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ADVANCE Blog for PAs

An NP on the DNP

Published January 14, 2009 7:02 PM by Stephen Cornell

From our sister publication, ADVANCE for Nurse Practitioners, New York nurse practitioner Anthony Pucek's take on the Doctorate of Nursing Practice.

The DNP
Will it Create a Second-Class NP?

It looks like the doctorate of nursing practice (DNP) will be part of our professional futures. By 2015, all new advanced practice nurses will need to have a DNP for certification. Those of us in practice before that date will not be required to get the degree; we will be grandfathered in.

Will the DNP make master's-prepared NPs appear unqualified to provide the services they have been competently providing for years? As NPs, we need to know how this will affect our lives. The push for the DNP has far-reaching consequences.

Expert Status
A master's degree has long been considered the terminal degree for nursing specialists to enter advanced practice. With master's degrees, NPs are highly educated specialists. We seek new and updated knowledge to serve our patients' best interests. We consult or refer to gain the input of others when faced with a particularly difficult case.

Our current system of certification and recertification demonstrates our commitment to stay current with knowledge. We attend conferences, seminars and other continuing education activities that have been accepted as credits toward recertification.

Most master's-prepared NPs have pursued patient-centered careers. Ongoing continuing education, as well as collegial discussions, are manifestations of our efforts to be the best we can be. I fear that the DNP will invalidate master's-level providers as experts and that only those with a DNP will be viewed as experts.

Financial Concerns
Several studies have proven that master's-prepared nurse practitioners provide safe and effective care equal to that of their physician counterparts. We sweat the details and immerse ourselves in the real world of health care, with its long hours and agonizing decisions. Will a DNP improve our income? Or will it send a message to insurance companies that master's-prepared NPs are no longer qualified? Will it reduce the opportunity to gain provider status on insurance panels?

Job Opportunities
As we gain experience, we get better at what we do as professionals. We also begin to think of our future - our retirement. Many of us will not have the resources to support a full-time retirement. Some of us just won't want to stop practicing completely. What we think about is a less stressed working life as we continue serving our communities. We think about relocating to a warmer or less busy environment.

Will I be qualified to get a job in another state? Will my qualifications be considered insufficient? Will I become an anachronism? As the DNP becomes the norm, will older, master's-level NPs be able to compete for jobs?

Independent Practice
The rush to implement this credential will seriously affect NPs' efforts to achieve independent practice. Advocates of the DNP speculate that the degree will lead to reforming statutory supervision and collaborative practice laws. But I predict that it will lead legislators and medical associations to clamp down on the independence of master's-prepared NPs.

The DNP push is ill timed, ill planned and controlled by forces that don't represent mainstream NPs. I urge my colleagues to search their souls and their wallets. Is this direction acceptable? Is it wise?

It's the bottom of the ninth for current NPs, and we are losing a game that we were never invited to. The sad part is that it's not a game. It is about authority, privilege and money. This is about our livelihood, and it is truly serious business.

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109 comments

I think the law of unintended consequences is at work here.  Raising the bar to DNP for entry level APN practice is going to make the number of new applicants and grads drop like a rock.  Why pursue a DNP with its fluff classes when you can graduate sooner with a solid medical foundation and great pay as a PA? These ivory tower academics who have decreed this change seem to think that the pool of applicants is static and will never look at other options.  This is a horrible idea just when the demand for NPs and PAs is likely to skyrocket due to the coming changes in healthcare.%0d%0a%0d%0a

Audrey , Urogynecology - WHNP-BC March 20, 2012 8:02 PM
Austin TX

Nurse leaders in the AANC should be ashamed of theirselves creating DNP that do not lead to increased medical knowledge and yet have the gall to call them a clinical doctorate. Come on...Capstone project!  Give MSN FNP's a a clinical doctorate with increased scientific ology backed knowledge. We need more pharmacology, Gross anatomy, pathology, physiology etc. coupled with a residency.  Make a hybrid degree that lables us as a doctor in the hospital with increased pay that gives us that extra 15% of knowledge that physicians have and we do not. What we need are true NP to MD programs. Call the graduates of these program nurse/physicians. Make us NMD's. Make these programs the 3rd entry level into the medical profession along with MD and DO. Nursing needs to stop with all the usless jargon and go for the true terminal degree. NMD!!! Nursing Medical Doctor that give the NMD all the rights and privliges of that of a physician!!!  Get busy nursing leaders!!!!!! This will definitely decreae the provider shortage, and will not lower standards of care while making the nursing profession strong and will  finally give our profession  the respect it deserves:)

Mark , MSN FNP July 24, 2011 6:57 PM

This is an interesting topic that I can offer an interesting viewpoint on.  For 13 years I was an electrician, and achieved the level of Master, which is the highest available.  I pulled a midlife career change and got into the health field and am pursuing a DNP.  I can say that for decades, electricians were only required to have licensing in the municipality in which they performed work.  Before that, there was no license at all.  Things are still changing.  There began a statewide license program and there is currently a push toward a national standard.  All apprentices currently are required to achieve at least a state journeyman license.  There must also be a master on site for supervision.  The older electricians were all grandfathered in as journeymen with their city licenses.  There was a great deal of talk throughout my colleagues that very closely resembles the concern I see here.  

I can say that this change has proved to be a good thing.  Most of the people that were in the old system are now nearing retirement.  I know of none that were treated differently or that made less money than the newer electricians with the new requirements.  In fact, as our skillset and qualifications improved, so did our wages and this was for everyone.  I will say that at least in the electrical field it has been nothing but a vast improvement in our wages and knowledge base.

March 13, 2010 8:08 PM

I agree with many of the comments about the DNP in here.  But, I don't really care about any of them.  I am getting the DNP to use as a tool to get more money, period.  **** everything else.  I'm sick of doing the same ******* thing as MDs and seeing jobs advertise for MDs for a quarter million and the same job descriptions advertised to us lowly NPs for peanuts.  The jobs mostly don't even mention the money for NPs because they know how rediculous it sounds to offer a health care practitioner such crap.  I know reimbursement will be no different, but if you're gonna argue that, then why aren't we getting offers for 85% of the salaries the primary docs are getting????  I shoulda went to law school...

