Current MSN Students and the DNP Transition

I was just researching NP schools, and it was sounding like it was going to be mandatory for an NP to have a DNP by 2015.

It is nice to read this is more of a "suggestion" than a mandate by the nursing boards, as with the affordable care act passage we are going to need as many NP's  as possible to assist with all the new patients who will be getting /or eligible for insurance coverage . Therefore, if the DNP is made mandatory it would seem to be a drain to current/future  supply and demand for NP's (given the passage of the affordable care act)

Does anyone have any information about how to obtain an MSN as a Certified Nurse Practioner with a BSN?  I became a NP in the early 1990s when an MSN was not a requirement and I went through a certificate program.  Then, in addition became certified in women's health.  It may be as simple as obtaining an MSN and the fact that I am a NP has no bearing on this.  Thanks for the help! I have been trying to find this info online with no luck!%0d%0aSherri

Q: If I graduate in 2015 with an MSN-ACNP degree, will I still be grandfathered as a nurse practitioner?

I have to say to the person that thinks there are too many ADN programs still open. I am not sure if you think them substandard or just don't like them but I am offended. Some of us went the ADN route for reasons beyond "not making the cut". I attended an ADN program because I had a family, job, and I live 1.5 hours from the nearest BSN program. I think that ADN's should work toward a BSN. I don't think cutting the programs is the solution to the problem. I think making uniform regulations about making academic progress toward a BSN would be a good step forward. I am now in a Bridge program for Nurse-Midwifery and I would not be here if it was not for the local technical collage that provided and ADN program.

Q: I am currently applying for MSN programs to become an acute care nurse practitioner. I am looking

Why are we worrying so much about the doctorate program? We need to worry that as a profession we cannot order Home Health Care for our patients, diabetic shoes, or that we get less reimbursement than physicians practicing next door. We need to push for the issues that are effecting us daily and not focus so much on if others can call us a "doctor." I will not even consider getting my doctorate until it actually will increase my reimbursement.

Wow!!  I really appreciate the blog posts I've read just now.

Absolutely---the issue includes the specter of RN vs BSN.  This is so disappointing to see happening Again in nursing---we (actually, the powers that be) keep shooting ourselves in the foot  over degrees!!!  We can't get anywhere as a group in large part due to this problem------

    Likewise, the alphabet soup of our credentials.  I called ANCC and spoke with the Director and several other PhD prepared nurses and pointed out the confusion being caused by too many credentials and letters.  I was told that "the ANA told us to do it so we did it" (make more credentials and certification exams).  They claimed to be "powerless to change" the credentialing process and simplify it and decrease the numbers of credentials and letters.

   I also appreciate someone's blog post about the lack of substance to DNP degrees.  I agree.  I work with several nurses who recently received their DNP.  I completed a dissertation and oral defense of my research when I completed my MS years ago.  My research was published in the journal "Nursing Research".  The DNP programs my fellows attended did not include any research requirements and the projects they had to do I already have done, plus more, in my work experience.  I agree that the DNP is not elevating the practice of nursing.

  There are fundamental problems occurring within the nursing profession that do not address our elevation as a profession and, in fact, are limiting our upward progress.

As a result of the Consensus Model, LACE (Licensure, Accreditation, Certification and Education) is being examined and requirements for each are going to be regulated at the National level to provide consistency in the way that NPs and other APRNs are licensed, accredited, certified and educated across the country.  As a result, NPs working with acutely or critically ill patients where ever they are geographically, will have to be educated as ACNPs AND certified as ACNPs.  Programs like the one at Penn are developing post-MSN options to provide practicing FNPs, ANPs and GNPs working with acutely ill patients the education they need to obtain this certification before it is mandated by State Boards of Nursing.  I'm not sure why this wasn't done from the beginning, but it makes sense that NP education align with certification and the areas in which they practice.  

With the change in population of adult to adult gerontology, we are also working on integrating the Adult Gero competencies into curricula - so these post MSN programs prepare you for the newest exams available (ANCC plans to launch in 2013).

I've been reading the comments about the DNP and I want to clarify that for Nurse Practitioners, there is NO MANDATE to obtain a doctoral degree; DNP or PhD, at all.  AACN did come out a few years ago stating that NPs must have a DNP, but there has been much resistance to this and the "requirement" to obtain a doctoral degree has been rescinded.

