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DNP Answers

Disadvantages of the DNP

Published August 27, 2010 10:35 AM by Michael Zychowicz

Here at the DNP Answers blog we take your questions about the DNP and answer them as best we can. This post is written by blogger Michael Zychowicz, NP. Zychowicz is new to our DNP Answers roster

Q: Are there any disadvantages to getting the DNP that would make it a less-than-ideal choice for some NPs?

A: This question needs to be dissected into two components. First, are there any disadvantages to obtaining the DNP?  Second, why would the DNP be a less than ideal choice for some NPs? 
 
As an educator, my first thought is that there are no disadvantages to furthering one's education.  I see no disadvantage to advancing ones education and obtaining a terminal degree no matter if this is a PhD, EdD, DNP, DPM, etc.  There are the obvious costs, work and inconveniences that come along with furthering one's education including time commitment and financial cost.  Some have advanced the arguments against obtaining the DNP, citing the disadvantages of no additional independence in practice, no additional pay, and so on.  I don't think these can be listed as disadvantages since they are not the intent of the DNP degree.
 
What would make the DNP a less-than-ideal choice for some NPs is that the degree may not be congruent with that NPs personal or career goals.  For example, if a NP wanted to be a researcher, the ideal degree choice for preparation as a researcher might be the PhD.  That is not to say that the DNP-prepared NP cannot perform research, because they can and do.

 
Although there is a call for the DNP to become mandatory for new NPs in 2015, there is no requirement at this time for NPs to obtain the DNP. So, the option to obtain the DNP is truly a choice and not a mandate at this time. One scenario where I could imagine a NP choosing not to further their education is if they were planning to fully retire in the very near future, if they did not have the financial ability to pay for the education or if the NP does not have the time commitment to invest in earning the degree.

In short, if the DNP is the right choice for the NP to meet their personal or career goals, then I do not see any disadvantages to earning the degree.

Editor's note: Comment below to continue discussion on this topic, or send new questions to jford@advanceweb.com.       
posted by Michael Zychowicz
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17 comments

Reading through all these comments is quite amusing. Everyone has thier own "preception" about NP's and DNP's. Despite whatever one believe the fact is that the outcomes of NP's are equal too if not better than their physcian counterparts. Now that's intersting because several people have stated we have "soft" Prerequisites and not enough clinical hours and no residency

Kisha MSN/MBA W, Diabetes - Education Specialist April 21, 2014 4:33 PM
Detroit MI

I cannot believe the comments posted!  I have been in healthcare for 15 years.  I started out as a nurse tech not even a CNA.  I have worked my way through many different programs including LPN, ASN, BSN and now I am working on a Master's in Primary Care.  I have continued my education while working full time taking care of sick individuals.  In my estimation this full time work is "clinical time"!!  Lets add this time into the equation! Thats is approximately 2000 hours of "clinical time" a year plus what is required by the educational tract chosen.  I plan on continuing my education and getting a DNP.  This is not because I want to be a doctor but because I want the highest degree offered in nursing.

On a side note, I have been seen by physicians in primary care and by NP's.  The examinations that I have received by the NP was much more thorough and holistic than the exams provided by the physician.

Amy, Emergency Department - BSN May 10, 2013 6:02 AM
Odon IN

DNP=one year natural science course and TEAS exam + 4 years BSN + 2 to 20 years 0r more  health care work experience +4 years post graduate NP training.

PA=Any type of BA/BS 4 years +One year natural science courses + 40 hours 0r more direct healthcare experience+GRE exam + 2 years Master in PA

AND few schools have undergraduate Certificate program in PA

MD= 4 years any type Degree + 4 years Medical Degree +3 years Residency Family physician other specialist more than three years Residency

PA and MD are medical model

DNP is Nursing Model .They treat from whole mind body sprite

strength

1.MD two more years training than PA and DNP.Old and respected profession

2.DNP more healthcare experience and older/ mature people joining the profession after real life experience. More women and so they are naturally caring

Caring

3.PA medical model more strong science than DNP and also people joining the profession have real healthcare experience and most them are mature/older in age than physician who are new graduate.

Abebe February 6, 2013 3:01 AM

I think many of you should look up the meaning of doctor but if you cant this is the definition. A "doctor" is a title given to somebody who has been awarded a doctorate, the highest level of degree awarded by a university. A medical Doctor is the one who gives treatment. SO to say that if NPs or nurses generally want to be doctors they should go to a medical school is an insult to the profession and dump. We need to examine th pros of issues and please if you are not a nurse i suggest you do not comment on this issue because clearly many people do not know the history of nursing and the humiliation that nurses go through everyday.

