DNP or Resident

[184013]

well I do not down play ARNPs and have great respect for those in my family and who are my friends in that job capacity.

However I do feel there online programs need immediate oversight, the dnp needs to be standardized, and clinical hours need to be in person-I say this as my friends and family support this because otherwise the lower quality output could damage the ARNP status and overall associated name.
v/r

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[tncekm]

I think it is quite insulting and degrading to PhD nurses that someone who got their DNP online can introduce themselves as "Dr."

I agree... there is nothing "Doctoral" about the DNP program. It doesn't resemble a doctoral degree in any way, shape or form.

Ph.D's: ~4-6yrs of specialized education and heavy, heavy, heavy research (60hrs/wk is pretty normal). Then, typically a Postdoc is performed for a few more years.

MD's: 4yrs of medical school + 3-5 yrs of residence and possibly + 1-2 yrs of fellowship.

There are no other academic programs that come close. IMHO that includes JurisD, PharmD, etc. IMHO those are like professional level Bachelor's degrees. I personally view the DNP as an overglorified and extended certificate program.

 

[rnnpmaybe]

I

I agree... there is nothing "Doctoral" about the DNP program. It doesn't resemble a doctoral degree in any way, shape or form.

Ph.D's: ~4-6yrs of specialized education and heavy, heavy, heavy research (60hrs/wk is pretty normal). Then, typically a Postdoc is performed for a few more years.

MD's: 4yrs of medical school + 3-5 yrs of residence and possibly + 1-2 yrs of fellowship.

There are no other academic programs that come close. IMHO that includes JurisD, PharmD, etc. IMHO those are like professional level Bachelor's degrees. I personally view the DNP as an overglorified and extended certificate program.

I get what you're saying about the online DNP stuff, I really do. A doctoral program cannot and should not be completed online. I hope (and believe) that these will go by the way-side as employers and those seeking an education will see the error of online programs. But assuming that everyone who chooses the DNP route is taking online fluff courses and generalizing it as an easy way to obtain an overglorified degree. For example, here is the program that I'm in. I'm not claiming that it's equivalent to med school. Mundinger does not speak for all of us. (I have yet to meet one nurse who agrees with her). But our degree isn't completely a load of bull.

The curriculum for the PMHNP Track includes a total of 85 credits and 1,200 clinical hours. The program can be completed either full-time (three years, eight semesters) accelerated part-time (four years, 12 semesters) or part-time (six years, 16 semesters) as follows. The program begins once a year in the fall semester.
Full-Time Option

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

 

[Taurus]

Anybody who is in the position to hire an NP should always ask:

How much of your training was online?

 

[isoman2000]

The question should not be how much was online, but what did you study? The truth is that there is no real difference between studying for an exam online or studying in a classroom. How many have been to a class in which the whole lecture was on power point and the instructor just review the presentation? Hell I can do that faster any damn place in the world, just like I can read a textbook any damn place. There are many courses in med school that you can cover the lectures online, does this make someone unqualified? Not this constant moaning and bit*ching about online education is asinine I just bet the Greeks had the same discussion over the written word vs. a lecture.

 

[rnnpmaybe]

Not this constant moaning and bit*ching about online education is asinine I just bet the Greeks had the same discussion over the written word vs. a lecture.

Good point.

 

[jwk]

The question should not be how much was online, but what did you study? The truth is that there is no real difference between studying for an exam online or studying in a classroom. How many have been to a class in which the whole lecture was on power point and the instructor just review the presentation? Hell I can do that faster any damn place in the world, just like I can read a textbook any damn place. There are many courses in med school that you can cover the lectures online, does this make someone unqualified? Not this constant moaning and bit*ching about online education is asinine I just bet the Greeks had the same discussion over the written word vs. a lecture.

Well gee, why go to college at all? Bio lab, chem lab, physics lab, all that superfluous stuff. Interaction with professors? Intellectual discussions and debate? Who needs it? Why have nursing school? Why have med school? Why even do it online? Surely you can learn it by reading a book, right?

Stupid debate Iso.

 

[Taurus]

The question should not be how much was online, but what did you study? The truth is that there is no real difference between studying for an exam online or studying in a classroom. How many have been to a class in which the whole lecture was on power point and the instructor just review the presentation? Hell I can do that faster any damn place in the world, just like I can read a textbook any damn place. There are many courses in med school that you can cover the lectures online, does this make someone unqualified? Not this constant moaning and bit*ching about online education is asinine I just bet the Greeks had the same discussion over the written word vs. a lecture.

Is there such a thing as online CRNA program?

 

[rnnpmaybe]

Furthermore, I may get flamed for posting this, but isn't this an RN/NP/PA forum? It seems like any time someone posts about NPs, the NP bashers come out of the woodwork. (Disregard that the OP was about residents). Can there not be a civilized discussion between midlevel providers? Med students and physicians have thier own forums to discuss this issue.

