DNP or Resident

[237696]

I don't understand why more people don't challenge this supposed research that shows NPs providing "care equal to or better than a physician" when the individual research projects support no such claim.

A typical study randomly assigns patients who have already been diagnosed with a specific disease (I think the study Mundinger authored and is always throwing around used specifically hypertension, type II diabetes and asthma) to either physicians or NPs and usually includes less than a dozen NPs and a few hundred patients. They track patients for a relatively short period (6 or 12 months maybe), calling it long-term follow up, and then measure patient satisfaction surveys and resource utilization (number of specialist/ER visits, etc) or basic lab numbers. They get comparable results and then somehow declare that their study shows NPs being "equal" to physicians. It's absurd. And if I hear or read one more person saying "studies show NPs to deliver care equal to or better than physicians" I'm going to scream.

Frankly, these studies could probably include a third group of RNs or medical assistants, plop patients with a pre-diagnosed condition on their lap and direct them to follow cookbook treatment algorithms and end up with another group providing "comparable care" to physicians. Teach them to smile and be on time and make good small talk and their "patient satisfaction" scores would be just as high.

There are so many holes in these research designs that I think people embarass themselves without realizing it when they reference them, and yet the faulty conclusions people extrapolate from them seem to have found a permanent hold in the DNP advocacy/propoganda machine and they go to their state legislatures and repeat this drivel unchallenged.

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[prairiedog]

I don't understand why more people don't challenge this supposed research that shows NPs providing "care equal to or better than a physician" when the individual research projects support no such claim.

A typical study randomly assigns patients who have already been diagnosed with a specific disease (I think the study Mundinger authored and is always throwing around used specifically hypertension, type II diabetes and asthma) to either physicians or NPs and usually includes less than a dozen NPs and a few hundred patients. They track patients for a relatively short period (6 or 12 months maybe), calling it long-term follow up, and then measure patient satisfaction surveys and resource utilization (number of specialist/ER visits, etc) or basic lab numbers. They get comparable results and then somehow declare that their study shows NPs being "equal" to physicians. It's absurd. And if I hear or read one more person saying "studies show NPs to deliver care equal to or better than physicians" I'm going to scream.

Frankly, these studies could probably include a third group of RNs or medical assistants, plop patients with a pre-diagnosed condition on their lap and direct them to follow cookbook treatment algorithms and end up with another group providing "comparable care" to physicians. Teach them to smile and be on time and make good small talk and their "patient satisfaction" scores would be just as high.
There are so many holes in these research designs that I think people embarass themselves without realizing it when they reference them, and yet the faulty conclusions people extrapolate from them seem to have found a permanent hold in the DNP advocacy/propoganda machine and they go to their state legislatures and repeat this drivel unchallenged.

I am wondering why you would not use this same method for MDs to attain the same scores? "Teach them to smile and be on time and make good small talk and their "patient satisfaction" scores would be just as high."

 

[237696]

I am wondering why you would not use this same method for MDs to attain the same scores? "Teach them to smile and be on time and make good small talk and their "patient satisfaction" scores would be just as high."

I think you're missing my point, which is that patient satisfaction scores have little to do with assessing the medical knowledge of a practitioner or the quality of care delivered. Most patients don't have the ability to accurately judge whether the medical advice they're getting is sound and appropriate, and the effects of poor care may not show up for many years. So they rate their provider on what they do understand- wait times, clean offices, price, friendly staff, etc. Yes those things are important, don't get me wrong, but anyone can do them. It doesn't make someone a superior provider and it doesn't mean they necessaily achieve better medical outcomes. Sometimes patients will also more highly rate someone who gives them what they want (narcotic pain medicine or antibiotics for a cold) than someone who appropriately denies such requests.

Patient satisfaction surveys have no value in a real research study designed to measure medical knowledge and competency, although they may be useful for a variety of other purposes.

 

[prairiedog]

I think you're missing my point, which is that patient satisfaction scores have little to do with assessing the medical knowledge of a practitioner or the quality of care delivered. Most patients don't have the ability to accurately judge whether the medical advice they're getting is sound and appropriate, and the effects of poor care may not show up for many years. So they rate their provider on what they do understand- wait times, clean offices, price, friendly staff, etc. Yes those things are important, don't get me wrong, but anyone can do them. It doesn't make someone a superior provider and it doesn't mean they necessaily achieve better medical outcomes. Sometimes patients will also more highly rate someone who gives them what they want (narcotic pain medicine or antibiotics for a cold) than someone who appropriately denies such requests.

