DNP required for entry level

[DogFaceMedic]

A Ped NP told me she was horrified at the idea of having to return to school to get a doctorate just to practice as an NP. Although she would likely be grandfathered (grandmothered?) like PAs without a bachelors.

So, where does the effort to make all NPs get a doctorate stand now? I have seen some literature in the nursing journals against DNP as a requirement for entry level practice, and even a long winded discussion of whether it should be a DNP or an NPD.

Is this still being pushed hard, or is there enough resistance to undermine the effort?

This is not a discussion to bash NPs; I want to know from people who know more about the academic and organizational battles going on.

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[deleted6669]

my understanding is that all nurse midlevels( crna, np, cnm) will require a doctorate by 2015. older folks would be grandfathered just like current certificate np's can still practice although a masters is now the entry level degree.

 

[core0]

A Ped NP told me she was horrified at the idea of having to return to school to get a doctorate just to practice as an NP. Although she would likely be grandfathered (grandmothered?) like PAs without a bachelors.

So, where does the effort to make all NPs get a doctorate stand now? I have seen some literature in the nursing journals against DNP as a requirement for entry level practice, and even a long winded discussion of whether it should be a DNP or an NPD.

Is this still being pushed hard, or is there enough resistance to undermine the effort?

This is not a discussion to bash NPs; I want to know from people who know more about the academic and organizational battles going on.

First of all I will point out that there has never been a grandfathering of PAs without a Bachelors. PA education continues to be competency based no matter what environment it is delivered in. A better analogy would be Medicare allowing NPs to bill if they had received their UPIN prior to Medicare enacting a requirement for NPs to have a Masters to bill for Medicare.

As far as where it stands. NONPF has drafted templates for a post masters and BSN transition program. AACN has declared a goal of transition to DNP by 2015 for APN programs. However AANA has come out stating that they support a transition to DNP by 2025 and the CNMs have not endorsed it at all. NONPF has not endorsed any particular timetable. Quite a few programs are already moving in that direction. Here is the aacn statement:
http://www.aacn.nche.edu/DNP/DNPFAQ.htm
Here is the FAQ from NONPF:
http://www.nonpf.org/cdfaqs.htm

David Carpenter, PA-C

 

[DogFaceMedic]

First of all I will point out that there has never been a grandfathering of PAs without a Bachelors. PA education continues to be competency based no matter what environment it is delivered in. A better analogy would be Medicare allowing NPs to bill if they had received their UPIN prior to Medicare enacting a requirement for NPs to have a Masters to bill for Medicare.

As far as where it stands. NONPF has drafted templates for a post masters and BSN transition program. AACN has declared a goal of transition to DNP by 2015 for APN programs. However AANA has come out stating that they support a transition to DNP by 2025 and the CNMs have not endorsed it at all. NONPF has not endorsed any particular timetable. Quite a few programs are already moving in that direction. Here is the aacn statement:
http://www.aacn.nche.edu/DNP/DNPFAQ.htm
Here is the FAQ from NONPF:
http://www.nonpf.org/cdfaqs.htm

David Carpenter, PA-C

I've read some of the press release stuff already, but I was looking for the "word on the street." It is apparent that there are some bureaucratic maneuverings taking place, and was hoping someone might know more than I can get from the AACN and NONPF websites.

 

[foreverLaur]

I wouldn't take what they say as fact. Anyone remember when they were going to totally phase at LPNs and only have RNs? That was something they claimed was 100% definitely going to happen. Yep... that lasted long :sarcasm:

 

[prairiedog]

I wouldn't take what they say as fact. Anyone remember when they were going to totally phase at LPNs and only have RNs? That was something they claimed was 100% definitely going to happen. Yep... that lasted long :sarcasm:

I don't recall that time, can you provide some information on that time period?

 

[foreverLaur]

I don't recall that time, can you provide some information on that time period?

I don't know too much but I could find out more. My mother used to work as an LPN (got it while she was in high school). All LPNs were laid off at her job at the hospital because everyone was going to an RN only environment - phasing out LPNs. It didn't last long - they were calling my mom and all her LPN coworkers back in 2 months asking them to please come back to work.

If anyone is interested in more information, I can talk to her and get it.... like a time frame

 

[core0]

I wouldn't take what they say as fact. Anyone remember when they were going to totally phase at LPNs and only have RNs? That was something they claimed was 100% definitely going to happen. Yep... that lasted long :sarcasm:

This is a completely different situation. There are two reasons that LPNs exist. The first is that most ADN students get their LPN midway through and may work as LPNs. The second is that they provide lower cost licensed nursing for those areas that can use them. Outside of the military and VA you would be hard pressed to find any major hospital that uses a lot of them on the floors.

