on the first attempt.

Nursing students very often come here and other forums saying that the DNP was not meant to compete with physicians. My response is:
1) how come it is touted as a clinical degree if it doesn't have the clinical hours
2) Why call it a doctorate when it doesn't add much in terms of clinical courses if it wasnt meant to compete...
3) Why does the leadership say it is meant to compete?
Click to expand...

To address the USMLE issue, I think that was a silly idea. I'm an NP student and we aren't trained as generalists the way PAs and MDs are. I'm in an Adult Acute Care NP program which means I'm trained to function in a hospital. I cannot work with children or in women's health and I have to be very, very careful when providing anything approaching primary care because it simply isn't what we're trained for. Similarly, the FNPs really ought to be out doing primary care and aren't trained for managing vents or other aspects of critical care. Having us take a test for generalists was poorly thought out.

To address your points:

1) That's a huge flaw with the degree, and it's why I'm in a MSN program. As is, the DNP seems like a year of moderately fluffy stuff tacked on to a MSN program. I don't do well with fluff. DNP grads are probably well prepared to go manage units and develop programs but I'd rather be seeing patients. I'd be all over the DNP degree if I thought it would make me a better clinician.

2) This one is a bit tricky. Nursing as a field needs people with doctorates. As is, we have lots of MSNs that function at the NP level, and a PhD option largely divorced from that which tends to be kind of... fluffy. Most Nursing PhDs would be completely unable to teach my courses. The few that do are people who first got their MSN and then went on to get their PhDs. There just aren't that many of them. Nursing has an incredible faculty shortage at all levels, and waving a magic wand and transforming our current MSN programs into Doctorate programs may help alleviate that. Then again unless someone starts paying our faculty more than they could make as bedside nurses, this may never get fixed.

3) The leadership is kinda screwy. and not necessarily representative of their profession. I think the current argument is that we aren't competing because there is a shortage of both of us. It sounds nice but it's a bit disingenuous.

So are we really competing? I'm not sure. NPs and PAs have certainly cracked the physician monopoly on health care, but it doesn't mean that one of our sides is going to end up on the streets starving. I think the future of health care across all specialties is going to be with MDs in more of a supervisory role. I already see it in Philadelphia. I just came off a heart failure floor staffed by three NPs, two PAs and one rotating attending. It works great. You certainly couldn't replace the attending with a DNP.

All this is really just my take on things though. Some of my faculty are involved in the incomprehensible mission statements AACN and our other organizations put out, and from what I gather nursing as a profession is one of the least organized things ever. It may look like there's some sort of plan from the outside but from the inside there's more confusion than anything. Remember we're the field that has spent forty odd years trying and failing to make a college degree our entry level.
 
Last edited:
Themanatee said:
To address the USMLE issue, I think that was a silly idea. I'm an NP student and we aren't trained as generalists the way PAs and MDs are. I'm in an Adult Acute Care NP program which means I'm trained to function in a hospital. I cannot work with children or in women's health and I have to be very, very careful when providing anything approaching primary care because it simply isn't what we're trained for. Similarly, the FNPs really ought to be out doing primary care and aren't trained for managing vents or other aspects of critical care. Having us take a test for generalists was poorly thought out.

To address your points:

1) That's a huge flaw with the degree, and it's why I'm in a MSN program. As is, the DNP seems like a year of moderately fluffy stuff tacked on to a MSN program. I don't do well with fluff. DNP grads are probably well prepared to go manage units and develop programs but I'd rather be seeing patients. I'd be all over the DNP degree if I thought it would make me a better clinician.

2) This one is a bit tricky. Nursing as a field needs people with doctorates. As is, we have lots of MSNs that function at the NP level, and a PhD option largely divorced from that which tends to be kind of... fluffy. Most Nursing PhDs would be completely unable to teach my courses. The few that do are people who first got their MSN and then went on to get their PhDs. There just aren't that many of them. Nursing has an incredible faculty shortage at all levels, and waving a magic wand and transforming our current MSN programs into Doctorate programs may help alleviate that. Then again unless someone starts paying our faculty more than they could make as bedside nurses, this may never get fixed.

