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DNP Discussions

DNP and Grandfathering

Published April 27, 2010 2:08 PM by Dena Galler

Here at the DNP Answers blog we take your questions about the DNP and answer them as best we can. DNP Answers blogger Dena Galler, NP, answers the following question.

Q: “Do present FNPs get grandfathered in as DNPs?” (from reader Mihaela Grecu Farley, who asked us on Facebook)

A: “Grandfathering” means that one is exempt from new requirements, so, in 2015, master’s-prepared NPs will continue to function in the NP role and be granted APN status by their state board of nursing (BON) if they graduated from an accredited NP program and were licensed and credentialed prior to educational requirement changes… but they will not be DNPs as that is an academic degree and not a role title. This same scenario occurred in the late 1980s when the MSN was finally considered the new entry level standard for NP practice and NPs who attended 1-year certificate programs were grandfathered in and not required to go back for their degree in order to continue practicing. Many of those NPs from certificate programs are still practicing today and will continue to be grandfathered in when the new DNP requirements take effect.

The DNP degree is recommended by various professional nursing organizations to become the entry-level educational preparation for nurse practitioners by the year 2015. In 2002, the American Association of Colleges of Nursing started exploring the need for a clinically oriented doctoral program based on the fact that NP programs had been progressively exceeding the number of academic credits generally required for most master’s degrees. Some programs now exceed 60 credits and require at least three years to complete. As the NP role has expanded and patient problems and health care have become more complex, the programs’ curricula have also had to expand to incorporate current practice guidelines and technology.

Even with additional course contents and added credits, many NPs continue to feel that they haven’t received all the training necessary to prepare them for clinical practice following graduation. Adding an additional 1-2 years to the current 2-year master’s-level NP programs would allow an increase in content to be included, with the final year geared towards a clinical residency for a higher level of competency and confidence. NPs are granted privileges by the state in which they practice and individual states may vary in their NP requirements.

Currently, all (or at least most) states require NPs to have a minimum of a master’s degree along with national certification in their field of specialty in order to be considered an advanced practice nurse. Agencies that provide NP national certifications now require a minimum of a master’s degree to sit for their exams but these requirements will also change in 2015, making the DNP necessary for all new NP certifications.

How will the master’s-prepared NPs be affected by the future DNP requirements? They have the option of returning to school for a 1- to 2-year DNP “bridging” program or can be grandfathered in by their state BON to continue practicing.

Editor's note: Comment below to continue discussion on this topic, or send new questions to jford@advanceweb.com. 

22 comments

I start NP school in a month. I will graduate December 2015. How is that going to work for me? Will I be able to take the boards? I agree that this is a way to force nurses into a PHD program and a money maker for universitys.  This will resort in less NP in the end. The finacial reward for DNP degree, is it really better?

Shana , Nursing - BSN , ER July 11, 2013 12:18 PM
Marquette MI

You know,  I'm a lowly associate degree RN that bridged up from LPN and that THOUGHT to bridge to do my BS/MSN and then do NP! (at least as recently as a few minutes ago...)

I've been debating for awhile WHICH direction to go, build more and get to NP or just lateral to PA - or - just shoot the rapids and do a foreign med school! ;) But I TRULY wanted to stay in NURSING & expand my scope of practice and ultimately open an MD collaborative clinic in a large metropolitan area (OR independant clinic) for rape victims...

After seeing this change coming I realize its a pipe dream - I can't beat the timeframe and the DPN is too costly time-wise for someone like me who would have to put in that many yrs anyway if they went into other lateral medical practices like PA - or even MEDICAL SCHOOL OUTRIGHT!!

and it does NOT give me anything that the MSN NP did not! So whats the point?  I can do a collabrative clinic with a PA degree...  and with all the shortages coming down the pike its just a matter of time until some states grant PAs all the things that NPs have including some independant clinic states and RX writing across the board as some NPs have now.  Bc I DONT think this will help the increase the numbers of NPs so states will naturally sway to the PAs in allowing them greater scopes of practice - its just common sense to do so for states with medical needs and more shortages just getting worse!!

And as everyone else is pointing out - it will NOT do anything for NPs in the scope of practical "practice" and it will NOT change the laws on the reimbursements and there is NO WAY a Dr. is going to increase your pay in his practice as an NP just bc you have DNP after your name now...  this DNP is a wrong move for the profession as a whole... it does NOT advance us in pracitce - but it will in THEORY - woohoo more theory!  may as well be a theoretical  MD - it would take the same time to to do anyway for most of us...

this is a defeatist situation for those of us trying to continue to improve our scope of NURSING PRACTICE...  