Now if you are talking about the ADN vs. BSN situation then that would be more appropriate. The ANA really wants all nursing to be at the BSN level for a number of reasons. However there are two different credentialing organizations for nursing schools. One for BSN and one for ADN. Therefore unless one of these organizations folds they have no real pull. They have managed to close pretty much all of the certificate programs out there on the other hand.

In the case of the NPs the driving force is coming from academia. If you read between the lines there are two reasons. One is to drive some NP programs out of business. There are programs that for a variety of reasons will not be able to offer doctoral degrees and will eventually have to close. The other reason is that more doctoral students provides a larger volume of nursing that can teach MSN classes which will theoretically lead to more MSNs and more BSN nursing instructors. This is the primary rate limiting step for BSN program expansion right now.

So the NONPF wants more doctoral students so they have larger departments which = more academic power. The secondary reason is that longer program = more tuition = either more instructors or more pay. ANA wants more doctoral students so they can produce more MSN so that they can increase the number of BSN programs.

The speed that this has been happening varies widely. If you look at Allnurses some people are reporting that all of the local programs are going to be DNP next year. Others are reporting that none are going to this. It probably depends on the local market and the number of doctoral faculty the program has.

The real question is the consequences of this move. There are a number of studies from the MBA world that show when you take a part time course (which many of the NP courses are) over two years the drop out rate increases dramatically. The other portion is that the opportunity cost between MD and NP is drastically reduced once the NP training is over 3 years. In addition if the intention is to use these doctoral students as instructors, it doesn't really address health care needs or fundamentally address the real reason for lack of instructors which is lack of a decent salary.

David Carpenter, PA-C

 

[foreverLaur]

I'm yet to find a hospital that doesn't use LPNs. They are a vital part of the healthcare team. You can't phase out LPNs and only use RNs. They tried and it failed miserably.

My mom used to work at a wide variety of hospitals (depending on where we lived). The main one being Akron General... where they used a lot of LPNs. She now works in a doctors office giving allergy shots and mixing all the vials for the allergy shots.

 

[DogFaceMedic]

I'm yet to find a hospital that doesn't use LPNs. They are a vital part of the healthcare team. You can't phase out LPNs and only use RNs. They tried and it failed miserably.

My mom used to work at a wide variety of hospitals (depending on where we lived). The main one being Akron General... where they used a lot of LPNs. She now works in a doctors office giving allergy shots and mixing all the vials for the allergy shots.

I think there is a partial parallel with DNP vs NP debate. All practicing NPs I have talked to oppose raising the requirements to DNP. I don't know too many academic NPs, but they seem to want the DNP for academic status. My sense is that if the requirement comes, it will shrink the NP pool when we need more healthcare professionals, just like with LPNs.

As to the ASN vs BSN debate: I don't think BSN should be a requirement either. It is virtually a 4-5 yr process already just to get an ASN. More hoops expands the power of academics and creates bottlenecks to increased healthcare professionals.

 

[core0]

I'm yet to find a hospital that doesn't use LPNs. They are a vital part of the healthcare team. You can't phase out LPNs and only use RNs. They tried and it failed miserably.

My mom used to work at a wide variety of hospitals (depending on where we lived). The main one being Akron General... where they used a lot of LPNs. She now works in a doctors office giving allergy shots and mixing all the vials for the allergy shots.

Yes most hospitals have some LPNs. I have yet to see one that has lots. The military model (and this was 15 years ago) was one RN supervising lots of LPNs with some aids. The only place you saw an all RN environment was in the ICU. This is similar to what the LTACs do from what I have observed. Nursing homes use lots of LPNs also. However, most hospitals that I have observed use a RN/aid model. My N is not huge but other PAs that I talk with are in similar models. Look around at allnurses and you will see a lot of LPN posts looking for hospital work and not finding it. As for not phasing out LPNs, I have seen it happen at 4-5 hospitals in the last 20 years. Notice I am talking hospitals not Physician offices, LTACs or nursing homes. They have a completely different model.

David Carpenter, PA-C

 

[foreverLaur]

LPN's don't need an ASN. At least they didn't used to. My mom was an LPN when she graduated high school and beyond that, the only "degree" she had was a high school diploma and her LPN certificate.

 

[Salamandrina]

University of Washington no longer offers the master's program in nursing because they are following the DNP trend. On the other hand, an advisor at Yale told me "I'll believe it when I see it" in reference to the transition to require new NPs to complete a doctorate. They are both good schools representing two different schools of thought. I, for one, am abandoning my goal of a master's in favor of entering a DNP program, for whatever that's worth.