Chi, Family - NP February 27, 2011 3:36 AM

I would like to see the "evidence" that DNPs have better outcomes than MSNs. I have not been able to find any studies at all to support spending big money on another degree with the same type of courses taken at the graduate level. Let's get real.

The biggest competency issue that I see with ARNPs is that programs are letting anyone with a nursing degree in. My observation is that NPs who have had meaningful experience in critical care settings as RNs are much more prepared to make clinical decisions.

There should be more emphasis on experience and the type of experience as an RN. For example,  requirements for nurse anesthesia programs as I understand it, are a certain number of years experience as a critical care nurse.

There are programs that allow a BSN with no experience into a DNP program. It is ludicrous. I think these programs are all about money and politics and less about quality patient care.

Madeleine, Surgery - APRN-BC, Baptist Hospital November 6, 2010 6:56 AM
Miami FL

BSN to DNP program at Duke university = 81 credits in length with 816 clinical hours.  Prerequisites:  RN degree.  Program completed online part-time over two/three years.  Practice oversight regulated by each states respective nursing boards.  One year of nursing experience preferred, but not required at Duke University Program. 812 hours of clinical training required for the program.  Prerequisites for the typical RN degree = A&P and statistics and sometimes a survey course in microbiology.  Education is degree based versus competency based.  Nursing programs call their clinical training in school "residency", which can create confusion because it is not post -graduate residency training as it would be known in the medical model of education, rather it is clinical training that is part of the educational program similar to a rotation as it is referred to in medical or PA school. NPs are not residency trained.    http://nursing.duke.edu/modules/son_academic/index.php?id=191

PA (physician assistant):  126 credits average length; full time study; average program 28 months in length.  Regulated by the state medical boards, Upon graduation, physician assistants take a national certification examination developed by the National Commission on Certification of PAs in conjunction with the National Board of Medical Examiners. To maintain their national certification, PAs must log 100 hours of continuing medical education every two years and sit for a re-certification every six years. Pre-requisites for PA school are similar to medical school less physics.  The average PA student has an average of 4 years of experience in paid patient care, although some programs admit students with high GPA's and minimal healthcare experience.  PA school is competency based education and not degree based and modeled after medical school.  PA's complete over 2000 hours of clinical rotations (minimum) as part of their program - including family practice, surgery, internal medicine, emergency medicine, OB/GYN, pediatrics and other electives.  Residency programs are optional, but not required

Physicians (MD/DO) 4 years of full-time study followed by a minimum 3 year residency program.  Additionally, many physicians complete fellowship training.  Medical school provides a broad based education in the basic sciences and clinical medicine.  Primary care doc will have over 17000 hrs of clinical training...more for specialists.  Physicians receive a very structured and broad based education in all aspects of basic medicine before specializing.  A post graduate residency is required for board certification.  Prerequisites for medical school include a minimum of 1 year of biology, 1 year of physics, 1 year of chem, 1 year of org chem, and some programs require biochemistry.  In residency, physicians round throughout the hospital, in emergency medicine, derm, psych, on athletic fields, inpatient/outpatient, …ect to become a primary care physician. You must complete rotations in all areas or medicine to become a competent provider in your specialty and practice holistically.  Seeing and being held accountable for this very objective and supervised training is what makes physicians independent practitioners and qualified to practice medicine independently.  All 17000+ hours of MS3/4 and residency training…all the exams….all the pimping….the thousands of patients examine during this training….the zebras you have an opportunity to see…..only which can be learned at an academic center where these patients are referred for care. Many of which you may never see again, but you will never forget. You don’t get this training as a nurse practitioner.  

Nurse practitioners have the least amount of training of all healthcare providers, yet want to call themselves doctor and practice without physician supervision. They compare themselves to physicians, but as a matter of fact have significantly less training and education than a PA.  

NP to DO Physician October 15, 2010 7:00 AM

I couldn't agree more, Jeremy. The idea that NPs and other APNs "need" a DNP has never made the least bit of sense to me. My view is that if you're a nurse who wants to do academic inquiry, get involved in public/health-care policy, deal with nursing issues on a macro level, etc., then you should get a Ph.D; if you're a nurse who essentially wants to be a doctor, then you should go to medical school!