The year of 'residency" is great!  now THAT improves your "practice"!

I agree with the post above by Alice - everything she has pointed out is gospel truth... and in the end I believe there just may be some monetary  element$$  that has pushed this agenda to happen.

Either that or the old guard at the AMA isn't happy with losing some momentum to NP's and this will hopefully cut the numbers of NPs down considerably...  I know it has cut me down  (and OBVIOUSLY quite a few other nurses here too) no sense in doing a DNP - more HOOPS to jump thru too - GRE STATS & MORE THEORY??  oh sheesh - this is a peice of sheer stupidity...  

....I'm finished... I am giving up nursing and going to expand my medical degree some other way - medical school or PA.  

I am sure I'm not alone in this type of decision bc there are LOTS of associate RNs out there trying to climb up and expand their skills and do more work that will allow them more quality time with their patients... and they will look at the years involved and leave the nursing field and make a lateral move to PA or SA or even med school - its the same time invested with med school - may as well!!  If u have a 4 yr BS then just do med school 4 more plus 24 more months in a residency! some take alittle longer but hey - ur in for a penny so pitch in for a pound!

AMAZING the way the BON just consistently SHOOTS ITSELF IN THE FOOT - it just can't HELP ITSELF but to CONSTANTLY re-set the course and cause yet ANOTHER round of nursing shortages and drop offs and making so many of us nurses trying to reshuffle to find footing AGAIN!!

well for sure the nursing shortage won't improve with THIS!  You would think they would be looking at ways to try to IMPROVE the workforce with some inclusive bridge programs for CNAs or MAs or EMTs.

oh well... one dream shot to hell and one less nurse in the workforce - gotta do MS or PA if I want to build on my existing degree and make it worthwhile in the end AND financially FEASIBLE to achieve bc the DPN programs ARE costly as Alice notes and the whole hoops to just GET IN is just SO tiresome after u already prove yourself over and over... and in the end it does NOTHING to make an NP's scope of practice BIGGER or better or even higher paying...

& alice is right on THIS account too - that we have fought SO HARD to get a place at the table and if we think the MDs are going to move over and pay us more bc we got a "D" in our title and we want to stand toe to toe with them and take more out of their pot - then we better for sure get some fire insurance for our BUTTS bc they WILL BURN US DOWN!!

real peice of work BON!  way to go...

roni, RN August 9, 2012 9:18 PM

I graduated with a BSN in 2010 and I am now pursuing a MSN- FNP.   Although I am a doctor of chiropractic, the profession is limited when you need care outside the scope of chiropractic practice.  Therefore, I began an education path leading me to FNP.  I will be licensed by 2014 as a FNP and look forward to the profession as I will once again be in a position of diagnosing but with a greater ability to complete patient care as an FNP.   It is my opinion that this DNP track is merely about money making and has nothing to do with educational uses in practice.  As a DNP you will still practice as you did with a FNP.  The doctorate degree does not change your care capability.  Who really cares about being called a doctor in the nursing profession.  If you want to be called doctor, get your MD, DO or DC degree.  Who wants to go to school all those years to obtain a DNP when you can go the same amount of time and be a "real doctor".   I spent 8 years obtaining my doctorate in chiropractic.  I will not spend another 4 obtaining a useless title of DNP.  The DNP is really more for the nurse educator route, not an APN, FNP, CRNA or ANP role.  If this degree becomes mandatory, the nursing profession will see a drop in enrollment.  Why spend money and time in an 8 year DNP education, when the same 8 years give you an MD degree with complete autonomy, and a much better salary.

Deb, Ortho/neuro - DC, RN, BSN August 7, 2012 10:52 AM

I am just finishing my BSN, will graduate in December 2012. I have a BSBA, ADN, LPN-Diploma, & assoc. in gen. ed.. I am now considering doing the FNP program but I will be in the middle of the program when the DNP is required to set for the boards in 2015. I work full time, have a family that depends on my income, and, personally, I am a little scared about the doctorate program. Not sure if I am smart enough. If I do start the MSN program for FNP, what will happend with the MSN-FNP degree in 2015? Will those students be allowed to set for the boards in 2015 or have to apply to a DNP program to finish the meeting the requirements?