 

[prairiedog]

University of Washington no longer offers the master's program in nursing because they are following the DNP trend. On the other hand, an advisor at Yale told me "I'll believe it when I see it" in reference to the transition to require new NPs to complete a doctorate. They are both good schools representing two different schools of thought. I, for one, am abandoning my goal of a master's in favor of entering a DNP program, for whatever that's worth.

I see PAs have added a professional doctorate
Baylor regents approved the doctor of science physician assistant
(DScPA) emergency medicine residency, a new joint U.S. Army/Baylor degree to be completed at Brooke Army Medical Center at Fort Sam Houston in San
Antonio. The new doctoral program will provide Army physician assistants
with an opportunity to develop advanced competencies in emergency medicine, while they participate in evidence-based clinical management of critical illnesses and injuries.

 

[foreverLaur]

I hate this doctorate trend. I don't want to get my doctorate. I hate the thought of being required to do any sort of research or write a thesis/dissertation.

 

[Salamandrina]

I hate this doctorate trend. I don't want to get my doctorate. I hate the thought of being required to do any sort of research or write a thesis/dissertation.

There are two different things going on here though. There is a PhD in nursing and there is a Doctorate in Nursing Practice.

 

[deleted6669]

I see PAs have added a professional doctorate
Baylor regents approved the doctor of science physician assistant
(DScPA) emergency medicine residency, a new joint U.S. Army/Baylor degree to be completed at Brooke Army Medical Center at Fort Sam Houston in San
Antonio. The new doctoral program will provide Army physician assistants
with an opportunity to develop advanced competencies in emergency medicine, while they participate in evidence-based clinical management of critical illnesses and injuries.

it's just a matter of time now before they start having a dhscpa option at the masters programs and postmasters online dhscpa completion programs....don't know if I will jump on that bandwagon unless it offers a professional advantage down the line. I can see it if you want to be pa program faculty but the dhscpa(non-residency version) will not make a stronger pa. the residency version I would consider but I'm not in the army and wouldn't join just for this.....
a civilian version that was local and paid a living wage stipend? that I might consider....of course I would consider it without the extra degree anyway.....

 

[foreverLaur]

There are two different things going on here though. There is a PhD in nursing and there is a Doctorate in Nursing Practice.

The DNP still requires a research component though, although MUCH less than the DNSc or Ph.D in nursing.

http://fpb.case.edu/DNP/curriculum.shtm

 

[jwk]

I think there is a partial parallel with DNP vs NP debate. All practicing NPs I have talked to oppose raising the requirements to DNP. I don't know too many academic NPs, but they seem to want the DNP for academic status. My sense is that if the requirement comes, it will shrink the NP pool when we need more healthcare professionals, just like with LPNs.

They don't want it for academic status. They want it so they can call themselves "doctor".

 

[horsenurse25]

They don't want it for academic status. They want it so they can call themselves "doctor".

No. They do not.

They want it because in order to teach for any other faculty in any University professors have their PhD. History, English, Law, you name it.

Why on earth should not the Nurse Practitioners??

I do think the law requiring everyone to have their DNP is ridiculous though. There have been no problems with the profession as it has been, why change it for everyone.

 

[deleted6669]

No, you idiot. They do not.

They want it because in order to teach for any other faculty in any University professors have their PhD. History, English, Law, you name it.

Why on earth should not the Nurse Practitioners??

I do think the law requiring everyone to have their DNP is ridiculous though. There have been no problems with the profession as it has been, why change it for everyone.

the dnp is mostly a clinical degree, not an academic degree.
the ND and phd in nursing satisfy any needed doctoral level requirements out there....look at columbia universities dnp site...it talks about clinical doctorate prepared nurses with very little mention of preparation for academics....

Columbia sets the standard
DrNP: Clinical Doctorate in Nursing

Columbia University School of Nursing was the first program in the United States to offer the Doctorate in Nursing Practice (DrNP) degree. Since its inception in 2004, the School of Nursing has set the standard for excellence in this clinically based doctoral program.

Built on evidence derived from over 10 years of increasing independence and scientific inquiry, including a randomized trial published in The Journal of the American Medical Association, Columbia University School of Nursing faculty developed the DrNP degree to educate nurses for the highest level of clinical expertise, including sophisticated diagnostic and treatment competencies.

The degree builds upon advanced practice at the master's degree level and prepares graduates for fully accountable professional roles in several nursing specialties. The program is comprised of 30 credits of science underpinning practice, a year of full-time residency, and the completion of a scholarly portfolio of complex case studies, scholarly papers and published articles.