Patient satisfaction surveys have no value in a real research study designed to measure medical knowledge and competency, although they may be useful for a variety of other purposes.

I think you missed my point, patient satisfaction scores have everything to do with success. Why not add this to the list of expected competencies. If "anyone" can do them, why can't so many MDs? In addition, I hope you are not suggesting that only non MDs give patients what they want (narcotic pain medicine or antibiotics for a cold). Maybe you can speak to the research about those who appropriately deny such requests.

 

[237696]

I think you missed my point, patient satisfaction scores have everything to do with success. Why not add this to the list of expected competencies. If "anyone" can do them, why can't so many MDs? In addition, I hope you are not suggesting that only non MDs give patients what they want (narcotic pain medicine or antibiotics for a cold). Maybe you can speak to the research about those who appropriately deny such requests.

Oh good grief, I did not suggest that patient satisfaction has nothing to do with "success" or that only mid-levels give unnecessary narcotics and antibiotics or any other crazy stretches you're trying to come up with in an effort to perceive offense.

Seriously, just take what I wrote at face value. The only thing I am speaking to is why "patient satisfaction" is not an appropriate measure for determining whether a provider has adequate medical knowledge and skills, delivers appropriate care or achieves favorable long-term outcomes. There may be a weak correlation, but it is subject to lots of error. The narcotics/antibiotics things was an example of why this is so, not an accusation against any one group. I have no idea which group, if either, is more likely to do this. But my point was that studies which include this metric in an attempt to demonstrate that NP's provide "equivalent" care to MDs are bogus because they are not measuring what they claim to measure. Studies of short-term patient satisfaction reveal just that- which group patients are most satisfied with. Not which group provided superior care.

Having a high degree of patient satisfaction is obviously important and critical for lots of things- patient compliance, financial success, whatever- but it is not a meaure of clinical competency in the context for which it was used in these studies.

Whether or not MDs have inferior bedside manners, or should have higher levels of patient satisfaction than they do, or are more/less likely to cave to patient demands, etc... those are all straw issues relative to the point of my original response.

 

[nebrfan]

What's happening in this world?

 

[Trauma Mama]

I don't have a problem with NPs working as mid levels. I have a problem with NPs trying to rise above that role and play doctor, especially when their education is VERY sub par to medical school.

The why are you over on Allnurses, claiming you plan on becoming a NP? Here on SDN, you are planning on becoming a PA. So, which is it?

 

[core0]

The why are you over on Allnurses, claiming you plan on becoming a NP? Here on SDN, you are planning on becoming a PA. So, which is it?

You need to read all the posts where she flips back and forth. Its actually quite amusing. On the other hand you have three posts and two are about foreverlaur? Seems like her question on allnurses stirred up some feelings.

 

[oldiebutgoodie]

This thread makes my stomach turn so much sometimes. It's repulsive and reckless how much we devalue a physician's hard work and sacrifices. What's happening in this world?

I, for one, truly appreciate the work that physicians have put into their training. But I tend to read the SDN forums, and am amazed at what you have to put up with in medical school. Perhaps all PA and NP wannabes should be required to read these forums!

On a different note, my guess is that the NP/DNP movement is partially fueled by anger that nurses have accumulated over the years over disrespect they have received from MDs. Most MDs I work with are great, but there are a lot of docs out there who see the nurses as waitresses, and have no problem screaming at them. I think the newer physicians are not like that, but older physicians (and unfortunately, a good percentage of surgeons) are on a power trip. Hell hath no fury like an RN scorned.

Oldiebutgoodie

 

[Trauma Mama]

You need to read all the posts where she flips back and forth. Its actually quite amusing. On the other hand you have three posts and two are about foreverlaur? Seems like her question on allnurses stirred up some feelings.

Good point. I'm recovering from surgery, and apparently have way too much time on my hands. Thanks for pointing that out.

My surgery was done by a surgeon, by the way.

 

[mig26x]

its amazing on how a curriculum that doesnt have anything to do with clinical medicine will give the power to nurses to become "physicians". I still look at the curriculum and start laughing but at the same time feel bad for patients. Its even residents after 4 years of med school and they have to precept to an attending patients during residency because the medical field feel they are not ready to make desicions w/o supervision. Im still amaze that they let nurses do this, which went to NURSING school to apply to nursing jobs.

