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DNP Discussions

Should We Be Certified As DNPs?

Published December 23, 2014 10:49 AM by Julie Schreiner

With the push for doctoral-level nurse practitioners, one of the major questions has been should NPs have to take an extended certification exam in order to be recognized as a Doctor of Nursing. This topic is highly controversial because most practice-based professions that have a doctoral degree do not required an extended certification in order to practice (i.e. physical therapists, pharmacists, etc.) Unfortunately though NPs are faced with physician counterparts arguing that although doctoral-level NPs have extended education, they do not have extended certification by a certifying body and therefore no difference should be made in the clinical arena between a nurse practitioner and a doctor of nursing practice. Many have argued that DNP graduates should the Comprehensive Care Certification (CCC) yet many NP organizations are saying no to such an exam.

So should we have to take an extra certification upon completion of our DNP education? I personally have not decided one way or another. In support of certification, I feel it does provide us with further leverage in both the clinical arena as well as in legislative issues. Certification would also provide a standard of accreditation for DNPs rather than simply going to school and coming out with a DNP especially due to the vast difference in some DNP educations. On the other side, I feel that the DNP education certainly does not support a further certification necessity. The focus of my DNP education was on leadership, evidence-based practice, and transformational care rather than on increased clinical knowledge like pathophysiology etc. So could this education and expanded knowledge actually be tested?? The debate certainly continues and I hope to hear some of your thoughts on whether or not DNP graduates should have to face certification exams.

7 comments

I come from a different perspective. I teach clinicals to these DNPs students because their DNP professors don't work treating patients. Most of their time is spent on "effecting change" nonsense within systems while pretending to treat patients as individuals. The two are mutually exclusive.

The only way to produce competent graduates is for the DNP professors to work in patient care establishing clinical rotations for students to become well rounded. Most importantly to gain the knowledge to become competent. Similar to a residency. Otherwise, DNP students are coming to me to learn real advance practice, and then wanting a special certification to distinguish them from me. Doesn't make sense.

Kyle Juneau, ANP/FNP-BC December 18, 2015 2:35 PM

I don't know why we make things harder for ourselves!  Nor do I understand the DNP for Non NP's.  If other doctoral programs don't take extended certifications, why should we?  Putting together the doctoral program was said to be difficult because much of what we did at the MSN level was already on par with what a lot of doctoral programs in other fields do.  Can we grow up and know that we already have it together and don't need to continue to "prove" ourselves?  Calling the DNP doctor varies from state to state.  In my state - we can, and should. We should also relay to patients that we are a doctor of Nursing practice.  I have no problem with that. I am not a medical doctor and don't want to be.

Teresa, DNP, PNP January 6, 2015 1:46 PM
Davenport IA

No. I do not think we should be certified as DNPs. It is a preposterous idea. And I totally agree with Michael O. Mahler's post. Thanks Michael. You said it all for many of us. Happy New Year.

Joy, NP January 4, 2015 12:45 PM

I graduated with a BSN in 1976 and the push then was for nurses to have BSNs  There are still diploma schools and many function from diploma programs or associate degrees almost 40 years later.  If that's the case how can they mandate a DNP by 2015 for new nps. Lets raise qualifications for registered nurses first

Lenora, Psychiatry - PMHNP,BC MSN, Chestnut Ridge January 2, 2015 8:28 PM
Uniontown PA

I am an Adult Nurse Practitioner(ANP), and have been for 15 years. At the time of my licensing, the requirements were to have a 4 year BSN followed by a 2 year MS/MSN in order to obtain this degree and the right and privilege to treat patients.

The American Nurses Association(ANA), without any professional body consensus/vote has imposed that as of 2015 the only way to become a Nurse Practitioner is to obtain a Doctorate in Nursing Practice(DNP). This will be not only the entry level, but also the terminal degree required.

This decision will have no impact nor affect on my licensure, but it will have tremendous impact on all Nurses that desire to become Nurse Practitioners that are to follow.

This new requirement will add 2 more years of study along with the considerable additional expense required to obtain this degree. Unlike physicians, upon graduation there is no job awaiting the newly graduated Nurse Practitioner.

This poorly thought out action will ultimately produce the opposite effect desired. This mandate will reverse all the progress attained in the 45 year history of our existence.

Ultimately this mandate will result in less Nurse Practitioners in the profession, resulting in delayed access to care for the increasing numbers of people/patients that will require our services.

Nurse Practitioners are more often utilized in the under served locations and populations of the inner city.

Again, the rank-an-file members of the Nurse Practitioner profession have had no vote/consensus in this decision. There has never been any dialogue with the working body; just an edict sent out to notify of the change to take place.

In a letter to Louise Kapalan, yet to be responded to, in charge of policy for the ANA I wrote the following:

Well, I'm going to speak for the silent majority who are afraid to go against the grain or rock the boat:

Unless the individual wants a DNP and wants to be employed at the University level and/or wants to do research; thinking of making it a mandatory requirement in the future is wrought with problems and a monumental mistake for the following reasons:

*the amount of money spent in obtaining a DNP will never be recouped - MD's are taking 30 years to pay back their student loans and their salaries are not as they were in the past along with being placed in a higher tax bracket based upon their gross income; burdens their payback ability. If you want to become Dr", go to Medical School: becoming a specialist in the area of your research will not make you a better practitioner overall.

*the Medical community will really cause you quite a bit of grief with the title in front of our names even though it will have DNP on paper after the printed name.

*pushing for this is just another example of "NURSING" having an inferiority complex and wanting to justify their existence: accept the fact that we do a GREAT job and provide a GREAT SERVICE to the community and go to bed at night feeling good about that. I LOVE WHAT I DO!

This will never fly; Nursing can't even get RN licensure on the same page - how many years has it been and still no progress. The DNP should be a voluntary, individual choice and not a mandated choice.

