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  #1  
Old 09-02-2007, 02:48 PM
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Wink Dnp?

This is aimed specifically at the NPs out there, but I'm curious in general--what do y'all think about the move to making NPs doctorally prepared? I personally have mixed feelings, but I'm not going to voice my opinion until I hear from others first
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Old 09-04-2007, 02:47 PM
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Originally Posted by Marachne View Post
This is aimed specifically at the NPs out there, but I'm curious in general--what do y'all think about the move to making NPs doctorally prepared? I personally have mixed feelings, but I'm not going to voice my opinion until I hear from others first
Okay, I'm not an NP, but my gut feeling is that you will see fewer NPs if the DNP is the entry level into advanced practice. There is nothing stoping an NP from getting their doctorate, but I believe the ability to be an APN seems to be fine at the Master's level.

JMHO!
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Old 09-05-2007, 05:32 PM
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My question would be why?

I have no problem with a nurse doing a doctorate, infact I might do one myself. But I am not sure about a nurse practitioners practice needing to be at that level, heck how do you assess such a thing?

If you want to practice as a doctor, go to medical school would be my assessment.
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Old 09-05-2007, 06:48 PM
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The arguments for include:

--other health care professionals have made "doctor" a terminal clinical degree (i.e. PharmD)

-- It will allow for more clinical hours before practice (which, with people doing direct entry NPs might be a good thing)

-- It will allow for specialization greater than the current FNP, GNP, PNP, etc...

If you want to get the AACN (American Academy of Colleges of Nursing)'s take on it, you can look at their "talking points" here: http://www.aacn.nche.edu/DNP/pdf/DNPTalkingPoints.pdf

There's a bunch of other thing on the AACN site about it, just put in "DNP" in the search field on their first page.

My issue with it is that NPs have been doing a good job in helping to fill the provider gap in underserved areas, providing (more) affordable health care. If the degree goes from being a Master's level to a doctoral level, then it's going to cost more, there will be fewer programs, and it will, in general, be less accessible, both for people wanting to pursue an advanced clinical degree and for people needing health care.

My other issue is that I think the discipline and profession of nursing, in general has had an inferiority complex, and this just reinforces it "we have to have that "D" to be considered 'real' HCPs."

Your argument about go to medical school if you want to be a doctor is, to my mind, not the point: the medical model (symptom-focused) is very different from the nursing model (holistic).

And a PhD in nursing is different from a DNP -- it's a research degree -- one that I too am pursuing (passed comps! finished coursework! dissertation, here I come!)...and has only been in existence for about 30 years -- before that, nurses would either get a DSc or a PhD in another field such as anthropology...and I still get regularly asked "just what good is a PhD for a nurse?" They have no idea about nursing research or scholarship. I guess advanced practice nursing has a parallel history.

Like I said, I'm of mixed mind about this, and was just wondering what others thought.
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Old 09-06-2007, 02:00 AM
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If nurses crave recognition and credibility why do they think they will get it by having a DNP? Don't you think the very holism that such a course followed would be ridiculed by our medical colleagues? As I said before clinical practice cannot ultimately be judged in this way unless you are going to undertake work that was previously the sole domain of the medical practitioner.
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Old 09-06-2007, 11:02 AM
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If nurses crave recognition and credibility why do they think they will get it by having a DNP? Don't you think the very holism that such a course followed would be ridiculed by our medical colleagues? As I said before clinical practice cannot ultimately be judged in this way unless you are going to undertake work that was previously the sole domain of the medical practitioner.
Well, I don't where/if attitudes and practices are different in the UK that in the US. I think that there are MDs who accept/respect/treat as peers NPs, and others (or perhaps medical institutions, like the AMA) who feel threatened by NPs.

And yes, NPs here do "undertake work that was previously the sole domain of the medical practitioner" -- licensing and scope of practice is determined on a state-by-state basis, but, for example, in Oregon, where I live, an NP can have their own, independent practice and/or hospital privileges, they can prescribe (within the scope of their practice) any and all medications including narcotics and other Class II drugs, etc. -- in other words, they are performing the same or similar duties. I know of one person who is an NP at the VA (Veteran's administration -- largest medical system in the US) who is a primary care provider. She is supposed to have a smaller panel and "less complicated" patients, but she's told me about very complex patients that are in her panel (but then, are there many vets in the VA system that aren't complicated?

In addition, there are programs that are called "direct entry." If you already have a bachelors degree, you can do a limited undergrad RN program and then move directly into the NP program (at the school where I am doing my PhD, this is only for Psych NPs and Nurse-Midwives, I don't know about other places). So there are NPs who are new grads from nursing schools, just like new MDs may have no prior clinical practice.

Again, I am not necessarily defending the practice (which will be transitioned in over the next 10 years I believe--different institutions at different rates), I am more wondering what people think, especially as I am of two minds about it.

But it's a done deal -- it is the decision of the AACN that NP will now be a doctorally-prepared position.

So, what's the case with NPs (or their equivalent) in the UK?

And are your Pharmacists now PharmDs?
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Old 09-06-2007, 12:29 PM
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I'm agree with Kim. I think we will see fewer NPs if they turn the job into a PhD position. I think they do just fine at a MSN level. I receive excellent care from my NP.
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Old 09-06-2007, 12:59 PM
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As someone who practiced as an advanced practitioner in the area of rheumatology I can see lots of benefits to being able to work at that level. Here in the UK nurses are also functioning in a similar way to the US, they are able to diagnose, prescribe and treat. I am just really questioning why there is a need to go to that next level. I am also wondering because both on this forum and elsewhere it is pretty obvious that not all doctors view the capabilities of nurses in the same way, and that won't change because the nurse is a DNP. It isn't that I disagree with your viewpoint, more that I am kind of challenging it (if that makes sense).
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Old 09-06-2007, 10:03 PM
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And as I said, I'm not necessarily disagreeing with you, I'm more interested in what people think--and so far, of the folks that have weighed in, most are saying "why?" As I said, my issue is that I see it as a problem in terms of making that advanced practice degree less accessible, and therefore reducing another potential source of care.

But, I also feel incumbent in presenting the other side, because most things do have at least to sides to them -- and my cultural background makes it hard to walk away from a debate
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Old 09-07-2007, 08:21 AM
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Boy would I like to see the day that doctors and advance practice nurses (MSN or DNP prepared) see each other as health care colleagues instead of antagonists.

I think nurses feel this way already, the problem is on the medical side - I think it's a time factor, actually. As younger doctors come into the field and more APNs are found in the field the dynamic should change.

Lord knows here is enough need for health care to go around. I will say this: if I see a medical practice that uses NPs I have a much greater respect for that practice and will use the NP whenever possible!
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