Thanks,

Eric, Critical Care - RN, Government July 23, 2012 12:14 PM
Ft. Bragg NC

Has anybody actually thought about push-back from the medical community when we are "mid-levels" no longer? It's been an uphill fight just to to get a place at the table. Only when physicians realized that nurse practitioners could be veritable group practice cash cows were we welcomed into practice. Medicare reimbursement for NPs is 85% of that for physicians. How many of us actually make 85% of physicians' salaries? It's the gap between what we are reimbursed and what we are actually paid that makes it possible for us to be employed (unless we go into practice for ourselves). Who's going to pay these higher DNP salaries? For what? We won't be able to see patients any faster with a DNP that with an MSN.  None of us like to admit it, but once we try to compete with physicians on a separate but equal footing they will try to burn us down. In my state if I were to open a solo practice I would have to hire an MD to review 10% of my charts and 100% of patient visits if I prescribed a schedule II medication. According to the data I am no less safe than a physician, but the law says that a nurse practitioner cannot practice safely without physician "supervision". And never mind all the uproar over whether, with a DNP, I would call myself "doctor". I'm not opposed to more education for nurses but I don't think there's been enough thought given to the real world implications of this change.

Ellen, palliative care - nurse practitioner, hospital based April 1, 2012 11:57 AM
Nashville TN

Why would anyone want to enter into a 4year long ANP program when they could just go to medical school? Next issue is the bridge program. The only one benifiting is colleges and universities not the nursing profession. Lets face the truth PHD enrollement is at all time low, most programs are taugth online. This program is a way to "FORCE" nurses back into school and into a watered down PHD program. Nothing more then JOB SECURITY. Why not advance NP education with post graducation residency like medicine does. Because then the university wouldnt get 36-40 hours of tution payments. Bottom line its all about MONEY and how they can make more of it. I would be all for a tradional residency program comparable to that of medicine. This would help strenghten the agruement regarding advancing our independence, pay and scope. But then again i am nothing more then a little old MSN ANP-BC,not one of those fancy PHD, MSN, RN, ANP-BC, AAPN, etc.

Joseph rasnick, ICU/Surgery - ANP December 21, 2011 11:49 PM
Buffalo NY

Ghozail, a foreign born MD cannot be "grandfathered" into the U.S. health care system, instead one must pass a series of medical exams and complete a residency program in the U.S. For more information on the steps involved, you might be interested in the following article:

http://www.medhunters.com/articles/foreignDoctors.html  

Dena Galler July 6, 2010 6:19 AM

hello, i'm an Algerian anesthesite, i'm very interrested by the palliative care and i'm looking for a grandfathering in an american hospital, but i really don't know how to search!!

please is there any one for helping me in this process?!

ghozali yacine, anesthesiologist June 28, 2010 5:01 PM
paris

Not sure what relevance your remark has to the topic at hand, Courtney, but since you brought it up, I'd like to point out that almost every other industrialized nation has some variation of the "socialist" health care system you mentioned, and large majorities of the people in those countries have consistently asserted that they like their system well enough despite its warts, and that they'd much rather have their system than our claim-denying, bankruptcy-inducing model. Such systems are certainly not perfect, but if they were half as horrid as people like yourself make them out to be, I doubt very strongly that they would be anywhere near that popular among those they serve.

Richard June 4, 2010 6:19 PM

Will it really matter when we are all government employees working for a socialist healthcare system?

Courtney May 27, 2010 8:51 PM
Midland TX

One must keep in mind that when you refer to the DNP, you are actually talking about two entirely different programs at this point... the 2 yr bridging program for those NPs who already hold a MSN and the 4 yr post BSN NP programs that will graduate DNPs instead of MSNs. For those of us MSN prepared NPs with years of clincal experience under our belt, what can a 2 yr DNP program teach us clincally that we don't already know-- and how do you include all clinical content for all those who work in speicalty areas? That's why you have little or no clinical content in the 2 yr programs-- we should already HAVE clinical knowledge and experience. The 4 yr DNP programs, for those WISHING to become NPs, will contain the clinical content PLUS (hopefully) a year-long clinical reidency along with the theory, healthcare policy, role classes, and research that we all had in our own 2 yr MSN programs.

Dena Galler May 25, 2010 7:35 PM

Currently I am enrolled in an online DNP program.  Sadly the program will not improve my clinical skills.  The professors who are mostly PhD's are more concerned about APA format than actually providing a program that will improve my ability in direct patient care.  Is this really what a DNP program should be?  More debt and stress is occurring than clinical knowledge.  At this point I am not sure I really need to continue with the DNP because it takes away time I could have to read appropriate journals, attend other beneficial continuing education like Margaret Fitzgerald's CE's and be available for patient care. I know I will not have an increase in salary with a DNP nor will reimbursement improve.  Academia has again missed the "boat".  Very sad for the advance practice nursing profession.  DNP should be redirected towards clinical improvement not another name for a PhD.  