I give it to you that some experience nurses (15-20 years of experience) might have SEEN how to practice medicine, but what happens in a few years and the DNP is the final degree to become a nurse-physician and you have all this new nurses practicing medicine?

Its going to be a field day for lawyers!!!

 

[silas2642]

Good point. I'm recovering from surgery, and apparently have way too much time on my hands. Thanks for pointing that out.

My surgery was done by a surgeon, by the way.

A nurse could have done it better.

 

[zenman]

: What's happening in this world?

Hang around for 2012 and see what happens

 

[foreverLaur]

A quote from someone on allnurses.com:

"On a related note, at a DNP info session that I attended recently, the director of the program mentioned Mary Mundinger's role in the push for the DNP, and said she had heard or read somewhere that Mundinger's NP students at Columbia School of Nursing had somehow been able to take the Medical Board Exams (that MD's take) and passed them. Has anyone else heard that? Interesting."

 

[Taurus]

A quote from someone on allnurses.com:

"On a related note, at a DNP info session that I attended recently, the director of the program mentioned Mary Mundinger's role in the push for the DNP, and said she had heard or read somewhere that Mundinger's NP students at Columbia School of Nursing had somehow been able to take the Medical Board Exams (that MD's take) and passed them. Has anyone else heard that? Interesting."

I think you're referring to the exam that Mundinger pushed for. The exam is loosely based on USMLE step 3.

I know that the AMA resolution did pass btw last summer. The AMA doesn't want the NBME to reuse the material from the USMLE for the nurses. If DNP's want to create a certifying exam, they can make their own. Because we all know what would happen if we allowed DNP's to take an exam that is supposed to be based on step 3. They will mislead lawmakers, other health professsionals, and patients by telling them that "we take the same test that doctors take." That frankly is unacceptable. It's typical nursing propaganda and lies. You can already see that in the allnurses.com post there.

I'm glad that the AMA is active on this issue and I hope it is just the beginning. You know I prefer a much more forceful and comprehensive response.

 

[psychbender]

A quote from someone on allnurses.com:

"On a related note, at a DNP info session that I attended recently, the director of the program mentioned Mary Mundinger's role in the push for the DNP, and said she had heard or read somewhere that Mundinger's NP students at Columbia School of Nursing had somehow been able to take the Medical Board Exams (that MD's take) and passed them. Has anyone else heard that? Interesting."

I'm going to go out on a limb and say that that's a crock of ****. Now, the powers that be with advanced nursing education did try to get the NBME to design an optional DNP board exam, that would be based off of USMLE Step 3, but that effort was shot down earlier this year before it could ever be truly developed.

 

[core0]

I'm going to go out on a limb and say that that's a crock of ****. Now, the powers that be with advanced nursing education did try to get the NBME to design an optional DNP board exam, that would be based off of USMLE Step 3, but that effort was shot down earlier this year before it could ever be truly developed.

Actually no it wasn't. The test was given in November with a 50% pass rate:
http://www.abcc.dnpcert.org/exam_performance.shtml

Of course its not exactly crystal clear what happened. For example how do you get a 50% pass rate with 45 people? What were the true numbers? Were the cutoffs the same as used for the USMLE? Did USMLE score the test or did ABCC?

Lots of questions, not much transparency.

David Carpenter, PA-C

 

[Taurus]

Actually no it wasn't. The test was given in November with a 50% pass rate:
http://www.abcc.dnpcert.org/exam_performance.shtml

Of course its not exactly crystal clear what happened. For example how do you get a 50% pass rate with 45 people? What were the true numbers? Were the cutoffs the same as used for the USMLE? Did USMLE score the test or did ABCC?

Lots of questions, not much transparency.

David Carpenter, PA-C

According to the stats from 2005, here are the USMLE step 3 passrate data for first-time takers:

MD: 96% for 16934 test takers
DO: 93% for 95 test takers
IMG: 75% for 8307 test takers

If only half of DNP's could pass an exam that is probably not even as difficult as the real step 3 whereas there is a 96% passrate for US MD's, this is the type of evidence that we need to demonstrate to lawmakers and the public that DNP's are dangerous to practice independently.

