NP with only MSN

[Medical field27]

Can you become a nurse practitioner with an MSN, being that their moving NP to a doctorate can you still be a nurse practitioner without having a DNP after 2015? And another question, can you get the RN license after two years of studying to get your BSN? Thank you

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[pamac]

Can you become a nurse practitioner with an MSN, being that their moving NP to a doctorate can you still be a nurse practitioner without having a DNP after 2015? And another question, can you get the RN license after two years of studying to get your BSN? Thank you

Yes, NPs with only masters degrees will still be able to practice without getting a DNP.

An MSN is not an NP degree, it's a masters degree in nursing.

The DNP is not a requirement, it's a suggestion that schools implement that level of education for NPs that they produce. There will still be schools that turn out NPs with masters degrees after 2015. No state laws have been changed to require a DNP to practice.

You cant sit down to take the nclex RN exam unless you have completed an RN program... Whether that is an associates degree program, or a bsn program. If there is some obscure program that allows it, it's not common to be able to do half a bachelors, and then call it good and take the nclex. Even if it were possible, you'd then have to deal with an employer that usually requires graduation from a program to work for them.

 

[deleted6669]

NPs with non-dnp degrees will still be able to practice when most programs convert to the doctorate. there are still older NPs with certs and a.s. degrees still in practice.

 

[sarjasy]

Can you become a nurse practitioner with an MSN, being that their moving NP to a doctorate can you still be a nurse practitioner without having a DNP after 2015?

The previous posters are correct - those already with MSN's will be unaffected and schools offering the MSN can, at the moment, continue to do so if they wish. However, I'll add some caveats. While the DNP is only a recommendation (for now), it is the recommendation of the AACN, the major accrediting body for graduate nursing programs. As a result, very many colleges and universities have dropped their MSN programs as a result and have gone exclusively to the DNP for APN's. The MSN for APN's will ultimately go away entirely in all likelihood.

Secondly, any state board could - in theory - begin requiring the DNP for advanced practice. Third, certain employers may start requiring it. Finally, insurance companies could start requiring it for reimbursement. None of this do I see as likely anytime soon, but it is a possibility.

And another question, can you get the RN license after two years of studying to get your BSN? Thank you

Yes. A BSN or an ADN will get you an RN in 1-2 years after completing prerequisites.

 

[Cmaj7th]

What is the point of the DNP? From what I've gathered it offers no more clinical rotations than the traditional NP. Sounds like an easy way for schools to make more in tuition.

 

[pamac]

What is the point of the DNP? From what I've gathered it offers no more clinical rotations than the traditional NP. Sounds like an easy way for schools to make more in tuition.

It is a way for schools to make more tuition. It's also a way for nursing to gain influence. I know only one DNP. This individual is in charge of administrative clinic issues through my hospital and its affiliates. It is an executive level position and pays at least twice (could even be much more) what a well paid PA or NP makes in my area. That position doesnt allow a PA to fill it, and carries with it a great deal of influence both within the organization, and outside of it in the community.

I'm convinced that the DNP isn't about clinical application or gaining the title of "Doctor" for the sake of getting into the doctors lounge, but it's about getting into the boardroom (which seems to be commonplace now). Everyone who talks about "noctors" is missing the point. Yes, quite a few NPs would like to argue NPs are equivalent in many ways to physicians, but the DNP was created for a different outcome than appealing to folks like that. The extra coursework they tack on to the DNP is "fluff" to anyone who doesn't recognize it's geared towards managing health policy issues, clinic management issues, public health issues, resource allocation, etc. The nursing world is cementing their access to key points.

DNP proponents could have added more clinical training, but they still would be the much weaker alternative to a physician. But they decided to break into a new realm of managing healthcare by providing the DNP. I think of it as a more specialized form of a healthcare administration degree, or a MBA. You sit down at a meeting where they are talking about allocating funding, and people perceive that a DNP offers the holder insight into the needs of providers as well as the nursing staff (from CNA, to charge nurse, to nonphysician provider). Docs don't want to be bogged down with that stuff. As long as they get a big enough piece of the pie, they don't care who cuts it, so why not a nurse. Then the nurse decides how to slice the rest of it. When they get pushback, they can address just about any arguement by pulling the nursing card. Cutbacks for the sake of profit? "Nope... A nurse has determined that the cutbacks can still take place because they don't affect patient care (they should know right?)". New policies are too onerous for non nursing personel? "Nope... Nurses know how hospital operations work, and are therefore best suited to decide what workflow best accomplishes the end goal (patient safety, right?)"