Wanna B. , NP April 21, 2009 11:56 AM
MO

Truely a money making proposition for acadamic insitutions.  Perhaps if they offered a Doctorate with a medical concentration that requires medical rotations instead of classes dealing with the  unreal world of nursing idealism, it maybe actually benefit our patients and make us better clinicians.  

I have precepted 3 doctorate students who are 1 yr away from graduation and have VERY limited medical knowledge.    I reviewed the doctorate  curriculum and found it amusing that there were so many "NURSING classes" with little or no emphasis on medicine.  

Also, for those of us who do not have hospital reimbursement and  working to serve the underprivledged or at a family practice office, we cannot afford to go back to school again just to be called doctor.

Linda , NP April 13, 2009 7:32 PM

The DNP degree is an expansion from the master of science specialty tracks (midwive, anesthesia, practitioner, etc).  As the profession progresses, nurses need to earn the degree of knowledge they are entitled to.  You simply can't just keep on adding more classes and only keep calling it a masters degree.  Just as pharmacy has expanded to doctorate level of education from their previous degree, so will nursing.

I find it a very sad affair that nurses don't support the expansion of knowledge they are entitled to and that most of the old school nurses eat their young as new inspiring future nurses try to advance the profession.

Anonymous , FNP/ACNP - DNP Student April 4, 2009 3:06 PM
Columbia SC

It appears everyone is upset with this news.  The question is what can we do about it?  Is this state driven in NY or is this going to be a national agenda?  States have difficulty agreeing on what functions a NP can do, I can't see all of them coming together on a topic that is complex as having all new NPs be DNP trained.  Do we contact a local coalition of NPs or is there a national coalition that is addressing this issue.  We as a group have fought for great progress in our profession.  This issue can definitely be stopped.

Bob , Orthopedics - ARNP January 29, 2009 3:39 PM

Truely a money making proposition for acadamic insitutions.  Perhaps if they offered a Doctorate with a medical concentration that requires medical rotations instead of classes dealing with the  unreal world of nursing idealism, it maybe actually benefit our patients and make us better clinicians.  

I have precepted 3 doctorate students who are 1 yr away from graduation and have VERY limited medical knowledge.    I reviewed the doctorate  curriculum and found it amusing that there were so many "NURSING classes" with little or no emphasis on medicine.  

Also, for those of us who do not have hospital reimbursement and  working to serve the underprivledged or at a family practice office, we cannot afford to go back to school again just to be called doctor.  

Linda , NP January 29, 2009 3:38 PM

The ivory towers that make the rules have limited exposure to the real world of providing care.  Reading articles about the DNP continues to evoke the same response that it had originally and naturally begs the question: When NP's are struggling in most states to get recognized on insurance panels as direct providers, and we continue to have restrictive collaboration/supervision language in most state laws why are we aiding the foes of Masters Level educated Nurses by introducing a degree that allows others to say "even the nursing profession believes their education is inadaquate... see they want all nurses to have a doctorate"........?

Anthony Pucek, Psychiatry - NP January 29, 2009 9:23 AM
Lagrangeville NY

I think having a doctorate no longer sets our profession apart. I think it will steer RNs away from nursing. Why do the DNP when for a bit longer they could be a PA?  We are nurses and doing a wonderful job just as we are. Part of the reason that nursing is having difficulty being viewed as a profession is because the ANA is always trying to change the standards. The ANA should set standards and stick together like the AAPA rather than creating dynamic states in which no one knows what the future holds. As united as the AAPA, I believe we would be an unstoppable force, but many of us are still eating our own.

Anonymous , BSN, CCRN, MSN, NP January 29, 2009 12:42 AM

The misconception ANA pushing the DNP is that they might be viewed as on par. The problem is other health care providers will never recognize DNPs, and as such NP or DNP will not make a major difference in the practice setting. All the fluff by DNP graduates and nursing academia about providing patients with most up-to-date treatment and and evidence based practice is misleading, as these topics are heavily emphisized in the MSN programs.  The MSN programs (or at least the one I attended) is an excellent nursing academia for MSN, NP, and superior to the programs I have reviewed DNP curriculum.

Anonymous , BSN, MSN, NP January 29, 2009 12:36 AM

It appears everyone is upset with this news.  The question is what can we do about it?  Is this state driven in NY or is this going to be a national agenda?  States have difficulty agreeing on what functions a NP can do, I can't see all of them coming together on a topic that is complex as having all new NPs be DNP trained.  Do we contact a local coalition of NPs or is there a national coalition that is addressing this issue.  We as a group have fought for great progress in our profession.  This issue can definitely be stopped.

Bob , Orthopedics - ARNP January 29, 2009 12:28 AM

have been an Nurse Practitioner for 20 years and have people asking me "What is a NP?" Pushing the DNP and the "DR Title" confuses patients more. We have just started to be recognized as providers with patients and the AAPA/AMA. DNP blurs the roles again. My other issue is cost. $30,000/per term to get a doctorate and not a larger pay check is a burden, especially for NP's with families and those putting away retirement money. Financially the health care system cannot afford expensive providers. Nursing colleges seem to be making out just fine with these new program enrollment and money.

Anonymous , BSN, CCRN, NP, BC January 29, 2009 12:26 AM

Truely a money making proposition for acadamic insitutions.  Perhaps if they offered a Doctorate with a medical concentration that requires medical rotations instead of classes dealing with the  unreal world of nursing idealism, it maybe actually benefit our patients and make us better clinicians.  

I have precepted 3 doctorate students who are 1 yr away from graduation and have VERY limited medical knowledge.    I reviewed the doctorate  curriculum and found it amusing that there were so many "NURSING classes" with little or no emphasis on medicine.  

Also, for those of us who do not have hospital reimbursement and  working to serve the underprivledged or at a family practice office, we cannot afford to go back to school again just to be called doctor.  

Linda , NP January 29, 2009 12:24 AM

DNP enhances nursing education prestige and training without medical knowledge. DNP is no more a new degree in the unreal world of nursing education than the MSN. Examine the varying, and woefully unstandardized DNP. MSN, NP, DNP is bureaucracy, and full independent practice. Nursing theories.  Nursing idealism.  

ANA is pushing the DNP and "DR title" without reason to accept this brand of fluffed up new degrees, and nursing education which is supposed to school us to be better nurses than the MSN, NP.  The DNP is a worthless doctorate schooling to add questionable "nursing prestige", and $$$$$$ DNP nursing academia.