 

[psychbender]

Actually no it wasn't. The test was given in November with a 50% pass rate:
http://www.abcc.dnpcert.org/exam_performance.shtml

David Carpenter, PA-C

I stand partially corrected. The last I had heard was from back in the summer when the AMA passed its resolution.

 

[core0]

I stand partially corrected. The last I had heard was from back in the summer when the AMA passed its resolution.

The USMLE is an independent body. They don't have to pay any attention to what the AMA wants. They have a long history of developing tests for other certifying bodies. The issue I have is that they allowed the test to be compared to the step III. If you look at what they say:
"While the CACC exam is derived from the USMLE Step 3, the certification for graduates of DNP programs is customized by CACC content experts."

So from that you have no idea what they really tested. Did they make it harder, easier or the same? Nobody knows. In addition if you look at who makes up the board its essentially three members of the Columbia Faculty (which Mundinger heads) a physician from U Penn (looks like he was dean of medicine in the past) and a nursing professor from University of Tennessee.

The primary purpose of a certification is to protect the public not advance a cause. I don't see representation of the public here. If you look at any other medical certification organization you have public representation either through the composite board (ie FSMB that oversees USMLE or the BONs that oversee the NCLEX.) or through direct representation. Only in advance practice nursing do the people being regulated do the regulation. In addition the organization that promotes the profession should be separate from the organization that does the certification (again in the interests of public protection). The BONs do not allow the ANA to run the NCLEX for that very reason. Look at the composition of ABCC and the CACC. The certification is simply a subset of the members that promote the DNP. Make your own conclusions.

David Carpenter, PA-C

 

[fab4fan]

You need to read all the posts where she flips back and forth. Its actually quite amusing. On the other hand you have three posts and two are about foreverlaur? Seems like her question on allnurses stirred up some feelings.

I just came across this fascinating gem:

I am not in nursing school nor have I ever been in nursing school. I will graduate in March with a BA in Psychology. The only health care experience I have is a lot of shadowing and volunteering in an ED.

Interesting, since she previously told us on several occasions she was an LPN, but she was choosing to work as a waitress because she made more money than she would as a nurse.

fL can't keep her stories straight over on allnurses, either.

 

[Farmer Jane]

Imagine that. Wow. Sure couldn't see that coming.

 

[237696]

Actually no it wasn't. The test was given in November with a 50% pass rate:
http://www.abcc.dnpcert.org/exam_performance.shtml

Of course its not exactly crystal clear what happened. For example how do you get a 50% pass rate with 45 people? What were the true numbers? Were the cutoffs the same as used for the USMLE? Did USMLE score the test or did ABCC?

Lots of questions, not much transparency.

David Carpenter, PA-C

Very shady indeed. 22/45 is 48.89% and 23/45 is 51.11%. Where did they get the 50% pass rate?

 

[Josh L.Ac.]

Have you sat through a nursing drug calculations class?



That was too easy.

 

[core0]

Have you sat through a nursing drug calculations class?



That was too easy.

My nursing classes ended with nursing theory (my first and only nursing class). We had a nurse teaching our Paramedic program. She couldn't figure out how I could do drip rates in my head and I couldn't figure out her "method" (which appeared to involve using base 12 numerals and translation into Sanskrit). I sometimes think there is math and nursing math.

 

[foreverLaur]

It wasn't really "nursing school." I did a LPN program to get out of taking boring high school classes and never did anything with it and I haven't ever looked back. I don't consider myself to have ever attended nursing school or have been a nurse. I am going to nursing school in the fall. Do I have to upload my high school transcript showing that I did the LPN program that I provided a link to earlier?!? I didn't care about it at that point, didn't paid attention, didn't learn much, and never did anything with it. Like I said, it was just simply a way to get out of boring high school classes.

 

[Therapist4Chnge]

My nursing classes ended with nursing theory (my first and only nursing class). We had a nurse teaching our Paramedic program. She couldn't figure out how I could do drip rates in my head and I couldn't figure out her "method" (which appeared to involve using base 12 numerals and translation into Sanskrit). I sometimes think there is math and nursing math.

*MOD NOTE: Let's keep it professional please.........*

 

[Taurus]

Very shady indeed. 22/45 is 48.89% and 23/45 is 51.11%. Where did they get the 50% pass rate?

Strong work, Sherlock. You caught the nurses red handed in another lie!