When I didn't work in the nursing world, I came to appreciate how my own distinct work was predicated upon and based around how it would impact the nursing staff. Yes, doctors seemed to reign supreme, but doctors also didn't seem to care about how things got done, just so it did. And in all reality, they didn't seem to be hard to please. Nursing, for all it's internal issues amongst ourselves, still circles the wagons. I remember when a program was set up to improve efficiency, and it depended upon nurses doing one activity differently than they wanted to... And it was minor... But they didn't want to do it (for a number of reasons that came down to personal preference). It would have made a big impact on our overall goal, but never made it out if the comittee. The nurse in charge didn't want to implement it, and when pushed basically said "you folks don't know what you think you know, and aren't familiar with how this impacts nursing care, so shove off. YOU guys work harder to make up for it". A DNP can pull that card and get away with it on an even larger scale. So at the next executive management meeting you have John Smith DNP at the helm coordinating each new project that involves nurses in any way because he has training in management, health care policy issues, staffing issues, provider issues... They probably even think he's better at picking out carpet colors for the new nurses break room they are building to help over stressed nurses (the one that they removed the allied staff locker room for). The doctors in the room either just want to get along and have things flow, or don't want to waste their time on something mundane that involves even more paper pushing than they already do. And with each project, the DNP gains more credibility and voice, until they are on a panel deciding which midlevel provider is allowed to qualify for a 50k EMR implementation grant. The end result in that case was that clinics that employ NPs, but not PAs, get reimbursed by the government to help offset the cost of setting up electronic medical records. With DNPs in management positions, it means that hospital credentialing committees will be looking to them to help decide what midlevel providers get to do. Those executives go on to be in positions of influence in insurance companies, and help decide what providers get reimbursed for.

Long way to say it, but that is the point of the DNP.

 

[deleted6669]

Totally agree with pamac above. the dnp is not a clinical degree, it is a dr level degree in business and management.
they have cornered the market on this. we will see what happens when the entry level Doctorate pa programs roll out in a few years with more of an emphasis on clinical medicine. should be interesting.
I think the docs will side with us over nps but I have been wrong before.

 

[pamac]

Totally agree with pamac above. the dnp is not a clinical degree, it is a dr level degree in business and management.
they have cornered the market on this. we will see what happens when the entry level Doctorate pa programs roll out in a few years with more of an emphasis on clinical medicine. should be interesting.
I think the docs will side with us over nps but I have been wrong before.

Docs will side with docs, and will be health system employees (highly valued of course) focused on medicine rather than practice management. I don't think that a clinical doctorate in PA studies will have much of a broad impact. Adding more time on to the back of pa education still puts the patient in the room with someone who isn't a physician, and begs the question why someone would go to PA school at all as opposed to medical school. That would be even more enhanced by making it an entry level doctorate. Look to the PA programs that offer an mph and see a good example of how trying to add value that way hasn't caught on in a big way. A PA with an MPH isn't driving the market to reward them any more than a regular PA degree, and you haven't seen it catch on in a big way. I'd be afraid of a situation where the industry starts to expect PAs to have doctorates, yet expects them to get paid the same as they did when they had masters.

 

[deleted6669]

I agree that when the dnp and dms(doctorate medical science) degrees become the norm(as they will) that avoiding medical school makes very little sense.
PAs will follow to the DMS just so they can compete in the eyes of HR folks who don't know the difference between a pa and an np other than one has a doctorate and the other doesn't.
residencies will be the difference I think. PAs have jumped on this bandwagon faster than nps and have something like 40 or so in almost every specialty to the 5 or so out there for nps. when the residency becomes first recommended, then required to be a pa or np(as it will) there really will be no reason to not just suck it up and go to medschool day 1.

 

[sarjasy]

It is a way for schools to make more tuition...It is an executive level position and pays at least twice (could even be much more) what a well paid PA or NP makes in my area.

It is a way for school's to gain more tuition, but it will not be the norm for APN's to double their salary. What state do you work in?

