DNP or Resident

[Tipps]

I have been following with kin interest the debate over the qualifications of midlevel practitioners (DNP). I have been a critical care nurse for 10 years and working in a teaching hospital I have seen first hand the "MAKING OF A DOCTOR" from Medical school throught Residency to fellowship. I find it upsurd that MD will claim to know alot because of their level of education.
Every honest MD will recall that during their first year in Residency, Most of the ICU nurses with just Associates degree or BSN had better judgement than them. Most of then wouldn't understand why you cannot give dopamine despite low BP ( if patient is tachycardic).
What is my point, most NP or DNP already have these enormous clinical first hand experience which Residents lack. If I may ask, which part of the MD training teaches what will produce a safe and proficient Medical Doctor? The obvious answer is Residency and fellowship.
No one can compare the clinical judgement of a Medical school graduate (without residency) with the judgment of a new graduate NP.
So do not compare apple with pears.
Tipps

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[deleted6669]

I think there is some truth to your statement when we look at np's with lots of time as rn's.
unfortunately many new np's come out of direct entry np programs and had minimal to no time as rn's. I am seeing this in my profession as well. it used to be that every pa was a former medic, rn, rt, etc but now with the advent of ms level programs some programs will take folks right out of undergrad with shadowing or volunteering only and no prior professional credential or training. it is a sad state of affais being pushed by universities trying to make the big bucks on grad school tuition at the expense of the quality of its new grads. I am in a position to hire pa's and np's and I pay special attention now to what they did before school both in terms of life and professional experience.

 

[Tipps]

I hope others in positions to hire PA and NP like you can do the same. If NP and PA want some respect and credebility then admission into Masters programs must require prior clinical experience.

 

[core0]

I hope others in positions to hire PA and NP like you can do the same. If NP and PA want some respect and credebility then admission into Masters programs must require prior clinical experience.

There are two incorrect statements there as far as PAs. For one thing PA education is competency based. There are a number of cert/associates that turn out very good PAs. The degree doesn't matter.

The other issue is that for PAs, despite what E believes there have always been programs that have not required prior health care experience (HCE). Initially it was around 25-30% of the programs. It probably reached around 40% of the programs in the early 90's and is currently around 33% of programs. The topic of HCE has been studied. There is no difference in PANCE pass rates or any other metric. It does seem that non-HCE students go into primary care at a higher rate than students with HCE.

I don't have as much experience as E precepting or hiring but I have come to a few conclusions. The first is that it is the student or PA that matters. I have seen stellar PAs that had no health care experience and PAs with more than 20 years of HCE that had no critical thinking skills. The program also seems to have a lot of impact. For what its worth I think that programs that take students with no HCE are run different than those with HCE students. Statistically those programs are longer. There also appears to be an element of self selection where more non HCE students go into primary care where they have received the most training. Even within HCE programs students will have a wide variety of experience. A student with a year as a CNA is different than a student with 20 years as an ICU RN. Obviously they start at a different level and the program cannot assume a common base experience.

Having been involved in hiring my replacement twice the biggest thing that we looked at was fit with the group. Adaptability and the ability to get along are the most important things. After that critical thinking skills are the most important. First hire was a PA with no HCE who had done a rotation and had great skills. Second hire was a PA with 4 years of primary care experience who had way better people skills than the PA with lots of specialty experience.

If all things are equal I would prefer a PA with prior HCE but they rarely are. After a few years of experience it really doesn't matter. It kind of like evaluating someone on their high school record. After they have demonstrated their ability in the field what they did before doesn't really matter.

David Carpenter, PA-C

 

[deleted6669]

as david and I have discussed ad nauseum elsewhere I think HCE is more important and relevant in specialty settings:
a former paramedic or er nurse will be a better fit for em most of the time than someone without this experience.
a former surgical tech will do better in the o.r.
a former orthotech or p.t. will do better in ortho or physical medicine
a former r.t. will do better in pulmonology/icu/critical care
etc
I agree that it is less relevant in primary care although the ability to rapidly judge sick vs not sick is a skill that comes only with time and experience.

 

[jwk]

I hope others in positions to hire PA and NP like you can do the same. If NP and PA want some respect and credebility then admission into Masters programs must require prior clinical experience.

A lot depends on the individual, as always. We hire people with experience that still have issues, and we hire new grads that had no prior clinical experience that are exceptional.

BTW - Tipps - you're confusing terms. "midlevel practitioners (DNP)" These are not the same thing. A PA is a midlevel practitioner, but they are not nor will they ever be a DNP. And although they'll never admit it, a DNP will still be a midlevel practitioner. Also the DNP concept is a long long way from reality, with only a handful of programs in the country, and most of them online, which gives almost zero credibility or value to the degree.

 

[schutzhund]

Tipps, you are WAY off base. Its insulting actually. I get really tired of the XYZ practitioner is as good as a doctor because of ABC. It's completely and utterly off base.

I think I can speak about this just as much or more than anyone else here. I was (am) an RN with LOTS of experience (including MICU, CVICU and others). I went to an NP program. I am now a physician. I can tell you unequivicaly that the level of understanding is no where near the same between the two. In almost all circumstances, people make similarity claims because they have an inferiority complex and really wanted to be a doctor but either could not or didn't have the fortitude to dedicate so much time to achieve their goal. It's true. People won't admit it but it's the truth. I felt the same way years ago.

Back to your post. Of course a new intern or resident doesn't have the same judgment as a seasoned nurse. They're not supposed to. That's why they are a resident. These arguments demonstrate your lack of understanding of medical education. Medical school teaches you science. It's not meant to prepare to function in a clinical setting by yourself right out of school. That's a major difference between nursing school and medical school. Medical students graduate with a tremendous base of science (anatomy, physiology, pharmacology, etc) but they don't really learn what to do with that until post-graduate training. That's why residency is 3-8 more years and it's required. Nobody can practice medicine straight out of school.