 

[rnnpmaybe]

Well gee, why go to college at all? Bio lab, chem lab, physics lab, all that superfluous stuff. Interaction with professors? Intellectual discussions and debate? Who needs it? Why have nursing school? Why have med school? Why even do it online? Surely you can learn it by reading a book, right?

Stupid debate Iso.

If my reading comprehension skills are adequate (I'm only a nurse, so they very well might not be), Iso was not trying to say that online courses take the place of things that need to be hands on, such as labs and procedural experience. Just that it may be an effective way to pass on information vs. listening to a professor read ver batim from his notes, which we've all experienced.

 

[rnnpmaybe]

Is there such a thing as online CRNA program?

As far as I know, there is not. However, I'm sure you'll be able to find one somewhere in say, Burma, and bring it to our attention.

 

[Taurus]

As far as I know, there is not. However, I'm sure you'll be able to find one somewhere in say, Burma, and bring it to our attention.

We're only interested in US accredited programs. I don't care what the laws are in Zimbabwe.

Dear wise isoman, why are there no online CRNA programs? If most NP programs are online and the people who take it swear it is the next best thing since sliced bread, why don't CRNA programs become online too?

 

[isoman2000]

Dear wise Taurus, in any medical profession there are usually two parts of education, The didactic portion in which information is passed on in a classroom environment, this is the part that can be done online to a great degree, if one has questions thy can use one of the many ways we have this century to contact the instructor for further explanation.
The second part are the clinical portion of education, you can read about any motor skill all day long but until you actually perform this task numerous times you will not be proficient, these skills include assessment of a patient or integrating information gained by testing with your physical exam of the patient to get an accurate assessment of the patients status.

Nowhere will you find any program suggesting the that a practitioner be qualified without supervised clinical practice, the DNP does not add any clinical skills, so all this moaning and complaining is just pointless.

If I should pursue my DNAP it will not teach me a new skill clinically I already perform every type of anesthesia just as every other CRNA can, instead I may learn how to teach or the financial aspects of anesthesia, is the DNP "clinical" I do not think so, any more then your DERMS rotation will add to your anesthetic skills in the future.

JWK the only real stupid thing posted is your statement, which is an absolutist statement taken out of context, if your logic is applied to you you should NEVER perform an anesthetic under any circumstances whatsoever.
AA's must be supervised because anesthesia is the practice of medicine and even in the most routine of anesthetics emergencies may occur, only an anesthesiologist is qualified to diagnose and treat such emergencies, therefore an AA is placing a patient at undue risk if an anesthesiologist is not available the surgery should be postponed. Geez dude love your "logic"

JWK, Tarus save your uninformed rhetoric for each other, neither of you are enrolled in these programs neither of you are trained nurses or ARNP's neither of you are familiar with their education outside of a syllabus. Although I must confess to a certain amusement when a medical student weighs in with such ignorance.

 

[Taurus]

Dear wise Taurus, in any medical profession there are usually two parts of education, The didactic portion in which information is passed on in a classroom environment, this is the part that can be done online to a great degree, if one has questions thy can use one of the many ways we have this century to contact the instructor for further explanation.
The second part are the clinical portion of education, you can read about any motor skill all day long but until you actually perform this task numerous times you will not be proficient, these skills include assessment of a patient or integrating information gained by testing with your physical exam of the patient to get an accurate assessment of the patients status.

Nowhere will you find any program suggesting the that a practitioner be qualified without supervised clinical practice, the DNP does not add any clinical skills, so all this moaning and complaining is just pointless.

If I should pursue my DNAP it will not teach me a new skill clinically I already perform every type of anesthesia just as every other CRNA can, instead I may learn how to teach or the financial aspects of anesthesia, is the DNP "clinical" I do not think so, any more then your DERMS rotation will add to your anesthetic skills in the future.

JWK the only real stupid thing posted is your statement, which is an absolutist statement taken out of context, if your logic is applied to you you should NEVER perform an anesthetic under any circumstances whatsoever.
AA's must be supervised because anesthesia is the practice of medicine and even in the most routine of anesthetics emergencies may occur, only an anesthesiologist is qualified to diagnose and treat such emergencies, therefore an AA is placing a patient at undue risk if an anesthesiologist is not available the surgery should be postponed. Geez dude love your "logic"

JWK, Tarus save your uninformed rhetoric for each other, neither of you are enrolled in these programs neither of you are trained nurses or ARNP's neither of you are familiar with their education outside of a syllabus. Although I must confess to a certain amusement when a medical student weighs in with such ignorance.

Is there any CRNA program where the didactic is online?

Do you favor modeling CRNA programs more like online NP programs?

 

[core0]

Is there any CRNA program where the didactic is online?

Do you favor modeling CRNA programs more like online NP programs?