Anonymous , BSN, CCRN, MSN, NP January 29, 2009 12:18 AM

When I first learned of the offering of a DNP and heard it would better prepare Nurse Practioners as clinicians, I thought it sounded like a good idea.  I did not think it would be required, rather offered.  So, like many other Nurse Practitioners, looking to increase their medical knowledge, making us even more adept at taking care of our patients, I began to review the curriculums of several schools.  Much to my surprise and dismay, I found programs consisting of more research, policy and theory classes.  Where were the classes that would teach me more on symptoms, diseases, treatment options, procedures and other topics that would truly help us become more expert at what we currently do for our patients.  There is already a Ph.D. in Nursing and in my humble opinion, the DNP mirrors this degree.  What is the point?

   I truly hope that those who decided to require the DNP, rethink their decision and change it from a requirement to an option for those who would like to pursue it and focus more on providing more seminars, symposiums and classes on true clinical based issues.

Patti , Primary Care - Adult Nurse Practitioner January 29, 2009 12:16 AM
St Louis MO

In an era when we need additional primary care providers--why we are choosing to make it more difficult by added a degree to a profession with proven quality outcomes astounds me.  I too, now think I may have well have gone to our local medical school.  They have a fast track PCP program that takes 3 years. Less money from me, better loan rates, and a much better salary.  Having been a nurse, I still think I would be able to provide the same holistic care I give now.  I see many new residents coming out with the same holistic philosophy, anywya, narrowing any philosophical difference.  I am more frightened, however at the proposals I saw in the agendas for our nat'l orgs that call for discussions on us taking the medical boards now--instead.  Why are we always trying to impress rather than blaze our own trail.  We, too, can lead!  Yet, we choose to be subservient and whine about it.  So many nurses--and so little power because we do not harness it.  Oh, I would like to know where Vicky is finding a cheap DNP program, by the way.  Even on-line and locally I cannot find one less than $500-600/credit--and that's cheap.  I am already paying about a quarter of my salary in student loans.

Bri January 29, 2009 12:14 AM

It appears everyone is upset with this news.  The question is what can we do about it?  Is this state driven in NY or is this going to be a national agenda?  States have difficulty agreeing on what functions a NP can do, I can't see all of them coming together on a topic that is complex as having all new NPs be DNP trained.  Do we contact a local coalition of NPs or is there a national coalition that is addressing this issue.  We as a group have fought for great progress in our profession.  This issue can definitely be stopped.

Bob , Orthopedics - ARNP January 29, 2009 12:12 AM

Truely a money making proposition for acadamic insitutions.  Perhaps if they offered a Doctorate with a medical concentration that requires medical rotations instead of classes dealing with the  unreal world of nursing idealism, it maybe actually benefit our patients and make us better clinicians.  

I have precepted 3 doctorate students who are 1 yr away from graduation and have VERY limited medical knowledge.    I reviewed the doctorate  curriculum and found it amusing that there were so many "NURSING classes" with little or no emphasis on medicine.  

Also, for those of us who do not have hospital reimbursement and  working to serve the underprivledged or at a family practice office, we cannot afford to go back to school again just to be called doctor.  

Linda , NP January 29, 2009 12:11 AM

Truely a money making proposition for acadamic insitutions.  Perhaps if they offered a Doctorate with a medical concentration that requires medical rotations instead of classes dealing with the  unreal world of nursing idealism, it maybe actually benefit our patients and make us better clinicians.  

I have precepted 3 doctorate students who are 1 yr away from graduation and have VERY limited medical knowledge.    I reviewed the doctorate  curriculum and found it amusing that there were so many "NURSING classes" with little or no emphasis on medicine.  

Also, for those of us who do not have hospital reimbursement and  working to serve the underprivledged or at a family practice office, we cannot afford to go back to school again just to be called doctor.  

Linda , NP January 29, 2009 12:11 AM

Truely a money making proposition for acadamic insitutions.  Perhaps if they offered a Doctorate with a medical concentration that requires medical rotations instead of classes dealing with the  unreal world of nursing idealism, it maybe actually benefit our patients and make us better clinicians.  

I have precepted 3 doctorate students who are 1 yr away from graduation and have VERY limited medical knowledge.    I reviewed the doctorate  curriculum and found it amusing that there were so many "NURSING classes" with little or no emphasis on medicine.  

Also, for those of us who do not have hospital reimbursement and  working to serve the underprivledged or at a family practice office, we cannot afford to go back to school again just to be called doctor.  

Linda , NP January 29, 2009 12:11 AM

I have been a NP for nearly 15 years and a nurse for 27 years. I am a graduate of diploma program and have a certificate to practice as a FNP.  I am nationally certified and am therefor grandfathered in to continue practicing. I am 53 years old. Retirement is rapidly approaching and I still have one child to get through college. I do not have the time or money to spend getting a DNP. I would never recoup the money. The time spent in class learning nursing theories that have little or no application to the real world is too valuable. In these times of health care crisis millions of uninsured working families, growing under served populations surely nursing can come up with a better plan than adding more classes teaching theories

Ray , fnp-c January 29, 2009 12:10 AM
syracuse NY

Where will it all end I'm a CNS FNP a twenty years in nursing and 7 of those as a NP with a clinic in this town of PAs and MDs who've "good ole syndromes" and the NPs here who will sell our own down the river to become one of "them".  10 years of nursing education 30 yrs of nursing experience and yet it's not good enough?  WHAT!!!!  This is too much $$$$$$ to be treated less than dirt on the road, and strike against the AMA.  I am not wasting yrs not make $$$$$$.  The AAPA/AMA call the shots and the ANA say yessir and how high did the AAPA/AMA say we need to jump?  Bull corn, we need to stand up to them and demand independence practice.  

Nina , RN, BSN, FNP January 29, 2009 12:09 AM

I have been an NP for 20 years.  We eat our own.  We see things on a daily basis people never see.  The nursing staffs did not comprehend when the PAs ordered 100 of Morphine it was Fentanyl. We did not comprehend why patients with pulmonary illnesses needed 16mg.  I've reviewed the DNP curriculum, and none of DNP courses had medical component.   DNP programs claim the DNP provides a expert nursing education but programs seem to be nursing theories.  Although, I comprehend evidence based practice, not one of the programs seems to offer additional nursing academia which would benefit MSN, NP.  Why is there a need for this new degree and "DR title" in this unreal world of nursing idealism?  