All this talk about the "need" for a "practice" doctorate in addition to an "academic" doctorate just doesn't hold water for me. It implies that RNs with Ph.Ds are incapable of implementing their research and other efforts into practice, which frankly is absurd. It's not like Ph.D-trained RNs are restricted solely to academic employment, after all; they can still practice just like any other RN, and they're also far better positioned than any DNP will ever be to implement practice changes or affect public policy due to their far more extensive training in research and analysis. Bottom line: Nursing already has a doctoral degree, and it is more than capable of covering all the same bases (and more) as the DNP. It would therefore seem that the DNP is a superfluous credential.

And again, with study after study proving that MSN-trained NPs are well capable of providing excellent patient care comparable to that of physicians within their mid-level scope of practice, there's also little to no evidence to suggest a pressing need to mandate that NPs be trained at the DNP level.  There is, however, some reason to suspect (as Jeremy noted) that the DNP represents little more than a money grab by certain nursing academics (Mary Mundinger being the most prominent example). Not to say those RNs who have invested considerable time, money and effort into earning DNPs don't deserve praise and credit (far from it), but there's just very little proof to suggest that NPs and other APNs really need to be trained at the doctoral level.

Just because certain other fields are tacking extra years onto their curricula and (rather laughably) calling their graduates "doctor" doesn't mean nursing has to mimic them! For me, the same principle applies to these other fields -- if a physical therapist or audiologist wants to be called "doctor," they should either earn a Ph.D or go to medical school instead!

Richard September 26, 2010 4:37 PM

I work with several NPs and see no difference in clinical ability whatsoever.  Sure- as a PA, I probably received more medical-based training, but it's a moot point a couple years out of school.

The issue isn't ABILITY- heck, a monkey can learn to do a physical exam and write a script.  The issue here is that Doctorate level NP or PA is a sham.  It improves nothing in way of clinical ability, and is only leading to:

A. Degree push; Making entrance into the Midlevel field more difficult for EVERYONE when the politics surrounding Doctorate level degrees forces this to be standard for all midlevels

-explain to me how the heck midlevels are supposed to help a medical provider shortage when you create a pipeline of training that keeps expanding in length?  Brilliant.

B. Friction between Physicians and doctorate level midlevels.  I mean- c'mon, if you want to be a doctorate level provider, become a physician.

Jeremy, EM - PA-C September 24, 2010 1:33 PM
Redding CA

Uh-huh. And yet somehow, in study after study conducted on the subject over the past few decades, NPs (including, it should be noted, those prepared at the master's level) are found to be capable of providing care comparable in quality to that of not only a PA, but a PHYSICIAN!

It would seem that ignorance, specifically on the part of the NP-bashing people on this thread, is indeed bliss!

Or is it? If these narcissistic NP bashers (especially the PAs) were truly confident in their alleged superiority, they wouldn't feel the need to run around flaming NPs in this manner. Just offers further proof that arrogance is always the surest sign of insecurity. Obviously, MDs/DOs aren't the only ones who feel threatened by NPs!

Richard September 24, 2010 11:10 AM

I am surprised by the number of non nursing, non DNP individuals answering a nursing professional question!

As a practicing RNP with over 31 years of combined RN/RNP practice, well on my way to a DNP, I will comfortably address some of the misstatements in the blogs in this thread.  I have more sciences in my 5 year BSN undergrad nursing program than PA programs have in their 18 month certification programs.  Those "hard" sciences expanded in my graduate program and have expanded again in my DNP program.  The advantage of a DNP is continuing education, expanded knowledge, renewed competency.  

In my state, I practice independently and evidenced based studies abound to prove not only the better care NPs provide but the increased education and experiential learning required to get to where I am today.  

What is most impressive about your blogs is your posting what is obviously a common thread ("good politicians") on another professions website about professional issues you clearly are ignorant about.  All of you posted similar blogs (or maybe just one of you under different names??).  Don't you have your own websites where you can keep your discontent to yourselves?  

I don't visit your websites and post false, nasty blogs about your profession, why would you do that?  Geez - how mean spirited and stupid in this very stressful healthcare environment - just when we need to work together.  

