"Hi, I'm Farmer Jane, RN. I'll be starting your IV. Don't you worry about that little ole hand tremor there. I swear it doesn't affect my IV skills, no sireee..."
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"Hi, I'm Farmer Jane, RN. I'll be starting your IV. Don't you worry about that little ole hand tremor there. I swear it doesn't affect my IV skills, no sireee..."
I think I built up a tolerance by starting early. In Norwegian farm country, toddlers are given coffee with lots of milk. I've been drinking it since I was two, no exaggeration. My grandma still makes coffee old-school in a stovetop percolator.
I heard a story on the radio this morning that a new study shows that people who drink more than 7 cups of cofee per day are more likely to have hallucinations. The study authors said they weren't sure whether the coffee caused the increased incidence of hallucinations, or if "the type of people more likely to have hallucinations" were the same type of people who would drink more than 7 cups of coffee per day!
I have a feeling schizophrenics drink coffee almost as much as they smoke cigarettes.
Yes...it's called dental school. 🙄
I know I'm tardy to the party, but this just really bugged me.
Its funny how confidence and ignorance are so often paired.
Whether we want to admit it or not, DNP programs are going to continue gaining popularity and success. There is a severe shortage of PCPs and many nurses willing to purse this path. It would be interesting however to see the DNP's reaction if suddenly primary care becomes the new fad to graduating medical students like it was decades ago...
As a medical student contemplating a career in primary care, I often wonder how much the field will change in the next 5 years in response to the DNP trend. BTW, the comment on dangerous self-confidence reminds me of a quote by Twain: "all you need in this life is ignorance and confidence, and then success is sure"
Hopefully demand will ensure high quality programs graduate well prepared novice providers, and hopefully those graduates will find physician partners to mentor their continued growth toward excellence and expert advanced nursing practice. It is what is best for everyone concerned, which is, after all, what we are all about. Is it not?
Nah, the solution is to graduate more medical students and have more of them going into primary care. If you take a national poll asking Americans if they would prefer to be treated by physicians or non-physicians, I would bet that the overwhelming response is that patients would want to see physicians. Patients are underserved by anyone less qualified than physicians, especially ones who work autonomously and claim equivalence. The DNP is a gamble by the nurses and I think it will be one they will come to regret.
Well, I'm not a DNP and not likely to be, so I don't have a dog in that fight. From a Public Health perspective, I think midlevels are very valuable, and I don't think it has to be either or. I'd like to see a confluence of professionals working together. I think "underserved" is prejorative language, which doesn't really have any place in a reasonable discussion.
I don't have a problem with NPs working as mid levels. I have a problem with NPs trying to rise above that role and play doctor, especially when their education is VERY sub par to medical school.
I don't blame you. I just don't know any midlevels who "play doctor," so I really can't speak to that. I think as a professional nurse, it would really annoy me. I might infer that they thought there was something inherently demeaning about nursing, and that position would be irksome. I don't actually know any PAs at all, but the APNs I know are all outstanding nurses. If they secretly pretend to be Dr. Quinn, Medicine Woman at home in front of the mirror, I'm not privy to it, lol.
I think the point I have been trying to make is that the fields of medicine and nursing are so very different and highly specialized, this notion of competitionseems silly. Neither is prepared to do the others' job, though either may be capable. I am not an APN, so I am not a fully informed individual wrt their scope in every state, etc. and I am certainly not knowledable about the politics involved in the DNP movement (Nor am I particularily interested). It just seems to me that designing excellent educational/training programs to prepare APNs is to everyone's benefit. I don't see how well educated, well prepared APNs are any threat to physicians or patients. At least none of the physicians I know are threatened by the role; they embrace it and appreciate the individuals for the professionals they are and the abilities they demonstrate. I guess I'm lucky to work in a collegial envionment. There really is an air of mutual respect among the various professionals. As much as I complain about being in BFE, I guess I should be grateful! 👍
I think the consensus that the new DNP programs are not yet what they should be is probably accurate. I hope they evolve into a better system for ensuring highly skilled and knowledgble professionals. If I attend a ANP program, I want it to be outstanding. My time (and my money) is too valuable to waste on mediocrity.
