Is the DNP a real threat, or a paper tiger?

[dragonfly99]

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The DNP program at my medical center is not an online degree. I don't have a problem with NP's but I don't think DNP's should try to hold themselves up as having equal or greater training vs. a MD/DO with a residency. I believe in the team model of practice/medical care, and don't think that NP's should be striving for totally independent practice. I think the model of physassist and his/her critical access hospital ER is a better model.

I also get offended when NP's are always stating that, "Patients are our top priority!" as if patients were not the top priority of MD's, DO's, PA's, pharmacists, RN's, EMT's, etc. It's as if the NP's think they are the only ones who care about patients, and are sticking up for patient care. Baloney.

physassist,
can you clarify one of your earlier comments. What is/was an ND?

 

[DNPDoctor]

The DNP program at my medical center is not an online degree. I don't have a problem with NP's but I don't think DNP's should try to hold themselves up as having equal or greater training vs. a MD/DO with a residency. I believe in the team model of practice/medical care, and don't think that NP's should be striving for totally independent practice. I think the model of physassist and his/her critical access hospital ER is a better model.

I also get offended when NP's are always stating that, "Patients are our top priority!" as if patients were not the top priority of MD's, DO's, PA's, pharmacists, RN's, EMT's, etc. It's as if the NP's think they are the only ones who care about patients, and are sticking up for patient care. Baloney.

physassist,
can you clarify one of your earlier comments. What is/was an ND?

I don't think any NP has said that patients are not the priority for the other health care professionals.

ND stands for Naturopathic Doctor
http://www.naturopathic.org/

 

[physasst]

The DNP program at my medical center is not an online degree. I don't have a problem with NP's but I don't think DNP's should try to hold themselves up as having equal or greater training vs. a MD/DO with a residency. I believe in the team model of practice/medical care, and don't think that NP's should be striving for totally independent practice. I think the model of physassist and his/her critical access hospital ER is a better model.

I also get offended when NP's are always stating that, "Patients are our top priority!" as if patients were not the top priority of MD's, DO's, PA's, pharmacists, RN's, EMT's, etc. It's as if the NP's think they are the only ones who care about patients, and are sticking up for patient care. Baloney.

physassist,
can you clarify one of your earlier comments. What is/was an ND?

An ND was a NURSING DOCTORATE. It was all the rage in the early to mid eighties, and at the time, there were a lot pf proponents claiming that it would "revolutionize" the advance practice nurses by providing a doctoral degree.

here's brief history where the ND is mentioned.

http://www.medscape.com/viewarticle/514544_2

"The development of doctoral programs in nursing then took divergent paths into the doctor of nursing (DNS), the doctor of nursing science (DNSc), the nursing doctor (ND), and the doctor of science in nursing (DSN). These degrees were said to be more clinically focused, hence more concerned with nursing issues and nursing practice. Curricula included nursing theory and strong research and statistics components. Later options to focus on clinical practice, administration, and education were added as role tracks."

http://www.medscape.com/viewarticle/561575

It was widely made popular at the time, but never truly materialized into a degree. I cannot comment on how similar it is to a DNP degree, but there were claims at the time about it being a "clinical" degree.

 

[DNPDoctor]

An ND was a NURSING DOCTORATE. It was all the rage in the early to mid eighties, and at the time, there were a lot pf proponents claiming that it would "revolutionize" the advance practice nurses by providing a doctoral degree.

here's brief history where the ND is mentioned.

http://www.medscape.com/viewarticle/514544_2

"The development of doctoral programs in nursing then took divergent paths into the doctor of nursing (DNS), the doctor of nursing science (DNSc), the nursing doctor (ND), and the doctor of science in nursing (DSN). These degrees were said to be more clinically focused, hence more concerned with nursing issues and nursing practice. Curricula included nursing theory and strong research and statistics components. Later options to focus on clinical practice, administration, and education were added as role tracks."

http://www.medscape.com/viewarticle/561575

It was widely made popular at the time, but never truly materialized into a degree. I cannot comment on how similar it is to a DNP degree, but there were claims at the time about it being a "clinical" degree.

Thank you for the lesson on the history of ND and the concept behind it.

From your posts here, allnurses and blogs, I understand that your responses are biased as a PA and perhaps, you even have an anti-DNP/NP agenda.

Perhaps, we should now start a new thread focusing on the entry level PA program, 1 military EM PA doctorate program, and the gunshot approach to medical training where your valuable input is most appreciated?

Bottomline is that DNP is here to stay. They must now focus on ways to improve the program. Only time will tell.

 

[MOHS_01]

Thank you for the lesson on the history of ND and the concept behind it.

From your posts here, allnurses and blogs, I understand that your responses are biased as a PA and perhaps, you even have an anti-DNP/NP agenda.

Perhaps, we should now start a new thread focusing on the entry level PA program, 1 military EM PA doctorate program, and the gunshot approach to medical training where your valuable input is most appreciated?

Bottomline is that DNP is here to stay. They must now focus on ways to improve the program. Only time will tell.

Huh... that certainly was a mouthful.... "DNP is here to stay"??? Maybe, but that statement cannot be validated for some number of years. I'm sure that the same was said for the ND mistake of years gone by....

The likelihood of DNP's being afforded total autonomy to practice whatever medicine they wish is probably significantly less than 50/50. This issue is barely a blip on the radar of organized medicine at this point; if the program shows some legs you can bet your tail that there will be an organized, and effective, oversight and scope of practice policy battle waged.

 

[physasst]

Thank you for the lesson on the history of ND and the concept behind it.

From your posts here, allnurses and blogs, I understand that your responses are biased as a PA and perhaps, you even have an anti-DNP/NP agenda.

Perhaps, we should now start a new thread focusing on the entry level PA program, 1 military EM PA doctorate program, and the gunshot approach to medical training where your valuable input is most appreciated?