Anonymous , RN, MSN, NP January 29, 2009 12:08 AM

In an era when we need additional primary care providers--why we are choosing to make it more difficult by added a degree to a profession with proven quality outcomes astounds me.  I too, now think I may have well have gone to our local medical school.  They have a fast track PCP program that takes 3 years. Less money from me, better loan rates, and a much better salary.  Having been a nurse, I still think I would be able to provide the same holistic care I give now.  I see many new residents coming out with the same holistic philosophy, anywya, narrowing any philosophical difference.  I am more frightened, however at the proposals I saw in the agendas for our nat'l orgs that call for discussions on us taking the medical boards now--instead.  Why are we always trying to impress the MDs rather than blaze our own trail.  We, too, can lead!  Yet, we choose to be subservient and whine about it.  So many nurses--and so little power because we do not harness it.  Oh, I would like to know where Vicky is finding a cheap DNP program, by the way.  Even on-line and locally I cannot find one less than $500-600/credit--and that's cheap.  I am already paying about a quarter of my salary in student loans.

Bri January 26, 2009 5:54 PM

It appears everyone is upset with this news.  The question is what can we do about it?  Is this state driven in NY or is this going to be a national agenda?  States have difficulty agreeing on what functions a NP can do, I can't see all of them coming together on a topic that is complex as having all new NPs be DNP trained.  Do we contact a local coalition of NPs or is there a national coalition that is addressing this issue.  We as a group have fought for great progress in our profession.  This issue can definitely be stopped.

Bob, Orthopedics - ARNP January 26, 2009 9:41 AM

I have been an Nurse Practitioner for 20 years and have people asking me "What is a NP?" Pushing the DNP and the "DR Title" confuses patients more. We have just started to be recognized as providers with patients and the AAPA/AMA. DNP blurs the roles again. My other issue is cost. $30,000/per term to get a doctorate and not a larger pay check is a burden, especially for NP's with families and those putting away retirement money. Financially the health care system cannot afford expensive providers. Nursing colleges seem to be making out just fine with these new program enrollment and money.%0d%0a

Anonymous , BSN, CCRN, NP, BC January 24, 2009 4:56 PM

I have been a NP for nearly 15 years and a nurse for 27 years. I am a graduate of diploma program and have a certificate to practice as a FNP.  I am nationally certified and am therefor grandfathered in to continue practicing. I am 53 years old. Retirement is rapidly approaching and I still have one child to get through college. I do not have the time or money to spend getting a DNP. I would never recoup the money. The time spent in class learning nursing theories that have little or no application to the real world is too valuable. In these times of health care crisis millions of uninsured working families, growing under served populations surely nursing can come up with a better plan than adding more classes teaching theories

Ray , fnp-c January 24, 2009 4:55 PM
syracuse NY

Where will it all end I'm a CNS FNP a twenty years in nursing and 7 of those as a NP with a clinic in this town of PAs and MDs who've "good ole syndromes" and the NPs here who will sell our own down the river to become one of "them".  10 years of nursing education 30 yrs of nursing experience and yet it's not good enough?  WHAT!!!!  This is too much $$$$$$ to be treated less than dirt on the road, and strike against the AMA.  I am not wasting yrs not make $$$$$$.  The AAPA/AMA call the shots and the ANA say yessir and how high did the AAPA/AMA say we need to jump?  Bull corn, we need to stand up to them and demand independence practice.  

Nina , RN, BSN, FNP January 24, 2009 4:53 PM

Truely a money making proposition for acadamic insitutions.  Perhaps if they offered a Doctorate with a medical concentration that requires medical rotations instead of classes dealing with the  unreal world of nursing idealism, it maybe actually benefit our patients and make us better clinicians.  

I have precepted 3 doctorate students who are 1 yr away from graduation and have VERY limited medical knowledge.    I reviewed the doctorate  curriculum and found it amusing that there were so many "NURSING classes" with little or no emphasis on medicine.  

Also, for those of us who do not have hospital reimbursement and  working to serve the underprivledged or at a family practice office, we cannot afford to go back to school again just to be called doctor.  

Linda , NP January 24, 2009 4:52 PM

I have been an NP for 20 years.  We eat our own.  We see things on a daily basis people never see.  The nursing staffs did not comprehend when the PAs ordered 100 of Morphine it was Fentanyl. We did not comprehend why patients with pulmonary illnesses needed 16mg.  I've reviewed the DNP curriculum, and none of DNP courses had medical component.   DNP programs claim the DNP provides a expert nursing education but programs seem to be nursing theories.  Although, I comprehend evidence based practice, not one of the programs seems to offer additional nursing academia which would benefit MSN, NP.  Why is there a need for this new degree and "DR title" in this unreal world of nursing idealism?  

Anonymous , RN, MSN, NP January 24, 2009 12:44 AM

I'm a Nurse Practitioner and have been working in the SICU for four years.  The ANA has been going down the toilet, and is getting to the point I can't deal with it.  We eat our own.  There's crap everywhere, but it is much worse in the nursing community.  The problem is the AMA who control health care don't care about quality patient care or safety. All they care about is money, and it gets worse. They cut back on everything except their salaries and force nurses to work under increasingly stressful conditions.

The PAs I work with most of the time work short staffed with high patient ratios and many times PAs are not having the time to take a breakor go to the bathroom- god bless the AAPA.  I got the point where I despised the AMA, the patients, and the floor administrators (a number of which are experienced PAs). Nurses could be working their butts off and all AMA members do is gripe. A lot of the times griping comes from the physicians clicking across the floor yelling at the nurses to answer those call lights.  I am covered in body fluids and I am with a patient---no you need to drop the body fluids and answer those call lights.

I had one family member of a patient's roommate yelling at the nurses.  The PA staffs were dealing with a blood transfusion. She said her brother needed to go to the bathroom and that the nurses had to get him to the bathroom. As if the *** couldn't see we were dealing with an emergency. There was no reason she couldn't help him to get to the bathroom herself, but no, bathroom stuff is beneath her and it is a nurse's job.