Deborah, Adult - ANP-BC, Community Health May 13, 2010 10:21 PM
Lake Zurich IL

Master's prepared advanced practice nurses identify additional knowledge that is needed for a higher level of advanced practice.

The time spent in master's level nursing education is not congruent with the degree earned.

A transition period be planned to provide nurses with master's degrees, who wish to obtain the practice doctoral degree, a mechanism to earn a practice doctorate in a relatively streamlined fashion with credit given for previous graduate study and practice experience. The transition mechanism should provide multiple points of entry, standardized validation of competencies, and be time limited.

AACN Position Statement on the Practice Doctorate in Nursing 2004

Given that the goal of nursing and AACN is to have all NP's become DNP's why is it that "No" DNP program provides a transition program for experienced, Masters prepared NP's?

Steve Hammer May 6, 2010 4:02 PM
Chicago IL

Thank you for pointing out the difference between a "clinical doctorate" and a "practice doctorate."  I think many of us were expecting that a doctorate in nursing practice (DNP) would be a clinical doctorate, particularly when we read that one of the rationales for a terminal degree for advance practice nurses is to bring us to the educational level of our colleagues in medicine, physical therapy, pharmacy, etc.  I believe the DNP, as it stands now, would be an excellent preparation for someone wishing to go into community health nursing, public health, nursing administration, or healthcare policy.  The DNP programs are heavily concentrated on the community or the public as the client, more so than the individual as a patient.  Since, I would guess, that most of us advance practice nurses actually work in clinical settings providing direct care to individuals, I believe that a clinical doctorate might be better received by the community of APNs.  Many of us would welcome an opportunity to expand our knowledge and skills as diagnosticians and direct care providers.  Adult learning theory tells us that adults want to learn things that they can directly apply to their own experience.  If most of us will not be going into fields of community health or the other population based fields, then why should the DNP be required to be so heavily based on population studies as opposed to clinical studies?  Requiring a DNP degree as the entry level into advanced nursing practice is a major change.  Since individual states write their own nurse practice acts, there is no guarantee that state legislators will grandfather in APNs who are not doctorally prepared.  There is also no guarantee that insurance companies or Medicare will not require a DNP to reimburse APNs for the services we provide.  We cannot assume anything.  Earning yet another degree is a major expense.  I researched the admission requirements and costs of many DNP programs, including online programs.  Many admission requirements require GREs and a graduate level statistics course within the past 5 years.  I took my GREs decades ago.  If I were to repeat my GREs, I would have to take some kind of review course to get an acceptable grade on the quantitative portion since it has been about 40 years since I studied geometry, trigonometry, calculus and algebra.  I thought GREs were intended to be used to determine if one could succeed in a graduate studies program.  I would think that after obtaining two masters degrees and a post-masters certificate, that I would have proven that I can succeed in graduate school without having to retake GREs.  I would also be required to retake a graduate level statistics course since my last statistics course was over 5 years ago, thus adding to the time and expense of even getting into a DNP program (I have taken 4 college level statistics courses in the past, forgotten much of what I learned since I do not conduct research and since I was always told that researchers have statisticians to help them with their research.  I also completed two masters theses that involved research and plenty of statistics).  I also have been thinking alot about retirement.  With the retirement age rising, I expect that I will have to postpone retirement for another 10 years or so.  Considering that it would take a few more years to complete another degree, is it really worth pursuing considering my age?  The tuition costs seem to range from about $34,000 to $64,000, not to mention other expenses.  Also, I do NOT believe that my salary would increase after going to the expense of earning a DNP, unless I were to leave internal medicine and direct patient care.  My career goal has been to work in a private internal medicine practice.  Do you think that a physician would want to increase my salary, particularly when (s)he has had his/her reimbursements cut by Medicare?  Do we really expect that the states will eliminate the collaborative practice agreements that most of them now require to allow us to become independent practitioners anytime soon?  I would feel better about this possibility if I had a clinical doctorate rather than a practice doctorate.  There are many ways that we can and do advocate for our clients.  Do we all need to spend our time and money on taking courses in "social justice" and "medical disparities" and replace another graduate thesis or dissertation with a "capstone project" where we demonstrate that we can change a system or organization or set up a program for the underserved?