Bottomline is that DNP is here to stay. They must now focus on ways to improve the program. Only time will tell.

actually, I don't have an anti-NP agenda, I do have serious questions and concerns about NP training, and specifically, the DNP, and how it will relate to workforce supply trends. Which, btw, many other NP's agree with. I have merely said in the past, that yes, I am concerned about potential confusion, and misrepresentation to patients. BOTH with PA's and NP's. I have also said, that I have concerns about making the DNP a mandate. I actually spoke a while back with the head of the AACN, and let her know that. I think it would have been far better for the NP profession to explore this as an optional degree requirement, collect 10+ years of data, regarding outcomes, variables, and workforce supply trends, and then perhaps make a decision about making it the mandatory entry level degree. My concern is that, graduates might avoid low paying primary care jobs in rural, and inner city underserved areas. They might avoid them due to increased length of schooling, and a burgeoning student debt load. Also, typically, the most likely candidates to practice in such areas, are candidates FROM these areas. They are also frequently at a financial disadvantage, and by doubling the length of school, and increasing the debt load, you may dissuade potential applicants from those areas. This is a real concern, and many NP's actually agree with me.

I don't like hasty, haphazard decisions made with a lack of evidence, and I would say the same thing to the PA profession, were they to mandate a clinical doctorate.

My posts will, of course, always have some bias in them towards the PA profession, just as yours will always have some bias in them towards the NP profession.

BTW, I can, and have been just as critical of the PA profession, I have been a proponent of mandatory 1 year clinical residencies for all PA graduates, and I have gotten a lot of flak from the PA profession as well. I have also been critical of the AAPA's apparent infatuation with the AMA, and have criticized a lot of the newer PA programs lack of serious prior HCE requirements.

I am an equal opportunity critic. Healthy debate, and careful, critical, and deliberate evaluation are never bad things. Just because I say I am concerned about something does not mean I am criticizing the entire profession, it means that perhaps we should take a more critical look, and evaluate the data.

In my policy role, I advocate for BOTH PA's and NP's, and will continue to do so, despite my misgivings about the DNP. At the end of the day however, I must always advocate for the patient.

 

[cpants]

Thank you for the lesson on the history of ND and the concept behind it.

From your posts here, allnurses and blogs, I understand that your responses are biased as a PA and perhaps, you even have an anti-DNP/NP agenda.

Perhaps, we should now start a new thread focusing on the entry level PA program, 1 military EM PA doctorate program, and the gunshot approach to medical training where your valuable input is most appreciated?

Bottomline is that DNP is here to stay. They must now focus on ways to improve the program. Only time will tell.

Well yes the DNP is here to stay in the sense that you can't unearn a degree. That doesn't mean that DNP's are going to get more autonomy, the right to be called "doctor" in the clinic, or any equivalence to MD/DO's. If nurses realize that they aren't getting these things by becoming DNP's, and are essentially just regular NP's with an expensive "D" added before their title, then the DNP programs will hastily disappear.

 

[DNPDoctor]

Huh... that certainly was a mouthful.... "DNP is here to stay"??? Maybe, but that statement cannot be validated for some number of years. I'm sure that the same was said for the ND mistake of years gone by....

The likelihood of DNP's being afforded total autonomy to practice whatever medicine they wish is probably significantly less than 50/50. This issue is barely a blip on the radar of organized medicine at this point; if the program shows some legs you can bet your tail that there will be an organized, and effective, oversight and scope of practice policy battle waged.

Well, then I guess only time will tell.

It's truly sad how much bickering and the hate health care professionals show against one another.

 

[physasst]

Huh... that certainly was a mouthful.... "DNP is here to stay"??? Maybe, but that statement cannot be validated for some number of years. I'm sure that the same was said for the ND mistake of years gone by....

The likelihood of DNP's being afforded total autonomy to practice whatever medicine they wish is probably significantly less than 50/50. This issue is barely a blip on the radar of organized medicine at this point; if the program shows some legs you can bet your tail that there will be an organized, and effective, oversight and scope of practice policy battle waged.

There actually has been to some degree. The "Truth and Transparency" act has been introduced in both of the last sessions of congress, it was buried in a subcommittee both times, my sources in DC have indicated that it will resurface, and there is some speculation that it may be added to one of the SEVERAL pieces of health reform legislation that we will see in the next month or so. This will likely smooth it's passage. But again, as with anything congressional....who knows.

 

[MOHS_01]

Look -- I have said - time and again - that I am a proponent of NP's & PA's as a valuable member of the healthcare team. The DNP degree, however, is redundant at best and an outright f'ing farce at worst. The PCP's should be all over this one if they are not. There are many legitimate reasons for this debate, but "bickering" has nothing to do with it....

 

[physasst]

Well, then I guess only time will tell.

It's truly sad how much bickering and the hate health care professionals show against one another.

I actually harbor no ill will towards NP's, and think of them as colleagues. Does this mean that I cannot question particular concerns that I have? Does that mean that I cannot question my own profession publicly? I agree that the DNP programs could be significantly strengthened as pertains to basic and clinical science structure.

 

[Taurus]

Well, then I guess only time will tell.

It's truly sad how much bickering and the hate health care professionals show against one another.

Actually, I love DNP's and they love me. 😍

 

[deleted6669]

Even though, unlike PA, we specialize, focus, master and spend all of our clinical hours in one field, I also believe that making an improvement to the number of clinical hours is important as well.

the problem behind this idea is the following: yes, np's spend all their time in 1 field but the hrs are still minimal(500-800 for a typical ms level np program).
in my "generalist pa program" I had more em hrs than an enp(more than 2x as many actually), more fp hrs than an fnp, more surgical hrs than an rnfa in addition to rotations in psych, ob, peds, and IM. so by that measure I am more qualified to specialize due to "a focus and mastery" than several different types of np's in their own fields....

 

[deleted6669]

1 military EM PA doctorate program

2 actually; 1 in em and 1 in ortho with new programs scheduled to start in other fields this yr...

 

[GeraldMonroe]

Ok, doing the math here.

It takes a year to get the masters to become an NP, and another year to become a DNP.

It takes 2 years to become a PA.