A NP will NEVER be a replacement for a physician. The difference in knowledge is beyond what you could imagine (and as a reminder, I've done both). Sure, an NP can function well in a clinical setting but they lack the depth of understanding and complex decision making that a doctor has. Experience is great but it doesn't replace knowledge. I could give an LPN a chart on JNC7 and they could manage hypertension, but that not mean they understand it.

Knowing what I know now, I am petrified of what I could have missed as an NP. There are whole categories of disease that I didn't even know existed.

Sorry, but your argument is foolish, incorrect, insulting, and quit frankly embarrassing.

 

[schutzhund]

Emedpa, I do agree with you that experience helps, probably more so for PAs than physicians because of the abbreviated education. The PAs that I've worked with that were medics were more clinically astute.

I think experience can help in medical training as well, but the curve flattens out pretty fast. In fact, I think my experience hurts now as much as it helps. Its sometimes hard to break out of the simple see this do that mentality of EMS and think like a doctor.

 

[mig26x]

tipps you are right, dont compare because its apple to pears!! residents went to medical school while NP or RN went to nursing school. two very different schools with very different goals of education, one is to be a physician and the other is to be a nurse.

 

[Sunfire]

A NP will NEVER be a replacement for a physician.

NEVER? NEVER EVER??

Only a Sith deals in absolutes.

I know one thing, if I were a patient, I'd want the person with the most experience in dealing with whatever problem I had. End of line. If I had some strange affliction, or if there were some chance of a differential, of course I'd want a Doctor, as they would most likely have the education to best figure out what was wrong with me and what to do about it. But as far as taking care of me...I don't care if you have a MD, a DO, a NP, a PA, or a 123 after your name. If you know what you're doing, I'm good with that, no, I'm best with that. I would want an experienced specialist, to whatever extent the definition of that word represented. That doesn't mean I'd automatically choose an NP over an MD (people have the weirdest complexes here and that is no joke), it means I'd want the person who best knew what they were doing!

What is it with these people who think that Doctors are some sort of magical beings with halos around their heads that atomically inject all-knowing and capable wisdom into their neurons. Yes, as a thankfully general rule they're excellent and proficient at what they do. But I've seen Doctors make mistakes, and I've seen Doctors make the wrong decisions. Point blank, if you can give me experience and education, that's option 1. End of that story. But if I as a patient had to choose between the two for the second option, I'd ask for the experience. Period. Anything else would be extremely insulting to me as a logical human being.

 

[Sunfire]

*edited*

 

[Dr.Millisevert]

That doesn't mean I'd automatically choose an NP over an MD (people have the weirdest complexes here and that is no joke), it means I'd want the person who best knew what they were doing!

Hey, I understand the point you're trying to make. ... I really do. However, 99.9% of the time.. the person who usually knows what their doing best when it comes to practicing medicine is someone who has completed medical school.

Yes, maybe a Nurse with 10 years experience will know more about clinical patient care than a 1st year intern.. however.. this quickly changes. Honestly.. what % of nurses do you really think will know more about practicing medicine than a board certified physician? If you rock up to the hospital in the middle of having a heart attack.. are you going to worry if there aren't any more Cardiologists or Emergency Physicians? What if the hospital was staffed with nothing but nurses? Would you send your ill mother to a hospital like that? .... come on. This is not the future. If it is.. then I'm moving overseas where I will get better health care.

I'm really afraid that America's new Universal health care system will mean everyone will get to see a "doctor", but you'll never get to see anyone who actually has a Medical degree. The new Family doctors that will be treating all americans will be Naturopaths and Nurses or some other alternative doctor. We will end up paying the same amount if not more than other countries on "our version" of universal health care.. and it won't work because we screwed it up.

At least overseas.. the goverments actually pay for everyone to see a GP/FP who has actually completed medical school and is board certified/obtained Fellowship with the college of General practitioners/Family Physicians, etc.

BTW: The last P in PCP origionally stood for Physician not Provider. ... but the nursing unions, etc have paid their lawyers to twist the words to fit their agendas.


I don't know about you.. but if I'm paying the same amount for either one.. or if someone else is paying for my care and I get to choose...
If PCPhysician A (Board certified physician) and PCProvider B (nurse, or alternative medicine provider).. I'm going with PCP A. Which 9 times out of 10 means more education and experience when it comes to practicing medicine

 

[Sunfire]

Well, I wasn't talking about nurses, I was talking about NPs. Anyhow, 9 times out of 10 is 90%. I can agree with 90%, because I'd bet that's likely what the number is closer to. Or even 95%. 99.9%, however, that number I do not agree with. It sounds unreasonable and extreme, and it insults my intelligence. Life is not comprised of such black and white extremes, there are not always such thick demarcations.

It is obviously as jwk stated, it would all simply depend on the situation and the individual in question. And I'm sure that, hopefully, people in positions of oversight would only be those who are qualified to be there, period. And of course that will most likely be a Physician. Or, in certain cases, their PA or NP who the Physician theirself entrusted to such a position based on their qualifications and capabilities. I read emedpa's writing enough to be able of comprehending that the man knows his stuff. And I was interviewed by a Cardiothoracic Surgical PA who was old and experienced enough to probably be able to write the book on Cardiothoracic surgery.

I'm not for the DNP, by the way...at least not as an automatic certificate of autonomy. That shouts >danger< in a big way, any idiot could see that. Physician supervision is imperative, because that's where the basic foundation of medicine comes from. That's where the medical model began and perfected itself, continues to perfect itself. I will always be for more education tho, I don't think that can ever be a bad thing, no matter who you are.