She went and complained to the nurse manager her brother had to go urgently, he would've pooped on himself because it was not a priority for the nurses. The nurse manager had the nerve to tell me, I should have called the other nurses to get to the patient to the bathroom as the PAs were dealing with the transfusion. Call who? When the other nurses were busy with other patients?

The PAs should have proceeded the blood transfusion til this patient went into shock and died so I could get her brother to hop a whopping 5 steps to the toilet and take a dump?  A nurse is nothing but a glorified butt wiper?  For nurses who think he/she is a health care provider see til a patient or family member calls administration griping about the nursing staffs.  That's when we nurses see our only health care provider function is fetching that pitcher and wiping that butt.  

Anonymous , BSN,RN,MSN, NP January 23, 2009 9:39 PM

I have been a NP for nearly 15 years and a nurse for 27 years. I am a graduate of diploma program and have a certificate to practice as a FNP.  I am nationally certified and am therefor grandfathered in to continue practicing. I am 53 years old. Retirement is rapidly approaching and I still have one child to get through college. I do not have the time or money to spend getting a DNP. I would never recoup the money. The time spent in class learning nursing theories that have little or no application to the real world is too valuable. In these times of health care crisis millions of uninsured working families, growing under served populations surely nursing can come up with a better plan than adding more classes teaching theories

Ray , fnp-c January 23, 2009 3:33 PM
sy NY

Truely a money making proposition for acadamic insitutions.  Perhaps if they offered a Doctorate with a medical concentration that requires medical rotations instead of classes dealing with the  unreal world of nursing idealism, it maybe actually benefit our patients and make us better clinicians.  

I have precepted 3 doctorate students who are 1 yr away from graduation and have VERY limited medical knowledge.    I reviewed the doctorate  curriculum and found it amusing that there were so many "NURSING classes" with little or no emphasis on medicine.  

Also, for those of us who do not have hospital reimbursement and  working to serve the underprivledged or at a family practice office, we cannot afford to go back to school again just to be called doctor.  

Linda , NP January 23, 2009 3:31 PM

    When I first learned of the offering of a DNP and heard it would better prepare Nurse Practioners as clinicians, I thought it sounded like a good idea.  I did not think it would be required, rather offered.  So, like many other Nurse Practitioners, looking to increase their medical knowledge, making us even more adept at taking care of our patients, I began to review the curriculums of several schools.  Much to my surprise and dismay, I found programs consisting of more research, policy and theory classes.  Where were the classes that would teach me more on symptoms, diseases, treatment options, procedures and other topics that would truly help us become more expert at what we currently do for our patients.  There is already a Ph.D. in Nursing and in my humble opinion, the DNP mirrors this degree.  What is the point?

    I truly hope that those who decided to require the DNP, rethink their decision and change it from a requirement to an option for those who would like to pursue it and focus more on providing more seminars, symposiums and classes on true clinical based issues.

Patti, Primary Care - Adult Nurse Practitioner, Medical Acute Care Center January 23, 2009 9:45 AM
St. Louis MO

I am a Nurse Practitioner at a busy underserved health clinic. The patients are very ill, and very demanding.  But the PAs here are awesome.  The work is tremendous and the stress is high.  The stress is high, the nurses snap at the nearest person including other nurses. The experienced PAs seem to have more patience for us and new nurses than the experienced nurses although they do not comprehend holistic nursing practice.  

I'm already planning to quit my job and return to my home country-MSN, NP and push the importance of nursing in my home country.  at this other underserved ICU unit I work the turnover of new MSN, NP grads is high because at this point in time, vocal gripes at work, and an overall discouraging nursing staff is totally.  i've seen more catty nurses than PAs than the other way around although I comprehend the stress of the work. the PAs always seem to be more unified than the nurses, and love working in the ICU unit than the other way around.  but where is nursing civility - and I can't comprehend the lack of equipment on the ICU unit- lack of infusion pumps, no o2 saturate machines to be found- is there a bar running out of vodka?

Sorry for the gripe, I am disappointed I spent $$$$, time, and effort towards nursing academia only to realize working in the ICU unit has made me sick. I dreaded going to work-but subsequent to these two weeks I would quit my job. not because I'm a weak MSN, NP or not quick enough to manage the underserved ICU unit as rapidly as the experienced PAs are, but because I'm quick enough to bail out of a lack of unity before I waste more time.

Anonymous , RN, CCRN, MSN, NP January 22, 2009 11:56 PM

I used to think the ANA was for us as the AAPA is for PAs, man was I misled.  We eat our own.  Where is ANA unity?  Our own clinics?  There are many times when we NP need problem resolution.  DNP is a region which we need problem resolution. This biting behavior is due to a volitile environment.

Anonymous , MSN, ANP, BC January 22, 2009 10:17 PM

DNP enhances nursing education prestige and training without medical knowledge. DNP is no more a new degree in the unreal world of nursing education than the MSN. Examine the varying, and woefully unstandardized DNP. MSN, NP, DNP is bureaucracy, and full independent practice. Nursing theories.  Nursing idealism.  

ANA is pushing the DNP and "DR title" without reason to accept this brand of fluffed up new degrees, and nursing education which is supposed to school us to be better nurses than the MSN, NP.  The DNP is a worthless doctorate schooling to add questionable "nursing prestige", and $$$$$$ DNP nursing academia.

Anonymous , BSN, CCRN, MSN, NP January 22, 2009 8:37 PM

I fear that Vicky's comment  "Where are you finding tuition of $30,000 per term?  The total cost of my DNP program is less than that.  It is my contention that the NP - whether MSN or DNP prepared will further the profession based on performance not just degrees" is very devisive, not helpful at all, and I take personal umbrage at it.  I agree with Anthony Pucek's  comments.  What he did not touch on is the issue of calling the NP, "Doctor" ...another can of worms.

Anonymous , Oncology - CRNP, Union MemorilalHospital January 22, 2009 8:03 PM

I fear that Vicky's comment  "Where are you finding tuition of $30,000 per term?  The total cost of my DNP program is less than that.  It is my contention that the NP - whether MSN or DNP prepared will further the profession based on performance not just degrees is very devisive, not helpful at all, and I take personal umbrage at it.  I agree with Anthony Pucek's  comments.  What he did not touch on is the issue of calling the NP, "Doctor" ...another can of worms.