Joslin, Urgent Care - RNP September 19, 2010 6:24 PM
RI

There are many direct entry nurse practitioner programs across the country that ONLY REQUIRE STATISTICS or even NOTHING AT ALL for matriculation...not even an RN DEGREE. EXAMPLE:  UVM's DIRECT ENTRY PROGRAM.  It requires a bachelors degree in anything, 3 credits of statistics and the GRE's.  NOTHING ELSE.  THe program is 1 year for your RN and followed by 2 years of part time study while you work full-time for one of two tracks....Adult NP or FNP.  

MAKE SPECIAL NOTE - NO PRE-REQUISITES REQUIRED.  They do take a very abreviated nursing version of microbiology.....scary stuff that you just can't make up

Sam Fils, BSN September 11, 2010 2:37 AM

You CANNOT COMPARE experience as a nurse to that of a practitioner.  The fact is that NP education is a softer degree academically. It's further diluted with nursing theory courses and other humanities coursework in lou of hard sciences and clinical studies.  IT's FACT.  Review programs for your self.  NP education is like a blend of social work and knowledge just above a nurse.  NOT EXACTLY THE TYPE OF PROVIDER THAT SHOULD BE WORKING UNSUPERVISED WITH PATIENTS.  

IGNORANCE.....is obviously bliss.  

COMPARE PROGRAMS - END OF STORY

Graduate of UC DAVIS conbined PA/NP program....Faculty of nursing program that leads to the DNP.....Former faculty of PA program.......All I can say is there is a very real difference in education.  The DNP students just aren't the real deal and I have to water down my courses.....Wish I had something good to say.  Somebody said it best ......NP's aren't great practitioners, but fantastic politicians.  

Linda G, PA-C/DNP September 10, 2010 6:34 PM

Actually, there is a tremendious difference between the two.  The fact is that NP programs have very soft pre-requisite requirements which DO NOT INCLUDE 8 Credits of general biology, microbiology for science majors, 8 credits of chemistry and 4-8 credits of organic chemistry.  Please note that PA's also have a significant healthcare hours before going to PA school in nursing, paramedic studies, physical therapy, pharmacy, ect.  PA is a science based degree modeled after medical education and very competitive to be accepted too.  NP on the other hand is very easy to get into, has little to no pre-requisites at most programs other than being a nurse ect.   I was an RN before PA school.....my 10 years experience didn't compare to the education I got in PA school....just saying.

elen McKay, BSN, PA-C September 10, 2010 6:25 PM

PG...your comments are ignorant and and very disappointing in someone who should view nurse practitioners as peers with shared interests. All the coursework you took to enter your PA program were also taken by we nurses prior to entry to our nursing programs. In addition to my nursing education and graduate work I spent years as a practicing nurse in a hospital working full time. Which do you think is of greater value.......your couple of hundred extra clinical hours as a student or our years of real experience at the bedside? I think to any fair minded individual the answer is obvious.%0d%0aNext time think before you post on a subject you obviously know little to nothing about. Your attitude is what is truly scary.

Collin Prince, Pediatrics - Pediatric NP, Mexico Pediatrics September 9, 2010 5:51 PM
Mexico MO

PA programs average 125 credits in length - full-time (8hours of study a day).  Average program is 28 months with over 2000 hours of clinical training.  regulated by the medical boards.  Hard pre-requisite science courses similar to medicine (biology, chem, organic chem, ect...)  PA's recieve a broad based generalist education nearly identical to physicians.  Residency for PA's is optional.  Previous paid healthcare careers are generally required (examples include physical therapy, pharmacy, athletic training, nursing, paramdics).  Students without previos healthcare experience typically have close to 4.0 GPA's....and almost never are admitted.  

DNP program average 80 credit hours in total length, have very weak pre-requisites if any at all. Average program has a total of 1000-1200 hours of clinical training (and apparently some of this doesn't even have to be clinical training).  they are regulated by the nursing boards rather than the medical boards.  they specialize in a certain area of medicine rather than a broad based generalist education followed by specialization.   Basically a house without a foundation.  SCARY.  Residency programs are NOT an option for NP's.  All Np's must become an RN first.  

NP's aren't the best practitioners, but they are great politicians

unedited......

P G September 9, 2010 4:11 PM

I have to agree with Louis, NP-C,. What is the advantage of obtaining a DNP? Except for an administrative advantage, it will not make one a better clinician.

Pamela Bassett, Internal Medicine - PA-C September 4, 2010 6:28 PM
Topanga CA

I feel the better question is what are the advantages of the DNP?

Louis, NP-C August 27, 2010 10:29 PM

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