Yes, quite a few NPs would like to argue NPs are equivalent in many ways to physicians...

Don't know what you mean by "quite a few." Any NP that thinks that needs to be defeated. Soundly. Harshly. And unequivocally.

. DNP proponents could have added more clinical training...

They did, but not in the right way. There is more clinical training, but it is highly specialized, e.g. what does such and such educational intervention have on A1C?

You sit down at a meeting where they are talking about allocating funding, and people perceive that a DNP offers the holder insight into the needs of providers as well as the nursing staff (from CNA, to charge nurse, to nonphysician provider).

I don't see why that is bad. Help me out here. Physicians, nurses, other clinical staff have complained for years that "administration" has no clinical insight and therefore makes poor decisions (I agree). What is so bad about a clinical person gaining admin training? Can that not help bridge the "gap?"

...it depended upon nurses doing one activity differently than they wanted to... And it was minor... But they didn't want to do it (for a number of reasons that came down to personal preference).

You are a nurse, so surely you understand the unending stream of changed policies that come down seemingly daily. A given nursing shift involves hundreds of individual tasks, often which are driven by JCAHO, state boards, state health departments, CMS requirements, nursing administration, business administration, etc. and almost all of which nothing to do with true patient care. Physicians face it too, e.g. Press Ganey in the ER. It's not just personal preference. It is often bureaucratic nonsense driven by reimbursement, metrics, etc. that have little to nothing to do with patient care. Where I am, for example, oral care policy has changed no fewer than three times in 2 months. And everyone rides everyone else's butt (RT, nursing, physicians, admin) about doing it "right." If it is "right," why the heck has it changed 3 times in 2 months?

.They probably even think he's better at picking out carpet colors for the new nurses break room they are building to help over stressed nurses (the one that they removed the allied staff locker room for).

Sorry dude, but you are either smoking crack, or work in the most nursing-centric place on the planet, or are a newbie, or are blowing smoke, or work in CA, or all the above. It's obvious you are a new nurse, not a nurse at all, and/or have only worked in a limited (i.e. one) number of places. That is not even close to the norm throughout the US.

 

[sarjasy]

we will see what happens when the entry level Doctorate pa programs roll out in a few years with more of an emphasis on clinical medicine.

Yeah, it will be interesting. Students trained in the "medical model" that are not MD's or DO's getting doctorates. That will be well received by physicians. 😉

I think the docs will side with us over nps but I have been wrong before.

And I'm afraid you will be again. You think physicians have pushed back hard against NP's? Wait till those that are "one of their own" start getting doctoral degrees.

 

[deleted6669]

You think physicians have pushed back hard against NP's? Wait till those that are "one of their own" start getting doctoral degrees.

The army/baylor university program has already graduated several classes of doctorate level, clinical DSc PAs in emergency medicine and ortho with very little physician resistance.
lots of PAs(well, 5% of 100,000 still counts as lots) of PAs currently get a doctorate after PA school and no one gives us a hard time about it, probably because we have
john doe, pa, phd
on our name tags not
Dr. Jane doe
FNP

and we still say,"hi, I'm john doe, one of the pas here, not I'm Dr doe, one of the np's here.

 

[pamac]

It is a way for school's to gain more tuition, but it will not be the norm for APN's to double their salary. What state do you work in?



Don't know what you mean by "quite a few." Any NP that thinks that needs to be defeated. Soundly. Harshly. And unequivocally.



They did, but not in the right way. There is more clinical training, but it is highly specialized, e.g. what does such and such educational intervention have on A1C?




I don't see why that is bad. Help me out here. Physicians, nurses, other clinical staff have complained for years that "administration" has no clinical insight and therefore makes poor decisions (I agree). What is so bad about a clinical person gaining admin training? Can that not help bridge the "gap?"



You are a nurse, so surely you understand the unending stream of changed policies that come down seemingly daily. A given nursing shift involves hundreds of individual tasks, often which are driven by JCAHO, state boards, state health departments, CMS requirements, nursing administration, business administration, etc. and almost all of which nothing to do with true patient care. Physicians face it too, e.g. Press Ganey in the ER. It's not just personal preference. It is often bureaucratic nonsense driven by reimbursement, metrics, etc. that have little to nothing to do with patient care. Where I am, for example, oral care policy has changed no fewer than three times in 2 months. And everyone rides everyone else's butt (RT, nursing, physicians, admin) about doing it "right." If it is "right," why the heck has it changed 3 times in 2 months?