Anonymous , Oncology - CRNP, Union MemorilalHospital January 22, 2009 8:02 PM

The ANA has been around decades prior to the AAPA. The majority of states already advocate full independent practice status.  I have been running my own clinic for seven years and I have many many patients who prefer NP holistic practice. The evidence based practice of NPs are excellent.  My patients prefer my more holistic practice over a more medical based practice.  

Anonymous , RN, CCRN, MSN, NP, BC January 22, 2009 7:49 PM

Truely a money making proposition for acadamic insitutions.  Perhaps if they offered a Doctorate with a medical concentration that requires medical rotations instead of classes dealing with the  unreal world of nursing idealism, it maybe actually benefit our patients and make us better clinicians.  %0d%0a%0d%0a I have precepted 3 doctorate students who are 1 yr away from graduation and have VERY limited medical knowledge.    I reviewed the doctorate  curriculum and found it amusing that there were so many "NURSING classes" with little or no emphasis on medicine.  %0d%0a%0d%0a Also, for those of us who do not have hospital reimbursement and  working to serve the underprivledged or at a family practice office, we cannot afford to go back to school again just to be called doctor.    %0d%0a

Linda , NP January 22, 2009 7:25 PM

I'd like to make 2 points:

1)  One of the MOST TELLING questions asked in my MSN program in reference to "Nursing Theory" was "Does any other medical profession require theory classes?"  Our instructor could think of none. To me, the requirement of TWO nursing theory courses at the graduate level was part of nursing academia's desperate attempt to make nursing somehow more professional. (I kept thinking, isn't there something more important that this that we can all be spending our time/money/efforts on???)  By the time I got around to getting my MSN, I'd been a BSN/certificate- prepared NP for over 20 years. (My OTHER Master's is in Business). The theory classes are compete bunk (and were a re-hash x 10 of my BSN classes 20 years prior) and those responsible for requiring them then are the same people who decided that we all need doctorates.  

2)  Was this decision EVIDENCE-BASED?  I think not.  As many of you have pointed out, study after study shows that NPs provide equivalent, if not superior care to that of MDs. WHAT the hell are we doing????

I call for those of us in the trenches to appeal to our nursing leaders to RE-THINK this decision.

I predict:  This requirement will shrink the numbers of NP graduates to approx one QUARTER of those currently graduating. A 2 year commitment is "doable" for many of us in the thick of our busy lives, but the prospect of a doctoral program will prove too daunting to a large number of RNs contemplating furthering their education.  We are committing professional suicide.

In this critical time, Americans NEED a "less expensive" alternative to medical care.  We APNs are the answer.  Our leaders should be spending their time jumping up and down getting Obama's attention as the saviors of the healthcare system, not shaking things up by implying that the way we are currently training our NPs is not good enough.

Anonymous , Women's Health - NP January 22, 2009 7:23 PM

Where are you finding tuition of $30,000 per term?  The total cost of my DNP program is less than that.  It is my contention that the NP - whether MSN or DNP prepared will further the profession based on performance not just degrees.  

Vicky January 22, 2009 3:27 PM

I have been an Nurse Practitioner for 20 years and have people asking me "What is a NP?" Pushing the DNP and the "DR Title" confuses patients more. We have just started to be recognized as providers with patients and the AAPA/AMA. DNP blurs the roles again. My other issue is cost. $30,000/per term to get a doctorate and not a larger pay check is a burden, especially for NP's with families and those putting away retirement money. Financially the health care system cannot afford expensive providers. Nursing colleges seem to be making out just fine with these new program enrollment and money.

Anonymous , BSN, CCRN, NP, BC January 20, 2009 11:44 AM

Nursing academia is so selfish here.  ANA will file a HRC complaint.  Academia is making more $$$$ marketing DNP than LPN, MSN.  We're leaving our jobs and clinics to call ourselves a new title, and then what? Did the ANA say there is not a shortage of NPs? There's a shortage of MSN, ANP. We aren't trained to do everything PAs are trained to do and physicians are trained to do in healthcare.  Knowing the laughingstock which is the HRC, the ANA would succeed filing higher reimbursement.

Anonymous , MSN, ANP January 19, 2009 8:47 PM

I would love to get a DNP IF I could go for free. I am just several years from retirement (by 2015) and have 2 children to get through college. I would never recoup the money spent for tuition in these few years. Also, the position I work in would make it difficult to take time off for full-time clinical rotations. I could end up losing this position and my benefits. I would really like to see the focus on BSN as the requirement for all nurses.

Karen, pediatrics - Fnp, schools January 19, 2009 4:32 PM
Highland Mills NY

Truely a money making proposition for acadamic insitutions.  Perhaps if they offered a Doctorate with a medical concentration that requires medical rotations instead of classes dealing with the  unreal world of nursing idealism, it maybe actually benefit our patients and make us better clinicians.  

I have precepted 3 doctorate students who are 1 yr away from graduation and have VERY limited medical knowledge.    I reviewed the doctorate  curriculum and found it amusing that there were so many "NURSING classes" with little or no emphasis on medicine.  

Also, for those of us who do not have hospital reimbursement and  working to serve the underprivledged or at a family practice office, we cannot afford to go back to school again just to be called doctor.    

Linda , NP January 19, 2009 3:52 PM

I have a colleague who is NOT an NP who is now a DNPand another in the same program now that they have worked the kinks out.....they were required to do a capstone project that is the same requirement I had in my MSN/Adult Nurse Practitioner program in the 90s in a major northeastern city. I am sure it was done for the initials rather than for any clinical reason (and to bring these 80s master-prepared nurses into the 21st century. In fact, these nurses would be incompetent in their neighborhood, period. My practice area is internal medicine and geriatrics. My collaborating physician has always respected my opinion and I feel that I have never been treated as second class. If you have the right stuff you don't need another title, just keep up with the evidence and best practice. You don't need to do a quality/research project either.