By the way, Sherwin Nuland's new book, 'The Uncertain Art', is a very good read.

 

[schutzhund]

Listen Sunfire, you don't seem to understand. Have you been to medical school? No, right? I HAVE BEEN TO BOTH!! THERE IS A HUGE DIFFERENCE!!! The fact that you continue to argue this point is a bit ridiculous don't you think?

You can say you want the "experienced specialist" or that education doesn't equal better care or whatever ego-sustaining garbage you want, the point is the physician is the top of the food chain in medicine. If you want to practice medicine, go to medical school.

I feel for you. I really do. I spent many years spouting off the same stuff that's said here by many of the midlevels "experience matters more" "I can do the same thing as a doctor" "I spent X years doing Y and that makes me the same as a doctor." It's simply not true. You simply can't understand the HUGE difference unless you've done both. Sorry.

I am strongly against the expansion of the NPs because, knowing what I know now I realize how dangerous it can be. The nursing agenda is manipulative and self-interested. It truly scares me what I could have done to people.

The problem is you don't know what you don't know. The vast majority of medicine is pretty straight forward, easy in fact. It's the 5% that will get you. You can't diagnose a problem if you have never even heard of it. That's the problem. That's why I've seen bad mistakes made by NPs. Innocuous rash or life-threatening Kawasaki's disease. Get it?

BTW, on a personal note, I really think you should go to medical school. Really. I have a feeling you will be miserable. Just a little advice from someone who's been there. PM me if you want.

 

[Sunfire]

See, at least Dr.Millisevert acknowledges his .01%. You don't even budge that much. And that makes me a little wary, to tell you the truth. You are correct tho, I haven't been to medical school. I haven't even started my PA program yet! And it's not in my plan to gain more experience than a Doctor, that's not what I decided on as a goal. I want to practice medicine, under the supervision of a Physician. I want to learn and do a lot, don't get me wrong, but I want to take the 5s and the 4s (and maybe a few 3s). I want to free up the Physician(s) so they can see the more critical patients. I'll be happy there for the rest of my life. I read up on everything as much as I can, I promise I do!

However. I don't need to goto medical school to know that there are those certain PAs and NPs, who are highly, highly capable (vastly more experienced than I most likely ever could or will be). I've met them! I would be flat out lying to deny those individuals, and I don't like feeling like I'm being asked to lie. What saddens me is that I think we're largely on the same page. I do get what you're saying, please do find that case of Kawasaki's! Thank you for that education, btw. But how can I say that an NP who had worked solely in Pediatrics for 12-20 years wouldn't be knowledgeable on that disease?

Thank you for your kind words of faith in my abilities, they are appreciated. Nope, I want to be a PA and I want to find a Physician or a group of, who'll value me highly for what I'll do. I know they're out there, and I'll find them! And at the very worst, you are most likely an extremely educated and competent individual and I'm so glad that people like you are out there to operate as fully as you possibly can. No matter what your title.

 

[Dr.Millisevert]

Well, I wasn't talking about nurses, I was talking about NPs.

hmm.. NPs are nurses. I think it is scary that you (and many others) think that a nurse after completing a DNP (Family Nurse Practitioner program) like this one, will be as qualified as a someone who has completed medical school and is board certified by the ABFM.

I'm not for the DNP, by the way...at least not as an automatic certificate of autonomy. That shouts >danger< in a big way, any idiot could see that.

Wow.. I agree with you here. Good stuff.

 

[Sunfire]

hmm.. NPs are nurses. I think it is scary that you (and many others) think that a nurse after completing a DNP (Family Nurse Practitioner program) like this one, will be as qualified as a someone who has completed medical school and is board certified by the ABFM.

I give up. Where is the crying emoticon? Is this seriously an example of the comprehension skills they teach in medical school? I never said such a blanket statement and I resent the accusation. And no, NPs are NPs. Nurses can't officially make diagnoses or write scrips.

I'm glad I said something that someone can agree with. Booo *hisss*, down with DNPs! I am curious tho, how do you feel about the Army's new Clinical PA Doctorate? I wonder when that'll cross over similar lines that people are drawing around the DNP, or if it will at all.

http://www.samhouston.army.mil/pao/pdf/12_20_07.pdf
(2nd page)

 

[deleted6669]

Just a note...np's are nurses first. one of the requirements of maintaining an np license is keeping an active rn license.
I know what you are trying to say sun but np's are entirely based in the nursing model so they are advanced practice nurses but nurses nonetheless.

 

[Sunfire]

one of the requirements of maintaining an np license is keeping an active rn license.

I of course knew that NPs are nurses first, but that I did not know. Thanks for the education.

 

[foreverLaur]

last time i checked, NP stands for NURSE practitioner as in, a nurse with a graduate degree in advanced practice nursing.

 

[Sunfire]

When all nurses are deemed with the title of Nurse Practitioner, someone please send me a pm and keep me updated!

Dictionary.com Unabridged (v 1.1) - Cite This Source - Share This prac·ti·tion·er

Audio Help /præk&#712;t&#618;&#643;

&#601;

n&#601;r/ Pronunciation Key - Show Spelled Pronunciation[prak-tish-uh-ner] Pronunciation Key - Show IPA Pronunciation –noun 1.a person engaged in the practice of a profession, occupation, etc.: a medical practitioner. 2.a person who practices something specified. 3.Christian Science. a person authorized to practice healing.
[Origin: 1535–45; alter. of practician (practic + -ian) + -er1

]


Dictionary.com Unabridged (v 1.1)
Based on the Random House Unabridged Dictionary, © Random House, Inc. 2006.
---------------------------------------------------------------------------------------

 

[foreverLaur]

When all nurses are deemed with the title of Nurse Practitioner, someone please send me a pm and keep me updated!