If the PA program is superior (and I see no reason to think otherwise from the descriptions of the programs that have been given) why don't they just open up more PA schools and PA school seats instead of bothering with two training paths? Either way, a nurse with a bachelors is going to have to do the same amount of work to become a midlevel.

And of course there's another logical idea : the main reason so many people avoid becoming a midlevel (creating a shortage) is that you can never apply the time you spent in training to becoming a doctor. If PA school is really half of medical school basic sciences and half of clinicals, could you not create an MD granting program that took just 2-3 more years?

All this would make too much sense, and it'll never happen, just daydreaming.

 

[core0]

Ok, doing the math here.

It takes a year to get the masters to become an NP, and another year to become a DNP.

It takes 2-3 years of part time work to become an NP. It takes another 2-3 years of part time work to become a DNP.

It takes 2 years to become a PA.

Two years of full time (30-60 hours per week)

If the PA program is superior (and I see no reason to think otherwise from the descriptions of the programs that have been given) why don't they just open up more PA schools and PA school seats instead of bothering with two training paths? Either way, a nurse with a bachelors is going to have to do the same amount of work to become a midlevel.

The training programs do different things. The NP is trained in advance practice nursing (theoretically) in one area of nursing practice. The PA is trained as a medical generalist that either practices primary care in conjunction with a physician or specialty care after further mentoring by a physician. Most nurses will not have the pre-requisites for PA school without 1-2 years of additional work.

And of course there's another logical idea : the main reason so many people avoid becoming a midlevel (creating a shortage) is that you can never apply the time you spent in training to becoming a doctor. If PA school is really half of medical school basic sciences and half of clinicals, could you not create an MD granting program that took just 2-3 more years?

All this would make too much sense, and it'll never happen, just daydreaming.

PA school is not half of medical school. Superficially it resembles medical school in the didactic then clinical model. However ultimately medical school prepares the physician for further supervised clinical experience and eventually independent practice. PA school trains the PA to go immediately into supervised clinical practice.

There are two real issues that will prevent a PA to MD bridge. The first is the structure of medical school. Clinical experience in medical school is intended to prepare the student for practice as a physician but also to decide (and screen) them for a particular residency. Anyone doing a shortened version of medical school will be impossibly disadvantaged for residency. There is at least one three year program, but it is coupled with a family practice residency for this reason.

The second reason speaks to the inability to evaluate individual medical training. While all PAs are trained to the same standard it is impossible to compare this standard to the training in medical school. This is the same reason that PA programs do not give advanced standing (for the most part) for medical students (or other professionals such as pharmacists).

There is no real shortage of PA student applicants. There were two applicants for every PA student seat last year. Overall the applicant pool looks remarkably similar to the DO applicant pool. PA programs are growing at a rate of 3-4 per year.

David Carpenter, PA-C

 

[physasst]

There are two real issues that will prevent a PA to MD bridge. The first is the structure of medical school. Clinical experience in medical school is intended to prepare the student for practice as a physician but also to decide (and screen) them for a particular residency. Anyone doing a shortened version of medical school will be impossibly disadvantaged for residency. There is at least one three year program, but it is coupled with a family practice residency for this reason.

The second reason speaks to the inability to evaluate individual medical training. While all PAs are trained to the same standard it is impossible to compare this standard to the training in medical school. This is the same reason that PA programs do not give advanced standing (for the most part) for medical students (or other professionals such as pharmacists).

There is no real shortage of PA student applicants. There were two applicants for every PA student seat last year. Overall the applicant pool looks remarkably similar to the DO applicant pool. PA programs are growing at a rate of 3-4 per year.

David Carpenter, PA-C

Nice to see you here David. This assumes of course, that the changes being discussed with the educational models both at our health policy center, as well as at the Brookings Institute don't occur.

It's going to be a wild decade my friend.

Michael Halasy, PA-C

 

[niranjan162]

And that data is lacking, I would agree. I am actually trying to do a CE study on Consultant vs PA in the ED for a limited number of "Level 3" diagnoses. Including renal stones, headache, and minor head trauma with LOC.

However, one would think, that even in the absence of clear data, one would see a rise in malpractice rates for PA's and NP's, if they were practicing beyond their scope, or if they were mismanaging patients. To claim that we are not MD's is completely accurate, and appropriate, to claim that we "don't know what we are doing" is erroneous, and borderline libelous.

BTW, I don't advocate for complete independence.

One of the ER's I moonlight at, is Waseca ER in Minnesota, it is staffed solely by PA's, no physician on site, although we have physician backup when needed. Interestingly, in the fall of 2008, we had the highest patient satisfaction scores in the entire country. Now, I am not naive enough to believe that that is solely due to PA's staffing the ED, but it is an interesting anomaly for sure.

from what ive heard, purley anecdotal, doing the right thing and having the patient satisfied is seldom the same thing in the ER.

If you could id be interested to know if this was a busy ED, how many PAs were on staff compared to another hospital.

My thinking is that its probably a smaller ED and that since they arent paying physicians they are perhaps keeping a few more PA's on staff, keeping wait times etc. low.

 

[EternalMD]

DNP Doctor with a new account and certain tendencies makes me think of...

 

[badasshairday]

DNP Doctor with a new account and certain tendencies makes me think of...

That is a nasty looking troll there.

Anyways, DNP will NEVER EQUAL MD until they take all of the USMLE exams that we take and do a residency.

 

[zenman]

I don't think any NP has said that patients are not the priority for the other health care professionals.

Just for the record let me state that patients should not be first priority for any health professional. You should always place yourself first.

Nursing has historically not been able to make a coherent decision. What other profession has three entry levels, for example? In addition to the ND, we also had a Doctor in Nursing Science (D.Ns. I think) which seems to have disappeared somewhere along the way. The good old Ph.D. still seems to hang in there although I used to laugh at fellow instructors who went off to earn that degree, only to return to teaching and make $2,000 more a year!

I'm all for improving NP programs before slapping together some combination of public health and business program with very little clinical.

What's with all the abcesses? When I was an ARMY medic, I just sprayed them with ethyl chloride and opened them up.