This program claims to be the first program to have some online didactic program:
http://www.mountainstate.edu/majors/whystudy/crna/

This program tried to get approval for an all online didactic portion and was shot down by COA:
http://www.sumnerhealth.com/accreditation/index.html

David Carpenter, PA-C

 

[Taurus]

This program claims to be the first program to have some online didactic program:
http://www.mountainstate.edu/majors/whystudy/crna/

This program tried to get approval for an all online didactic portion and was shot down by COA:
http://www.sumnerhealth.com/accreditation/index.html

David Carpenter, PA-C

Very interesting, David. That leads to the natural question, Why is it that most NP programs are online but not CRNA programs? The NP's who have done online programs say that students receive equivalent or better training online than in the classroom. Are they wrong? Perhaps, Mr. Isoman can shed some light for us.

 

[jwk]

JWK, Tarus save your uninformed rhetoric for each other, neither of you are enrolled in these programs neither of you are trained nurses or ARNP's neither of you are familiar with their education outside of a syllabus. Although I must confess to a certain amusement when a medical student weighs in with such ignorance.

Funny - you're a CRNA, not a "nurse practitioner" in the context of these posts. Yet somehow you feel you're informed and we are not. Amusing indeed.

Correct me if I'm wrong - most of the DNAP programs now starting up are online/correspondence classes (totally absurd to me that one can get an online doctorate - but I digress), yet DNAP is supposed to be the "entry level" by 2015, now only 6-7 short years away. Where will their clinical component come from? Will the didactic portions be online and the clinical portions strictly OJT with a willing "certified" CRNA?

 

[FNPkathy]

I

I get what you're saying about the online DNP stuff, I really do. A doctoral program cannot and should not be completed online. I hope (and believe) that these will go by the way-side as employers and those seeking an education will see the error of online programs. But assuming that everyone who chooses the DNP route is taking online fluff courses and generalizing it as an easy way to obtain an overglorified degree. For example, here is the program that I'm in. I'm not claiming that it's equivalent to med school. Mundinger does not speak for all of us. (I have yet to meet one nurse who agrees with her). But our degree isn't completely a load of bull.

The curriculum for the PMHNP Track includes a total of 85 credits and 1,200 clinical hours. The program can be completed either full-time (three years, eight semesters) accelerated part-time (four years, 12 semesters) or part-time (six years, 16 semesters) as follows. The program begins once a year in the fall semester.
Full-Time Option

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

I'm impressed, but I have to admit, I expected a minimum of 3,000 clinical hours.

 

[niranjan162]

JWK, Tarus save your uninformed rhetoric for each other, neither of you are enrolled in these programs neither of you are trained nurses or ARNP's neither of you are familiar with their education outside of a syllabus. Although I must confess to a certain amusement when a medical student weighs in with such ignorance.

If you read near the beginning of the thread there are people who have been in both NP schools I believe and are currently in Medschool. Not sure how to link to those posts. Their opinions are that these programs are in no way comparable to medschool

 

[isoman2000]

TCU and TWU have multiple satellite sites in which the students listen to lectures live via web cast in addition lectures can be reviewed via streaming video. These satellite sites are located at the students clinical sites, exams are proctored and students are required to attend classes.
A JWK CRNA certified registered nurse anesthetist, note the RN, among the first of ARPN's. Clearly better informed about the APRN education.

 

[Taurus]

TCU and TWU have multiple satellite sites in which the students listen to lectures live via web cast in addition lectures can be reviewed via streaming video. These satellite sites are located at the students clinical sites, exams are proctored and students are required to attend classes.
A JWK CRNA certified registered nurse anesthetist, note the RN, among the first of ARPN's. Clearly better informed about the APRN education.

Tsk-tsk, Iso. Stop beating around the bush. Watching video lectures and taking proctored exams is not the same thing as the online NP programs, where you read online material and take unproctored exams in the comfort of your home. Does your avoidance of the question suggest that you think that online NP programs are inferior to CRNA programs?

 

[isoman2000]

Tsk-Tsk Taurus, Exams are proctored and does it make a difference if the lecture is live or memorex, can you read, or do you need to be spoon fed information, stop being so obtuse, even if it does fit you.

And no no comparison was made or implied except in your fevered imagination.

 

[bradt9881]

Popcorn anyone?

 

[Taurus]

Tsk-Tsk Taurus, Exams are proctored and does it make a difference if the lecture is live or memorex, can you read, or do you need to be spoon fed information, stop being so obtuse, even if it does fit you.

And no no comparison was made or implied except in your fevered imagination.

What part of online reading materials and unproctored exams taken at home do you have trouble understanding? Reading comprehension obviously is not your forte.

 

[isoman2000]

You are hopeless the exams are proctored end of story period now go find some other paranoid fantasy to try on, I just do not understand how a nurse can scare you so much, unless you really suck at med school, I bet that is it, are you getting ready to try to be a PA, or AA and making friends?

 

[core0]

Very interesting, David. That leads to the natural question, Why is it that most NP programs are online but not CRNA programs? The NP's who have done online programs say that students receive equivalent or better training online than in the classroom. Are they wrong? Perhaps, Mr. Isoman can shed some light for us.

Personal opinion - the reason that CRNA schools do not offer distance education and NP schools do boils down to one concept - standards. While you can question the relationship between the AANA and COA, you can't question that the CRNAs have educational standards and a method of enforcing them. Contrast this with the NP educational environment where there is no NP specific accrediting agency and no central certifying agency.