Not all nurses are nurse practitioners. Depending on their level of education, nurses are given different titles. Doesn't mean they still aren't nurses.

 

[dfk]

When all nurses are deemed with the title of Nurse Practitioner, someone please send me a pm and keep me updated!

Dictionary.com Unabridged (v 1.1) - Cite This Source - Share This prac·ti·tion·er

Audio Help /præk&#712;t&#618;&#643;

&#601;

n&#601;r/ Pronunciation Key - Show Spelled Pronunciation[prak-tish-uh-ner] Pronunciation Key - Show IPA Pronunciation –noun 1.a person engaged in the practice of a profession, occupation, etc.: a medical practitioner. 2.a person who practices something specified. 3.Christian Science. a person authorized to practice healing.
[Origin: 1535–45; alter. of practician (practic + -ian) + -er1

]


Dictionary.com Unabridged (v 1.1)
Based on the Random House Unabridged Dictionary, © Random House, Inc. 2006.
---------------------------------------------------------------------------------------

non-sensical space filling drivel.

 

[Sunfire]

It's called a definition. But the way some people view NPs and PAs around here, maybe yours is more appropriate.

 

[Dr.Millisevert]

Is this seriously an example of the comprehension skills they teach in medical school? I never said such a blanket statement and I resent the accusation. And no, NPs are NPs. Nurses can't officially make diagnoses or write scrips.

My point was that NPs are nurses.. and this "extra training" you speak of is not standardised nationwide and greatly variable.. and can even come in the form of an online program. I would not want someone like that writing my prescriptions or treating my family.

 

[8744]

I have been following with kin interest the debate over the qualifications of midlevel practitioners (DNP). I have been a critical care nurse for 10 years and working in a teaching hospital I have seen first hand the "MAKING OF A DOCTOR" from Medical school throught Residency to fellowship. I find it upsurd that MD will claim to know alot because of their level of education.
Every honest MD will recall that during their first year in Residency, Most of the ICU nurses with just Associates degree or BSN had better judgement than them. Most of then wouldn't understand why you cannot give dopamine despite low BP ( if patient is tachycardic).
What is my point, most NP or DNP already have these enormous clinical first hand experience which Residents lack. If I may ask, which part of the MD training teaches what will produce a safe and proficient Medical Doctor? The obvious answer is Residency and fellowship.
No one can compare the clinical judgement of a Medical school graduate (without residency) with the judgment of a new graduate NP.
So do not compare apple with pears.
Tipps

I just got done with the sixth ICU month of my residency and I have enjoyed immensely working with the nurses in our ICU, many of whom knew me as an intern and can take tremendous satisfaction that they "raised me right." With that being said, we have different jobs and we try not to step on each other's toes. But the nurses do not think they are better than residents because they corrected me (gently) on giving dopamine when I was an intern just like I don't think I am better than the nurses because I can read a plain film of the chest. That's rookie stuff anyway. We have different jobs, you see. Mine requires a medical degree and residency which is why, on our first day as interns, we don't know that much...that is, we are still in training.

Not a hard concept to understand. It's pretty easy to make fun of a brand-new intern. Hell, even the janitors probably do it. But it's a little disingenuous to suggest that doctors don't know what they are doing because at one time, an experienced ICU nurse had to give them some much-needed guidance.

You sound bitter.

 

[Taurus]

I have been following with kin interest the debate over the qualifications of midlevel practitioners (DNP). I have been a critical care nurse for 10 years and working in a teaching hospital I have seen first hand the "MAKING OF A DOCTOR" from Medical school throught Residency to fellowship. I find it upsurd that MD will claim to know alot because of their level of education.
Every honest MD will recall that during their first year in Residency, Most of the ICU nurses with just Associates degree or BSN had better judgement than them. Most of then wouldn't understand why you cannot give dopamine despite low BP ( if patient is tachycardic).
What is my point, most NP or DNP already have these enormous clinical first hand experience which Residents lack. If I may ask, which part of the MD training teaches what will produce a safe and proficient Medical Doctor? The obvious answer is Residency and fellowship.
No one can compare the clinical judgement of a Medical school graduate (without residency) with the judgment of a new graduate NP.
So do not compare apple with pears.
Tipps

I'm too busy with sub-I's and studying for Step II to spend much time on these boards. But I had to respond because this just cracked me up. If this is representative of nurse thinking, docs have nothing to worry about.

 

[Farmer Jane]

I just got done with the sixth ICU month of my residency and I have enjoyed immensely working with the nurses in our ICU, many of whom knew me as an intern and can take tremendous satisfaction that they "raised me right." With that being said, we have different jobs and we try not to step on each other's toes. But the nurses do not think they are better than residents because they corrected me (gently) on giving dopamine when I was an intern just like I don't think I am better than the nurses because I can read a plain film of the chest. That's rookie stuff anyway. We have different jobs, you see. Mine requires a medical degree and residency which is why, on our first day as interns, we don't know that much...that is, we are still in training.

Not a hard concept to understand. It's pretty easy to make fun of a brand-new intern. Hell, even the janitors probably do it. But it's a little disingenuous to suggest that doctors don't know what they are doing because at one time, an experienced ICU nurse had to give them some much-needed guidance.

You sound bitter.