 

[Thisplaceisfun]

Holy massive insecurities Batman! Did you all really spend three pages debating whether graduates of a different doctorate level program may rightfully be called doctors? "Boo hoo, we want to be the only one called doctors! We worked sooooooo hard!" Grow up, everybody works hard and most don't get the same privileges you all have.

Physicians do not own the word "doctor." It merely means teacher in Latin. If one earns a doctorate degree from an accredited university then she may call herself a doctor. Debate over. I have a radical idea. How about you call yourselves what you truly are: physicians? Then no one can steal your thunder when you enter a room. Because, you know, people are, like, really impressed that you spent over $200k and seven years of training to make, what, $120k a year?

The notion that the nursing lobby is more powerful than the AMA is laughable. Talk about being willfully ignorant in your pathetic attempt at playing the innocent victim. The nursing lobby is fragmented and is handicapped by chronic infighting. They cannot even agree on a single post-nominal for nurse practitioners. The AMA, by contrast, is one of the most powerful, well financed, and well organized lobbies for a profession in America. It does whatever it can to obstruct the growth of the nursing profession in order to preserve physicians' profitable monopoly.

The reason the NP and DNP are gaining ground is because the market wants a low cost alternative to MDs for relatively simple and routine procedures. Medical costs and the population are rising but the number of new MDs is not keeping up. If your leadership continues to refuse to accredit new medical schools people are going to look elsewhere for their entry level health care needs. I'm not going to pay $150 for a five minute visit for a physician to tell me I have a strep throat and to write me a script for amoxicillin. I could have done that! A NP can do that kind of work just fine and the public knows it. Next on the chopping block should be dentists. They personify overcharging.

physasst, you obviously got an anti-NP/DNP agenda evidenced by your blog and the comments you post. Why are you against NPs/DNPs? Do you feel inferior because the best you can ever be is an assistant? Irritated that people you believe are your peers are obtaining greater privileges than you? I can understand those frustrations, but venting about it online with people that do not and will never respect you (physicians) doesn't appear to be wise.

And who is this Taurus guy? He must be a real winner, spending his days belittling his hardworking, skilled and knowledgeable co-workers online. Well done buddy.

 

[Rendar5]

Holy massive insecurities Batman!

Holy troll Batman!

 

[ToldYouSo]

I just have to say that I spent half an hour reading every single post and this is one of the weirdest threads ever.


And DNPDoctor and Thisplaceisfun are the worst trolls I have ever seen on SDN and I strongly bet that they are from the same person (IP address).

 

[DNPDoctor]

I just have to say that I spent half an hour reading every single post and this is one of the weirdest threads ever.


And DNPDoctor and Thisplaceisfun are the worst trolls I have ever seen on SDN and I strongly bet that they are from the same person (IP address).

No, I'm not Thisplaceisfun. Mods can verify.

I understand that everyone here has an agenda and each has his or her own motives when creating the posts.

Physicians have their own agenda.
Nurses have their own agenda.
Physician assistants have their own agenda.

Let's not go into personal attacks, and let's try keep this thread as civil as possible.

 

[deleted6669]

Even the assistants have their own agenda.....
let's try keep this thread as civil as possible.

yeah, that's civil.....
at least call us pa's or physician assistants if you don't want to draw fire.....
or if you would like we can have a discussion of certificate level pa vs doctorate np clinical hrs.....
guess who does more by almost twice as much....

 

[DNPDoctor]

yeah, that's civil.....
at least call us pa's or physician assistants if you don't want to draw fire.....
or if you would like we can have a discussion of certificate level pa vs doctorate np clinical hrs.....
guess who does more by almost twice as much....

I apologize for that. It was not intentional.
My post has been edited.

 

[deleted6669]

I apologize for that. It was not intentional.
My post has been edited.

thank you.

 

[Taurus]

And who is this Taurus guy?

I'm just the messenger, buddy. The truth behind the DNP is embarrassing. I'm just exposing it. Online DNP. Only 700 hours of training. Yet, nursing is lobbying for MD = DNP.

 

[Thisplaceisfun]

I just have to say that I spent half an hour reading every single post and this is one of the weirdest threads ever.


And DNPDoctor and Thisplaceisfun are the worst trolls I have ever seen on SDN and I strongly bet that they are from the same person (IP address).

Exactly how am I a troll? Most of the people on here are completely rude and pretentious. I am simply sticking up for the good people you all are bullying. How about you try responding to the substance of my argument rather than relying on tired and weak ad hominem attacks?

And I am obviously not the same poster as DNP Doctor. My rhetorical style and voice are clearly different from his/hers.

 

[Taurus]

How about you try responding to the substance of my argument rather than relying on tired and weak ad hominem attacks?

How about you respond to DNPDoctor's assertion that DNP's should be supervising PA's? Convince people that's not a complete joke.

 

[DNPDoctor]

How about you respond to DNPDoctor's assertion that DNP's should be supervising PA's? Convince people that's not a complete joke.

fyi I was merely being hopeful.

 

[deleted6669]

fyi I was merely being hopeful.

do you have any understanding of how insulting that was?
it's along the lines of "maybe chiropractors should supervise dnp's".

 

[Thisplaceisfun]

You don't need little ol' me to help you out with DNP Doctor, do ya? It is, like, thirty on one in here. I am merely balancing the numbers. I know my argumentation skills are formidable, but you all were doing a pretty good job before I got here.

And what is so outrageous about that poster's comments? If a nurse practitioner is more qualified than she ought to be the supervisor. Even assuming for argument's sake the PA masters degree provides a better foundation education than the MSN or DNP (an assumption which is suspect) that does not forever make a PA more knowledgeable and qualified. I can imagine many scenarios where a NP supervises a PA and vice versa.

Furthermore, I really don't care about my reputation on an internet message board, especially this one. You all were out of line with your comments and I am taking you to task. I fully expected people to have a negative reaction to my post.

 

[Instatewaiter]

What I still cannot understand is how anyone getting a DNP actually feels qualified to have the same priveledges as a normal attending does...