From that perspective the CRNA profession is substantially different from other ARNP professions. In reality it fits the medical model of accreditation and certification.

I also think that there needs to be differentiation between different models of distance education. Its fairly well established that distance education is a viable model for some classwork. There are a number of medical schools that are using distance learning modules for part of their curriculum. In someways this is an outgrowth of the move to PBL in medical education. That being said there are portions of medical education that cannot be done via distance learning. Primary among these are physical exam skills. These have to be taught in a consistent manner and rigorously evaluated on a continuing basis. There is no good way to do this outside of personal observation (in my opinion).

This leads to differences in distance learning models. There are PA programs where substantial portions of the didactic curriculum are done by distance learning. There are now various portions of medical schools that are done by distance learning. However, there are no PA or medical schools (or AA or CRNA programs) that are completely done by distance learning. LCME has stated publicly that a medical school that consisted solely of distance learning would not be accredited.
http://www.lcme.org/distancelearning.pdf
The reason is that LCME like ARC-PA, COA and CAAHEP believes that medical education occurs in a community of learning. Specifically LCME states that does not provide access to a full range of student services is not in compliance with accreditation standards. This is to be contrasted by programs that do not require any face to face contact by the student what so ever (which are a minority of the NP programs). There are a number of other characteristics in NP programs that are not tolerated in other medical provider programs (forcing students to find their own preceptors for example).

Face to face contact also allows faculty members to evaluate the abilities of a student and should be the first part of a multi part process that prevents poor providers from entering the profession. While members of the NP community obviously want to prevent providers from entering the profession that discredit the profession there are too many forces with different agendas that don't have this as a top priority. This can be evidenced by the lack of accountability in certification among other problems.

Accountability should also extend to the student population. It is relatively easy find the number of students that did not marticulate from Med school, AA school, PA school or CRNA school. It is also relatively easy to find out the percentage of a given class that has become certified. I would challenge you to find this information for NP programs. In this issue in particular distance learning becomes a crutch. By isolating students outside of the classroom you disenfranchise students from attempting to effect collective change in a program that does not treat students fairly.

So from my position, distance education is a useful tool. Warning signs that distance education is being used as a crutch to hide poor learning environments:
1. Programs that require no face to face evaluation from academic staff
2. Programs that do not bring students together for collective learning
3. Programs that do not use a centralized focused program for clinical skills with consistent evaluation
4. Programs that require the student to find their own preceptors.

There are a lot of NP programs that are excellently run and do not use any of the crutches mentioned above. There are more than a few (some quite large) that use all of the techniques mentioned above. You have to be able to critically distinguish between them.

David Carpenter, PA-C

 

[Taurus]

There are a lot of NP programs that are excellently run and do not use any of the crutches mentioned above. There are more than a few (some quite large) that use all of the techniques mentioned above. You have to be able to critically distinguish between them.

That goes to the heart of the issue. If executed well, online learning can be effective. However, it's too easy to slap together some powerpoints and post it online and call it distance learning. Therefore, hiring physicians and patients alike really have no idea as to how well trained that NP is when she walks through that door. I would argue that it is much harder to guarantee a consistent, high quality product if your admissions standards are low and the students only come to campus for like 3 days in a semester. Nursing accreditation bodies need to get their act together and tighten their standards so that, when somebody calls herself an NP, I as a physician who may hire one trusts that she can at least perform at a certain level. I should not have to wonder about the qualifications of the NP I'm looking to hire. I hear too many stories of poorly trained NP's fresh from completing their online NP degree. You don't really hear that about MD/DO's, PA's, CRNA's.

That's the answer I was looking for, iso. Was that so hard?

 

[Farmer Jane]

That goes to the heart of the issue. If executed well, online learning can be effective. However, it's too easy to slap together some powerpoints and post it online and call it distance learning. Therefore, hiring physicians and patients alike really have no idea as to how well trained that NP is when she walks through that door. I would argue that it is much harder to guarantee a consistent, high quality product if your admissions standards are low and the students only come to campus for like 3 days in a semester. Nursing accreditation bodies need to get their act together and tighten their standards so that, when somebody calls herself an NP, I as a physician who may hire one trusts that she can at least perform at a certain level. I should not have to wonder about the qualifications of the NP I'm looking to hire. I hear too many stories of poorly trained NP's fresh from completing their online NP degree. You don't really hear that about MD/DO's, PA's, CRNA's.

That's the answer I was looking for, iso. Was that so hard?

I completely agree. I'm pretty sure I've told this story before, but I'm okay with repeating myself. Last year I took a course in telemetry monitoring. I--a mere ADN--passed the course with a grade of over 99%. I believe 80% was required to pass. One of the other people in the class was a recent graduate of a FNP program, and she had passed her boards. She failed the telemetry class.

 

[zenman]

You don't really hear that about MD/DO's, PA's, CRNA's.

Cough, cough, cough, cough, cough, cough, cough....