"We are extremely pleased to be the first academic institution in the country to offer a clinical doctorate in nursing that prepares nurses for practice at such a high level," stated Mary O'Neil Mundinger, DrPH, Dean and Centennial Professor in Health Policy at Columbia University School of Nursing. "The implications of the Doctor of Nursing Practice degree cannot be overstated. Currently, primary care is a medical specialty in decline. Due to the unique training provided during the DrNP program, graduates will be able to fill the gap that has been left in the primary care specialty. In addition to complex diagnostic and treatment skills, DrNPs will add a unique focus on health promotion, disease prevention, and health education, ultimately bringing added value to the patients they serve."

Dr. Mundinger continued, "The establishment of the DrNP will have a direct impact on the nursing shortage this country is currently experiencing. The rigor and depth of training required of individuals undertaking the DrNP will lend increased status to the nursing profession. In turn, the profession will become a more attractive career choice for those entering higher education."

 

[foreverLaur]

The DNP is more clinical than a DNSc or PhD in nursing, but it still is not clinical.

 

[core0]

They don't want it for academic status. They want it so they can call themselves "doctor".

If you are talking about practicing NPs this is probably incorrect. You have to look at the driving force for this. The ANA and the NONPF (faculty group) are really the only ones pushing this. The NONPF wants more doctorally trained nurses so they have more profressorships and academic power. The ANA wants this as part of their goal to make the BSN the entry level nursing degree (to "professionalize" nursing). The current bottleneck is the requirement for MSN trained nurses as instructors for BSN programs. With more DNPs as instructors they can have more MSN programs. This goes along with their push to put more MSNs on the floor as part of the Clinical Nurse leader program. Of course it doesn't really address the real reasons that nurses don't teach - the lack of decent pay and the horrible infighting in academics.

David Carpenter, PA-C

 

[fab4fan]

The DNP is more clinical than a DNSc or PhD in nursing, but it still is not clinical.

???

 

[foreverLaur]

???

All the programs I have looked at don't look too clinical.

with classes like "nursing theory," "advanced nursing research I/II," "health policy planning & information management systems," "curriculum and instruction," "educaton testing and evaluation," "action research & program evaluation," "teaching practicum," and a required thesis.... i'm not really seeing the clinical part. this is for a DNP program at a highly regarded school that also has a Ph.D in Nursing program.

 

[jwk]

No, you idiot. They do not.

They want it because in order to teach for any other faculty in any University professors have their PhD. History, English, Law, you name it.

Why on earth should not the Nurse Practitioners??

I do think the law requiring everyone to have their DNP is ridiculous though. There have been no problems with the profession as it has been, why change it for everyone.

Spoken like a true nurse - you really haven't paid attention to the politics of all this, and you certainly don't understand or comprehend the facts near enough to be calling anyone an idiot.

There is NO LAW ANYWHERE requiring a DNP for anything. There's a lot of difference between a "law" and a recommendation from a nursing organization. Scope of practice is not determined by degree. That ADN nurse can do the exact same thing as a BS nurse and many MS nurses (excepting those with true ARNP licensure/certification).

There are plenty of nurses teaching without a doctorate degree - and the "P" in practice is for PRACTICE - it has nothing whatsoever to do with teaching. Nurses can already obtain degrees designed for academics. The DNP ain't it.

If the nursing political organizations had their way, the ADN would have gone the way of the dodo bird 30 years ago, which is about the time they proposed the BSN as the "entry level" for RN's. How long do you think it will take to put the DNP in place? And how on earth would it have any effect on the nursing shortage as the advertisement shown previously for the DNP program at Columbia? And how many of these programs will be online-only? Wow, that's really going to be a rigorous program for a "practice" doctorate.

And David and emed - we've all seen this discussion in other threads both on SDN and others - and for those of you that think RN's with a DNP won't be wanting to call themselves "doctor", you're either uninformed or in denial. Why do you think legislation has been introduced at both federal and state levels to regulate who may refer to themselves as a doctor in a healthcare situation? Take a trip over to allnurses.com - you'll actually find threads that ask the question "Can I call myself doctor if I get a DNP? ".

 

[core0]

snip

And David and emed - we've all seen this discussion in other threads both on SDN and others - and for those of you that think RN's with a DNP won't be wanting to call themselves "doctor", you're either uninformed or in denial. Why do you think legislation has been introduced at both federal and state levels to regulate who may refer to themselves as a doctor in a healthcare situation? Take a trip over to allnurses.com - you'll actually find threads that ask the question "Can I call myself doctor if I get a DNP? ".

Well you and I happen to live in a state where they can't use the term "Doctor". There are already nurses with PhD (often in unrelated fields) that use the term. I don't think this is proper and is confusing. When (uggh) I finish my doctorate I will not use the title either. Realistically I think that it is OK to use the term in the proper environment such as the classroom. I do not think that it is proper to use the title in a clinical environment. Are there a minority that think the title gives them equal authority to a physician - yes. However, it is a definite minority.