I am a very good student, near the top of my class, and nearly every day I am astounded by the sheer amount of knowledge I have yet to learn. It seems that the more I know, the more it becomes clear just how much I do not know. I have been through almost 3 very rigorous years of didactics and clinicals and there is still an enormous amount to learn, that, after the first 2 years, i didn't even know existed. It astounds me that people who clearly have such a paucity of science foundation and clinical training can be pushing so hard for such broad rights...


I am honestly curious to anyone on the DNP side of things- how can you justify asking for such broad practice rights when it is clear that your training barely scratches the surface?

 

[DNPDoctor]

do you have any understanding of how insulting that was?
it's along the lines of "maybe chiropractors should supervise dnp's".

Yes, now I realize that upon reflecting on myself.

I also do hope that you see that many posts written by respected PAs here against NP are degrading and insulting to nurses as well (many are written in a passive aggressive manner).

 

[DNPDoctor]

Delete

 

[Taurus]

I can imagine many scenarios where a NP supervises a PA and vice versa.

Which raises an interesting question: should new DNP grads be supervised by experienced PA's? PA's already have more training while in school and with experience they are easily more qualfied than any new DNP grad.

 

[Thisplaceisfun]

Hmm, and you wonder why NPs and DNPs are getting defensive? You completely dismissed their education and training out-of-hand.

Yes, their education may not be as intensive as MDs. However, that does not mean they only have a "paucity of science foundation and clinic training." Get off your high horse! Until you win the Nobel Prize (and probably even after that) you are going to have to work with others and treat them with a modicum of respect. These people earned master's degrees or more, and you just completely diminished their accomplishments. You must really look down on your patients who, for the most part, have obtained fewer degrees. Snobbery isn't a virtue and something you ought to beware.

And to whom do you keep referring that believes the DNP is the equivalent to the MD? The NPs and DNPs I know do not want to be physicians nor do they think they are the equivalents of physicians. They are nurses with advanced training and skills. That one woman's statement, which I believe is being taken out of context here, doesn't represent the beliefs of all NPs and DNPs. Furthermore, you all can refute that assertion without belittling members of the profession.

In fact the NPs I know do not believe it should become a DNP. Why? Because it will just add more time and money to obtain the same privileges they already possess and be a further barrier to entry into the profession by those with limited financial means.

 

[DNPDoctor]

I, for one, believe that DNP programs will improve in terms of education and clinical levels with time.
You have to work thousands of hours through nursing school and nursing experience in certain clinical setting like ER, ICU before being eligible to apply for NP/DNP. You get to learn a lot through experience, working with the physicians and patients.
BSN nursing students already take the following courses:
Pathophysiology
Nutrition and disease
Nutrition and health
Chemistry
Anatomy and physiology
Pharmacology
and so forth.
We have a lot of knowledge going into practice as a nurse.

We expand on that and more through graduate programs.

NPs are very competent at their jobs. I have yet to see a NP who actually flip flops.

Here's a curriculum for DNP - adult nurse practitioner (1200 clinical hours in one specialty area):

http://www.rmu.edu/OnTheMove/wpmajd...UAD&it=&ipage=850&iattr=D&icalledby=WPMAJDEGR

Year 1
Fall (11 credits)
HSIC8010 Clinical Teams and Teamwork I (2 credits)
NURS8010 Advanced Pathophysiology (3 credits)
NURS8020 Research and Theory (3 credits)
STAT8010 Statistics for Health Sciences (3 credits)
Spring (11 credits)
NURS8030 Principles of Epidemiology (2 credits)
NURS8110 Advanced Pharmacology (3 credits)
NURS8120 Health Promotion/Clinical Prevention (3 credits)
Elective (3 credits)
Summer (9 credits, 60 clinical hours)
NURS8130 Advanced Physical Assessment/Diagnosis (4 credits, 60 clinical hours)
NURS8140 Evidence-Based Practice for Advanced Nursing Roles (3 credits)
NURS8150 Integrating Research and Practice (2 credits)
Year 2
Fall (12 credits, 336 clinical hours)
NURS9160 Clinical Diagnostics (3 credits)
NURS9165 Clinical Diagnostics Practicum (3 credits, 168 clinical hours)
NURS9170 Diagnosis and Management of Adults I (3 credits)
NURS9175 Diagnosis and Management of Adults I Practicum (3 credits, 168 clinical hours)
Spring (10 credits, 168 clinical hours)
HSIC8020 Health Policy (2 credits)
NURS8230 Clinical Genetics (2 credits)
NURS9270 Diagnosis and Management of Adults II (3 credits)
NURS9275 Diagnosis and Management of Adults II Practicum (3 credits, 168 clinical hours)
Summer (6 credits, 168 clinical hours)
NURS9150 Diagnosis and Management of Women's Health (3 credits)
NURS9155 Diagnosis and Management of Women's Health Practicum (3 credits, 168 clinical hours)
Year 3
Fall (10 credits, 168 clinical hours)
HSIC8030 Heath Care Economics (2 credits)
HSIC8210 Health Law and Ethics (2 credits)
NURS9220 Diagnosis and Management of Geriatric Clients (3 credits)
NURS9225 Diagnosis and Management of Geriatric Clients Practicum (3 credits, 168 clinical hours)
Spring (11 credits, 300 clinical hours)
NURS9130 Evidence-Based Practice and Information Systems (3 credits)
NURS9610 Practice Management Issues/Role Integration (3 credits)
NURS9620 Applying Evidence-Based Practice in Health Care Settings (5 credits, 300 clinical hours)


DNP - Adult Psych MH Nurse Practitioner (1200 clinical hours in one specialty area)

http://www.rmu.edu/OnTheMove/wpmajd...AP&it=&ipage=1196&iattr=M&icalledby=WPMAJDEGR

