The DNP Exam - Talking with Mary Mundinger

A certification exam to document actual advanced clinical competency? That's great!   Looks like some of the "fluff" DNP training programs will have to reinvent themselves.

PhysiciansNews.com published an article titled " Growing Role of Nurse Practitioners " last week, which

Having a national DNP certification will be a great thing across the board whether you specialize in primary care, acute care, midwifery, anesthesia.  Physicians sit before different boards yet all of the have the same degree--MD. It is time in the 21th century that we nurses band together and unite to strengthen our profession and do away with old arguments.  Even though we have concerns about the entry into practice, we should establish the apex and leaders of the profession.  

Yes, the DNP will be designated to all APNs (CRNAs, CNMs, NPs, CNSs) and the accrediting bodies of each speciality is working on unifying degree titles and competencies across the board--a BIG challenge that will ultimately bring uniformity and strength.

Although not all DNP programs alike, we as the representatives to the public of our profession, should add our comments to the DNP task force (those who have the power to direct the cirriculum), in order to help guide our profession in the direction we should go.  Nurses outnumber all other healthcare providers 11:1 . If we stand together we can rule healthcare with an iron fist.

The problem with this exam is that not all DNPs are FNPs. Some nurses earning the DNP are CRNAs, some are psych-mental health, some OB, some are administrators.  This exam appears to assume that all DNPs are FNPs and that is not the case. Advanced practice nurses are not "little" doctors. If they are Board Certified, they have already taken an exam designed to ensure they have the knowledge to practice at a safe level.

This is an excellent concept. Even though most DNP programs don't prepare a graduate for the exam in any real way, having an exam that is creditable to other professions, administrators, and privileging bodies is a positive step.  Perhaps this exam will push DNP programs away from the PhD-light curriculum that is currently in place and toward the clinical or practice based doctorate that they claim to be. Columbia's model is the model of credibility to the laity and the now famous study demonstrating APN clinical outcome parity was out of Columbia itself. It is time that the AACN and AANP catch up and recognize that there should be a difference between the skill set of a master prepared APN and a doctorate prepared APN, otherwise what is the point of the DNP besides adding to the alphabet soup?

If DNP is the direction that our profession is going and we are going to sit for an exam comprable to MD's then someone seroiusly needs to look at the curriculum for many of the programs.  I have spent hours investigating programs and they seem to be PHD degrees in disguise.  I have not yet found a program that offers clinical rotations, or one that will let you design your program around your area of expertise.  The research in these programs needs to focus on understanding on it and applying to clinical practice (EBM), not necessarily on conducting it.  

I have heard that many of the colleges are reluctant to accept the DNP degree for tenured positions.  If this is the future of NP practice then it would not make sense to complete a PHD or DSN.

Pushing a comprehensive care certification for DNP graduates is putting the horse before the carriage.

At the present time only a small percentage of DNP programs have any meaningful clinical course work in them. Most programs are composed of a mixture of administration, theory, leadership, education, research methods, etc., in no way does this prepare a DNP student for a comprehensive care certification exam.  These DNP students come from a wide variety of NP specialization programs, such as adult, family, peds, mental health-psych, oncology, geriatrics etc.. These specilty programs don't all prepare students for a primary care type examination.  I can unstand why Dr. Mundinger is promoting this certification,  Columbia is one of the few DNP programs that does train their graduates in advanced comprehensive care.  

However, I think it makes no sense to promote a certification that less than 5% of DNP's programs are geared toward.  I would like to see all DNP prgrams follow a comprehensive care education model like Columbia, but we have a long way to go before that is a reality. In the mean time let's stop worrying about yet another certification to put behind our names. I think we currently have too many. I don't want to get started on how silly all the alphabet soup behind our names look!!

How complicated are we going to make this both for the profession and the public?  Why do nurses always complicate life.  If the goal of the DNP was to prepare nurse practitioners at a higher level and one on par with terminal degrees for other professions such as pharmacy, physical therapy and others, then our exam should only be that of the specialty in which we we were prepared ( ie family, pediatrics , psych etc).  The DNP is the means to achieve this and just as the MD takes his or her boards in a variety of specialties they do not have  yet another exam that says MD as well.  They successfully complete their program and do whatever the qualifying things that requires and then do residency and boards in their selected fields.  

All nurses and the public need to be able to clearly understand what a nurse practitioner is and we need to stop the confusion about who is what and what exam allows you to do what .  Just as we created confusion between the AD and BS nurse among both nurses and the public, let us not start yet another unresolved controversy about appropriate level of entry into practice because as we saw with the AD/BS dilemma we have yet to resolve that issue either and this is about 40 years later.

I guess I've been asleep, but this is the first I've heard of a certification exam for the DNP.  I thought I'd been keeping up with the various issues surrounding the continuing development of this advanced degree, but I evidently missed something along the way.

As we all sit for different certification exams based on our specialties, I would assume that a different certification  will be developed for each specialty as well?  I also would assume that certification at this level will be optional at this point in time, once a DNP is attained  If I understand correctly, not every state requires certification to practice as a NP.  If I remember correctly, FL is one such state.

As there is yet no standardization of DNP programs at this time, with them still continuing to evolve, I think we still have many questions yet to be answered before Certification can be required for this level of Advanced Practice Nursing.