98% of NPs work either for a health care system or a physician practice. For those working for a health care system there is a potential for benefit. For those working for physician practices there is really only a downside to the title. The other part that we didn't discuss is that integral to the DNP is independent practice. This is the other agenda for the ANA. I do find it interesting that the AANA is really against this when it could be a way around the current opt out situation.

I do read allnurses and generally the NPs that are actually working in the field are against the DNP (as opposed to the ones in the threads like "I want to be an NP but don't want to be a nurse"). The other issue that has popped up there recently is entire areas of the country that are DNP only after next year. Most academic centers have good reason to push this (more classes = more $$$). The centers that don't have the ability or resources to offer a doctorate will probably hang on as long as they can before being forced out. Given the history I would also anticipate a push to make the DNP a requirement for Medicare billing somewhere around 2020 (assuming the CRNAs and CNM get on board).

David Carpenter, PA-C

 

[jwk]

Well you and I happen to live in a state where they can't use the term "Doctor". There are already nurses with PhD (often in unrelated fields) that use the term. I don't think this is proper and is confusing. When (uggh) I finish my doctorate I will not use the title either. Realistically I think that it is OK to use the term in the proper environment such as the classroom. I do not think that it is proper to use the title in a clinical environment. Are there a minority that think the title gives them equal authority to a physician - yes. However, it is a definite minority.

98% of NPs work either for a health care system or a physician practice. For those working for a health care system there is a potential for benefit. For those working for physician practices there is really only a downside to the title. The other part that we didn't discuss is that integral to the DNP is independent practice. This is the other agenda for the ANA. I do find it interesting that the AANA is really against this when it could be a way around the current opt out situation.

I do read allnurses and generally the NPs that are actually working in the field are against the DNP (as opposed to the ones in the threads like "I want to be an NP but don't want to be a nurse"). The other issue that has popped up there recently is entire areas of the country that are DNP only after next year. Most academic centers have good reason to push this (more classes = more $$$). The centers that don't have the ability or resources to offer a doctorate will probably hang on as long as they can before being forced out. Given the history I would also anticipate a push to make the DNP a requirement for Medicare billing somewhere around 2020 (assuming the CRNAs and CNM get on board).

David Carpenter, PA-C

I have no problem with "doctor" in an academic setting. The healthcare setting is different.

As far as it being a requirement for Medicare biling - I doubt it will ever happen. Far too many non-degreed CRNA's practicing even now, and thousands with a masters. It will take 50 years for all of them to retire. Like I indicated - there are tons of ADN RN's out there, and they haven't been shut out yet, and never will be.

 

[horsenurse25]

Obviously jwk you have never been in the academic world.

As it is now, a person getting their NP can get their clinical experience under a doctor or another NP. Same as the nurse programs, most of the teachers giving the BSN have only a BSN themselves. There is considerable pressure for these people to get their masters. Accordingly, there is pressure for NPs to get their DNP to better teach the NP program. I know. I am one myself and I have been getting pressure. I have also been told that if I plan on teaching I had better get it as eventually they will only hire DNPs to teach. I think this is reasonable, however, I hate to think this also means that an NP will have to be a DNP to practice. I hope that in 2015 they decide not to enforce this. But I think they will... It does not matter to me, as I will be grandfathered in. But it makes a difference to any others behind me.

So yes, I call it as I see it. TO blantantly make such an idiotic statement that they only want to be called 'doctor' is ignorant and completely missing the point. There is a crisis in the medical system on many different levels. The same old, same old is not going to work any more.

No NP that I know wants to be called doctor. No NP that I know WANTS to be a doctor, and actually takes pride in the differences (and considerable advantages) of NOT being a doctor. I am SO glad I am not one. On so many different levels.

 

[Taurus]

Horsenut has shown again and again that she can't see the forest from the trees. Maybe the first class they should teach in DNP school is critical thinking.

She's pretty much alone in thinking that the main purpose of the DNP is to create more professors for nursing schools.

Then why make it mandatory to convert all NP schools to DNP ones? Why not create DNP programs in a few select schools and make it very rigorous like the PhD? That will make the DNP more respectable whereas today the DNP = NP. Don't tack on a bunch of fluffy seminars to the NP curriculum and call it a doctorate.

Nobody except horsenut is swayed by the propaganda from the ANA. She ignores the fact that there will be eventually tens of thousands of DNP's outside of academia. The motive behind the DNP is political and the ultimate goal is to put themselves on the same level as physicians. The president of the group representing nursing schools freely admits this.