Very well said. And really, making fun of an intern is like making fun of a student nurse in his/her first clinical. It's not a game I like to play, because everyone has to start somewhere. It's also ridiculous to insist that physicians aren't knowledgeable because they were once interns. Um, hello? Every nurse was once the nervous student terrified to do an IM. We all learn, we all grow, and doctors and nurses end up with different roles--no need to compete.

 

[prairiedog]

You can say you want the "experienced specialist" or that education doesn't equal better care or whatever ego-sustaining garbage you want, the point is the physician is the top of the food chain in medicine. If you want to practice medicine, go to medical school.

I would place the insurance company on top of the food chain. If you want to be on top of the medical food chain be the CEO of BCBS

 

[schutzhund]

I would place the insurance company on top of the food chain. If you want to be on top of the medical food chain be the CEO of BCBS

Sad but true.

 

[pialpha2000]

Like schutzhund, I have a similar educational background. I graduated PA school, and worked as a PA for 2 years prior to returning to medical school. I'm currently in my 4th year. You really don't get a true perspective of the training until you go through both levels of training, and I realize how much I didn't know as a PA. This is not to say that PA's or NP's aren't qualified to fulfilled there roles as a mid-level provider, but there is a vast difference in training.
I'm very concerned in the expanding role of NP's, not because I feel threatened by job security, but for patient safety. I think that PA's and NP's are capable of fullfilling everything they want without further training, advanced degrees, or independant practice. They can already practice soley in rural clinics by themself with very little oversight with the occational phone call to a physician, so if they are already filling the roles of providing health care to the indigent population with little supervision currently, what difference would it make if the person now was a DNP. The job role would not change, but of course they would demand more money which would defeat the purpose cost effective health care.

Just chipping in my 2 cents.

 

[Lamictal]

DNPs aren't midlevel, they have doctorate degrees. In addition, these programs are not all online and there are not only a handful of them. (I don't know if you have noticed or not, but many educational programs are offered online these days). I think you will see that they will be the way of the future. I'm not sure if I am hearing ignorance or fear. In any case, it doesn't really matter. NP's and PA's really should stick together and get rid of this ridiculous "mid level" term.

 

[mig26x]

DNPs aren't midlevel, they have doctorate degrees. In addition, these programs are not all online and there are not only a handful of them. (I don't know if you have noticed or not, but many educational programs are offered online these days). I think you will see that they will be the way of the future. I'm not sure if I am hearing ignorance or fear. In any case, it doesn't really matter. NP's and PA's really should stick together and get rid of this ridiculous "mid level" term.

have you seen the curriculum?? its a freaking joke!!!

here's an example:

The DNP curriculum listed below is intended for Post-MSN students, since a Masters degree is required en route to completion of the DNP. DNP students who do not yet have Post-MSN status should check the curriculum requirements for Graduate Entry for Non-Nurses or Post-Licensure MSN/DNP (based on their chosen MSN major).

The Bolton School has a unique approach to "distance" learning. All Post-Masters DNP courses are given as intensive classes, with a 3-credit hour class given over a six-day period. Intensive sessions are given three times a year (January, May, and August) for at least two weeks. Papers and projects are due in the semester following the intensive session. Check the intensive course schedule.

REQUIRED
Course Code Course Title Semester Offered Pre-Requisites Hours
NURS 401 OR STAT 401
Advanced Statistics or equivalent with prior approval Intensives or course approved by DNP Director 3
NURS 504 Nursing Theory Intensives Consent of instructor 3
NURS 520 Advanced Nursing Research I Intensives NURS 504 3
NURS 521 Advanced Nursing Research II Intensives NURS 520 and STAT 3
NUND 483 Health Policy Planning & Information Management Systems Intensives 3
TOTAL 15
Research Project
NUND 505 DNP Project As arranged NURS 521 6
OR
DNP Thesis
NUND 500 DNP Thesis As arranged NURS 521 6
TOTAL 6

EDUCATIONAL LEADERSHIP
NUND 478 Curriculum and Instruction Intensives 3
NUND 479 Theoretical Foundations: Education Testing & Evaluation Intensives NUND 478 2
NUND 480 Action Research & Program Evaluation Intensives NUND 479 or consent of instructor 1
NUND 481 Teaching Practicum with Portfolio As arranged NUND 479 and NUND 480 2
TOTAL 8
OR
CLINICAL LEADERSHIP
NURS 471 Organizational Theories Intensives 3
NUND 441 Management in Advanced Practice Intensives 3
TOTAL 6

 

[Taurus]

DNPs aren't midlevel, they have doctorate degrees. In addition, these programs are not all online and there are not only a handful of them. (I don't know if you have noticed or not, but many educational programs are offered online these days). I think you will see that they will be the way of the future. I'm not sure if I am hearing ignorance or fear. In any case, it doesn't really matter. NP's and PA's really should stick together and get rid of this ridiculous "mid level" term.

Oh, there's more than a handful of online DNP programs. Furthermore, some degrees can have some online component, but how what other respectable degrees, clinical or non-clinical, can be done almost entirely online besides the DNP?

DNP's will be competing against PA's for midlevel jobs because no place will credential DNP's like if they're physicians. Yet it will take DNP's twice as long and cost to finish compared to PA's.

If people can get a correspondence PhD for $49.99 in the mail, does that make them "Dr" now? There's no point in getting this supposed doctorate that you call a DNP if no one takes it seriously.

 

[Therapist4Chnge]

MOD NOTE: I know this is a "Hot Button", so I'd like to preemptively remind people to keep it:

1. Professional
2. On Topic
3. Constructive

Okay....now I'm going to take a stab at outlining a few different areas of this discussion. I combined a number of my previous posts from other threads to help outline my points....no sense trying to re-invent the wheel!. -t4c

DNPs aren't midlevel, they have doctorate degrees. In addition, these programs are not all online and there are not only a handful of them. (I don't know if you have noticed or not, but many educational programs are offered online these days). I think you will see that they will be the way of the future. I'm not sure if I am hearing ignorance or fear. In any case, it doesn't really matter. NP's and PA's really should stick together and get rid of this ridiculous "mid level" term.