Regarding the Consensus model and the changes in the exams.  If you are currently certified as an NP in the specialty that matches your education, as long as you NEVER let your certification lapse, you will be able to maintain your certification through practice hours and CEUs.  If you allow it to lapse, you will have to meet the eligibility requirements at the time you plan to recertify that will require you to obtain additional education before being permitted to take the certification exam.

I would recommend doing the MS FNP program and then doing the DNP later as time allows; possibly while in practice. The problem is the debt that is going to be incurred to obtain the DNP. Once it is "required" by the ANCC & AANP to be a DNP, the cost of the courses/program by the universities will sky-rocket in tuition because of no alternative. I am not in favor of the current programs that the universities in the country have established for the DNP.  Most being based on research and theory, does not improve the profession nor the practitioner's knowledge in the clinical and business aspects (in agreement with Michael, El Paso). The programs are geared to make the universities money by more classroom costs and the research funding available through the government agencies such as NIH (millions).

If we really want to benefit the profession let's keep the NP or FNP the foundation (as Al, Adult NP stated) and do a one or two residency in a subspecialty for the DNP including FNP (Shelby stated as medical doctors and other disciplines). Possibly get paid during residency, be better qualified on exiting the subspecialty program and be able to demand a higher salary based on the hospital/clinical experience and knowledge. Even allow a subspecialty residency in research and theory for those who want it. I know FNPs who have gone on to obtain their DNP, only to be further in debt and disappointed of no offers of better income. It appears that ANCC and AANP are being persuaded by the self-serving universities to change to the DNP; not listening to those in clinical practice.

RN, AD, BSN, MSN, CNS, CRNP, ACNP, ANP, APN ,ARNP,FNP, WHNP, PNP = Alphabet Soup of Nursing Credentials.

Is this a repeat from the days of RN vs BSN?

How can nursing ban together to provide a clear pathway for the profession and public?

That is correct, Vicki, I am also under the impression that it is not setting specific but population specific. Even though the patients are not located in the ICU, they are still considered acute care patients if the at any point they become hemodynamically unstable ie:  hypotensive due to volume depletion or tachycardic due to PE, etc. they fit the criteria of an acute care population.  It's actually the U of P that is mandating all FNP's and Adult Health NP's to return for credentialing of ANP and being told that a DNP does not trump an ANP therefore needing both credentials.

Sincerely,

Liz

I graduated from a hospital program with my FNP after a BSN and several years experience. The program was medically based with a combined nursing abckground.   I went on to get my Masters and I have to say, most of it was a waste of time and money.  It had little to do with real life and the credentalling exams reflect this.  Nursing has gone so far off thier it's own direction to make sure it maintains it's idendity that it's becoming irrelevant.  The course are riddled with theory and quite redundant course after course.  What NP's need are more science and experience.  Many new NP's are going straight through these programs without any experience and eventually it's going to come back and bite us as aprofession.  DNP?   Are you kidding? For what a title, it doesn't offer much more clinically.

I'm curious about why Phyllis thought that her credential as a CNS was a downgrade from an APRN. I, too, graduated with an MSN in the 1980s as a CNS. Eventually my state certified CNSs and NPs as advanced practice nurses (APNs), treating both identically. I became an adult NP to pursue primary care and because I got tired of explaining what a CNS is.  I found that NPs were the least aware of what a CNS is and many had the misconception that we could not prescribe.  They were not aware of their own Nurse Practice Act. I know that CNSs were not always treated the same by Medicare and other insurers. CNSs were always required to have a minimum of a masters degree, whereas many NPs did not have graduate degrees but were grandfathered in. My intent is not to suggest that one credential for APN is better than the other.  My point is that there is already alot of confusion about the different APN credentials, even among APNs.  How then can the public and other healthcare professionals understand the differences of so many credentials?  I was laid off a job nearly a year ago and I am still looking for an NP job.  I am unable to relocate.  First I found that I was at a big disadvantage in that the few NP jobs that were available, were looking for FNPs, not Adult NPs (ANPs). Now I'm not even finding job openings for FNPs.  However, there do seem to be jobs for NP hospitalists or NPs to work in EDs.  I have searched for online post-masters certificate programs for acute care NP (ACNP) but can't seem to find any.  I did receive my ANP as a post-masters certificate.  Don't let anyone tell you that online education is any less rigorous than classroom education. And there still are the clinicals one needs to arrange on one's own time.  I need an online program to allow flexiblity in case I am lucky enough to find a full time job.  I researched DNP programs and found them to be primarily healthcare policy programs with emphasis on change theory and promoting the profession of nursing.  They are not clinical doctorates; they are practice doctorates.  I share many of the concerns that previous bloggers have written about the changes in credentialing as a result of the Consensus Model.  The "nursing leaders" and "powers that be" are making it more difficult to practice.  My opinion is that the entry level into advanced nursing practice should be the FNP since it covers the lifespan, and then one can go on to subspecialize in areas such as acute care, etc.  APNs should have a more rounded education to allow us to transfer more easily from one practice setting to another.  Perhaps there could be a truly clinical doctorate to provide a higher level of clinical education in a chosen specialty area.