The biggest beneficiaries of the DNP and DNAP will be PA and AA schools. Students will realize that as PA's and AA's they can get the same role and income as DNP's and DNAP's and spend less time in school. This is yet another example of the nurses shooting themselves in the foot.

 

[jwk]

Obviously jwk you have never been in the academic world.

As it is now, a person getting their NP can get their clinical experience under a doctor or another NP. Same as the nurse programs, most of the teachers giving the BSN have only a BSN themselves. There is considerable pressure for these people to get their masters. Accordingly, there is pressure for NPs to get their DNP to better teach the NP program. I know. I am one myself and I have been getting pressure. I have also been told that if I plan on teaching I had better get it as eventually they will only hire DNPs to teach. I think this is reasonable, however, I hate to think this also means that an NP will have to be a DNP to practice. I hope that in 2015 they decide not to enforce this. But I think they will... It does not matter to me, as I will be grandfathered in. But it makes a difference to any others behind me.

So yes, I call it as I see it. TO blantantly make such an idiotic statement that they only want to be called 'doctor' is ignorant and completely missing the point. There is a crisis in the medical system on many different levels. The same old, same old is not going to work any more.

No NP that I know wants to be called doctor. No NP that I know WANTS to be a doctor, and actually takes pride in the differences (and considerable advantages) of NOT being a doctor. I am SO glad I am not one. On so many different levels.

Go ahead and call it as you see it - I can't help it you're wrong.

You are so confused it's amazing - a DNP has nothing to do with the law - it has nothing to do with teaching. If you're already an NP, why don't you already know and understand that? It has everything to do with politics and the desire of nurses' lame attempts to convince the public that they're preferable to physicians. Is there a crisis in health care? Sure. Are DNP's the answer? Hell no! Who's going to care for the patients at bedside? obviously you've already removed yourself from that picture. How do DNP's help the nursing shortage? They don't - it simply takes nurses away from the bedside.

 

[fab4fan]

Obviously jwk you have never been in the academic world.

As it is now, a person getting their NP can get their clinical experience under a doctor or another NP. Same as the nurse programs, most of the teachers giving the BSN have only a BSN themselves. There is considerable pressure for these people to get their masters. Accordingly, there is pressure for NPs to get their DNP to better teach the NP program. I know. I am one myself and I have been getting pressure. I have also been told that if I plan on teaching I had better get it as eventually they will only hire DNPs to teach. I think this is reasonable, however, I hate to think this also means that an NP will have to be a DNP to practice. I hope that in 2015 they decide not to enforce this. But I think they will... It does not matter to me, as I will be grandfathered in. But it makes a difference to any others behind me.

So yes, I call it as I see it. TO blantantly make such an idiotic statement that they only want to be called 'doctor' is ignorant and completely missing the point. There is a crisis in the medical system on many different levels. The same old, same old is not going to work any more.

No NP that I know wants to be called doctor. No NP that I know WANTS to be a doctor, and actually takes pride in the differences (and considerable advantages) of NOT being a doctor. I am SO glad I am not one. On so many different levels.

None of the NPs in my area are agitating for this, either. I think what is going on is a lot of pressure from a few ivory tower people--the ones who don't really do the day to day care of pts. I blame this on the ANA, which long ago lost sight of what its focus should be.

Unfortunately, the vocal few get everyone all riled up. It's certainly made me rethink my career goals. I don't think I want all this sturm und drang--life is too short. And there is no way I am getting a PhD in nursing. No way, no how.

 

[horsenurse25]

It has everything to do with politics and the desire of nurses' lame attempts to convince the public that they're preferable to physicians. .

Well, now that you mention it...there are NUMEROUS studies saying just that...

At any rate, I think it is just your (and predictably Taurus') blantant paranoia of nurses or anyone who might try to achieve higher education at work here.

Do I think that there needs to be a DNP degree to practice? Of course not. Do I think there needs to be a degree to further the profession of nursing? Sure.

The bottom line is that more and more physicians are moving towards specialization. There needs to be far more people offering basic front line care and assessment who can refer any potential problems on. Physicians may try to hang on to their Ivory Tower status with all fingernails screeching in protest, but the bottom line is that they do not have a monopoly on medical knowledge. Yes, GASP! An experienced nurse does indeed have basic medical knowledge. And an NP or especially a PA more than that. Add on experience in the practice setting, and you have extremely competent medical personnel who can ease the strain on the medical system.

Family medical doctors are becoming a thing of the past. I know that is not a popular idea, but that is the way it is.

*Sitting back and watching the venomous spluttering begin*

 

[Taurus]

The bottom line is that more and more physicians are moving towards specialization. There needs to be far more people offering basic front line care and assessment who can refer any potential problems on.