I think the point I have been trying to make is that the fields of medicine and nursing are so very different and highly specialized, this notion of competitionseems silly. Neither is prepared to do the others' job, though either may be capable. I am not an APN, so I am not a fully informed individual wrt their scope in every state, etc. and I am certainly not knowledable about the politics involved in the DNP movement (Nor am I particularily interested). It just seems to me that designing excellent educational/training programs to prepare APNs is to everyone's benefit. I don't see how well educated, well prepared APNs are any threat to physicians or patients. At least none of the physicians I know are threatened by the role; they embrace it and appreciate the individuals for the professionals they are and the abilities they demonstrate. I guess I'm lucky to work in a collegial envionment. There really is an air of mutual respect among the various professionals. As much as I complain about being in BFE, I guess I should be grateful! 👍
I think the consensus that the new DNP programs are not yet what they should be is probably accurate. I hope they evolve into a better system for ensuring highly skilled and knowledgble professionals. If I attend a ANP program, I want it to be outstanding. My time (and my money) is too valuable to waste on mediocrity.
The DNP program is trying to do just that - allow nurses to "play doctor."
According to a letter written by the Board Chair of the AMA...
"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."
The nursing side of things is trying to say that with the DNP... APNs should have independent practice rights like doctors (MDs) - no longer mid levels. It also does cause confusion when an ANP walks into the room and says "Hi I'm Dr. XXX." The patient thus assumes the person is a physician who attended medical school and don't nkow that the practitioner is actually an advanced practice nurse who may have completed his/her training entirely online with little or no patient care experience.
Bottom line: It's dangerous. If you want to "play doctor," go to medical school. You can get a doctorate degree and be a BETTER mid level who can better hit the ground running, but unless you go to medical school, you are still a mid level (PA or NP) and should practice as such. If you want more, further your education by attending medical school, not fabricating a nursing education that is FAR below the standards set by the AMA.
According to a letter written by the Board Chair of the AMA...
"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."
The nursing side of things is trying to say that with the DNP... APNs should have independent practice rights like doctors (MDs) - no longer mid levels. It also does cause confusion when an ANP walks into the room and says "Hi I'm Dr. XXX." The patient thus assumes the person is a physician who attended medical school and don't nkow that the practitioner is actually an advanced practice nurse who may have completed his/her training entirely online with little or no patient care experience.
Bottom line: It's dangerous. If you want to "play doctor," go to medical school. You can get a doctorate degree and be a BETTER mid level who can better hit the ground running, but unless you go to medical school, you are still a mid level (PA or NP) and should practice as such. If you want more, further your education by attending medical school, not fabricating a nursing education that is FAR below the standards set by the AMA.
Interesting you mention this because nurses have a pretty good shortage too. I really dont know why they are so into this DNP program to "play" doctor and not working toward fixing the shortage of nurses. You dont see doctors saying "lets become nurses because they have a shortage".
I agree with everything you had to say.
Here's one of the curriculum for DNP: its really a joke!!!
FPB has a unique approach to "distance" learning. All Post-Master's DNP courses are given as intensive classes, with a 3-credit hour class given over a six-day period. Intensive sessions are given three times a year (January, May, and August) for at least two weeks. Papers and projects are due in the semester following the intensive session. Check the intensive course schedule.
REQUIRED
NUND 450
Applied Statistics
3 cr
NUND 504
Nursing Theory
3 cr
NUND 506
Leadership in Organizations & Systems
4 cr
NUND 508
Health Policy Development & Implementation
3 cr
NUND 530
Research Principles & Methods
3 cr
NUND 531
Approach to Practice Focused Res
3 cr
NUND 610
Translating Evidence into Nursing Practice
3 cr
NUND 611
Practicum
2 cr
NUND 619
Proposal Development
2 cr
NUND 620
Scholarly Project
3 cr
EDUCATIONAL LEADERSHIP TRACK
NUND 509
Curriculum and Instruction
3 cr
NUND 609
Theoretical Foundations of Testing & Evaluation
2 cr
PRACTICE LEADERSHIP TRACK
NUND 507
Management for Advance Practice
3 cr
NUND 607
Advanced Leadership & Management
2 cr
FPB has a unique approach to "distance" learning. All Post-Master's DNP courses are given as intensive classes, with a 3-credit hour class given over a six-day period. Intensive sessions are given three times a year (January, May, and August) for at least two weeks. Papers and projects are due in the semester following the intensive session. Check the intensive course schedule.