Year 1
Fall (11 credits)
HSIC8010 Clinical Teams and Teamwork I (2 credits)
NURS8010 Advanced Pathophysiology (3 credits)
NURS8020 Research and Theory (3 credits)
STAT8010 Statistics for Health Sciences (3 credits)
Spring (11 credits)
NURS8030 Principles of Epidemiology (2 credits)
NURS8110 Advanced Pharmacology (3 credits)
NURS8120 Health Promotion/Clinical Prevention (3 credits)
Elective (3 credits)
Summer (11 credits, 60 clinical hours)
NURS8130 Advanced Physical Assessment/Diagnosis (4 credits, 60 clinical hours)
NURS8140 Evidence-Based Practice for Advanced Nursing Roles (3 credits)
NURS8150 Integrating Research and Practice (2 credits)
NURS9010 Principles of Biological Psychiatry (2 credits)
Year 2
Fall (11 credits, 168 clinical hours)
HSIC8210 Health Law and Ethics (2 credits)
NURS9110 Psychopharmacology (3 credits)
NURS9210 Psychiatric Diagnosis (3 credits)
NURS9215 Psychiatric Diagnosis Practicum (3 credits, 168 clinical hours)
Spring (10 credits, 168 clinical hours)
HSIC8020 Health Policy (2 credits)
NURS8230 Clinical Genetics (2 credits)
NURS9310 Diagnosis and Management of Psychiatric Disorders I (3 credits)
NURS9315 Diagnosis and Management of Psychiatric Disorders I Practicum (3 credits, 168 clinical hours)
Summer (10 credits, 280 clinical hours)
NURS9320 Diagnosis and Management of Psychiatric Disorders II (3 credits)
NURS9325 Diagnosis and Management of Psychiatric Disorders II Practicum (3 credits, 168 clinical hours)
NURS9330 Individual Therapy (2 credits)
NURS9335 Individual Therapy Practicum (2 credits, 112 clinical hours)
Year 3
Fall (10 credits, 224 clinical hours)
HSIC8030 Heath Care Economics (2 credits)
NURS9410 Psychiatric considerations in the Geriatric Population (2 credits)
NURS9415 Psychiatric considerations in the Geriatric Population Practicum (2 credits, 112 clinical hours)
NURS9510 Family Therapy (2 credits)
NURS9515 Family Therapy Practicum (2 credits, 112 clinical hours)
Spring (11 credits, 300 clinical hours)
NURS9130 Evidence-Based Practice and Information Systems (3 credits)
NURS9610 Practice Management Issues/Role Integration (3 credits)
NURS9620 Applying Evidence-Based Practice in Health Care Settings (5 credits, 300 clinical hours)

 

[Instatewaiter]

Hmm, and you wonder why NPs and DNPs are getting defensive? You completely dismissed their education and training out-of-hand.

Yes, their education may not be as intensive as MDs. However, that does not mean they only have a "paucity of science foundation and clinic training." Get off your high horse! Until you win the Nobel Prize (and probably even after that) you are going to have to work with others and treat them with a modicum of respect. These people earned master's degrees or more, and you just completely diminished their accomplishments. You must really look down on your patients who, for the most part, have obtained fewer degrees. Snobbery isn't a virtue and something you ought to beware.

And to whom do you keep referring that believes the DNP is the equivalent to the MD? The NPs and DNPs I know do not want to be physicians nor do they think they are the equivalents of physicians. They are nurses with advanced training and skills. That one woman's statement, which I believe is being taken out of context here, doesn't represent the beliefs of all NPs and DNPs. Furthermore, you all can refute that assertion without belittling members of the profession.

In fact the NPs I know do not believe it should become a DNP. Why? Because it will just add more time and money to obtain the same privileges they already possess and be a further barrier to entry into the profession by those with limited financial means.

Well this is a "straw man argument" if I have ever seen one!

This has nothing to do with snobbery and definitely nothing to do with looking down on patients. It has everything to do with training that just doesnt cut it to be the leader of the team. The sheer fact that you are not concerned about possibly having unrestricted practice rights leads me to believe that you dont know just how much you dont know.

 

[deleted6669]

that looks good and is certainly an improvement over programs with 500-800 hrs which is more typical for the ms level np programs. given the # of non-clinical courses in this program however I think the time would better be spent on extra clinicals instead of courses like "health care economics", etc but this is certainly a good start.

 

[MOHS_01]

I call BS on the whole dam* thing -- what is the value added for the DNP degree over and above the NP degree? They're still not physicians -- and for those who enjoy the mental masturbation of word play and semantics, for the purposes of this and all medical discussions, doctor = physician in the medical setting. In this medical realm, a doctorate does not equate to "doctor" -- a doctorate in medicine or osteopathy does. PhD's are doctors in the classroom, not at the bedside... Dentists, optometrists, and chiropractors are doctors as well... there simply has to be some clear definition and universal understanding of qualifications, and standards, in order to avoid public confusion.

What's next -- subspecialization for DNP's / PA -Docs? Further, are you really trying to tell me that the 1000's of medical students who annually get either involuntarily left out through the match, or the even greater numbers who choose a specialty other than the one that they would really like for competitive reasons should accept it that someone can waltz through a basically diluted educational curriculum just to emerge on the other side claiming to a doctor equal to? That is horse sh**, plain and simple.

The DNP program is merely a rebranding of the NP name with a few added hours in a feeble effort to justify its existence.

And I'm a fan of midlevels (when utilized appropriately)............

 

[Instatewaiter]

I, for one, believe that DNP programs will improve in terms of education and clinical levels with time.
You have to work thousands of hours through nursing school and nursing experience in certain clinical setting like ER, ICU before being eligible to apply for NP/DNP. You get to learn a lot through experience, working with the physicians and patients.
BSN nursing students already take the following courses:
Pathophysiology
Nutrition and disease
Nutrition and health
Chemistry
Anatomy and physiology
Pharmacology
and so forth.
We have a lot of knowledge going into practice as a nurse.

We expand on that and more through graduate programs.

NPs are very competent at their jobs. I have yet to see a NP who actually flip flops.