What a bunch of degree chasers. It is so sad that the DNP will not expand scope of practice nor increase reimbursement. As well the acute care being touted for hospitals is a narrow NP. The Family NP can see the age range while the acute care see' s adults. I am helping a law firm litigate a ACNP who saw a six month who died later that evening. We all need to look at the consensus model and rebel. It is placing us in a box while the PA's are doing their PHD in residency becoming board certified Ortho, emergency medicine. We the NP's cannot even have a unified curriculum much less a decision on what degree. The DNP is a ghost of clinical training, it is a change project with nothing that improves clinical skill. We are not advancing our profession. We cannot even have the BSN as entry to practice. How many ADN and Diploma schools are left open-too many. We as nurses need to clean up our act rather than make a new degree that has nothing with clinical competencies.

I think the FNPs that are currently working in acute care area need to be grandfathered in.  Do you not think an experienced FNP or ANP with years of acute care experience would be better than a new grad with the title of acute care np?  

I think that it would best to enroll in a DNP program.  If you enroll in an MSN program you will likely be OK for awhile, but then your degree and credentials may be retired.  

Look at the AANC credentialing site.  This has already happened with the Clinical Nurses Specialists.  I am a CNS from 1980.  I have full prescriptive authority.  I also have a separate license for prescribing narcotics.  So I have 3 licenses (RN,APN, and narcotics prescriptive authority)  I can make rounds independently on patients and write orders.

But the last time I re-credentialed, 2011, I lost my designation, ARPN and was downgraded to CCNS.  However, in the state of Illinois I am still and advanced practice nurse, APN, with full prescriptive authority.

Recently I checked the AACN site and my degree and credentials are NO LONGER GOING TO BE AWARDED TO ANY NURSE AFTER THIS YEAR.  My degree and credentials have been retired.  I retain what I now have, but other nurses wanting to be credentialed like me CAN NO LONGER DO IT.

Yes, 1980 is a long time ago--------but think of this------times are changing very, very quickly now.  

I have been telling any nurses I work with---for several years already----Do NOT get an MS----get a doctorate.  DO NOT (in my case) follow my footsteps and get a CNS  ( note:  years ago there was NO nurse practitioner training in existence----I am a forerunner and pioneer of the nurse practice degree and credentialing----and look at what is now happening to me).

   So------GET YOUR DOCTORATE.

               DO NOT get an MS.

While all of this is still up in the air as to what will really happen in 2015, I do believe the DNP is a better option over the MSN option for the future of nursing.  If you look at other disciplines, most have already gone to the doctoral degree.  Students who wish to be medical doctors obtain a doctoral degree