 

[isoman2000]

Well that is a bit different then all of your other posts, complete change, well if you are looking for the statment are there poorly trained NP's sure as well as poorly trained MD's PA's etc, etc. The stories are a legion.
The concern that distance learing provides poor educaztion is not backed up by any data just personnal opinion, which of course you may have, but it is not fact.

 

[zenman]

Well that is a bit different then all of your other posts, complete change, well if you are looking for the statment are there poorly trained NP's sure as well as poorly trained MD's PA's etc, etc. The stories are a legion.
The concern that distance learing provides poor educaztion is not backed up by any data just personnal opinion, which of course you may have, but it is not fact.

Who are you addressing isoman?

 

[isoman2000]

Tarus.

 

[core0]

Well that is a bit different then all of your other posts, complete change, well if you are looking for the statment are there poorly trained NP's sure as well as poorly trained MD's PA's etc, etc. The stories are a legion.
The concern that distance learing provides poor educaztion is not backed up by any data just personnal opinion, which of course you may have, but it is not fact.

My thoughts are the concern for distance education is precisely because it is not backed up by any research. The original research on NPs was done in the 70's and 80's. This was all traditional educational models. The move to distance education has been made without any metrics. If you look at the move to PBL in medical and PA schools there is substantial academic study on the student population. There are studies that show that the students preform as well or better on standardized tests. This data as far as I know does not exist for distance education NPs. Similarly, what are the student experiences for distance educated NPs. Are the graduation rates similar? Are the board pass rates similar? Medical education should inherently be a conservative profession. New educational methods should be equivalent or better to what has been done before. At least thats where my concern lies.

David Carpenter, PA-C

 

[zenman]

I'll bet sometime in the future we'll even have CME via medical journals and video and even telemedicine.

 

[silas2642]

I'll bet sometime in the future we'll even have CME via medical journals and video and even telemedicine.

I kind of feel like CME via telemedicine is kind of different-- having grand rounds via the webcam is not the same thing as having your core education come via the net with no standardization of the degree (i.e. NP, DNP). Simultaneously, I don't think that it would be wise to have ALL CME to be online-- I think that it's important to have face to face communication your colleagues to facilitate discussion and debate. It's just way too easy to nod off when the speaker isn't there in person. It's sometimes way too easy to fall asleep when the person is there giving grand rounds live.

I believe that when the internet/webcams do and will come into play even more is when clinicians (who already have PROPER clinical training) are practicing in places where it is difficult to stay up to date with a world of medicine that is constantly changing. I think that it would be great if you could listen to grand rounds from MGH or Johns Hopkins on the latest updates on CHF or whatever from some place in the rural boonies so you know what the best medications to prescribe are.

But the fact that a nurse practitioner, who can be licensed to practice independently in some states, can obtain her degree online, choose her own preceptor, and take her exam onlines-- that is really, really, disturbing.

 

[primadonna22274]

Kathy,

If you have qualms about the preparation of the online NP students you precept, you really should in good conscience refuse to precept them.

I have some experience precepting PA students as a PA. The program always gave me a heads-up on the individual student's preparation and performance in the program thus far and let me know in advance if there were particular issues that each student had, or needed special attention in certain areas, etc.

My guess is you're not given much of this kind of info on these NP students. I'm afraid to ask, but I will anyway: are you being paid to take these students? I suppose we can have some philosophical discourse on the ethics of paid clinical rotations but I can infer from your post that you're uncomfortable with the type of students you're precepting. Hell, I would be. But always remember you can refuse to participate in being part of the problem.

Now, as far as your off-base comment about PA education, let's be fair: while there certainly are a variety of credentials awarded to PA graduates ranging from certificate to bachelor's to master's degrees of various descriptions (MPAS, M.MSc., mine was just a plain ol' M.S.) you cannot ignore that for all PA programs 1) the prerequisites required are strikingly similar and require more basic science than is required of NP programs; 2) the curricula of PA programs, while allowing for differences between programs, is concordant and follows national accreditation standards; 3) the clinical preparation of all PAs is remarkably consistent across programs and in general offers significantly more clinical training hours than NP programs (on the order of 100% more at minimum); and 4) the national licensing exam is required of ALL PA graduates to become licensed and practice in any state (excluding federal employment) . What this all adds up to is a PA is a consistent product, and while of course there are individual differences, you pretty much know what you're gonna get when you hire a PA. Regardless of the pro-DNP movement, which I've gotta hand it to ya nurses, you certainly know how to enact change and move forward with it (heck, we PAs can't even agree on a simple issue like changing our name to Physician Associate), there is far more variability among NP programs in terms of didactic curricula and clinical preparation requirements. I think this is a huge weakness in the nursing field which will only be magnified under the lens of "online doctorate degrees".

There is a fire storm over at the "allnurses" forum regarding online NP programs. Personally, I find it amazing that entire NP programs are being offered online and I believe it damages our profession.

I started out with an online program (took 7 hours), but decided I needed live interaction, so I transferred to a traditional program. I could have saved a ton of time and money by staying with the online school, but I didn't feel that it would prepare me to practice safely as a nurse practitioner.