REQUIRED
NUND 450
Applied Statistics
3 cr
NUND 504
Nursing Theory
3 cr
NUND 506
Leadership in Organizations & Systems
4 cr
NUND 508
Health Policy Development & Implementation
3 cr
NUND 530
Research Principles & Methods
3 cr
NUND 531
Approach to Practice Focused Res
3 cr
NUND 610
Translating Evidence into Nursing Practice
3 cr
NUND 611
Practicum
2 cr
NUND 619
Proposal Development
2 cr
NUND 620
Scholarly Project
3 cr
EDUCATIONAL LEADERSHIP TRACK
NUND 509
Curriculum and Instruction
3 cr
NUND 609
Theoretical Foundations of Testing & Evaluation
2 cr
PRACTICE LEADERSHIP TRACK
NUND 507
Management for Advance Practice
3 cr
NUND 607
Advanced Leadership & Management
2 cr
Most DNP programs I have seen would make advanced practice nurses become great nurse educators and nurse leaders... "Dean of Nursing" type of deal. The curriculum is geared towards education, research, management, etc. Not clinical.
while there is wide variation of DNP programs out there (from the clinically centered to the PhD light) the reality is that they are all doctorates and as such those completing the degree aren't "playing doctor" they are in facts doctors (note that "doctor" is a title granted by academia, not medicine). the first physicians to use the title "doctor" did so to claim a higher level of education, not to identify themselves as healers). DNPs are nurses, not physicians; just as PharmDs are pharmacists, not physicians; PsyDs are psychologists, not physicians; and DDSs are dentists, not physicians - but all are doctors. the AMA claim of "patient confusion" is bogus and sadly we have seen this game before (optometrists and osteopaths jump to mind). having saisd all that, unless and until DNP programs come to some standardized curriculum questions will continue as to the rigor of their preparation.
as for the clinical aspect of the programs that fall into the PhD light category, I agree that more clinical time would be appropriate for DNPs, restriction of the DNP to the four clinical categories (NP, CNM, CRNA, and CNS) as would opportunity to sit for the USMLE 3 exam (if a DNP desires), in addition to the required APN boards for their specialty, and participate in a federally funded apprenticeship for APNs (seems like osteopaths fought this battle just four decades ago doesn't it?). in addition, it would be good for medical education to actually address the ideas of collaboration (among professions - not specialties), coordination of care, and prevention in a meaningful way, especially for those entering primary care.
the problem, as i see it, is that the AMA and ANA (and other groups in organized nursing and organized medicine) can't seem to talk to each other. the AMA has a long history of trying to control nursing as if it were a subservient to medicine and the ANA has a long history of playing itself as a victim. i see individual APNs and physicians working together in a collegial environment all the time (without the misplaced claim that one is somehow better, smarter, or more caring than the other). if we could get the "leaders" of both sides to recognize that medicine can learn from nursing and nursing can learn from medicine both professions would be better off, and more importantly the patients we care for would be better off as well.
just my two cents though.
as for the clinical aspect of the programs that fall into the PhD light category, I agree that more clinical time would be appropriate for DNPs, restriction of the DNP to the four clinical categories (NP, CNM, CRNA, and CNS) as would opportunity to sit for the USMLE 3 exam (if a DNP desires), in addition to the required APN boards for their specialty, and participate in a federally funded apprenticeship for APNs (seems like osteopaths fought this battle just four decades ago doesn't it?). in addition, it would be good for medical education to actually address the ideas of collaboration (among professions - not specialties), coordination of care, and prevention in a meaningful way, especially for those entering primary care.
the problem, as i see it, is that the AMA and ANA (and other groups in organized nursing and organized medicine) can't seem to talk to each other. the AMA has a long history of trying to control nursing as if it were a subservient to medicine and the ANA has a long history of playing itself as a victim. i see individual APNs and physicians working together in a collegial environment all the time (without the misplaced claim that one is somehow better, smarter, or more caring than the other). if we could get the "leaders" of both sides to recognize that medicine can learn from nursing and nursing can learn from medicine both professions would be better off, and more importantly the patients we care for would be better off as well.
just my two cents though.