Cris, MSN, ANP, BC January 19, 2009 3:07 PM

As is the case with many of the commentors, I too have progressed from AA degree to MSN, CRNP in adult primary care over the course of my 23 year nursing career. I certainly can understand the push for the DNP requirement however as a practicing NP who loves education and has considered returning to pursue the DNP, I have many reservations with the programs I have researched. The claim is the DNP provides a clinical based expert education and yet all the programs I have researched seem to be researched based. Although, I understand the importance of evidence based medicine, not one the programs seems to offer me any more clinically based medical education that I feel would be the utmost beneficial to me in pursuing yet another clinical degree. As a practicing NP for almost 6 years, I have  learned a great deal each day from my physicians, other NP's, PA's and other healthcare disciplines. I have also learned how much clinically I have yet to learn. It seems to me the medical argument against NP's (at least from within my own practice setting) is not the lack of a doctorate degree but that our own educational program lacks a clinical curriculum similar to a physician's internship/residency. Perhaps if the NP or DNP programs actually become more clinically based our fellow physicians would be more open in accepting our role in today's healthcare. In my short experience, I have learned that the best clinicians whether MD, NP, DNP, PharmD, etc. are those who recognize their limitations and know when to seek the advice/expertise of someone more qualified or more experienced. It has also been my experience that most will respect the education and expertise of others regardless of degree and those who do not are usually those with issues of their own. For those who choose to pursue an advanced degree, do it for yourself and no other reason. This will make you a much better practitioner!

Patricia Warble, CRNP, Vascular Surgery - CRNP, AAMC January 19, 2009 3:04 PM
Annapolis MD

I think that acheiving a doctorate degree earns the title to be called "doctor" but I cannot help to ponder what AMA/AAPA think of the ANA when DNP flops. Our lack of unity, and failure to regulate weakens ANA. The ANA has over-idealized the results.  Academia is overexaggerating the benefits.  As more DNPs graduate, issues sure will resurface.  Think about it.  Does DNP get us leverage re: ANA issues? No.  

Anonymous , RN, MSN, FNP January 19, 2009 2:07 PM

I completed a Doctor of Nursing Science (DNSc) program which was a mix of practice and research. I completeted 1000 clinical hours post-masters, 61 credit hours,  and a dissertation, much more than the current DNP curriculums.  I did it because it was a goal of mine to have a doctorate and I did not want a Ph.D. and of course this was before the DNP existed.  I can say that I am glad I accomplished my goal. It did it not to make any more money but it does give you equality within physician circles because they understand doctoral level education. So when a patient tells you "Dr. H. referred me to you for a well woman exam because he told me Dr. W. you are an excellent nurse practitioner", I know I made the right choice.  I know I practice much differently from knowledge that I gained in the 3 years it took for me to earn my DNSc. I would encourage any practicing NP with an MSN to look into DNP.  Education offers many opportunities but I think the best things I learned were from interactions from my peers during the program.

Valerie, Internal med/Peds - FNP PNP, Private Practice January 19, 2009 1:07 PM
Collierville TN

If nurses are required to have a DNP to be an APN, then the Masters requirement needs to be deleted just as Pharmacy and Medicine have done and the ancillary services such as PT are preparing to do.  The coursework needs to be focused to being an independent practitioner and all aspects of maintaining a practice and less theory.

During my coursework, I was told the reason for the required DNP was to provide more nursing instructors.  From comments about 'second hand NPs' expressed here, I would infer this increase of instructors would be from the 'second hand' masters prepared NPs who can no longer function as an NP because they are not the 'standard of care - DNP'.

None of the ANA mandates for degrees has resulted in a set off of more compensation to cover the excessive school costs.  The BSN is paid the same as an ADN.  The DNP will receive the same pay as a NP (if the MSN NP is still allowed to work).  The only way to obtain a different salary rate is to go into management.    

Cheryl, Neurosciences - Coordinator January 19, 2009 1:03 PM
Oklahoma City OK

I have been a NP for nearly 15 years and a nurse for 27 years. I am a graduate of diploma program and have a certificate to practice as a FNP.  I am nationally certified and am therefor grandfathered in to continue practicing. I am 53 years old. Retirement is rapidly approaching and I still have one child to get through college. I do not have the time or money to spend getting a DNP. I would never recoup the money. The time spent in class learning nursing theories that have little or no application to the real world is too valuable. In these times of health care crisis millions of uninsured working families, growing under served populations surely nursing can come up with a better plan than adding more classes teaching theories

Ray , fnp-c January 19, 2009 12:54 PM
syracuse NY

I agree with your commentary.  The fact is that the medical association stays right on course, does not alter their time frame in education, make it shorter or do most on-line.  Why then are we constantly changing our education measures, creating short cuts to learning. Why not follow throught and become a physician?

linda , women's health - arnp-bc, brch January 19, 2009 8:29 AM
boca raton FL

Have you ever seen the titles we NPs scribble after our names?  A PA scribbles PA-C or tacks on their registration title, and that's all the knowledgeable patient needs to know.  We NPs have sunk into a world of post-nominals titles.

Anonymous , BSN, MSN, NP, BC January 18, 2009 10:11 PM

Having so many professional standardizations confuses patients. I believe there are increasingly bureaucratic and $ issues at work which pressure academia to create new titles rather than advocating, and crediting existent roles.  But I believe new degrees and new titles would be less apt to get role focus.  We are blurring the "doctor" title, and CONFUSING THE PUBLIC!  Nursing would be better served by less confusion, and distinct roles the public comprehends, whether you earned a doctorate as a Ph.D, Ed.D, AuD, CRNA or as an LPN or whatever.  We are becoming scattered about meagerly as we eat our own.

Anonymous , NP, BC January 18, 2009 8:27 PM

Where will it all end I'm a CNS FNP a twenty years in nursing and 7 of those as a NP with a clinic in this town of PAs and MDs who've "good ole syndromes" and the NPs here who will sell our own down the river to become one of "them".  10 years of nursing education 30 yrs of nursing experience and yet it's not good enough?  WHAT!!!!  This is too much $$$$$$ to be treated less than dirt on the road, and strike against the AMA.  I am not wasting yrs not make $$$$$$.  The AAPA/AMA call the shots and the ANA say yessir and how high did the AAPA/AMA say we need to jump?  Bull corn, we need to stand up to them and demand independence practice.  