3) The leadership is kinda screwy. and not necessarily representative of their profession. I think the current argument is that we aren't competing because there is a shortage of both of us. It sounds nice but it's a bit disingenuous.

So are we really competing? I'm not sure. NPs and PAs have certainly cracked the physician monopoly on health care, but it doesn't mean that one of our sides is going to end up on the streets starving. I think the future of health care across all specialties is going to be with MDs in more of a supervisory role. I already see it in Philadelphia. I just came off a heart failure floor staffed by three NPs, two PAs and one rotating attending. It works great. You certainly couldn't replace the attending with a DNP.

All this is really just my take on things though. Some of my faculty are involved in the incomprehensible mission statements AACN and our other organizations put out, and from what I gather nursing as a profession is one of the least organized things ever. It may look like there's some sort of plan from the outside but from the inside there's more confusion than anything. Remember we're the field that has spent forty odd years trying and failing to make a college degree our entry level.
Click to expand...

There was no monopoly on healthcare.

It was a standard of independent practice set up by the government to ensure necessary training.

A standard which has dropped to compete with increasing costs
 
Themanatee said:
To address the USMLE issue, I think that was a silly idea. I'm an NP student and we aren't trained as generalists the way PAs and MDs are. I'm in an Adult Acute Care NP program which means I'm trained to function in a hospital. I cannot work with children or in women's health and I have to be very, very careful when providing anything approaching primary care because it simply isn't what we're trained for. Similarly, the FNPs really ought to be out doing primary care and aren't trained for managing vents or other aspects of critical care. Having us take a test for generalists was poorly thought out.

To address your points:

1) That's a huge flaw with the degree, and it's why I'm in a MSN program. As is, the DNP seems like a year of moderately fluffy stuff tacked on to a MSN program. I don't do well with fluff. DNP grads are probably well prepared to go manage units and develop programs but I'd rather be seeing patients. I'd be all over the DNP degree if I thought it would make me a better clinician.

2) This one is a bit tricky. Nursing as a field needs people with doctorates. As is, we have lots of MSNs that function at the NP level, and a PhD option largely divorced from that which tends to be kind of... fluffy. Most Nursing PhDs would be completely unable to teach my courses. The few that do are people who first got their MSN and then went on to get their PhDs. There just aren't that many of them. Nursing has an incredible faculty shortage at all levels, and waving a magic wand and transforming our current MSN programs into Doctorate programs may help alleviate that. Then again unless someone starts paying our faculty more than they could make as bedside nurses, this may never get fixed.

3) The leadership is kinda screwy. and not necessarily representative of their profession. I think the current argument is that we aren't competing because there is a shortage of both of us. It sounds nice but it's a bit disingenuous.

So are we really competing? I'm not sure. NPs and PAs have certainly cracked the physician monopoly on health care, but it doesn't mean that one of our sides is going to end up on the streets starving. I think the future of health care across all specialties is going to be with MDs in more of a supervisory role. I already see it in Philadelphia. I just came off a heart failure floor staffed by three NPs, two PAs and one rotating attending. It works great. You certainly couldn't replace the attending with a DNP.

All this is really just my take on things though. Some of my faculty are involved in the incomprehensible mission statements AACN and our other organizations put out, and from what I gather nursing as a profession is one of the least organized things ever. It may look like there's some sort of plan from the outside but from the inside there's more confusion than anything. Remember we're the field that has spent forty odd years trying and failing to make a college degree our entry level.
Click to expand...

I think this was a very level headed response. I rarely see NPs who don't feel the same way. Unfortunately, the most vocal are those who feel NPs should be completely independent in all realms. It is also those militant NPs who are politically active. Quite frankly it will end up doing patients a disservice.

Dr Oops said:
There was no monopoly on healthcare.

It was a standard of independent practice set up by the government to ensure necessary training.

A standard which has dropped to compete with increasing costs
Click to expand...

I agree with this wholeheartedly. The gov't is in a bind since they want to provide what US citizens expect in a healthcare system but at costs which cannot be delivered.
 
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