One problem...although we were taught in nursing school that all members of the health care team are equal, that's does not mean that their training is equal.
When it comes to medicine, physicians are better than APN's.
you are right that the training is not the same, but i disagree that one is 'better' than the other as a general premise. a person trained to do a particular job will do better at that job than a person who was not trained to do that job. the argument breaks down when both are trained to do the same job (ie provide primary care) from two different approaches. one will likely be better at the items that fall into the perspective that they were trained in. for example, NPs are more likely to provide patient education and self-management techniques to a patient for a chronic condition (hypertension, diabetes, copd, pick a problem) and a physician is more likely to write a script without addressing lifestyle, diet, or exercise and move on to the next patient.
which approach is 'better'?
the physician may be better at writing the 'script (ie 'medicine') but in this case i would say the NP approach addresses the cause of many problems (and they may write a script in addition to pt education etc) while the physician approach treats the problem but not the cause.
this scenario happens a lot in the world of primary care and it is why both sides could stand to learn from the other.
again, just my two cents
which approach is 'better'?
the physician may be better at writing the 'script (ie 'medicine') but in this case i would say the NP approach addresses the cause of many problems (and they may write a script in addition to pt education etc) while the physician approach treats the problem but not the cause.
this scenario happens a lot in the world of primary care and it is why both sides could stand to learn from the other.
again, just my two cents
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... no i really think one can be better then the other.
Wow, have you ever actually worked in Primary Care, or did you just pick that pearl up from a pamphlet for NP school? Patient education is part of every PC residency, and every doctor I've worked with in those areas (FM, IM, Peds) actually did talk to the patients at great length about their conditions. The only "Primary Care" docs that tend not to do this, in my experience, are the Emergency Physicians, as they are trained more to move the meat (stabilize and dispo). Some doctors are more rushed, and push scripts, because they are given massive time contraints with regards to how many patients they have to see in a given time, so cannot spend more than a handful of minutes in the room with the pt (which often must be spent actually examining the pt, and taking a history). I guarantee you that when NPs are put in the same situation (short visit times), they will do the same exact thing.
IMO, anyone with enough time and dedication can pass the USMLE boards. It wouldn't be easy, but it is doable. Same way that somebody could pass the BAR exam without going to law school. Just because a DNP can study like crazy and pass step 3... doesn't prove they are an equal medical provider to physicians.
Finally, DNP grads are "playing doctor." Yes, they have a doctorate degree. But society has turned the word "doctor" to be equal to "physician." In that sense, they are "playing doctor."
DNP programs need to incorporate a lot more science and patient contact to their programs. The programs are supposed to be graduating advanced practice nurses. Not MBA/MPH/M.Ed combo grads.
Finally, DNP grads are "playing doctor." Yes, they have a doctorate degree. But society has turned the word "doctor" to be equal to "physician." In that sense, they are "playing doctor."
DNP programs need to incorporate a lot more science and patient contact to their programs. The programs are supposed to be graduating advanced practice nurses. Not MBA/MPH/M.Ed combo grads.
Yes, i have spent time in primary care and the reality is that lack of time and high patient load is one of, but not the only, reason NPs spend more time with patients than physicians. No, my observation did not come out of an NP pamphlet, rather it came out of what I have witnessed and is backed by a Cochrane Review.
But step 3 is not an "end exam" as in if you pass step 3 you know everything that a physician should know. It is part of the overall process that includes step 1 and 2. You have to take step 1 and 2 to even be able to take step 3.
Aside from which, should Pharm Ds be allowed to take step 3 and practice as physicians? They shouldn't anymore than an MD should be allowed to challenge a pharm doctorate test and practice as a Pharm D. DOs can't challenge the test to become a PA or a nurse. I think most nurses would be insulted if an MD said "I passed the nursing test so therefore I can work as a nurse." It is saying that nurses don't really learn anything in nursing school that MDs don't learn. Different school's, different tests, different degrees.