Here's a curriculum for DNP - adult nurse practitioner (1200 clinical hours in one specialty area):

http://www.rmu.edu/OnTheMove/wpmajd...UAD&it=&ipage=850&iattr=D&icalledby=WPMAJDEGR

Year 1
Fall (11 credits)
HSIC8010 Clinical Teams and Teamwork I (2 credits)
NURS8010 Advanced Pathophysiology (3 credits)
NURS8020 Research and Theory (3 credits)
STAT8010 Statistics for Health Sciences (3 credits)
Spring (11 credits)
NURS8030 Principles of Epidemiology (2 credits)
NURS8110 Advanced Pharmacology (3 credits)
NURS8120 Health Promotion/Clinical Prevention (3 credits)
Elective (3 credits)
Summer (9 credits, 60 clinical hours)
NURS8130 Advanced Physical Assessment/Diagnosis (4 credits, 60 clinical hours)
NURS8140 Evidence-Based Practice for Advanced Nursing Roles (3 credits)
NURS8150 Integrating Research and Practice (2 credits)
Year 2
Fall (12 credits, 336 clinical hours)
NURS9160 Clinical Diagnostics (3 credits)
NURS9165 Clinical Diagnostics Practicum (3 credits, 168 clinical hours)
NURS9170 Diagnosis and Management of Adults I (3 credits)
NURS9175 Diagnosis and Management of Adults I Practicum (3 credits, 168 clinical hours)
Spring (10 credits, 168 clinical hours)
HSIC8020 Health Policy (2 credits)
NURS8230 Clinical Genetics (2 credits)
NURS9270 Diagnosis and Management of Adults II (3 credits)
NURS9275 Diagnosis and Management of Adults II Practicum (3 credits, 168 clinical hours)
Summer (6 credits, 168 clinical hours)
NURS9150 Diagnosis and Management of Women's Health (3 credits)
NURS9155 Diagnosis and Management of Women's Health Practicum (3 credits, 168 clinical hours)
Year 3
Fall (10 credits, 168 clinical hours)
HSIC8030 Heath Care Economics (2 credits)
HSIC8210 Health Law and Ethics (2 credits)
NURS9220 Diagnosis and Management of Geriatric Clients (3 credits)
NURS9225 Diagnosis and Management of Geriatric Clients Practicum (3 credits, 168 clinical hours)
Spring (11 credits, 300 clinical hours)
NURS9130 Evidence-Based Practice and Information Systems (3 credits)
NURS9610 Practice Management Issues/Role Integration (3 credits)
NURS9620 Applying Evidence-Based Practice in Health Care Settings (5 credits, 300 clinical hours)


DNP - Adult Psych MH Nurse Practitioner (1200 clinical hours in one specialty area)

There are a group of DNP programs that are Straight to DNP from college without nursing experience so your argument that DNPs have extra clinical experience as nurses is bunk. Furthermore, what a nurse does and what a DNP is meant to do are completely unrelated. Your argument that this should be taken into consideration is like saying the time you spend as a pharmacy tech should be included as "education" and we can just shorten the time it takes to get a PharmD. Finally, the clinical hours in nursing school most definitely are not the same as you are doing completely different things- in nursing school your are not learning to manage patients, their disease and their medications.

1200 clinical hours is not much clinical exposure so you really shouldnt hold it out as such. It makes no difference if it is in 1 field or not. I will get over 1000 clinical hours in internal medicine just from my third year clerkship in internal medicine. Does that make me competent to practice internal medicine? (guess what, the answer is no)

Looking at the first curriculum you posted, I count 27 credits worth of fluff (see bolded). I count 6 credits of pathophysiology/pharmacology. There are a total of 80 credits in the psych program and 27/80 are fluff. That's more than 1/3!

If the DNP were not a politically motivated attempt to gain more ground and more rights I would be totally fine- there is nothing wrong with trying to improve the education and raise things to the next level- much like medicine did by expanding to 4 years. Pushing for same rights as physicians is just flat out irresponsible though.

 

[Thisplaceisfun]

Well this is a "straw man argument" if I have ever seen one!

This has nothing to do with snobbery and definitely nothing to do with looking down on patients. It has everything to do with training that just doesnt cut it to be the leader of the team. The sheer fact that you are not concerned about possibly having unrestricted practice rights leads me to believe that you dont know just how much you dont know.

Ha, too funny. You don't know how to recognize a straw man argument, do you? You just constructed your own straw man bud. All right, I'll go really slow and spoon feed this to you. My critique of you all from the very beginning .has been primarily focused on pretentious and disrespectful statements about NPs and DNPs. So, while the subject of this thread is concerned with DNP practice rights, my mission from the start has been taking you all to task for the many arrogant, ignorant and rude statements on this thread directed towards your nurse colleagues. Hopefully I will reach one of you thus you will show a little humility and respect to those you work with in the future.

I have never been concerned with defending DNPs rights to unrestricted practice because I do not assert they should have such rights and I don't know any NPs who think so either. Hence, my argument certainly wasn't a straw man. So congratulations! You tore down an imaginary argument I never advanced and never attempted to refute my main contention (i.e. a straw man fallacy)! 👍 .Is that slow enough for you? Or do I need to send you a powerpoint presentation?

Go work on your reading comprehension. It's woefully inadequate.

 

[Taurus]

Hmm, and you wonder why NPs and DNPs are getting defensive? You completely dismissed their education and training out-of-hand.

I don't think that I dismiss the education and training of DNP's out of hand. DNP's receive just enough training to work as midlevels.

Although, based on everything I have read about the training of PA's and DNP's, I believe that PA's are still more qualified than DNP's. If I am in the position to hire, I would go with the PA over the DNP because PA's are 1) better trained and hence need less training 2) won't be bitter because they can't go around calling themselves "doctor" 🙄 3) won't be demanding more money for their "doctorate". If you support medicine, then you support PA's.

 

[Taurus]

That one woman's statement, which I believe is being taken out of context here, doesn't represent the beliefs of all NPs and DNPs.

Then I'll post the entire article.

Who Will Be Your Doctor?
Mary O' Neil Mundinger 11.28.07, 6:00 AM ET

A quietly emerging trend in health care is likely to have a major effect on who will diagnose and treat your illness in the coming years. Rather than a physician, that comprehensive-care provider may very well be a nurse--who also happens to be a doctor.