I have practiced as a NP for almost 4 years now and I currently precept students from an online program. They don't have to take the GRE to get into grad school, they aren't required to have a formal interview for admission and everything is done "online." Most of the students have never met each other or their professors. They aren't watching lectures on CD's or on the internet, but instead, they are basically reading an online text book. Furthermore, these students get to take their tests at home!

As far as clinicals, they only have to complete a minimum of 500-700 hours and they get to choose the preceptors themselves. One Family NP student spent the majority of her clinical hours with a neurologist who doesn't see kids, even though she is now licensed to work in primary care. Other FNP students never received any training in pedes or OB, yet their license allows them to work in these fields.

I don't have a problem with certain classes being offered online, but I find it unbelievable that a person can take 100% of their classes online and then find a preceptor they want to work with...a lot of them never get an "on site" visit from a faculty member.

Can you imagine a medical school being run like this? Since you're our future employers, what do you think about this?

 

[deleted6669]

heck, we PAs can't even agree on a simple issue like changing our name to Physician Associate

we can agree, we just can't do anything about it because our natl organization has other priorities that none of us care about....
have you seen the assistant vs associate poll at the pa forum recently? with around 600 responses > 85% favor associate.....
and the clinical hrs for pa vs np are something like this:
typical np 500-800 hrs(range 400-1000 or so)
typical pa 2000 hrs+(range 1800-3000)

 

[ChillyRN]

I really appreciate David C's input. As a potential DNP applicant, I would welcome standardization and rigorous oversight. I think I'll go all the way to DNP b/c my parents really beat it into us that there is no such thing as too much education, but I do want my degree to be worth the paper it's printed on (or the 40K I pay for it, lol).

I agree think it has not been proven that the DNP will improve the quality of the field of practitioners as a whole, but everyting I learn today makes me a better person tomorrow, so I read three newspapers a day, professioal journals (even of those profession to which I do not belong) and learn whatever I can, whenever I can. My current passion is physics. Will quantum physics make me a better nurse? Of course not, but I believe all learning has value, even if it only serves to make me a more sought after dinner guest.

I welcome higher standards across the board. I firmly belive nursing should brequire the BSN as a minimum entry point (and I say this as an ADN grad back in the day), a masters for supervision and teaching minimums and a real nursing doctorate (research or clincial, but rigorous in any event) for advanced practice. More education and stricter standards are a win win for everyone.

I hope the future brings a clear way to evaluate all these individual programs, so that we students who want an outstanding education know where to pursue it!

 

[bradt9881]

I really appreciate David C's input. As a potential DNP applicant, I would welcome standardization and rigorous oversight. I think I'll go all the way to DNP b/c my parents really beat it into us that there is no such thing as too much education, but I do want my degree to be worth the paper it's printed on (or the 40K I pay for it, lol).

The problem I have with "degree creep" is the ones that benefit the most are the educatonal institutions, not the students. The same job you can do with a master's now requiring a doctorate and an additional 40K just seems crazy. Save the doctorates for those that want to teach and do research on a University level, and let people like me with no management aspirations wanting to see patients daily alone.

 

[ChillyRN]

The problem I have with "degree creep" is the ones that benefit the most are the educatonal institutions, not the students. The same job you can do with a master's now requiring a doctorate and an additional 40K just seems crazy. Save the doctorates for those that want to teach and do research on a University level, and let people like me with no management aspirations wanting to see patients daily alone.

I'll admit I have a limited background in the educational curriculum for PAs. I am speaking only about NPs. It is simply my opinion that entry to advanced nursing practice should be at the doctorate level. I also think there should be a residency requirement. At least, that is what I'd wish for in a program I attend. If that isn't available to me, I'll have to do the best I can with the avenues that are available. I am certain there is plenty for me to learn, either way!

 

[ChillyRN]

Well, having nothing better to do than sit here and read the entire thread at allnurses while my son gets his braces on (too bad orthodontists don't have midlevels to speed this process up!) I have to say I don't see the aforementioned ballyhoo. I did see one person being unfairly hostile and belligerent to people utilizing distance ed programs. The individul at fault used a lot of hyperbole and straw man arguments and the response varied from rolley eyes icons to brittle defensiveness. It seems crystal clear to the uninfomred reader both here and there that there is no such thing as a 100% online NP program. It seems it is possible to get 100% of the diadactic portion online, which seems OK to me, so long as it is of high calibre. That remains to be seen perhaps, but insulting hard working learners seems counterproductive, and dare I day it, unprofessional. I was led to really question the motives of one individual in particular who seems to have a large chip on his/her shoulder. I do not believe that advancment of the profession is the basis of the diatribe.

All for one and one for all, that is my motto. Another professional's learning methodology doesn't impact me much. I fail to se how the public is impacted if a NP candidate watches a lecture on streaming video vs in person., assuming of course the participant utiizes critical thinking skills and follows up with thoughts, questions, etc. Clearly, clinical hours must be performed on real persons in real clinical enviornments. It appears that all NP programs have to do more to be accountable for that portion. I assert again, that competency is critical and needs to be ensured in a way that it seems it is not at present. Not universally anyway.