Professionals wanting more education isn't a bad thing, but I think other professionals take pause because the education being delivered, combined with the implied scope changes, don't seem congruent.

There are really 3 different issues being discussed in this thread:

1. DNP Training / Classes
2. Online v. Residential
3. Change in Scope

DNP Training:
In general, there seems to be a lack of a core curriculum that matches up with what a doctorate typically encompasses. A doctoral degree is suppose to be the highest terminating degree in a particular field, and represent mastery in a given area. I don't see how mastery can be established if the coursework is so varied. If the only difference between an MS and a doctorate is a handful of random classes....should it really be a doctorate? How is that not a certificate or another MS or advanced training?

If the DNP is meant for advanced clinical training, the curriculum should primarily be clinical. If it is meant for research/stats training, why not a Ph.D? If it is meant for business classes, why not an MBA? If it is just a mishmash of those things....it sounds like, "a jack of all trades, and a master of none."

As someone finishing a doctoral degree, I'm perturbed that this coursework is passing for a doctorate....as it doesn't display mastery of the given area, nor does it seem a rigorous academic endeavor meant to prepare the person to represent the highest training in the chosen field. It is pretty frustrating to be honest.

Fulton & Lyon (2005) wrote an article that addresses some of my concerns, and I think it is a pretty good read (http://www.medscape.com/viewarticle/514545_1, free sign up for access).

Here are some excerpts (with my bolding):
-----
Confusion is created when there is one degree proposed for varied outcomes and the functional role is not well articulated. Role refers to a constellation of functions for which an individual is responsible – educator, administrator, clinical nurse specialist, and so forth – and role preparation occurs in an academic setting where an individual learns to perform the circumscribed role functions. Educational preparation for each role is accomplished through completion of a distinct curriculum that prepares graduates to function in the scope of practice of the role.

*snip*

The notion that PhD programs are not necessary for effective practice raises questions about the nature of research and inquiry in a practice discipline. First, should PhD programs, with all inherent resources, be reserved for only those nurses who wish to become nurse researchers/scientists (Fitzpatrick, 1989)? That is, is the degree not appropriate or useful for nurses who intend to: (a) improve their own practice; (b) change clinical practice; (c) improve teaching; and/or (d) improve executive nursing administration? Second, are the theory development and testing competencies gained through a PhD too limited for disciplined inquiry in the practice setting such that program evaluation research is not a legitimate type of research to include in PhD programs? Third, while PhD programs in nursing are expected to be congruent with the gold standard of research-intensive preparation, with well-funded faculty mentors who have research intensive careers, is this model of PhD education in nursing not the most appropriate for the preparation of nurse scholars who desire non-academic careers such as administration (Edwardson, 2004)? We believe that PhD programs can and do prepare nurse scientists for clinical settings and health care administration as well as academia.

SOURCE: Fulton, J.S., Lyon, B.L. (2005). The Need for Some Sense Making: Doctor of Nursing Practice. Online Journal of Issues in Nursing.
-----
fan4fan summed up my feelings well in this post from another thread: In my mind, the DNP should be about providing hard-core sciences, advanced skills--not more theory, not more of this ethereal "nurse-speak." If I want to get a degree as an acute care nurse practitioner, then by golly I want some really solid critical care education. Education that goes way beyond the master's level. What I see being offered by most DNP programs doesn't look like what I want or need. A nurse theoretician isn't going to help me manage a critically ill patient.

Online v. Residential Training:
I was reading through a study by Anstine & Skidmore (2005) and they had a few points that help illustrate my issues with online learning.

----
A few studies suggest that learning outcomes in the online environment are inferior or similar to those in the traditional environment. Hiltz et al. (2000) asked professors to describe how students learn best in virtual classrooms. Their results suggest that if students are actively involved in the class material, then students in an online class learn as much as they do in a traditional class. However, if students are just responding to posted material, doing assignments, e-mailing them, and having them graded, or otherwise following correspondence-type class work, they do not learn effectively.

Harrington (1999) taught two statistics classes as part of a Master of Social Work program. She found that students with a high GPA (grade point average) that were enrolled in a distance-education statistics course did as well as those in a similar traditional class. However, students with a lower GPA in the online class did not do as well as their counterparts in the traditional statistics class. Her study was constrained by a relatively small sample (94 students) and by not having much information about student characteristics. In addition, she noted that a limitation of her study was that there may have been some systematic differences between the students taking the classes in the two learning environments for which she did not control.

*snip*

Most recently, Brown and Liedholm (2002) found significant differences in the teaching formats. They examined student scores in three different introductory microeconomics classes-a live class, a hybrid class, and a virtual class. Their results showed that scores on simple test questions were similar for the three classes, but students in the traditional class did much better on questions involving complex material. Some of this learning differential was attributed to the in-class students spending more time on the class work.

SOURCE: Anstine, J., Skidmore, M. A Small Sample Study of Traditional and Online Courses with Sample Selection Adjustment. Journal of Economic Education. Washington: Spring 2005. Vol. 36, Iss. 2; pg. 107, 21 pgs.
------------

The more time I spend in the clinical setting, the more I see the value of F2F...as there are subtle nuances to things, particularly when learning it for the first time. I know for psychiatric presentation (what I am most familiar with), there is no substitute for seeing the variety of symptoms a pt may exhibit. People may argue that there isn't a difference in book learning, but I think learning online lacks that immersion feel that can be present in classroom learning, not to mention all of the learning that happens between classes, during breaks, over coffee, attending seminars/brown bags/workshops. "Campus" time is really a big component of learning and shouldn't be minimized.