Alice, Internal Medicine - Nurse Practitioner, recently unemployed May 4, 2010 9:23 AM
Toms River NJ

I think the DNP is a misnomer.  All of the DNP programs must contain the same general curriculum to be accredited.  This is why they all appear to be so similar.  One can review these criteria by referring to the 2006 American Assoc. Colleges of Nursing's The essentials of doctoral education for advanced practice nursing at http://www.aacn.nche.edu/DNP/pdf/Essentials.pdf.  The programs have a heavy emphasis on health policy and organizational theory.  Some buzz words you'll see in the program descriptions include "social justice," and "medical disparities."  "Capstone projects" remind me of the "Change Project" I had to do in my MSN program, only the change in the DNP program will be some type of community or organizational change that will address those buzz words I mentioned.  The client is the community, more so than the individual. I think the programs would prepare nurses well for careers in community health, public health, health policy or health administration.  But what about the NP working in a physician's office?  How will the DNP help her/him to better manage those patients' illnesses?  With all of the cutbacks in Medicare reimbursement and rationed care of the current Health Care Deform (oops, Reform) legislation why should I expect a higher salary for a DNP degree if I work in the private sector? The DNP program emphasis is not on preparing advanced practice nurses to be better diagnosticians or providers of health care to individuals.  Much talk has been about the need for more primary care providers.  I don't believe the DNP will help advanced practice nurses to fill this role. Even though outcome studies show that APNs provide as good care as MDs in primary care, I do believe we should have the opportunity for higher education at the doctoral level in the areas of pathophysiology, pharmacology, diagnostic decision making; all of the things we had in our Masters or post-masters programs, but at a more advanced level.  I would have liked to have seen more shared courses between APN and medical students demonstrating a basic core of "medical" knowledge that APN and medical school graduates should have.  I'm at the age when I'm thinking alot about retirement, but, particularly as the retirement age is expected to rise, I expect I'll be working for at least another 10 to 12 years as a senior citizen (I expect to be working after the 2015 deadline).  Is this enough time to be worth another degree?  I have investigated many of the DNP programs available.  Many admission requirements require GREs within the past 5 yrs.  It's been about 40 years since I studied geometry, trigonometry, calculus, alegebra, so I can only imagine how well I would do on the quantitative section of the GRE.  I thought the purpose of GREs was supposed to predict how well you would do in graduate school.  I would think that, after 2 masters degrees and a post-masters certificate, I have proven I can succeed in graduate school.  I would also have to retake a graduate level statistics course since my last statistics course was more than 5 years ago (I have had 4 college level statistics courses plus 2 masters theses).  Just preparing to meet the admission requirements to a DNP program would be time consuming, not to mention the expense of the preparation to meet admission requireements and not to mention the cost of tuition.  As far as the grandfathering issue, since this is up to the individual states, I don't think there is any guarantee that all states will not require a DNP to practice as an APN.  Furthermore, there is also no guarantee that insurance companies and Medicare will not require a DNP for reimbursement of APNs or, that there might not be a different level of reimbursement for DNP vs MSN-prepared APNs.

Alice, Internal Medicine - APN, recently unemployed May 3, 2010 8:59 PM
Toms River NJ

I have recently completed 3 years of an NP program in Tx and have played with the idea to continue on to the DNP program. But, there are some concerns....why should I get into MORE debt while not making anymore than any other NP? I have yet to hear how DNP salaries differ from NPs. After looking at many job openings and salaries, positions are still posted for NPs and salaries have not budged to compensate for the higher DNP degree. I love nursing, but I have to make plain that my decision to go back to school was based on my desire to be a primary care provider and to provide top notch clinical care. With this shift in focus comes a need to be equiped with clinical/medical knowledge that only a higher degree can offer. I feel that my current NP training has provided that save for a more robust clinical/residency. And so I have researched DNP curriculums in search of one that is more medically based and am shocked to see that the emphasis is still on theory, theory and more theory. Theory is not going to make me an expert clinician (I am sure I have shocked academia)! I thought that the purpose of the DNP was to make us into expert clinicians (as opposed to the PhD). I think the academic crowd has missed the boat...as care providers,  care is based on medicine. We must accept and embrace this. In caring for a hypertensive individual, for example, I am not going to rely on a middle range theorist but on the JNC 7 guidelines!

Liz Blaise, R.N., B.S.N. May 1, 2010 11:29 PM
Houston TX

If you do the bridge, do you have to retake state board testing?

Christy Davis, Famil Practice - FNP May 1, 2010 8:25 AM

I can appreciate your sentiment as I have been in practice for 30 years as a master's prepared NP; but I find it interesting that your argument is against the need for an academic degree, yet you have spelling/typographical errors within your posting!