Regardless of the method/ location of delivery of diadactic material, testing of said material and clincal competency must be rigorous and transparent. I think some universal standards for both online and brick & mortar programs are needed.

I don't have a strong inclination to either a distance or on the ground program, I just want the best education available. I'd like to see some data that might help me decide what it might be!

Forgive the typos, I'm doing the best I can on a blackberry, lol.

 

[Taurus]

It seems crystal clear to the uninfomred reader both here and there that there is no such thing as a 100% online NP program. It seems it is possible to get 100% of the diadactic portion online, which seems OK to me, so long as it is of high calibre.

Here are some interesting descriptions of DNP programs from their students:

I am currently enrolled in a DrNp program at Robert Morris University in Pittsburgh. The program requires you to be on campus one week each semester. The rest of the course work is done online.

I am completing a DNP online program this May at UTHSC. It is a great program that has more than a couple of options to choose from. You do have to go to campus 4x a year for a few days to meet requirements (for presentations and the occasional lecture), but residencies and coursework is done from home.

I take courses online, and then attend a 3 day seminar each
trimester.​

Do you think that physicians have a positive or negative impressions of DNP programs after reading these comments?

I fail to se how the public is impacted if a NP candidate watches a lecture on streaming video vs in person., assuming of course the participant utiizes critical thinking skills and follows up with thoughts, questions, etc. Clearly, clinical hours must be performed on real persons in real clinical enviornments. It appears that all NP programs have to do more to be accountable for that portion. I assert again, that competency is critical and needs to be ensured in a way that it seems it is not at present.

The weak online NP programs need to be weeded out. I hear way too many stories of incompetent NP's and that hurts the image of NP's in physician eyes. It means that a physician has to take on higher risk when hiring NP's because the NP hasn't learned the basic skills. Chances are, the hiring physician wants an NP who can hit the ground running, not spend 6 months training that NP on skills that she should have already learned.

If physicians don't want to risk hiring NP's, then that decreases the job opportunities for NP's. Ask yourself these questions:
Why is it that many NP's can't find suitable employment and remain working as floor nurses?
Why is that in many places RN's with overtime make more than starting NP salaries?
Why is it that PA's have higher average salaries than NP's?

Until NP's increase their standards and have better enforcement, these problems will persist.

 

[Instatewaiter]

I

The curriculum for the PMHNP Track includes a total of 85 credits and 1,200 clinical hours. The program can be completed either full-time (three years, eight semesters) accelerated part-time (four years, 12 semesters) or part-time (six years, 16 semesters) as follows. The program begins once a year in the fall semester.
Full-Time Option

[List of classes has been removed]

Wow. 1200 clinical hours. That is very little.

I have already done 1200 clinical hours this year and am not even half way done with 3rd year. Frightening that Mundinger is saying that these programs are the same as medical school + FP residency.

If my reading comprehension skills are adequate (I'm only a nurse, so they very well might not be), Iso was not trying to say that online courses take the place of things that need to be hands on, such as labs and procedural experience. Just that it may be an effective way to pass on information vs. listening to a professor read ver batim from his notes, which we've all experienced.

I was not a regular class goer for the first 2 years of med school. By second year I only went to class for lectures I didnt understand, for small group/PBL or for clinical stuff which amounted to only around 5hours/week. I am not an auditory learner, have a terrible attention span and get next to nothing out of lecture. Despite the fact that I did well by studying at home, i fundamentally disagree with online programs.

There is no way to ensure a proper education, no way to check up on students and no way to help those who need it. The problem is in the variability of education.

having unproctored exams is ridiculous.

 

[Faebinder]

Unfortunately, Tired is pretty much right on.

As for the clinical hours... my core surgery rotation in 3rd year med school exceeded 1000 hours. The DNP hours are a joke.

 

[deleted6669]

As for the clinical hours... my core surgery rotation in 3rd year med school exceeded 1000 hours. The DNP hours are a joke.

agree- I spent over 600 hrs on trauma surgery alone as part of 54 weeks of full time rotations including 22 weeks of em( 12 weeks community em/5 weeks peds em/5 weeks urban trauma ctr em).
certainly not as many as an em doc but I had many individual rotations longer than the entire clinical phase of some ms level np programs....although I certainly had more em hrs than a typical fp or im resident ends up with for medschool + residency....the fp residents I precept at my facility do 3 months of em out of 3 yrs....

 

[zenman]

having unproctored exams is ridiculous.

Let's look at exams. What kind do you have in PA and Med school? If you have multiple choice like many instructors write you aren't getting much. Recalling memorized information is the lowest level of learning. You can write multiple choice questions to test comprehension, application, analysis, synthesis, and evaluation but I'll bet most instructors don't know how to do that.