I believe it has to do with immersion and taking advantage of the full experience, vs. taking classes here and there and just trying to get through it. For example, I've seen degree creep in Education (everyone and their brother going for an MS because they want the letters after their name and a bump in pay) and many/most look for the path of least resistance (typically online/distance learning).

I don't mean to generalize that everyone is trying to do this, but considering there are entire threads/discussions on programs that are completely online and/or the easiest to get into.....it makes me wonder the true motivation of the individuals. A doctorate should really be about mastery and depth of education, as it is the highest terminating degree in each field, but it somehow has turned into finding the easiest/quickest way to cut corners, and that is concerning to me because I think it weakens the perception of everyone who pursues doctoral training.

People often complain that a person shouldn't have to suffer/work through a doctorate, but I'd argue that immersion and a rigorous course of study, combined with in-depth clinical application and application of research learning is essential in any doctoral program...regardless if it is more 'clinical' in nature.

Ultimately, I believe all of the cutting corners diminishes the training, experience, and overall effectiveness of the degree. The path should be about wanting to become the best provider in your area of expertise, but it seems that for many it is about collecting letters, which is not going to garner the respect or acceptance of colleagues. Some may say they don't need the approval of others, but I think it would at last offer an opportunity to hear the criticisms/feedback and evaluate if there is anything that can be done to better address the concerns.

Change in Scope
I think NPs fill a vital role in the healthcare system, and I believe the current relationship of having a collaborating physician best utilizes both the skills of the NP and the additional training of the physician (when needed).....why change this now if there isn't a huge shortage or need in the area? It doesn't seem like there is a shortage of physicians willing to consult with NP's....and there doesn't seem to be a huge need for more autonomy for NPs, so why the push?

Autonomy is both about responsibility and training. I think being able to collaborate helps everyone involved. The community member gets services, the NP can provide care, and the physician can consult when needed, while not needing to get pulled for run of the mill stuff. It is up to the NP supporters to provide peer-reviewed empirically supported data that shows it is safe, feasible, and meets a need. If they can do that, then a move towards autonomy makes a lot more sense. Things can't be done because someone thinks they can do it, they need to show that it can be done.
-----

For anyone who took the time to read through my entire post....thank you! I think this is an important discussion to have, and I hope we can do it in a constructive way.

 

[silas2642]

DNPs aren't midlevel, they have doctorate degrees. In addition, these programs are not all online and there are not only a handful of them. (I don't know if you have noticed or not, but many educational programs are offered online these days). I think you will see that they will be the way of the future. I'm not sure if I am hearing ignorance or fear. In any case, it doesn't really matter. NP's and PA's really should stick together and get rid of this ridiculous "mid level" term.

DNP's are mid-level providers, period. It doesn't matter how many letters you add after a nurse practitioner's name, he/she is still a mid-level provider. The DNP movement is a crusade that is led by Mary Mundinger in an effort to equate nurse practitioner's with physicians, which won't work. You simply can't turn oranges into apples.

Pharmacists and physical therapists have already done this-- they've created doctorate level programs for their professions, and what do we still call them? Pharmacists and physical therapists because that is what they are.

 

[Dr.Millisevert]

DNP's are mid-level providers, period. It doesn't matter how many letters you add after a nurse practitioner's name, he/she is still a mid-level provider. The DNP movement is a crusade that is led by Mary Mundinger in an effort to equate nurse practitioner's with physicians, which won't work. You simply can't turn oranges into apples.

Pharmacists and physical therapists have already done this-- they've created doctorate level programs for their professions, and what do we still call them? Pharmacists and physical therapists because that is what they are.

Bingo

 

[Taurus]

DNPs aren't midlevel, they have doctorate degrees. In addition, these programs are not all online and there are not only a handful of them. (I don't know if you have noticed or not, but many educational programs are offered online these days). I think you will see that they will be the way of the future.

The future? After reading this posting from an NP on allnurses.com, I sure hope not for patient safety sake. It's scary stuff.

We've had 2 NP students within the past few months at the family practice clinic I work and both of them attend the local online NP program. They also trained on SP's. Trust me, this is not a substitute for the real thing.

One of the students was inserting (more like shoving) open speculums into the vagina, because she didn't know better. There were complaints from patients and MA's, so the doctor called the school and complained. He just assumed that she knew how to examine a patient and he certainly didn't have time to teach her the basics, so he's no longer willing to serve as a preceptor. At both schools I attended, we practiced on live surrogates and we were checked off on pelvics, PAP's, prostate/rectal exams, full body exams, etc BEFORE we were sent off to work with preceptors. I can't imagine doing it any other way.

Another student with over 25 years of ICU experience had no idea what a carotid bruit was nor where to locate them. She also didn't know anything about heart murmurs or how to grade them. She was precepting with one of the PA's and that PA would give me a detailed report of what she didn't know everytime she was there...I was embarrassed for MY PROFESSION!

All this information is getting around to the physicians, our potential employers, and our profession is getting trashed. Just the other day one of the docs pulled me aside and told me that his patient had seen a NP at a walk in clinic a few days before. The patient had prostatitis and the NP gave him a 3 day course of Bactrim. I reminded him that I would have treated the patient differently and he admitted he knew that I would, but he said, "Look at the REST of those NP's!"

