View Full Version : Dnp?


Marachne
09-02-2007, 02:48 PM
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

KimRN
09-04-2007, 02:47 PM
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! :)

Julie
09-05-2007, 05:32 PM
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.

Marachne
09-05-2007, 06:48 PM
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.

Julie
09-06-2007, 02:00 AM
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.

Marachne
09-06-2007, 11:02 AM
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? :o

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?

Mother Jones, RN
09-06-2007, 12:29 PM
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.

Julie
09-06-2007, 12:59 PM
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).

Marachne
09-06-2007, 10:03 PM
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 :D

KimRN
09-07-2007, 08:21 AM
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!

Nps Save Lives
10-19-2007, 01:17 AM
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!

I would also like to see MDs and NPs work as colleagues instead of antagonists as well. :egg: I don't see how becoming a DNP is going to make any difference in their perception or whether it will make any difference in payscale either. The insurance companies probably won't change their policies either. I will probably go back and get the DNP someday just because I am a perpetual student but will remain on the fence for now. I don't agree with it being the entry level. They've been trying for years to make the BSN entry level and can't seem to do that either. We'll see!
Thanks for using us Kim!

Nurse Stella
10-19-2007, 06:58 AM
Ok, so my physician is "Dr. So and So", my pharmacist is Dr. So and So A", and my nurse is "Dr. So and So, RN, MSN, DPN". Hmmmm.... Seriously, NP's at the Masters level is what the position was created for. And they do provide low cost health care, under a physican, in rural areas, with more advanced training than an RN. I guess I disagree that they be required to have a doctorate degree to practice.

B.

P/J
12-18-2007, 06:41 PM
Once again I think it is a matter of standards. The NP plays a very specific role in the health system and Aust NP is a new phenomenon and still being worked out (I believe). But as more people become nurses the standards of these nurses need to be examined. We now have programs which go from any degree to a masters, but does this guarantee that they can do the job? From what I understand of the system you are sponsored to do your MNP here.

But don't forget that your doctor has got a degree not a PhD, they are two different doctors.

Marachne
12-18-2007, 07:18 PM
The DNPs won't have a PhD, it's a clinical doctorate. I think the best parallel is the PharmD. They'll have more hours of internship, and a better understanding on a systems level than the masters prepared NP, and the opportunity to specialize (more than the current population-based family, adult, peds, or gero or psych). So it's more like having being a psychologist with a clinical PsyD)

As I said when I started this thread, I have very mixed feelings about this whole process. My biggest concern is how it will impact availability of providers in rural areas. But I guess it's too late now, it's a done deal in the US

It's interesting, my uni started its bridge DNP program this year (current NPs can get their 2 year DNP, they won't take post bachelor's students until 2009, who then will have a 3 year program). The only positive that I can see is that the last year is in essence a clinical residency, which is not the norm now, I don't think.

storknurse05
12-18-2007, 11:05 PM
The only concern I have is...there are already so many different clinical levels and degrees for nurses, it's confusing for the public. by creating a DNP program it's muddying the waters even more. In my state, at least, DNP is not approved for teaching in Nursing Programs. So you've got PhD, DNP, DNSc, MSN, BSN, ADN, diploma programs, and LPNs....hmmmm. How will we sort it out?:swordfight:

Marachne
12-18-2007, 11:45 PM
Wow, that's interesting that the DNPs can't teach. I know that here one of the approaches they're taking is "we have to have doctorally prepared faculty to teach in the new DNP program, and we want people who are clinically appropriate as well, so we'll start by taking existing NPs and offer them the DNP, and then offer them jobs!"

The one thing I do find interesting about how it's being approached at OHSU is that they took the first class and then closed the program until this first cohort is done. So, the class that came in in 2007, (all experienced NPs) will graduate in 2009. At that point they will start the post-bac program as well as a post masters program. They kind of want to get the first cohort through and figure out what then need to fix before they move on to the next cohort. Considering how many program changes I've been a guinea pig in, it's quite an unusual step!