Aside from which, should Pharm Ds be allowed to take step 3 and practice as physicians? They shouldn't anymore than an MD should be allowed to challenge a pharm doctorate test and practice as a Pharm D. DOs can't challenge the test to become a PA or a nurse. I think most nurses would be insulted if an MD said "I passed the nursing test so therefore I can work as a nurse." It is saying that nurses don't really learn anything in nursing school that MDs don't learn. Different school's, different tests, different degrees.
Yes, anyone can pass a test with enough preparation time and dedication, so i'm not sure what your point is here. No test measures ability to provide care, all any test measures is the ability to take a given set of circumstances coupled with knowledge in one's possession and come up with the appropriate response.
Next item, I hate to break it to you but society didn't make that change, medicine has been pushing the 'doctor equals physician' for a long time. the first doctors were theologians and physicians tied themselves to this heritage for two very practical reasons - first to claim they had more education than the laymen (which was not always the case right up until Flexner) and second to avoid accusations of witch-craft and blasphemy. i can go into the number of professions whose members are doctors, in healthcare and outside healthcare, but it was been reviewed by others ad nausea and the AMA continues to make the claim.
Last item, more clinical time & more science? - no argument from me, i whole heartedly agree and think DNPs should have a residency at the end of their training funded by the same federal government program that funds current medical residency programs - Medicare.
As for combination degrees, I will have to disagree. One of the things that distinguish nurses is our long history of patient advocacy, public health work, care coordination & interdisciplinary collaboration, and patient education - why would we abandon our principles as we care for our patients? (as for the MBA, frankly lack of business acumen has held nurses back for decades, we could use more economics courses in the undergrad program).
I don't necessarily have a problem with non-physicians practicing some medicine. However, any group that practices any form of medicine needs to be regulated by the boards of medicine, period. Only the boards of medicine have processes, people, and experience to ensure the highest level of patient safety in this country. Allowing boards of nursing to regulate "advanced" nurses like NP's who practice medicine creates inherent conflict of interest because nursing has to both regulate NP's but at the same time try to expand their scope into more of medicine. Competing conflicts of interest is how we got into this financial crisis in the first place. The patients are put at great risk and suffer.
I strongly support filing lawsuits to clearly define what is medicine and what is not. Anything that is medicine needs to be regulated by boards of medicine. For example, the CRNA's in Louisiana tried to claim that pain medicine was within their scope (after just 2 weekend courses, someone actually became paralyzed by an unsupervised CRNA doing pain medicine). The courts disagreed strongly.
Politicians can be bought with donations, but the courts are far more objective. Physicians need to use the courts more often.
Sadly, state boards of nursing may be underreporting unprofessional behavior and incompetence to the National Practitioner Data Bank, according to one government representative who spoke at the meeting. APNs whove had a lot of claims against them and have settled out of court can often work in different states without fear of retribution because of confidentiality agreements.
regulators [California Board of Nursing] acted belatedly or not at all, even when explicitly told that nurses had committed serious crimes. Some were handed renewals after reporting their own felonies to the bureau.
I strongly support filing lawsuits to clearly define what is medicine and what is not. Anything that is medicine needs to be regulated by boards of medicine. For example, the CRNA's in Louisiana tried to claim that pain medicine was within their scope (after just 2 weekend courses, someone actually became paralyzed by an unsupervised CRNA doing pain medicine). The courts disagreed strongly.
The practice of interventional pain management is not the scope of practice of a nurse anesthetist.
The practice of interventional pain management is solely the practice of medicine.
The advisory opinion issued by the nursing board is an effort to substantively expand nurse anesthetist scope of practice and is an improper attempt at rule making.
A permanent injunction issue prohibiting the nursing board from enforcing the statement.
The practice of interventional pain management is solely the practice of medicine.
The advisory opinion issued by the nursing board is an effort to substantively expand nurse anesthetist scope of practice and is an improper attempt at rule making.
A permanent injunction issue prohibiting the nursing board from enforcing the statement.