Sorry dude, but you are either smoking crack, or work in the most nursing-centric place on the planet, or are a newbie, or are blowing smoke, or work in CA, or all the above. It's obvious you are a new nurse, not a nurse at all, and/or have only worked in a limited (i.e. one) number of places. That is not even close to the norm throughout the US.

I apreciate your posts on here, and the way you seem to think. Maybe you wont disagree with me so vehimantly after i explain myself. You might be mistaking my tone a bit, as I don't think it's a bad thing for the DNP to exist, nor for it to have the impact i expect it will end up having in times to come. The commenter i was responding to asked "why the DNP?", as if to blow it off. I wanted to make the point that there was much more to the degree than what everyone is parroting about just the clinical aspects... And lay it on thick. My Account of that DNP was one that illustrates how a DNP would be a good fit where something else might not be. Most of the emphasis in pa forums focus on NPs weaknesses, but demonstrate little introspection on why PAs are stuck with few options for advancement beyond clinical practice workhorses... Then they complain about how they are left behind. Constantly posting that PA>NP, and then wondering why NPs are involved in things they aren't isn't getting them any closer to answers. You have to be on the team to play in the game, and there is a good reason DNPs will be on the team. The fact that they don't feel the need to drag PAs along with them seems to be a sore point.

So much of what you said was right, except for me being clueless about nursing. I've been in nursing a relatively short time, but I've been in healthcare close to a decade, so I can say a lot about how administration works, and how we as nurses come across to others. To those outside of nursing, it sounds like a lot of explanations fed to folks who don't get their way are based on nurse centric themes that they dont quite grasp. Folks that discount nursing (as Pre PAs sometimes do), do so at their own ignorance, because nurses tend to have a big voice. It's not just because of numbers, but of knowledge. The first thing NP critics pull out to compare NP and PA is the few direct entry programs for NPs, and compare them head to head. But most nps, and most DNPs in leadership roles making executive salary won't be direct entry grads, so I try to explain to those outside of the healthcare sphere what it is that contributes to nurses getting placed where they can advance the profession.

APNs (and even DNPs) shouldn't expect the salary level I mentioned, and I brought it up to demonstrate the value that my organization placed on that particular DNP based on their perspective. The DNP provided an enhanced value above what just a masters degree in NP offered. It's a distinct set of qualifications, and fit well with their needs. I hear non nurses complaining about the outsize nursing influence, and how they seem to fill all these roles outside of bedside nursing. They don't realize what you and i do, and that is that there are so many aspects to policy, regs, procedures, standards, and requirements that it makes sense to put a nurse behind a desk to wade through it. The week I got my RN, I got a lucrative job offer in a non nursing hospital role based entirely on the new initials. They wanted my non nursing skills, but the credibility that came with being an RN to advance this project. You see enough of that kind of thing, and you start to piece together how perception and being a member of the nursing community opens doors.

And as far as my mention of "quite a few NPs", I didn't know how best to quantify that. I could say "some NPs" and have a bunch of subjective comments from folks who know such extremists, or I say "many NPs", and get jumped on by folks who don't know any NPs like that. Fact is they exist, and are often the more rabid activists in the ANA with outsize impact.

 

[pamac]

Yeah, it will be interesting. Students trained in the "medical model" that are not MD's or DO's getting doctorates. That will be well received by physicians. 😉



And I'm afraid you will be again. You think physicians have pushed back hard against NP's? Wait till those that are "one of their own" start getting doctoral degrees.

Yep. Rebellion is the surest way to draw ire. The harshest response is reserved for folks who yearn for independence from a group. You won't be just a threat, but would be demonstrating ingratitude.

 

[ChillyRN]

In so far as I know, I am presently the only DNP member of the site. I think pamac has very good insight to the rationale for promoting the DNP among Nursing leaders. Clinical nurse leaders will be prepared to impact the role of Nursing and the future of health care in general, by virtue of their DNP education, not by the fact that they could be accurately called "Doctor."