 

[Taurus]

The USMLE is an independent body. They don't have to pay any attention to what the AMA wants. They have a long history of developing tests for other certifying bodies. The issue I have is that they allowed the test to be compared to the step III. If you look at what they say:
"While the CACC exam is derived from the USMLE Step 3, the certification for graduates of DNP programs is customized by CACC content experts."

So from that you have no idea what they really tested. Did they make it harder, easier or the same? Nobody knows. In addition if you look at who makes up the board its essentially three members of the Columbia Faculty (which Mundinger heads) a physician from U Penn (looks like he was dean of medicine in the past) and a nursing professor from University of Tennessee.

The primary purpose of a certification is to protect the public not advance a cause. I don't see representation of the public here. If you look at any other medical certification organization you have public representation either through the composite board (ie FSMB that oversees USMLE or the BONs that oversee the NCLEX.) or through direct representation. Only in advance practice nursing do the people being regulated do the regulation. In addition the organization that promotes the profession should be separate from the organization that does the certification (again in the interests of public protection). The BONs do not allow the ANA to run the NCLEX for that very reason. Look at the composition of ABCC and the CACC. The certification is simply a subset of the members that promote the DNP. Make your own conclusions.

David Carpenter, PA-C

I think the AMA should turn around and use certification exams against the DNP's. If according to Mundinger, DNP's have the medical knowledge of a physician, shouldn't they then be tested like a physician?

Let them take the USMLE steps I, II CK & CS, and III. Let them take the written and oral boards for FP, IM, psych, etc. If any NP or PA can pass this gamut of tests, then they should be considered equivalent to physicians. It's similar to the idea of the bar exam. Pretty much anybody can take the bar exams but it is very difficult to pass without the proper training. This would be a far better system than what we have now. A NP/DNP today could graduate and not be able to pass any part of the USMLE or boards and yet have the same scope as a physician in some states. If the unwitting public realized how much risk that NP's pose, there would be public outcry. To me, this is no different than the flying security issue before 9/11. The public did not know how much at risk they were until it was too late.

 

[foreverLaur]

I think the AMA should turn around and use certification exams against the DNP's. If according to Mundinger, DNP's have the medical knowledge of a physician, shouldn't they then be tested like a physician?

Let them take the USMLE steps I, II CK & CS, and III. Let them take the written and oral boards for FP, IM, psych, etc. If any NP or PA can pass this gamlet of tests, then they should be considered equivalent to physicians. It's similar to the idea of the bar exam. Pretty much anybody can take the bar exams but it is very difficult to pass without the proper training. This would be a far better system than what we have now. A NP/DNP today could graduate and not be able to pass any part of the USMLE or boards and yet have the same scope as a physician in some states. If the unwitting public realized how much risk that NP's pose, there would be public outcry. To me, this is no different than the flying security issue before 9/11. The public did not know how much at risk they were until it was too late.

There is the part of me that enjoys stirring up trouble like this. I'd love to see the responses you'd get from currently practicing advanced practice nurses over on allnurses.com...

 

[Taurus]

There is the part of me that enjoys stirring up trouble like this. I'd love to see the responses you'd get from currently practicing advanced practice nurses over on allnurses.com...

The response would be fear. Not only would additional testing make it more difficult to be licensed as an NP/DNP but also how would it reflect on the profession if only 5% of NP/DNP's could pass the testing gamut whereas 96% of US MD's can. The nurses don't want to give lawmakers, lawyers, and insurance companies concrete evidence and more ammunition of the vast differences in the abilities of physicians and NP/DNP's.

No matter how the nurses feel about it, the AMA would never stand for DNP's trying to practice medicine like physicians without having the same credentials. There's not much the nurses can do about it either. It's inevitable that DNP's in the future will require more years in school, more clinical hours, more tests to take. The AMA will force them to jump through more hoops, just like how they have physicians do it. The AMA could easily go to the state legislatures to demand more licensure requirements for public safety reasons. How can DNP's argue otherwise? If a profession is claiming to have the medical knowledge of physicians, shouldn't they also be tested like physicians?

In the end, the question is, why would anybody become a DNP then if the length of training and rigor are similar? The vast majority of the public will never know that the DNP's is a "doctor" just like how the vast majority of the public doesn't know that DO's are physicians. Most students would prefer to go to an MD school vs a DO school just because they don't want to explain to people what a DO is.

 

[mig26x]

Im with you Taurus, if they want to practice medicine independently lets give them the chance to take step 1, 2 CK and CS, 3 and then get board certified in IM or FM.

lets not forget about the shelf exams in 3rd year of med school!!

thats easy!!

