Docs Oppose DNP Exam

please everyone....I am sick an tired of everyone implying that nursing is somehow substandard to medicine. Is social work substandard to dietetics, is teaching substandard to law? Medicine and nursing both work to improve the human condition by improving the health of humans. MD's have the hippocratic oath, and Nurses have the Code of Ethics. We are or should be partners in a team. I used to work in Hospice and I really learned a lot about the interdisciplinary concept. If a patient is crying any team member can respond...If a patient asks me as a nurse if I believe their is an afterlife, just because I am not a chaplain, it doesn't mean that I can't respond, it just means that I would respond differently. As a nurse I can still call for meals on wheels for an impoverished patient, even though I am not a social worker. As an NP I am not a 'mini doc'. I am a nurse with advanced training. I am still and foremost a nurse. I didn't and don't want to be a doctor, I have respect for them and I call my physician colleagues for questions regarding complex issues or to deal with things I haven't dealt with before. I consider them to be experts on all things medicine..I consider myself to be expert on nursing..having first been an RN for 25 years. Maybe we should get back to the idea that NP's should first be nurses for a number of years before becoming NP's, maybe then they will know the difference between medicine and nursing.

...."Just because the amount of time (4 years) needed to earn a DNP is roughly similar to that needed to earn an MD does not at all imply the true amount of time required to practice is anywhere close.  If graduate level nurses are pulling 80-100 hours/week on their education alone, I would love to hear about it. "Excellent points of view, Bill, which I hadn't taken into full consideration, and I should know better, having worked in a teaching hospital for many years.  I stand better informed.  Though I'd like to know if the DNP education prepares an RN as thoroughly for patient care as medical school and 3+ years of residency does for a doc.  It was determined that medical school  education should be four, instead of three, full years in order to keep apace with the rapidly growing knowledge base.  How can it be better to have less, not more, education? I'm thinking that this is coming to a head for another reason: the socialization of medicine, and all the undesirable aspects that are associated with it.  Costs of pharmaceuticals, provider visits and interventions - they are escalating out of control. Well, the docs fees are are climbing because of the rising costs of equipment, office overhead, liability insurances, continuing ed (many nurses don't know that a doc gets the priviledge of retaking boards every ten years at 1500$ per retake) not to mention the medical school tuition that has to be paid off is as expensive as the home mortgage plus lifestyle (I don't mean a Rolls in the dooryard either - I'm not that naive). What I am saying is that this is not likely going to change - more of the doctors' hard-earned edcuation is going to be farmed-out to lesser-paid ancillaries.

"Furthermore, if I were to continue my studies from BSN to a doctor's level, I would enter medical school with the same amount of time invested, and avoid the confusion of he said, she said, what do you know / not know, who are you, what do you do? issues."

I applaud you for considering going to medical school instead of pursuing a DNP.  Unfortunately, it does not appear as though the pathway is very attractive to many nurses.

For one, many (if not all) would have to go back and take required pre-med prerequisite classes, including 3 sem of inorganic chemistry, 3 sem of organic chem, 2 sem of physics, and a few sem of upper level "soft" science classes.  An average GPA of ~ 3.7 would be required in all those classes to have a good shot, as well as in their previous baccalaureate classload.  Then comes the MCAT, an ~ 8 hour exam that will test you over all of the above mentioned classes-a 30 is the average matriculant score, although a 25 is about the average score for the country.  If you have a bad day, you either kiss your chances good bye or study all over again and hope for the best.  Then comes med school interviews, if you get any.  They are a crap shoot.  If you are fortunate enough to be accepted (my school had a 16% acceptance rate, which is pretty liberal, most have ~10%), then you have 4 years of very hard work.  80-100 hours/week, every week for 3+ years,  The 4th year lets up a little, though.  Oh, and none of this can be done online.  Many schools still have required attendance to every lecture/small group.

If you want to go into FP, which is what most DNPs/APNs want to do, competition for residency will thankfully not be difficult, you should be able to pick where you want to do residency.  Then you get at least 3 years of 80 hour work weeks (~12,000 hours compared to 1,000 for DNP), including over night call shifts away from family.  Then, finally you are finished.  A fully trained physician.  You get to go out and look for work amongst a sea of APNs and soon DNPs, all of whom decided to take a path that is perceived as, and rightfully so, a shortcut, yet have all the same privileges that took you countless hours longer to achieve.  After residency, you are basically minimally competent.  I am not saying family doctors are minimally competent, I am saying that many physicians (regardless of specialty) do not consider themselves "fully" trained until they are out in practice for 3-5 years.  The learning curve is still that steep after everything they experienced.

The above description is just too much for most people.  They look at that road and then look at the NP road, which is 2-3 years, or the DNP road, which is 3-4 years; both are significantly less competitive than medicine.  I don't blame them for taking the shorter path.  Why wouldn't you?  Medical education is long and difficult.  I entered medical school 10 years ago and will be finishing my post-graduate training in a week.  It's a long road that requires a level of commitment most people don't possess.

Based on everything I have seen of MSN and DNP curricula, and in my speaking with APNs (a med school classmate of mine was a NP), the education of a graduate level nurse bears little, repeat little, resemblance to a physician's.  Just because the amount of time (4 years) needed to earn a DNP is roughly similar to that needed to earn an MD does not at all imply the true amount of time required to practice is anywhere close.  If graduate level nurses are pulling 80-100 hours/week on their education alone, I would love to hear about it.  

I have mixed regard for this new nursing designation.  In theory, it seems to have a potential benefit for APRNs. But if advanced practice nurses are already assuming the roles of care providers w/ prescriptive authority, why is there a need for another degree?  

I am concerned about the splintering of the profession.  The transition from diplomaed RNs to ADNs was a slow process.  The 1985 Proposal was the proposal that never was: in light of the nursing shortage, nursing colleges continue to graduate ADNs in record numbers. Secondary to the overwhelming response of ADN applicants, LPN programs have flourished to meet the need.  Now, instead increasing the numbers of BSN-degreed RNs, we are taking educational and licensure steps backwards.  While more RNs are now recognizing the BSN as the professional standard and are actively pursuing their degree, the ADN and LPN programs are keeping apace, if not exceeding, the BSN applicant pool.

How confusing will this new RN status be to the patients?   Patients complain that they cannot identify their nursing staff from the other ancillaries who are similarly garbed as the nurses; how, on a clinical level, will the patients understand with whom they should be speaking?  Their MD doctor, or their RN doctor?  They may be puzzled, wondering what the RN knows (or does not know) as opposed to the MD's working knowledge.  Patients are familiar with APRNs: they see them in office visits: in doctors offices, hospitals, and as independent practitioners.  How will the DNP be practicing any differently than APRNS ?  Furthermore, if I were to continue my studies from BSN to a doctor's level, I would enter medical school with the same amount of time invested, and avoid the confusion of he said, she said, what do you know / not know, who are you, what do you do? issues.

This DNP Exam is just the first iteration of what we are going to see in the future. DNP grads (who are nurse practitioners or other advanced practice RNs) are going to have to distinguish themselves above and beyond the MSN NP if this degree is going to mean anything - including increased career leverage, salary, etc. While this new certification is indeed controversial, it is likely to expand and I think it will give my Drexel grads DrNP more leverage in the workplace.