I would also point out that DNP education is not universal. Capstone projects and accompanying clinical experiences vary widely among students based on their interests, and some are far more clinical than others. Mine consisted of 1,000 hours and was decidedly clinical, as it dovetailed with a post masters certification I was earning concurrently. Surveying the titles of any good DNP program (and I went to one of the best- I believe it is #3) should indicate that the purpose is to educate a clinician prepared to direct a practice, health care organization and/or public health policy. They are preparing leaders. That those students are also solidifying some expertise in a niche of special interest to them is also true.

So I will tell you the details of mine that you better understand. I am a FNP in family medicine, with a post master specialty certification in orthopedics. I work in a state with independent NP practice, in a very large multi-specialty group. I have complete parity with my physician colleagues and my own panel. They are very supportive. They have all been used to independent NPs for so long they have to be reminded it isn't that way everywhere, and they can't believe it. I do not have formal "collaboration" and certainly not "supervision."

I have no intention of working in an ortho practice, but we see so many patients in FM with ortho issues, it seemed valuable. My DNP capstone was on shared medical appointments for patients undergoing joint replacement. I ran SMAs for 2 years while also seeing patients in traditional setting, and compared outcomes. Not surprisingly (as there is a mountain of evidence on the subject) the patients in the group setting had better outcomes and were more satisfied with their experience. We also demonstrated that we could be very profitable with SMAs, which was important because our office was formerly in the red. I earned a great deal of money for the clinic with SMAs in the 2nd year ,and pretty much single handedly put my clinic in the black for the first time in 9 years. Our pt satisfaction scores also went up tremendously, which is also credited in large part to the SMAs.

The orthopods know more about performing joint replacement than I do, for sure, lol. but I know more about running group visits than anyone in my region and I am being asked to travel all over this half of the country to help people implement group visits for a variety of problems (including CHF, diabetes, breast cancer) because while successful once they are in full swing, they can be hard to get off the ground. I am THE foremost local expert on shared medical appointments. Earning a lot of money for the company, not to mention publishing a few things on SMAs, speaking to the Governor and in the state legislature about the potential for SMAs, and being asked to help implement them for the State health dept, being on the local news and local morning shows and talk shows, in the newspaper, in several magazines, and on local radio, has given me a lot of traction, and yes, power. The company ran a big billboard, magazine and newspaper advertising campaign this year. They used 40 providers for the various ads. 39 physicians, and me. And the ad says "XYZ Health Care is proud to have Chilly, the only doctorally prepared NP in the region."

And that is something for a NP that has been out of school for just a few years.
I already exert influence that my MSN prepared NP colleagues do not, and indeed, that many physician providers do not. Not because they aren't "smart." Clearly they know their niche. But I know mine, and right now, with the changes going on in health care, mine is valued just as much and sometimes more, regardless of title. A lot of it is personality too. I'm personable, and I'm well liked. All the important people in the company know who I am, lol. Since we have 1,800 providers, it's kind of nice to stand out.

Anyway, there it is. BTW, my physician and NP colleagues and the staff do call me "Doctor" when they talk about me to patients (they are proud of me, and very supportive). My name is on the sign as Dr. Chilly, FNP-BC

My name tag says Chilly, DNP, FNP-BC. I introduce my self: "Hello, I'm Chilly Pepper, I'm one of the Nurse Practitioners." I don't wear a white coat of any length. White coats are dumb. Sorry, it's true. I dress very well, and I'm not ruining my outfit with a stupid white coat.

So people can call the DNP a joke all they like. I work for the largest private multi specialty practice in the country, and they think I, and my DNP, are the bees knees. Even though I didn't do it to impress them, or any one else, I'm enjoying the benefits tenfold. It was rigorous, enriching and infinitely beneficial. I'd definitely recommend it.
And that's all I have to say about that.

 

[Divergent]

In so far as I know, I am presently the only DNP member of the site. I think pamac has very good insight to the rationale for promoting the DNP among Nursing leaders. Clinical nurse leaders will be prepared to impact the role of Nursing and the future of health care in general, by virtue of their DNP education, not by the fact that they could be accurately called "Doctor."