 

[jbar]

Im with you Taurus, if they want to practice medicine independently lets give them the chance to take step 1, 2 CK and CS, 3 and then get board certified in IM or FM.

lets not forget about the shelf exams in 3rd year of med school!!

thats easy!!

One thing that worries me about saying "if you can pass the test you are all set" is that the MD tests are incorporated into the timeline of medical school. You have to study for these tests during school because you can't go on to the next step, third year or residency or whatever, until you pass the last test. So it would worry me if people could finish the DNP and then spend a year or two studying for these tests and claim that they are just as prepared. Just about anyone can pass any test if they have long enough to study.

 

[mig26x]

One thing that worries me about saying "if you can pass the test you are all set" is that the MD tests are incorporated into the timeline of medical school. You have to study for these tests during school because you can't go on to the next step, third year or residency or whatever, until you pass the last test. So it would worry me if people could finish the DNP and then spend a year or two studying for these tests and claim that they are just as prepared. Just about anyone can pass any test if they have long enough to study.

that's a very good point.
Step 1 in summer of second year to third year
Step 2 CS and CK during rotations of 4th year
Step 3 during residency in between the 80 hours per week
Board certified: months after finishing residency.

so yeah, all this exams are taken with few weeks off to prepare.

 

[fab4fan]

It wasn't really "nursing school." I did a LPN program to get out of taking boring high school classes and never did anything with it and I haven't ever looked back. I don't consider myself to have ever attended nursing school or have been a nurse. I am going to nursing school in the fall. Do I have to upload my high school transcript showing that I did the LPN program that I provided a link to earlier?!? I didn't care about it at that point, didn't paid attention, didn't learn much, and never did anything with it. Like I said, it was just simply a way to get out of boring high school classes.

No, just try to keep your lies straight. Your previous posts can be used against you. (FWIW, an LPN program is a type of nursing school. What kind of fool goes all the way through an LPN program and then doesn't bother to at least take a stab at the licensing exam? Something doesn't pass the smell test...again.)

 

[core0]

Just to make it more confusing I saw a posting on another list. There are DNP programs out there that are not for APNs. These programs are for leadership roles. If you look at the DNP white paper its clear that the DNP is designed for APNs (ie CRNA, NP, CNS and CNM). However there are a number of programs that are awarding the DNP for nursing leadership. Here is one such example:
http://www.usfca.edu/nursing/programs_of_study/dnp_program_for_bsn_hcsl.html

Right now you can tell who is an NP since NP is a protected term in pretty much every state. However, apparently with the DNP you won't be able to tell who can treat and prescribe and who cannot.

David Carpenter, PA-C

 

[Therapist4Chnge]

Wow.

From USF.....

Practicum I: Role Development
Practicum II: Role Implementation
Practicum III: Role Evaluation
Practicum IV: Role Synthesis

So no real research, no real advanced practice clinical hours.....just a bunch of weak sounding classes.

If a DNP program came out with a real curriculum, real research requirements, and real clinical requirements...then maybe it would gain more respect. As it is now, it seems like a lot of fluffy classes.

 

[fab4fan]

Just to make it more confusing I saw a posting on another list. There are DNP programs out there that are not for APNs. These programs are for leadership roles. If you look at the DNP white paper its clear that the DNP is designed for APNs (ie CRNA, NP, CNS and CNM). However there are a number of programs that are awarding the DNP for nursing leadership. Here is one such example:
http://www.usfca.edu/nursing/programs_of_study/dnp_program_for_bsn_hcsl.html

Right now you can tell who is an NP since NP is a protected term in pretty much every state. However, apparently with the DNP you won't be able to tell who can treat and prescribe and who cannot.

David Carpenter, PA-C

This is one of the many reasons why you will never see my support of this foolishness. Healthcare is turning into a morass of providers with alphabet-soup titles.

 

[zenman]

Wow.

From USF.....

Practicum I: Role Development
Practicum II: Role Implementation
Practicum III: Role Evaluation
Practicum IV: Role Synthesis

So no real research, no real advanced practice clinical hours.....just a bunch of weak sounding classes.

If a DNP program came out with a real curriculum, real research requirements, and real clinical requirements...then maybe it would gain more respect. As it is now, it seems like a lot of fluffy classes.