So she finally spits it out. Typical nurse with an axe to grind. And only a nurse would think that we wouldn't be able to see your true agenda.

An experienced nurse does indeed have basic medical knowledge. Add on experience in the practice setting, and you have extremely competent medical personnel who can ease the strain on the medical system.

I have no problem with this. If you want to practice medicine, then your oversight should be under the Board of Medicine. Doesn't that make sense? Don't bother responding because we don't want to hear more of your lies. If this is challenged in court, I'm pretty confident that the nurses would lose. The Supreme Court of Louisiana saw through the CRNA's attempt to practice medicine and shot them down. The courts aren't easily fooled as politicians and the lay public.

 

[DogFaceMedic]

I was on-call so can't spend time reading the treatises posted so far.

Taurus, Lighten up.

Fab4fan: I agree, all the clinical NPs I know -- and RNs thinking of becoming NPs -- overwhelming resist the degree inflation to DNP.

I have a lot of academic experience, and a Doctorate is not needed to teach in academics, especially technical specialties from nursing to engineering, business, etc. I think the effort to force DNP is academically driven irrespective of the true needs of clinicians and the public for more healthcare providers. Taking RNs out of the clinics to create academic DNPs does not expand the # of RNs.

I think there is a disconnect between academic and clinical nursing which is a long term problem for academics. The clinical nurses, on the other hand, will always be in high demand, and they are my buddies.

 

[core0]

I have no problem with "doctor" in an academic setting. The healthcare setting is different.

As far as it being a requirement for Medicare biling - I doubt it will ever happen. Far too many non-degreed CRNA's practicing even now, and thousands with a masters. It will take 50 years for all of them to retire. Like I indicated - there are tons of ADN RN's out there, and they haven't been shut out yet, and never will be.

The ADN is a different issue. There are a number of reasons that ADN programs still exist. There are two accrediting agencies. One the NLN accredits any program including ADN programs (No new graduate programs from what I understand). The other CCNE accredits bachelors and graduate programs. They have different accreditation standards. The bachelors programs generally have to be taught by MSN prepared nurses. If I understand things the ADN programs can be taught by BSNs. This means that there is a larger pool to draw instructors for the ADN programs. As long as NCLEX recognizes both accrediting agencies NLN is free to continue its policies. Since NCLEX is administered by the State BONs there is a tendency to maximize the number of nurses produced regardless of the wishes of the ANA.

The NP situation was very similar. The ANA desired to move the entire profession to the graduate level. The NLN schools resisted this for many similar reasons to the ADN fight. The solution the ANA found was to convince Medicare to require a Masters in the guise of better nursing practice. They did this despite the fact that there was no data to support this. This process eventually led to a substantial number of nurse practitioners not being able to bill for medicare services. The ANA has a definite agenda to promote higher levels of nursing education as evidenced by this article:
http://www.aacn.nche.edu/Media/NewsReleases/Archives/2003/2003AikenStudy.htm
Which highlights this study which was unfortunately published in JAMA:
http://jama.ama-assn.org/cgi/content/abstract/290/12/1617

The rate limiting step in the production of BSN students is MSN instructors. The rate limiting step in MSN instructors is doctorally prepared instructors. The thought behind the DNP from the ANA side is that some of these DNPs will be willing to work as instructors. The other side of this is the development of a "clinical" MSN for staff nurses (as opposed to the traditional MSN which is either research or management oriented). For example:
http://www.nursing.virginia.edu/programs/cnl.aspx

So do I feel that the ANA would sacrifice some NPs to achieve their goals, well I would refer you to the past history of the organization.

David Carpenter, PA-C

 

[horsenurse25]

So she finally spits it out. Typical nurse with an axe to grind. And only a nurse would think that we wouldn't be able to see your true agenda.



I have no problem with this. If you want to practice medicine, then your oversight should be under the Board of Medicine. Doesn't that make sense? Don't bother responding because we don't want to hear more of your lies. If this is challenged in court, I'm pretty confident that the nurses would lose. The Supreme Court of Louisiana saw through the CRNA's attempt to practice medicine and shot them down. The courts aren't easily fooled as politicians and the lay public.

Boy smilies are fun.

Chill out Taurus, this is not a secret opinion. Nor an uncommon one. And I was speaking for both PA's AND NP's. So save your hatred for both groups since both of them are going to doing the bulk of the non-specialized work in the future.
Obviously you are going for family medicine and it freaks you out. Sorry. But don't worry, you will always have a job. Maybe. <grin>

As for medicine;
Nurses have been practicing medicine forever, and perhaps if the Board of Medicine would not be so terrified of admitting that things would be better.