I would also point out that DNP education is not universal. Capstone projects and accompanying clinical experiences vary widely among students based on their interests, and some are far more clinical than others. Mine consisted of 1,000 hours and was decidedly clinical, as it dovetailed with a post masters certification I was earning concurrently. Surveying the titles of any good DNP program (and I went to one of the best- I believe it is #3) should indicate that the purpose is to educate a clinician prepared to direct a practice, health care organization and/or public health policy. They are preparing leaders. That those students are also solidifying some expertise in a niche of special interest to them is also true.

So I will tell you the details of mine that you better understand. I am a FNP in family medicine, with a post master specialty certification in orthopedics. I work in a state with independent NP practice, in a very large multi-specialty group. I have complete parity with my physician colleagues and my own panel. They are very supportive. They have all been used to independent NPs for so long they have to be reminded it isn't that way everywhere, and they can't believe it. I do not have formal "collaboration" and certainly not "supervision."

I have no intention of working in an ortho practice, but we see so many patients in FM with ortho issues, it seemed valuable. My DNP capstone was on shared medical appointments for patients undergoing joint replacement. I ran SMAs for 2 years while also seeing patients in traditional setting, and compared outcomes. Not surprisingly (as there is a mountain of evidence on the subject) the patients in the group setting had better outcomes and were more satisfied with their experience. We also demonstrated that we could be very profitable with SMAs, which was important because our office was formerly in the red. I earned a great deal of money for the clinic with SMAs in the 2nd year ,and pretty much single handedly put my clinic in the black for the first time in 9 years. Our pt satisfaction scores also went up tremendously, which is also credited in large part to the SMAs.

The orthopods know more about performing joint replacement than I do, for sure, lol. but I know more about running group visits than anyone in my region and I am being asked to travel all over this half of the country to help people implement group visits for a variety of problems (including CHF, diabetes, breast cancer) because while successful once they are in full swing, they can be hard to get off the ground. I am THE foremost local expert on shared medical appointments. Earning a lot of money for the company, not to mention publishing a few things on SMAs, speaking to the Governor and in the state legislature about the potential for SMAs, and being asked to help implement them for the State health dept, being on the local news and local morning shows and talk shows, in the newspaper, in several magazines, and on local radio, has given me a lot of traction, and yes, power. The company ran a big billboard, magazine and newspaper advertising campaign this year. They used 40 providers for the various ads. 39 physicians, and me. And the ad says "XYZ Health Care is proud to have Chilly, the only doctorally prepared NP in the region."

And that is something for a NP that has been out of school for just a few years.
I already exert influence that my MSN prepared NP colleagues do not, and indeed, that many physician providers do not. Not because they aren't "smart." Clearly they know their niche. But I know mine, and right now, with the changes going on in health care, mine is valued just as much and sometimes more, regardless of title. A lot of it is personality too. I'm personable, and I'm well liked. All the important people in the company know who I am, lol. Since we have 1,800 providers, it's kind of nice to stand out.

Anyway, there it is. BTW, my physician and NP colleagues and the staff do call me "Doctor" when they talk about me to patients (they are proud of me, and very supportive). My name is on the sign as Dr. Chilly, FNP-BC

My name tag says Chilly, DNP, FNP-BC. I introduce my self: "Hello, I'm Chilly Pepper, I'm one of the Nurse Practitioners." I don't wear a white coat of any length. White coats are dumb. Sorry, it's true. I dress very well, and I'm not ruining my outfit with a stupid white coat.

So people can call the DNP a joke all they like. I work for the largest private multi specialty practice in the country, and they think I, and my DNP, are the bees knees. Even though I didn't do it to impress them, or any one else, I'm enjoying the benefits tenfold. It was rigorous, enriching and infinitely beneficial. I'd definitely recommend it.
And that's all I have to say about that.

Thanks a lot for your perspective as a DNP. I really appreciate it, especially since commentary on the DNP on this and other forums can seem very negative and ridiculing, so it's great to have your voice added.

 

[AnnoyedByFreud]

Thanks a lot for your perspective as a DNP. I really appreciate it, especially since commentary on the DNP on this and other forums can seem very negative and ridiculing, so it's great to have your voice added.

I think you have to take the commentary on this forum with a grain of salt. People around here think very little of nursing education, all the way from the RN to the DNP. Even I vastly underestimated the knowledge that a RN has until I became one, haha.