Let's put the course descriptions in for a clearer picture.

NURS - 790. Practicum I: Role Development (3)

Prerequisite: NURS - 783. Corequisites: NURS - 784, NURS - 786. Clinical practice course which provides for the role development of the clinical systems manager under the supervision of preceptor. Students will select a setting (i.e., hospital, long term, community health agency) where principles of management of clinical systems can be evaluated. Students will determine individual goals and learning objectives consistent with a learning contract negotiated with a preceptor and approved by faculty. Clinical placement will be based on students' clinical interest and the availability of preceptors.

NURS - 791. Practicum II: Role Implementation (3)

Prerequisite: NURS - 790. Clinical Course. A clinical practice course in which the student implements the role of the clinical systems manager under the supervision of a preceptor. Students will select a setting (hospital, long term or community health agency) where concepts, theories, and principles of administration and management can be applied. Students will determine individual goals and learning objectives consistent with a learning contract negotiated with a preceptor and approved by faculty. Clinical placement will be based on students' clinical interest and the availability of preceptors.

NURS - 792. Health Systems' Practicum III: Role Evaluation (5)

Clinical practice course in which the student evaluates the role of the clinical systems leader. Students will develop, implement, and evaluate evidence-based practice designed to positively impact patient care outcomes. Students will determine individual goals and learning objectives consistent with a learning contract negotiated with a preceptor and approved by faculty. Clinical placement will be based on students' clinical interest and the availability of preceptors.

NURS - 793. Health Systems' Practicum IV: Role Synthesis (5)

Clinical practice focused on synthesis of the advanced practice role based on an evidence-based practice approach to healthcare systems. Students will determine individual goals and learning objectives consistent with a learning contract negotiated with a preceptor and approved by faculty. Clinical placement will be based on students' clinical interest and the availability of preceptors.

 

[prairiedog]

Just to make it more confusing I saw a posting on another list. There are DNP programs out there that are not for APNs. These programs are for leadership roles. If you look at the DNP white paper its clear that the DNP is designed for APNs (ie CRNA, NP, CNS and CNM). However there are a number of programs that are awarding the DNP for nursing leadership. Here is one such example:
http://www.usfca.edu/nursing/programs_of_study/dnp_program_for_bsn_hcsl.html

Right now you can tell who is an NP since NP is a protected term in pretty much every state. However, apparently with the DNP you won't be able to tell who can treat and prescribe and who cannot.

David Carpenter, PA-C

Are you saying anyone with a DNP will be able to treat and prescribe?

 

[oldiebutgoodie]

Well, the problem (among many others) is that the DNPs are being designed to sound more like Health Care Administration/MBA/Project Management. They aren't clinical.

Here is Columbia's curriculum (teken from http://cpmcnet.columbia.edu/dept/nursing/programs/drnp_factsheet.html )

Support Core 19
Translation and Synthesis of Evidence for Optimal Outcomes
Quantitative Research Methods
Epidemiology and Environmental Health
Legal and Ethical Issues
Clinical Genomics Advanced Seminar
Practice Management
Informatics
Clinical Core 11
Doctor of Nursing Practice I and II
Didactic
Clinical
Didactic and Clinical
Chronic Illness Management
Residency/Seminar10
Total credits 40

What a lot of foolishness. This is supposed to be the equivalence of an MD?

Oldiebutgoodie
(MSN student)

 

[mig26x]

this dnp thins is a complete joke!!!

 

[core0]

Are you saying anyone with a DNP will be able to treat and prescribe?

If you look at the DNP white paper the DNP is an extension of the APN practice. However, the problem is that nursing has a problem with defining a role by the degree. Even within the NP community there have been a variety of Masters degrees given out not all of them in nursing (although this has changed with reimbursement issues related to NPs having non nursing masters). A few years back there was a new MSN degree developed called the Clinical nurse leader. The evolution is difficult to describe but it is similar to the CNS role in states where the CNS is not an APN. The DPN seems to have been coopted by this same group who are attempting to use it to make a universal clinical doctorate regardless of APN status or not.

Organized nursing would like to tie the degree to the profession. However, just as with the RN licensure they seem to be unsuccessful in tieing the NP to the DNP.