KimRN
12-27-2007, 11:02 AM
Wow, that's interesting that the DNPs can't teach. I know that here one of the approaches they're taking is "we have to have doctorally prepared faculty to teach in the new DNP program, and we want people who are clinically appropriate as well, so we'll start by taking existing NPs and offer them the DNP, and then offer them jobs!"

The one thing I do find interesting about how it's being approached at OHSU is that they took the first class and then closed the program until this first cohort is done. So, the class that came in in 2007, (all experienced NPs) will graduate in 2009. At that point they will start the post-bac program as well as a post masters program. They kind of want to get the first cohort through and figure out what then need to fix before they move on to the next cohort. Considering how many program changes I've been a guinea pig in, it's quite an unusual step!

That IS an unusual step! It actually makes a lot of sense. Does OHSU have a regular PhD program in nursing?

Marachne
12-27-2007, 02:58 PM
That IS an unusual step! It actually makes a lot of sense. Does OHSU have a regular PhD program in nursing?

Yup. That's the program I'm in (closing in on that dissertation defense....).

We also have a newish Masters in Nursing Education (focus on gero or community health) that I keep trying to sell you on Kim -- we've got some of the best nurse educators (Chris Tanner, Barbara Gaines) in the country, and innovative programs like OCNE, extensive simulation lab work, case-based learning that introduces "patients" in the first year who they follow (along with family and community) through their whole education.

You really do need to check it out (if you want any introductions to faculty, just let me know).

That goes for anyone else interested in graduate level work. If you're interested in the pacific NW, let me know!

KimRN
12-27-2007, 08:46 PM
Yup. That's the program I'm in (closing in on that dissertation defense....).

We also have a newish Masters in Nursing Education (focus on gero or community health) that I keep trying to sell you on Kim -- we've got some of the best nurse educators (Chris Tanner, Barbara Gaines) in the country, and innovative programs like OCNE, extensive simulation lab work, case-based learning that introduces "patients" in the first year who they follow (along with family and community) through their whole education.

You really do need to check it out (if you want any introductions to faculty, just let me know).

That goes for anyone else interested in graduate level work. If you're interested in the pacific NW, let me know!

I will most definitely keep you in mind! Hubby not talking about moving soon - I'm working on him.:whistle:

Mr Ian
12-28-2007, 01:48 AM
I wrote somewhere else about nurses moving up the ranks to doctors - LPN/EN's moving up the ranks to be RN's and HCA/CSW's moving up the ranks to LPN/EN... etc... if anyone knows where I left it.... I'm a forum-slut, sorry.

Anyhow, it makes sense to me in the grand scheme.
Nursing is set to take up the slack from doctors (due to numbers issues etc) and will eventually become the lead role in assessing, diagnosing, determining and evaluating clinical care. Medics will probably act in consultation and liaison only.

However, patients have long dismissed nurses opinions because they weren't "doctors" and insisted on 'speaking with the doctor'. So lets give nurses title of Dr Nurse. That obviates the patient-doctor recognition issue. The title is academic, literally. And this academic title will promote not just nursing status, but also responsibility and accountability.

Mr Ian
12-28-2007, 07:01 AM
Ha! I found it - "Nurses above the daily grind" was the thread I wrote in.

I recant my slutiness.

Julie
12-28-2007, 11:27 AM
I have moved the whole thread to Politics/Debates where it probably belongs. I hope everyone is ok with that.

This is one of that issues that will run and run!
:nurse::whistle::dancing2:

Marachne
12-29-2007, 01:27 AM
I will most definitely keep you in mind! Hubby not talking about moving soon - I'm working on him.:whistle:

Well, let me know if there's anything I can do to help--moving is never fun, but Portland is sure a tempting place to move to!:secret:

Mr Ian
01-14-2008, 10:38 AM
I have moved the whole thread to Politics/Debates where it probably belongs. I hope everyone is ok with that.

This is one of that issues that will run and run!
:nurse::whistle::dancing2:

..and then it died.

lol

Julie
01-14-2008, 11:50 AM
Hope that isn't my fault! :o