As more physicians move toward specialties and away from general care, there is a troubling lack of providers in this critical health-care sector. The need is even more urgent in light of the growing number of Americans who are suffering from chronic illnesses such as asthma, diabetes and hypertension and require long-term disease treatment and coordination of care. Many others who survive extraordinary medical interventions or trauma need sustaining care for the rest of their lives.

The doctor of nursing practice (DNP) is a new level of clinical practice that is attracting a rapidly growing number of nursing professionals. This doctoral degree enables advanced-practice nurses to gain the knowledge and skills necessary to practice independently in every clinical setting. [This is one of their ultimate goals. They want to work independently in any setting including outpt, inpt, ED, etc. They are not just content with primary care.]

DNPs are the ideal candidates to fill the primary-care void and deliver a new, more comprehensive brand of care that starts with but goes well beyond conventional medical practice. In addition to expert diagnosis and treatment, DNP training places an emphasis on preventive care, risk reduction and promoting good health practices. These clinicians are peerless prevention specialists and coordinators of complex care. In other words, as a patient, you get the medical knowledge of a physician, with the added skills of a nursing professional.

Truly comprehensive care requires both medical and nursing skills, and nurses with a clinical doctorate have that complement of abilities. Skilled at identifying nuanced changes of condition, and intervening early in a patient's illness, these clinicians are also expert at utilizing community and family resources, and incorporating patient values into a family-centered model of care.

Once patients move beyond the common bias that only doctors of medicine can provide top-flight care, they typically come to appreciate these added benefits. Most important, research has demonstrated that DNPs, with their eight years of education and extensive clinical experience, can achieve clinical outcomes comparable to those of primary-care physicians. [Most of the research stuides are biased and poorly designed. Mundinger has done several studies and one of the main outcomes measured is "satisfaction".]

As more advanced-practice nurses pursue this new level of clinical training, we are working to create a board certification to establish a consistent standard of competence. To that end, we are working to enable DNPs to take standardized exams similar in content and format to the test that physicians must pass to earn their M.D. degrees. By allowing DNPs to take this test, the medical establishment will give patients definitive evidence that these skilled clinicians have the ability to provide comprehensive care indistinguishable from physicians. [50% of DNP's at Columbia where Mundinger is dean failed a watered-down USMLE step 3, but in their propaganda they imply that they take the same tests as physicians.]

Along with a doctorate and the title of "doctor," the fact that a nurse practitioner has fulfilled this certification requirement will instill confidence in patients that DNPs have the expertise to serve as their health-care provider of choice.

Nurse practitioners are reimbursed by Medicare and Medicaid in every state, but only variably by commercial insurance carriers. [This is one of their main reasons for the DNP -- money.] That is certain to change soon, as these DNP graduates prove they are the logical choice to become the new comprehensive-care clinicians.

As this valuable new resource grows and becomes fully established, the health-care system's ability to meet the nation's desire for accessible, high-quality care will be greatly improved, yielding better health for all. Medical specialists are in short supply; patients increasingly need their care. With the advent of the DNP clinicians, we can have both dedicated, brilliant specialists and effective health management. It is the future we all need and want.

Mary O' Neil Mundinger, Dr.P.H., is the Dean of the Columbia University School of Nursing, which was the first to pioneer the DNP concept.
​

 

[Thisplaceisfun]

That comment was directed towards Instatewaiter's post at 6:31pm not you.

Doesn't hurt my feelings that you wouldn't hire a NP. I'm not one. However, it appears to me that they are similar enough that I would interview both PAs and NPs and make my decision based on their performance in the interview.

I think the whole doctor title debate is silly anyway. Who has time for such pomposity? Question, why do doctors introduce themselves as Dr. ____ but call their patients by their first names? I would think if one is going to insist on formalities than a doctor should have the courtesy to call their patients by their formal title as well.

---
Edit:

Well, I can't defend this woman's view as I do not share it. I think there is a place for a NP to work in a primary care setting, but as the difficulty of the problem increases the patient should be handed over to an affiliated physician. However, I think physicians should do well to note that a leader's view on the matter may not accurately represent the views of your garden variety NP. Furthermore, one does not need to denigrate your colleagues to make the point that NPs cannot displace MDs in every (or most) clinical settings.

 

[physasst]

physasst, you obviously got an anti-NP/DNP agenda evidenced by your blog and the comments you post. Why are you against NPs/DNPs? Do you feel inferior because the best you can ever be is an assistant? Irritated that people you believe are your peers are obtaining greater privileges than you? I can understand those frustrations, but venting about it online with people that do not and will never respect you (physicians) doesn't appear to be wise.

I do, really? You can infer that I have an "agenda" because I question the validity of the DNP, and also have serious questions surrounding NP education?

Wow, I must have an anti-PA agenda then too, because I have been just as critical of my own profession on my blog. But you must not have read those parts.

Critical examination, careful scrutiny, and questioning of our educational processes, and abilities as practitioners, is not only the right thing to do. EVERYONE should be doing it, as part of our duty to our patients.

BTW, when I had breakfast with Polly Bednash two weeks ago, she agreed with that, and also, to some degree, agreed with some of my concerns. Not all of them mind you, but some of them.

We also had a splendid talk about increasing interprofessional dialogue, and there is some discussion of having me speak at an NP conference, and likewise, inviting some NP's to speak at some of ours.

We are colleagues, equals, I see nothing wrong with the NP's I work with, and I consider them friends. Yes, they know my concerns and criticisms, and guess what?

Most tend to agree with me.

I hardly have an anti-NP agenda. I might have some serious concerns, especially about workforce supply trends in primary care and the effect the DNP will have on this. But I guess that means I have an "agenda"

Michael Halasy, PA-C

 

[Thisplaceisfun]

Ha, you got me! I haven't read your whole blog. But it was near the top of my "to do" list! Right after ingesting large quantities of arsenic and stabbing myself to death.

Look, your comments sure seemed to betrayed an anti-NP bias. Do you actually have one? Maybe not. I don't know you personally but that was the impression I got from the limited information I had available.