Politicians can be bought with donations, but the courts are far more objective. Physicians need to use the courts more often.
Its not only step 3 but do nurses realize that then physicians have to be board certified in their current specialty just to practice medicine?
Again, if you want to practice medicine independently go to med school, finish residency, pass all steps and get board certified!! Is that easy!!
Again, if you want to practice medicine independently go to med school, finish residency, pass all steps and get board certified!! Is that easy!!
just in case some people think is going to be easy!!!
the courts have stepped into this discussion several times in the past. CRNAs were accused of practicing medicine (so were dentists) and the court stepped in and stated that the act of providing anestesia is only the practice of medicine if a physician does it; it is nursing when a nurse does it and dentistry when a dentist does it. when NPs were accused of practicing medicine, the court stepped in and noted that they were in fact practicing nursing. physicians have very few wins in the courts on the issue of where nursing ends and medicine begins (or where allopathic medicine ends and osteopathic medicine begins, or where chiropractic care ends and medicine begins, et al), otherwise i suspect they would use the courts more often.
NPs practice advanced nursing independently (do physicians realize that nurses can practice without direction / supervision / collaboration from them?). While there is significant overlap between the two, NPs practice nursing and physicians practice medicine. It is the physicians who seem to believe that NPs are incapable of providing safe and effective primary care (absent any evidence to support the claim) and while passing an exam does not turn a nurse into a physician, it does demonstrate, coupled with already published research, that the physician is not the sole profession capable of providing quality care to the public, politicians, and the courts.
Yes, nurses realize that those physicians (the vast majority at this point) pass specialty boards that only physicians are permitted to take. if the AAFP is willing to permit FNPs to sit (and if the AANP permits physicians to sit if they desire) I'm all for it. the arguement that "you didn't pass the test i passed (oh and you aren't allowed to sit for it) so you aren't qualified to do what i do" is a tired one and has no evidence to support it.
I was stating that the current most-Masters DNP program IS ALREADY essentially a watered down combination of those three degrees. Look at the curriculum:
http://fpb.case.edu/DNP/curriculum.shtm
menetopali said:
I think that most are saying the argument is more like "you want to take one part of the tests I took and use that to say you are just as qualified to practice medicine at the same level as we are. And that test is just a part of an overall education that includes school and residency."
This isn't a question of if APN who does a "doctorate" in nursing are capable of practicing medicine, or providing good primary care. It is if people who have gotten a degree based mainly on nursing theory, public health classes, stats etc. should be representing themselves as just as well trained as physicians who have completed a residency.
and some of that coursework should stay, frankly some of it would be beneficial, in my opinion, for aspiring physicians in med school (notably principles of public health, health systems, and using evidence to guide practice). some of the DNP coursework (notably 'theory', 'research', and 'leadership & management' for those entering clinical practice), in my opinion, could be dropped in favor of more clinically applicable coursework.
again, no arguement from me that DNP residency is a positive thing or that more clinical education and less nursing theory, leadership, & management is a positive thing. although i think public health, using evidence for practice, and health systems & policy are all valuable courses.
as for people representing themselves as somthing they aren't, i'm against it - but first, studies have repeatedly shown that an NP provides safe and effective primary care; and second, the title 'doctor' makes no such representation of the same training anymore than it does for a dentist, vet, pharmacist, optometrist, chiropractor, or any other doctorate degree.
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Oh no they won't. Haven't you heard? Midlevels can warp space-time and not only see more patients than physicians but, thanks to their shorter curriculum which nonetheless still includes everything a dull, plodding physcian needs four times as long to learn, get better Press-Ganey scores, the One True Indicator of Medical competency.
Excellent post. 👍 It hits all the high points that have been discussed before. So please shelve the "studies have shown NP's provide equal care, blah blah" argument. It's been dissected here on SDN and it doesn't hold up. Those studies are garbage. As group_theory pointed out, those studies often measured "patient satisfaction" and not outcomes and they were seriously underpowered (how can you reach any generalizations when you only ask the opinions of 20 patients for a "study"?)
As to answer group_theory's above question, I recommend that when evaluating an NP/DNP for employment to ask the following:
How much of your training was online?