I think that it would best to enroll in a DNP program.  If you enroll in an MSN program you will likely be OK for awhile, but then your degree and credentials may be retired.  %0d%0aLook at the AANC credentialing site.  This has already happened with the Clinical Nurses Specialists.  I am a CNS from 1980.  I have full prescriptive authority.  I also have a separate license for prescribing narcotics.  So I have 3 licenses (RN,APN, and narcotics prescriptive authority)  I can make rounds independently on patients and write orders.%0d%0aBut the last time I re-credentialed, 2011, I lost my designation, ARPN and was downgraded to CCNS.  However, in the state of Illinois I am still and advanced practice nurse, APN, with full prescriptive authority.%0d%0aRecently I checked the AACN site and my degree and credentials are NO LONGER GOING TO BE AWARDED TO ANY NURSE AFTER THIS YEAR.  My degree and credentials have been retired.  I retain what I now have, but other nurses wanting to be credentialed like me CAN NO LONGER DO IT.%0d%0aYes, 1980 is a long time ago--------but think of this------times are changing very, very quickly now.  %0d%0aI have been telling any nurses I work with---for several years already----Do NOT get an MS----get a doctorate.  DO NOT (in my case) follow my footsteps and get a CNS  ( note:  years ago there was NO nurse practitioner training in existence----I am a forerunner and pioneer of the nurse practice degree and credentialing----and look at what is now happening to me).%0d%0a    So------GET YOUR DOCTORATE.%0d%0a                DO NOT get an MS.

I think that it would best to enroll in a DNP program.  If you enroll in an MSN program you will likely be OK for awhile, but then your degree and credentials may be retired.  

Look at the AANC credentialing site.  This has already happened with the Clinical Nurses Specialists.  I am a CNS from 1980.  I have full prescriptive authority.  I also have a separate license for prescribing narcotics.  So I have 3 licenses (RN,APN, and narcotics prescriptive authority)  I can make rounds independently on patients and write orders.

But the last time I re-credentialed, 2011, I lost my designation, ARPN and was downgraded to CCNS.  However, in the state of Illinois I am still and advanced practice nurse, APN, with full prescriptive authority.

Recently I checked the AACN site and my degree and credentials are NO LONGER GOING TO BE AWARDED TO ANY NURSE AFTER THIS YEAR.  My degree and credentials have been retired.  I retain what I now have, but other nurses wanting to be credentialed like me CAN NO LONGER DO IT.

Yes, 1980 is a long time ago--------but think of this------times are changing very, very quickly now.  

I have been telling any nurses I work with---for several years already----Do NOT get an MS----get a doctorate.  DO NOT (in my case) follow my footsteps and get a CNS  ( note:  years ago there was NO nurse practitioner training in existence----I am a forerunner and pioneer of the nurse practice degree and credentialing----and look at what is now happening to me).

   So------GET YOUR DOCTORATE.

               DO NOT get an MS.

I actually had not thought much about this until Liz had mentioned it a few weeks ago.  I work in the ED and have been doing so for 20 years as an NP.  I didn't think that this would affect me but now reading the clarification that Vicki wrote, I'm not so sure.  Any comments?

Just to clarify the prior comment by Liz in Cardiology.%0d%0aThe Consensus Model focuses on patient care needs NOT setting.  So you are providing ACUTE care if you provide :   %0d%0a%0d%0a1. Management of unstable chronic illness %0d%0a2. Management of complex acute illness OR %0d%0a3. Management of critical illness  %0d%0a %0d%0aMANY NPs who are not acute care trained will continue to work in hosptials because  they are caring for patients that don't meet the criteria for "Acute care". %0d%0a Liz is correct, With the adoption of the Consensus Model - job, education and license must all match so IF you are Primary care trained and providing care to critically ill patients,  the DNP would be one option to obtain the needed education. %0d%0a%0d%0a%0d%0a%0d%0a%0d%0a%0d%0a%0d%0a%0d%0a%0d%0a%0d%0a%0d%0a

I think the biggest issue currently is the fact that FNP's and  Adult Health NPS are being required to return to school to obtain an Acute Care NP certification if they still intend to work in a hospital by 2015. Apparently due to the consensus model, all NP's who are employed in hospitals will need to obtain ANP certification by the year 2015 or they can no longer work in that facility. I have researched this topic thoroughly and all are confirming this.

In the past when I was just starting my NP education, I was encouraged to follow the FNP track so that my options would be greater and I would have the entire lifespan of adults and children as a qualifications. I find out now more than 10 years later that now I need to pursue a ANP certification if I still intend to work in a hospital.  I am currently in a DNP program so that I could be one step ahead of future requirements and am now finding myself in this situation. When I speak to other current nurse practitioner students, they are unaware of this change. I think it is necessary to let these students know their limitations in career choices prior to graduation so they can change their tracks now.

Sincerely,

Liz