David Carpenter, PA-C

 

[Taurus]

One thing that worries me about saying "if you can pass the test you are all set" is that the MD tests are incorporated into the timeline of medical school. You have to study for these tests during school because you can't go on to the next step, third year or residency or whatever, until you pass the last test. So it would worry me if people could finish the DNP and then spend a year or two studying for these tests and claim that they are just as prepared. Just about anyone can pass any test if they have long enough to study.

That's a good point. However, the USMLE steps are not written in stone. As you may know, the powers that be are evaluating revising the steps. In the near future, it's likely that steps 1 and 2 will be combined and you take this exam in the 4th year.

The AMA and NBME need to go further. Why not have one comprehensive exam that combines all the steps? Make this exam the minimum to be licensed as a physician and then in addition you have your boards in your specialty. The idea is to raise the bar very high so that only individuals with knowledge and mastery of the material can pass. It's similar to the idea of the bar exam for lawyers. If DNP's want to claim that they have the "medical knowledge of physicians", then force them to take the same damn exam so that everyone can see how they DNP's and physicians compare in knowledge.

We all hear stories about NP's not knowing their basic physiology and pathology and how an NP with 20 years of experience can't perform at the same level as an intern, but unless it's documented somewhere or published it's all anecdotal. The nursing organizations will do their best to discredit anecdotes and use propaganda and junk studies to convince lawmakers and the public that they are just as good or superior to physicians. "Research supports NPs out-perform physicians in these areas." What we need to convince the lawmakers and the public and not to mention the lawyers and insurance executives out there the differences between physicians and DNP's, you need concrete evidence like this.

I have no doubt that some of the DNP proponents are starting to regret that they went down this path with the DNP degree and pushing for a watered-down step 3 exam. If only half of DNP's can pass a watered-down exam while 96% of US MD's can pass with the real thing, then that has to give them pause. If we had a comprehensive exam, I'm guessing that only 5% of DNP's and 95% of physicians would pass. Keep in mind that the DNP's who took the exam so far were from Columbia University and probably had many years of NP experience prior going back for their DNP's. They had a 50% passrate. Just imagine how the DNP's who got their degrees online or from direct entry programs would fare. Much less than 50%. Or imagine what their passing rate if the NBME sets the level to pass difficult enough so that US MD's have a passrate of 75%. There are many levers that the AMA can pull.

 

[meister]

Do you have a link stating that only half of them passed the watered down test?

 

[Taurus]

Do you have a link stating that only half of them passed the watered down test?

50% passing, n = 45

Keep in mind a few things
- Step 3 is the easiest of the all steps. Many residents study for 2 days on post-call days. 96% of US MD's pass this test on their first try, n > 16,000 students. Only 50% of these DNP's could pass a watered down step 3.
- From what I heard, the 45 who took it were from Columbia's DNP program where Mundinger is dean. Compared to many other DNP programs, these Columbia students are probably the creme de la creme of DNP's. How would DNP's who got their degrees online or from Podunk U do? Much worse. Furthermore, the some of the first graduates of DNP programs are highly experienced NP's with +20 years of experience. How would a DNP with no experience such as those BSN-DNP programs do on this exam? Much worse.

 

[basupran]

Wow....

 

[meister]

Wow...that is horrible. Can't say I'm surprised.


And as we speak they're lobbying for full and complete autonomy based on ******ed malpractice figures. Unbelievable that this is happening. Legislators will grant their wish solely to save money, and we all get the shaft.

 

[mig26x]

Wow...that is horrible. Can't say I'm surprised.


And as we speak they're lobbying for full and complete autonomy based on ******ed malpractice figures. Unbelievable that this is happening. Legislators will grant their wish solely to save money, and we all get the shaft.

we will get the shaft but ultimately the patients are the one's that are going to suffer the consequences.

when you have only 50% of the class that represents the DNP movement pass a test that tends to image USMLE step 3, which we all know is the easiest step, its a little bit worrisome.

 

[foreverLaur]

It would have made sense if you would have known me back then. I was lazy and unfocused and I didn't care. I made fun of all my friends going to nursing school. I thought it was stupid and a joke. I had zero desire to go into nursing. I was just insanely bored in high school and wanted a way to get out of going. I figured the LPN classes would be as close as I could get to meshing up with my medical school dreams. I have slept through my "LPN" program and didn't retain anything. I had no desire to work as a nurse. None. I was lazy and unfocused when I was younger. I thought I was on top of the world and better than everyone else. Going to a university will shut someone up there really quick. I realized I had a LONG way to go and A LOT to learn.