That will answer most of your questions and concerns about competency.
Looking up the vast amounts of research out there on distance education should be one of your pursuits, lol!
http://www.nosignificantdifference.org/
Like I answered in another thread about online education:
"I see, because I imagine that dealing with a crashing patient with X, Y and Z co-morbidities (in different age groups, with different family members that wants different things done in term of code status) and taking 7 different medications in a rural vs academic hospital is going to be learn much better via the computer than first hand experience!!! Yeah right!!!
maybe in the 8-5 schedule of cubicle world the online experience is good, but this is medicine".
Perhaps your educational experience has failed you since you seem to have difficulty with this. What you're talking about is clinical which is exactly that - "clinical experience." "Clinical is not done via distance education because it is "clinical experience." But then again, maybe you haven't heard of Sim Man either. Now, let me finish this video on suturing in NEJM.
It seems like most of the programs I've seen (in addition to the ones posted on here) have quite a bit of "filler". I had an earlier post that broke down my arguement, but the gist of it was this:
If you want to do hospital administration, get an MBA/MPH.
If you want to teach, get a Ph.D.
If you want to complete more advanced training, go do more clinical work.
The degree's only purpose is for inflation.
I take offense to a cluster of ill-conceived classes being considered doctoral-level, as it cheapens every other doctoral degree. It is suppose to be the capstone of a person's education....and not something that can be done at a person's leisure, with mostly filler classes. And then there is the whole, "you can do everything online!" Sad.
Taurus, you seem to have a real good knowledge base of DNP programs. Can you save me the effort of a search and tell me how many of these generic DNP programs ( those admitting RN students with a BSN) are entirely on line?
Thanks
That's hard to say because that's a moving target. Existing MS programs are being converted to DNP ones and new DNP programs open. The curricula are also constantly changing.
However, it's not just a few DNP programs that have extensive online components and/or "filler" statistics/leadership/management courses that make up the bulk of their "doctorate". It's scary the percentage of DNP programs are like this. I would hazard a guess of > 50% of all DNP programs have an online component.
Why don't the NP organizations publish this information for the world to see? Why don't Mundinger and other DNP proponents never mention these facts in their publications? Instead, they try to convince the public that DNP's are equivalent to physicians.
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Wow, this website is kind of... lame. Only extremely vague snippets of the findings are provided, with no link to an actual article or even a full abstract for many of the studies. I searched for studies with the keyword "online" and there are about thirty articles total.
The first one measures course withdrawal rates, the next one seems to involve a community college and is not clear about what it is actually measuring and has no link to more detailed info, the third one studies "student persistence" in online business statistics courses, the next one appears to use a sample size of exactly one professor for the online group, next there's the study comparing final grades achieved in an English course (with apparently no investigation into any differences in rigor and difficulty between sections, but it's hard to tell because again there's no link to any details)... and that's when I stopped reading.
Scrolling through the rest of the studies it's apparent that some of them are repeats and most, if not all, are studying some facet of student performance in very basic undergraduate level courses. And the quality of the research methods and statistical analysis for most of them looks pretty worthless. One of the "studies" is actually relying very inappropiately on a chi-square analysis for its conclusions. Good grief. With an undergraduate dual major in mathematics and statistics, a graduate degree in education, and several years of experience teaching both high school and college level mathematics in a former life I have quite a bit of experience analyzing "research" like this, and, uh... this is mostly crap. Clearly this website has an agenda, namely reinforcing the conclusions found in whatever 2001 book it's pimping out.
It's interesting reading but I don't think any of it is really applicable this subject. Do you have any research examining what really matters here- the ultimate content mastery and clinical competence in practice of healthcare providers who have completed the majority of their professional/graduate coursework online versus in residence? I have an open mind on this and would be interested in reading any such research, but that link you provided yields nothing of real substance here.
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That helps, as I was getting the impression that entire DNP programs were online. What is defined as extensive in your world? If 50% have an online component, you could be suggesting only one course all the way to 100%. Clearly, one/two online courses would be reasonable where 50% or more is of significant concern, and if clinical and other core were online would be more than a significant concern.