Jean, Palliative Care - MSN, CRNP April 30, 2010 8:57 PM
MD

I became a nurse practitioner in 1977.  I am from a certificate program.  I am still working full time.  I had a family practice for 28 yrs and urgent care ever since.  I don't think getting a doctorate degree will teach you to be a more well rouned nurse pratitioner.  The courses that you take are not improving your clinical skills or judgement.  I think the best thing that nursing could have done was to base the credentials on experience.  I have to help train nurse practitioners after they finish their master's programs because they lack the clinical experience.  I really get upset when schoold accept nurses right out of training into nurse pratitioner programs without working for several years first.  I'm not against master degree levels but make them work for at least 1 year before they get certified.  We had like a year internship we did after training and then sat for our certification. But somehow I feel that if you create a doctorate approach it should be based on more clinical experience unless those students are going to work in administration or teaching, but not in the clinical setting.  Just the idea from an "old" nurse practitioner who believes that experience is the best teacher and gains you more respect in the medical field from your collegues.

marilyn myers, family - cnp, urgent care April 30, 2010 2:00 PM
findlay OH

Nancy, you're 100% right-- going back to school is extremely tough, considerably expensive, and a real time commitment! I continued to work full-time in my 40 hr+/week job, had a total of 2.5-3 hours commute round trip from work each day, and managed to exercise and train for marathons during the whole 2 yrs-- oh, yeah, I also had a new relationship I started at the same time I started the program (bless him-- he's still around after all of this <G>). I'd probably be the first person to admit that it wasn't an easy thing to do or how many times I swore I was going to quit along the way. And, yes, it was VERY expensive-- I wouldn't have been able to do it if my mother hadn't given me a generous advance on part of my inheritance to pay for it (I just 3 days ago finally paid off my 15 yr old student loans from my MSN program). The whole 2 yrs was a tremendous exercise in time management and survival. After working out, I spent week nights researching for assignments and, as soon as I got home Friday evening from work, I stationed myself in front of my computer where, except for breaks to go run for a couple of hours early every Saturday morning, I stayed at my computer until late Sunday night, writing all my papers. I was one of the very few in my program to be able to walk across the stage at graduation having actually finished everything and really have my degree-- most students took much more time. But what motivated me was the need to stay marketable in my profession. If the world is going to be flooded by NPs with DNPs, would I be at risk for losing out on job opportunities to them someday? Then there's always the Medicare reimbursement question... if the DNP becomes the entry level for NPs, will Medicare someday decide to reimburse only those NPs who have the new degree (like they did in the early '90s when they decided to only reimburse NPs with MSNs)? Plus, I'm never one to back down on a challenge or take the easy path for anything and to look at that degree in front of me everyday is extremely personally rewarding. I did it! The DNP might not be for every NP-- one really has to weigh the pros and cons for themselves as well as their own professional goals and future.

Dena Galler, Spinal Cord Injury - FNP-BC, VA Palo Alto Health Care System April 30, 2010 11:29 AM
Pacifica CA

Hello- I appreciate that study for DNP is considerable. I completed my DNP while practicing, speaking, working with my company, etc. At the same time, I believe the end product was worth it. I took my time (much to the dismay of some of the program's faculty! But they remained positive and supportive) but completed the degree requirements with a 4.0 average.

I do not view the DNP  as "catch up" education. As Dr. Dena pointed out so well, the progression to the DNP is part of an evolution of the profession.

Margaret Fitzgerald, , President Fitzgerald Health Education Associates, Inc. April 30, 2010 7:59 AM
North Andover MA

Going back for a DNP bridging course would be great, but who wants to be seriously in debt again? Also, for those who work full time, often with long commutes at each end of the day, even online courses mean agonizingly decreasing time for adequate sleep, healthy nutritiion, and exercise  for ourselves-- which we need to keep performing at our best with longevity, and would therefore also mean increasing the stress level quite markedly for a prolonged period -- also quite debilitating. Who respects the health care provider who gives anti-smoking advice while continuing to smoke  herself? What about telling our patients to get adequate rest, eat healthy and exercise when we ourselves often cannot find time for these basic essentials? I believe our profession needs to consider better, more comprehensive ways to fund, and deliver this sort of catch-up education.

Nancy Honeychuck, Primary and urgent care - APRN, BC, FNP, Winslow Indian Health Care Center April 29, 2010 9:11 PM
Winslow AZ

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