The DNP is not the BE ALL/END ALL of our profession.

The DNP does not move "our profession forward". It just satisfies ego(s). You want a DNP, that's fine, but don't make it a requirement, it should be an optional choice.

Do MD's require all their clan to go for a fellowship? This is for one's own optional personal and professional growth. This mandate will go the way of the EDSEL FORD of the 50's.

This is truly the most ridiculous idea the powers that be could ever dream up! You have bought into the propaganda, because you are part of it; and according to "Cognitive Dissonance Theory", as proven by Milliken, Festinger and Lowell in the 50's. You always justify anything you have paid a price for or expended energies towards.

The greatest majority of the supporters of making the DNP a mandatory requirement are those who already obtained their DNP and need to justify their decision to obtain it, spend the money for it and expended the rigorous energy needed to obtain it. Just as "Cognitive Dissonance Theory" has proven. I have not exhausted any type of resource, nor expense to justify nor influence my decision making, so I can look at things quite objectively.

Doctors have a guaranteed job waiting for them upon graduation, NP's do not. New graduates are having a heck of a time obtaining their first NP position and still have to work as a BSN to stay gainfully employed in order to pay their normal expenses let alone paying back their advanced degree, which added 2 more years of didactic and the additional financial debt incurred along the way.

I, myself back in 1998 did not obtain a job as an NP until 5 months of very aggressive searching and the only job I was offered was in a dialysis center. I never worked a day in dialysis, but was given the job despite 2 other NP applicants with dialysis/ESRD experience applying for the job. Why did I get the job? I was offered this position because I was offered a under-market salary; I had an excellent Medical/Internal Medicine background as a BSN and because the Navy had this program for transitioning retirees which paid the employer $5,000 kick-back incentive if they hired the Vet. So, my employer paid me below market value and obtained a kick-back to hire me as well.

NP's are thriving as a result of a "Perfect Storm" scenario!

Lets review the facts:

IN THE BEGINNING, if it wasn't for money, insurance companies would not have given the NP the right time of day. It was their cost savings that allowed us to progress to where we are today.

a. First DRG's came along for cost savings

b. Physicians practice CYA Medicine because of the litigious nature of this country, thus ordering all tests whether appropriate or inappropriate

c. As a result, reimbursement dropped and then reimbursement to the MD dropped, following suite.

d. Insurance companies initially wouldn't give the NP the right time of day, but one genius realized that if they reimburse NP's at a reduced rate over the MD, WOW, what a cost savings there would be. As a result, insurance companies have become our best friend. This led to continual decrease in reimbursement of the physician.

As a result, MD's left the Primary Care/Internal Medicine specialties:

The physicians did it to themselves. Primary Care/Internal Med docs are not adequately reimbursed by their standards and point of view, so there are less and less MD's going into these specialties. Someone has to fill the void; NP's to the rescue. If it wasn't for that, NP's would still be trying to get in the front door. As Gordon Gecko said in "WALL STREET": GREED IS GOOD! Greed by MD's put us on the map and we are definitely here to stay! GO GREEN.

The new mandate for DNP as the only way to become an NP after 2015 will break the Universities back. Now that it will require 4yrs vs 2 yrs and alot of money and time on the part of the RN applicant, compounded with the lack of to miniscule payback on the other end; this program will go the way of the dinosaur. If I have to expend all that time and money for virtually no difference at the end of the day, I'll go to Medical School, and any rational thinking applicant will see this as well. This is not ROCKET SCIENCE to be able to figure this out.

As a result, access to care will get worse because of lack of providers because of the decisions of the "Powers That Be". This was really thought out well - lol

A DNP will not make the NP any better as a Clinician. We already outshine the MD community in patient approval and outcomes. So, now you are "beating a dead horse" and expect more people to want to ride this non-productive creature.

Then there is the "PUSH-BACK" from the Medical Community, that has deeper pockets than the NP Community.

DNP: "Doctor of Nursing Practice." Excuse me, no matter what you say or might think, "WE PRACTICE MEDICINE" with a Nursing DNA in our heritage.

When we order a medication, the bottle says Dr/MD, not NP, no matter how often you tell the pharmacist the we are NP's and not MD's. The DNP will not change anyone's perception of us no matter how hard you try to justify our existence.

Arbitrary decisions such as mandating that the DNP become the "Law of the Land", should be brought to the rank and file "Professional Body" for discussion and a vote. I didn't realize that GOD has died and left a few in charge of the working majority, without the majorities approval. If this isn't a case for our profession to unionize as a professional body to protect against poorly thought out and emotionally based decisions, I don't know what is?

Michael O. Mahler, CRNP, ANP-BC

Michael, Pain Management - Nurse Practitioner, Walter Reed National Military Medical Center January 2, 2015 6:35 PM
Bethesda MD

Dave, Thank you for your input. I definitely agree with you on the need for distinguishing non-NP DNPs from those that are NPs. The thought on certification is that those who are in a practice setting would provide an advanced  certification. This comes on the tail of those who are wanting to say that DNPs should not be called doctor in the clinical arena. Do you think this certification process would provide a step up for those that do have their DNPs and are in clinical practice??

Julie Schreiner DNP,FNP, RN December 29, 2014 3:23 PM

IS this an exam for NPs with a DNP or any DNP. One mistake I think my NP colleagues have made is not to distinguish the NP with the DNP from the administrator with the DNP. Both name tags will say DNP and they are not all NPs. The public will think they are.

Hope you get my point.

Why would an administrative non-NP DNP think they could pass a rigid clinical exam? If the exam would not be clinical, why do it?

Dave

Dave Mittman, PA, DFAAPA December 23, 2014 12:42 PM
Livingston NJ

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