 

[RedCole]

In so far as I know, I am presently the only DNP member of the site. I think pamac has very good insight to the rationale for promoting the DNP among Nursing leaders. Clinical nurse leaders will be prepared to impact the role of Nursing and the future of health care in general, by virtue of their DNP education, not by the fact that they could be accurately called "Doctor."

I would also point out that DNP education is not universal. Capstone projects and accompanying clinical experiences vary widely among students based on their interests, and some are far more clinical than others. Mine consisted of 1,000 hours and was decidedly clinical, as it dovetailed with a post masters certification I was earning concurrently. Surveying the titles of any good DNP program (and I went to one of the best- I believe it is #3) should indicate that the purpose is to educate a clinician prepared to direct a practice, health care organization and/or public health policy. They are preparing leaders. That those students are also solidifying some expertise in a niche of special interest to them is also true.

So I will tell you the details of mine that you better understand. I am a FNP in family medicine, with a post master specialty certification in orthopedics. I work in a state with independent NP practice, in a very large multi-specialty group. I have complete parity with my physician colleagues and my own panel. They are very supportive. They have all been used to independent NPs for so long they have to be reminded it isn't that way everywhere, and they can't believe it. I do not have formal "collaboration" and certainly not "supervision."

I have no intention of working in an ortho practice, but we see so many patients in FM with ortho issues, it seemed valuable. My DNP capstone was on shared medical appointments for patients undergoing joint replacement. I ran SMAs for 2 years while also seeing patients in traditional setting, and compared outcomes. Not surprisingly (as there is a mountain of evidence on the subject) the patients in the group setting had better outcomes and were more satisfied with their experience. We also demonstrated that we could be very profitable with SMAs, which was important because our office was formerly in the red. I earned a great deal of money for the clinic with SMAs in the 2nd year ,and pretty much single handedly put my clinic in the black for the first time in 9 years. Our pt satisfaction scores also went up tremendously, which is also credited in large part to the SMAs.

The orthopods know more about performing joint replacement than I do, for sure, lol. but I know more about running group visits than anyone in my region and I am being asked to travel all over this half of the country to help people implement group visits for a variety of problems (including CHF, diabetes, breast cancer) because while successful once they are in full swing, they can be hard to get off the ground. I am THE foremost local expert on shared medical appointments. Earning a lot of money for the company, not to mention publishing a few things on SMAs, speaking to the Governor and in the state legislature about the potential for SMAs, and being asked to help implement them for the State health dept, being on the local news and local morning shows and talk shows, in the newspaper, in several magazines, and on local radio, has given me a lot of traction, and yes, power. The company ran a big billboard, magazine and newspaper advertising campaign this year. They used 40 providers for the various ads. 39 physicians, and me. And the ad says "XYZ Health Care is proud to have Chilly, the only doctorally prepared NP in the region."

And that is something for a NP that has been out of school for just a few years.
I already exert influence that my MSN prepared NP colleagues do not, and indeed, that many physician providers do not. Not because they aren't "smart." Clearly they know their niche. But I know mine, and right now, with the changes going on in health care, mine is valued just as much and sometimes more, regardless of title. A lot of it is personality too. I'm personable, and I'm well liked. All the important people in the company know who I am, lol. Since we have 1,800 providers, it's kind of nice to stand out.

Anyway, there it is. BTW, my physician and NP colleagues and the staff do call me "Doctor" when they talk about me to patients (they are proud of me, and very supportive). My name is on the sign as Dr. Chilly, FNP-BC

My name tag says Chilly, DNP, FNP-BC. I introduce my self: "Hello, I'm Chilly Pepper, I'm one of the Nurse Practitioners." I don't wear a white coat of any length. White coats are dumb. Sorry, it's true. I dress very well, and I'm not ruining my outfit with a stupid white coat.

So people can call the DNP a joke all they like. I work for the largest private multi specialty practice in the country, and they think I, and my DNP, are the bees knees. Even though I didn't do it to impress them, or any one else, I'm enjoying the benefits tenfold. It was rigorous, enriching and infinitely beneficial. I'd definitely recommend it.
And that's all I have to say about that.

Thank you, Dr. Chilly. I was quite disgruntled that I seemed to have no other option but to become an NP, but your post really changed how I feel about the possibilities with my degree. I was so caught up in what the degree itself signified, that I forgot that one can do anything as long as they apply themselves, regardless of their title. Thank you!