I heard about a professor who gave out his tests before exam date. He knew most would forget about half of the crap he covered during the semester and he wanted them to know the key points. So he gave out the test with what he wanted them to focus on and told them they had to get it 100% correct. It wasn't multiple choice either.

 

[foreverLaur]

Let's look at exams. What kind do you have in PA and Med school? If you have multiple choice like many instructors write you aren't getting much. Recalling memorized information is the lowest level of learning. You can write multiple choice questions to test comprehension, application, analysis, synthesis, and evaluation but I'll bet most instructors don't know how to do that.

I heard about a professor who gave out his tests before exam date. He knew most would forget about half of the crap he covered during the semester and he wanted them to know the key points. So he gave out the test with what he wanted them to focus on and told them they had to get it 100% correct. It wasn't multiple choice either.

I had a professor last quarter who was just lazy. He'd make sample exams for us to do and then the actual exam would be an exact replica of the sample exam... literally. The multiple choice questions were in the same order and the essays were the same. We'd just do the sample exam at home and memorize it. Easiest A ever! It shouldn't have been though -- it was a first year class for Neuroscience Ph.D candidates and an advanced undergraduate elective for the neuroscience degree.

 

[rnnpmaybe]

I had a professor last quarter who was just lazy. He'd make sample exams for us to do and then the actual exam would be an exact replica of the sample exam... literally. The multiple choice questions were in the same order and the essays were the same. We'd just do the sample exam at home and memorize it. Easiest A ever! It shouldn't have been though -- it was a first year class for Neuroscience Ph.D candidates and an advanced undergraduate elective for the neuroscience degree.

Please note that I am against calling DNPs the equivalent of doctors - the training is not as rigorous by ANY means as med school. (which is why I've jumped the DNP ship and will be applying to med school) However, my original post (regarding the amount of hours the program I was in) was to compare DNP hours to PA hours, NOT MD hours. I agree with most here that Mundinger is crazy, and she is part of what is driving me away from nursing. But I still think that NPs have a place, and consider this: Since NPs don't have lateral movement, ALL of the clinical hours are in thier "expertise", such as woman's health. So they may have less clinical hours than PAs, but the clinicals are more focused. Not saying that one is any better than the other. The cracker jack box NP programs do need to be weeded out. They are a hindrance to the nursing profession.

I still sincerely hope that Mundinger is not successful, for nursing's sake. But seriously, you guys honestly think that the public will let physicians go by the wayside to make room for nurse practitioners? I don't see that happening AT ALL.

 

[primadonna22274]

I agree with you rnnpmaybe, and I think Mundinger's responsible for disturbing a LOT of smart NPs who have no interest in the DNP thing.
My office mate is a delightful ANP who's really torn by the whole DNP movement. She doesn't know if it's worth it for her to jump on board and do it now (she's 53) or just hang in as an MSN until she can retire.
As a PA, I'm disturbed by the DNP movement because it WILL spill over into the PA world, like it or not. There's already rumblings of some kind of DPA program. The idea is ostensibly to create a doctoral degree for PA faculty, and I agree there is a need for that, but it won't be long until folks propose it's time for DPA to be an entry-level degree, and that's a concept that I am vehemently opposed to. What is the point of being a PA or NP (sorry, I hate the term "midlevel") if it requires a "clinical doctorate" that is not in any way, shape or form equivalent to an MD/DO and still requires physician supervision?
All it will do is make the training process more expensive and longer and marginalize even more potentially excellent PAs who can't afford the time or money to do a 3-4 year program to be "just a PA". It's silly.
And as far as DNPs edging out primary care physicians, nope, will never happen. I've been in primary care my entire 8 year career and I'll tell you, there is a tremendous need for MORE physicians, not less. PAs and NPs can do a LOT of primary care, and many do it well, but we still need DOCTORS.

I still sincerely hope that Mundinger is not successful, for nursing's sake. But seriously, you guys honestly think that the public will let physicians go by the wayside to make room for nurse practitioners? I don't see that happening AT ALL.

 

[Taurus]

But I think you're fighting a losing battle with the "insufficient training" line. You're essentially saying that with more classroom and training time, they would be competent to perform physician functions. But this will never be true, and we all know it. Nursing school does not prepare one to function as a physician. Neither does a DNP, or even DNP residency.

I am a firm believer in the free market and competition. What I oppose is deception. To me, someone is a fraud who introduces themselves as a "doctor", wears a long white coat, and performs many of the traditional duties of a physician but only has a DNP. The DNP degree is a joke because of the absurdly low bar for admissions and coursework. What's worse, the nursing leaders are actively encouraging their students to perpetuate this fraud on the unwitting public. If the DNP's were like the DO's who accepted the medical model as MD schools with its course content, rigor, and residency, I wouldn't have as much of a problem with DNP's.

While it doesn't seem like we're doing much by talking about this issue, I believe that it is having an effect. There is increasing awareness of this issue by medical students, residents, attendings, etc. The AMA is actively engaged. While we can't win all battles, we can do as much as we can to shape the future. We can get involved politically and in policy-making.

Patients deserve nothing less.