The 'nursing diagnosis' concept is insulting and I do not know of a single nurse that does not cringe when looking at them. SOme of them are ok, but some of them. Sheesh.

Go ahead. Tell me how nurses ARE NOT practicing medicine every single day. This I gotta hear....

 

[Northerner]

Boy smilies are fun.

Chill out Taurus, this is not a secret opinion. Nor an uncommon one. And I was speaking for both PA's AND NP's. So save your hatred for both groups since both of them are going to doing the bulk of the non-specialized work in the future.
Obviously you are going for family medicine and it freaks you out. Sorry. But don't worry, you will always have a job. Maybe. <grin>

As for medicine;
Nurses have been practicing medicine forever, and perhaps if the Board of Medicine would not be so terrified of admitting that things would be better.

The 'nursing diagnosis' concept is insulting and I do not know of a single nurse that does not cringe when looking at them. SOme of them are ok, but some of them. Sheesh.

Go ahead. Tell me how nurses ARE NOT practicing medicine every single day. This I gotta hear....

If it weren't so dangerous, I'd think this sort of hubris to be endearing.

 

[fab4fan]

The 'nursing diagnosis' concept is insulting and I do not know of a single nurse that does not cringe when looking at them.

Truer words were never spoken. I have no need to "diagnose" anything as a bedside nurse. I see a problem as a nurse, and I take the appropriate action. I cringe to think of the careplan I should write for this typical interaction:

Me, to anesthesia doc: Hey, the post-op lap choley is having some nasty rigors. May I give her some Demerol?

Anesthesia: Sure; 12.5mg, repeat x1 prn.

Me: Thanks.

Now I am sure than out there in "Ivory Tower Nurse Land" there is some wordy care plan I should be writing out for this problem--meantime, the pt. is like a Mexican jumping bean, but hey, at least the paperwork will be impressive.

 

[docgnosis]

Why can't we just set up a multiprofessional board representative of every licensed healthcare personnel and give them direct oversight of all healthcare practices. This Board of Health Care (BOHC) would define all educational, licensing and practice scopes of all professions that evaluate, touch, or otherwise interact with the public. The BOHC would have representatives from all licensed healthcare bodies within the prospective fields, DDS, DC, MD/DO, Nursing, etc.

Let them decide scope of practice, and board lisencure issues that come up with new degrees, let them decide instead of interprofessional squabbles. If a profession wants an expansion in their scope of practice, (like NP's doing independent primary practice, Psycologists getting access to psycotropic prescriptive drugs, or chiropractors getting access to prescriptive drug and invasive spinal procedures) it can be decided 1) if they can 2) how they can 3) what steps are needed to educate them on their prospective new roles (such as a primary care residency and additional baisc science training for DNP's, Rx training for DC's and Psycologists.)

Just my two cents.

 

[docgnosis]

Why can't we just set up a multiprofessional board representative of every licensed healthcare personnel and give them direct oversight of all healthcare practices. This Board of Health Care (BOHC) would define all educational, licensing and practice scopes of all professions that evaluate, touch, or otherwise interact with the public. The BOHC would have representatives from all licensed healthcare bodies within the prospective fields, DDS, DC, MD/DO, Nursing, etc.

Let them decide scope of practice, and board licensure issues that come up with new degrees, let them decide instead of interprofessional squabbles. If a profession wants an expansion in their scope of practice, (like NP's doing independent primary practice, Psycologists getting access to psycotropic prescriptive drugs, or chiropractors getting access to prescriptive drug and invasive spinal procedures) it can be decided 1) if they can 2) how they can 3) what steps are needed to educate them on their prospective new roles (such as a primary care residency and additional baisc science training for DNP's, Rx training for DC's and Psycologists.)

Just my two cents.

 

[Paseo Del Norte]

We cannot even produce competent, safe, and effective entry level nurses. The system for entry level nursing education is a mess, and we want to focus on the production of this DNP provider?

Clearly, somebody in my great profession has the patient's best interest at heart.

 

[Therapist4Chnge]

Why can't we just set up a multiprofessional board representative of every licensed healthcare personnel and give them direct oversight of all healthcare practices.

For the same reason the U.N. is a joke.....you can't expect independent bodies to agree to something that may violate one or more of their beliefs (let alone laws/standards). It'd be nice in theory, but it would never work in practice.

 

[devilpup]

Family medical doctors are becoming a thing of the past. I know that is not a popular idea, but that is the way it is.

No. It's an opinion, not a fact.

With the proposed redistributions of the Medicare Pie in favor of primary care MD's, the gap might change. How likely this is to happen remains to be seen.