Something else, the ANCC & AANP need to make their exams a lot tougher and they definitely need to ask a lot more questions before they determine whether we're safe to practice on the public. I believe the AANP gives you 3.5 hours to answer 150 questions and that's just ridiculous. There should be more like 500 questions on those exams.​

 

[Dr.Millisevert]

DNPs aren't midlevel, they have doctorate degrees. In addition, these programs are not all online and there are not only a handful of them. (I don't know if you have noticed or not, but many educational programs are offered online these days). I think you will see that they will be the way of the future.

So.... you would be happy to allow a neurosurgeon who obtained most of his training online to operate on your mother's brain tumor?

... interesting. Well... I do suppose its the way of the future.






Btw: don't know if you've noticed.. However, everyone in all fields of health care in the United States obtain "doctoral" degrees now. Doesn't negate the fact that they are still entry-level/basic degrees in allied health care and mid-level practice.

Medical doctors who graduate from Oxford and Cambridge recieve a "bachelors" of medicine (which is 100% equal to a US MD degree). It is mostly an American phenomenon to offer "doctoral" degrees as "entry-level" degrees. Even in Canada, the MD is classified as an undergraduate degree.

American Universities mainly do this because it allows them the ability to charge more tuition for an (occupational therapist for example) to complete a DOT "doctor of occupational therapy" degree than for them to simply complete a bachelors in occupational therapy. An OT who has a doctoral degree does the exact same job, has the exact same scope of practice, and gets the same salary as an OT with a bachelors. An occupational therapist is an occupational therapist regardless of what degree you have. Same goes for Nurse Practitioners.

 

[Dr.Millisevert]

Except, you know, in the United States, where it's not worth the paper it's printed on unless accompanied by a U.S. internship/residency.

Same goes for any US degree! If you graduate from Harvard Medical school and never complete an internship to obtain your license. Then you equally will never be licensed as a doctor. And same goes for any US medical grad who wants to work in Canada, the UK, (or anywhere)... until you obtain a "medical license" to practice, your degree is worthless. (glad you pointed that out Tired.. )

Your point is?

 

[Farmer Jane]

You know, forget education and training. If you are an owner of a vagina, you should know how to insert objects into a vagina without causing pain. If one does not know this, it really raises aaaalllllllllll sorts of questions, beyond those of proper training.

 

[zenman]

You know, forget education and training. If you are an owner of a vagina, you should know how to insert objects into a vagina without causing pain. If one does not know this, it really raises aaaalllllllllll sorts of questions, beyond those of proper training.

If you don't own one you can do things like the intern who did an episiotomy...all the way up! Ye ow!!

 

[Dr.Millisevert]

Foreign degrees are inferior to American degrees, and therefore not "100% equivalent".

riiiight. keep up the good good buddy. I'll leave you to it.

 

[fab4fan]

You know, forget education and training. If you are an owner of a vagina, you should know how to insert objects into a vagina without causing pain. If one does not know this, it really raises aaaalllllllllll sorts of questions, beyond those of proper training.

Boy howdy!

Where's that old thread on the OB forum where that weird gal was worried about males in the OB profession? It would totally blow her mind if she were to read this thread!

Here it is, and her name is "Janice."

 

[Whittier2006]

I think that the DNP program is a little new for people to be judging it so harshly, at least where I live....

Has anyone ever worked with a DNP?

Stop judging professions you know very little about.

A nurse with 25 years experience who completes a DNP program could treat me or any member of my family anyday, as long as they know what they are doing.

I have met doctors that I wouldnt trust to treat a corpse.

Stupidity doesnt discriminate between doctor and nurse.

 

[Faebinder]

I think that the DNP program is a little new for people to be judging it so harshly, at least where I live....

Has anyone ever worked with a DNP?

Stop judging professions you know very little about.

A nurse with 25 years experience who completes a DNP program could treat me or any member of my family anyday, as long as they know what they are doing.

I have met doctors that I wouldnt trust to treat a corpse.

Stupidity doesnt discriminate between doctor and nurse.

Typical post... The classic "All men are created equal and therefore the MD and the DNP should be equal." followed by the iconic anecdotal conclusion "I saw some doctors that didn't do what I want them to do and therefore I want more options cause customer service is more important than competency."

Please do come to my ward and tell the 25 year practicing nurses that when I order a consult to take care of an issue with the patient I'm not doing it to torture them. A couple even cursed at me on the ward, and later acted like it never happened. Why do I even bother telling you this really... ? I'm better off going to work early.

 

[184013]

It's time to move on >3

Here is the link: http://www.moveon.org/


BTW you obviously haven't seen the entry level DNP programs.

 

[BlurredFocus]

A nurse with 25 years experience who completes a DNP program could treat me or any member of my family anyday, as long as they know what they are doing.

Except that in terms of the scope of practice they are fighting for, the nurse / DNP won't know what he or she is doing...

In terms of nursing - yes I am sure that person is a wonderful nurse.

In terms of being an independent medical practitioner equal to that of a doctor - no way.

 

[jwk]

A nurse with 25 years experience who completes a DNP program could treat me or any member of my family anyday, as long as they know what they are doing.

Well duh - there's an absolutely BRILLIANT post.

 

[jbar]

I think that the DNP program is a little new for people to be judging it so harshly, at least where I live....

Personally I think it needs to be thought of the other way around. The burden of proof should be on DNP programs to show that the DNP is equivalent to being a MD/DO in terms of clinical training, rather than saying "you need to work with a bunch of bad DNPs before you can say their not well trained."

Think of it like a medical procedure. You don't throw something into widespread practice like a new drug and assume it works until you get evidence that it doesn't. You test it first then put it out there. So these DNP programs need to show something like equivalent board scores, equal diagnostic and complication rates etc. before they argue that a DNP is equal to a MD/DO in terms of clinical skill.