Nina , Rural Clinic - RN, MSN, FNP January 18, 2009 1:01 PM

Perhaps the AMA's members (MDs) should be ones recertifying their medical knowledge not the PAs, especially with such an emphasis on evidence based practice.  Onto more "advanced" topics, the DNP already is a "advanced" shift.  We eat our own.  Nursing has enough other areas in which we are splintered without adding on a lot of time/debt/energy into yet another title which has questionable benefits.  Too many AMA members treat nurses poorly.  Why provide AMA a tool to squash NP ultimate goal for full independent practice?  DNP won't increase NP salary and practice at the bedside.  This would breed extreme AMA insecurity and goodness knows, we don't need more of those.%0d%0a

Renee , FNP January 17, 2009 7:25 PM

Perhaps the AMA's members (MDs) should be ones recertifying their medical knowledge not the PAs, especially with such an emphasis on evidence based practice.  Onto more "advanced" topics, the DNP already is a "advanced" shift.  We eat our own.  Nursing has enough other areas in which we are splintered without adding on a lot of time/debt/energy into yet another title which has questionable benefits.  Too many AMA members treat nurses poorly.  Why provide AMA a tool to squash NP ultimate goal for full independent practice?  DNP won't increase NP salary and practice at the bedside.  This would breed extreme AMA insecurity and goodness knows, we don't need more of those.%0d%0a

Renee , FNP January 17, 2009 7:25 PM

I am not endorsing 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/ limited authority, why is there a need for another degree?  I am concerned about the splintering of nurses.  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 NP 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 MUCH MORE CONFUSING would this RN status be to patients?   Patients complain that they cannot differentiate their nursing staff from the other staff garbed as nurses!

DW , BSN,RN,CCRN,MSN(c) January 17, 2009 6:03 PM
Springfield VT

Well, I would like to just jump in, as I have often before.  I am interested in getting a DNP, I have a PhD.  I did this all for me.  I am a life-long student.  Type A old nurse.  I recently called for info from the Samfor University on-line program.  I asked the price, 22,000.00 plus for the 6 semesters that I would have to take, 525.00 per hour.  This price does not include books.  I was astonded at the BS that you have to go through to get a degree.  I have paid my dues.  But I still want the DNP.  FOR ME.  Who gives a flying rats a-- about what everyone thinks.  I know for me and all of my commrades out there, that we have the knowledge to do a great job.  It boils down to the "good ole boy sydrome."  You know who they are.  The government, your congress person.  They are bought by the AMA.  If you do not believe me go the the "Hill" and meet that person.  Sure they blow smoke up your b---, but that is what they are paid to do.  They tell you what ever you want to hear.  Promise you the moon.  You know that the nursing word is not rich.  We cannot pay lobbyist.  We need a voice from each one of you that shared their opinion.  I met the Great John Linder, Congressman of Georgia for my region.  Trust me, he did not care to support the NPs that showed up at his door.  He made this remark while sitting pompus in his chair, "If you wanted to be doctors, you should have gone to medical school."  That statement coming from a dentist.  I know more about medication and treatment than he will ever know.  I do not know of a dentist that would tell you in detail about your illness and what and what not to do.  If you do know one of those dentist, please share with me and I will eat crow and humble pie.  How many of you have discussed this with the powers that be?  Not many I am sure.  The way I see it, get the DNP if you want it for yourself, other wise continue to practice like you are.  There is a world of people that do not get medical care.  The docotors I know want to stay in the high rise buildings and create a clinic botique environment.  The family practice people are quitting by the droves.  Let us hope that we can get the government to loosen the grips on us.  Those that have the experience.  I would not want a NP that is just out of school and never practiced as a nurse to take care of me nor would I want a knew doctor out of medical school.  We must stick together.  No matter your level.  As said above, we eat our young.  So sad.  Women in leadership want to eat first then slowly just feed.  They are never satisfied.  Going back to the Samford investigation, WOW, we still have to do a Capstone Project and base it on theory.  I cannot find a theroist that can solve my problems here at work.  Women without experience, want to slap down those who want the same thing.  It is a constant frenzy.  Why, because of insecurity.  Is that is a nursing theorist book?  No, the last time I was forced to study those people, I thought, my goodness.  These people need a life.  I am all about Clara Barton and Ole Florence, but why keep kicking a dead horse.  Let us look at the problems of the 21st century.  Is there a school out there that can do that, PLEASE?  Enough is enough.  Sorry for going on and on.  But that is what the theorist do.  I learned it from the time of ADN, to BSN, to MSN.  ***, I got my PhD in Health Admin.  I could not take another page of theroy.  Good luck my colleagues.  Stay focused.  

Denise Tennison, Family - FNP, Hospital January 17, 2009 5:52 PM
Atlanta GA

Truely a money making proposition for acadamic insitutions.  Perhaps if they offered a Doctorate with a medical concentration that requires medical rotations instead of classes dealing with the  unreal world of nursing idealism, it maybe actually benefit our patients and make us better clinicians.  

 I have precepted 3 doctorate students who are 1 yr away from graduation and have VERY limited medical knowledge.    I reviewed the doctorate  curriculum and found it amusing that there were so many "NURSING classes" with little or no emphasis on medicine.  

 Also, for those of us who do not have hospital reimbursement and  working to serve the underprivledged or at a family practice office, we cannot afford to go back to school again just to be called doctor.    

Linda , NP January 17, 2009 5:46 PM

I have enjoyed the diverse comments on this blog.  I am in the final stages of completing my DNP and have found it a rewarding adventure in gaining new knowledge and perspective in global and national issues in health care.  I have been in independent practice for nine years and currently own my own practice.  I try not to compare PA practice and NP practice as they have varied foundations for entry into practice and different philosophical underpinnings.  

I strongly believe that we all know that the best way to compete in the national and local health care economy is to be on similar playing fields with our colleagues in medicine.  Here in Arizona, we have some of the most supportive multidisaplinary teams in the country working together to take good care of our patients.  When I talk with our other NP colleagues in states that have limited practice independence, it is clear to me that physicians have worked in close contact with state legislators in those states to keep NP care restricted.  Keep working hard in your states to promote full independent practice!  As advanced practice nurses, we also need to continue to work towards changing the national mindset that the word "Doctor" is synonymous with medicine only.  

I do not see the DNP as a degree that ANPs get just to be equal with physicians.  It should be a degree that helps us to gain more knowledge for impacting practice by improving health care for groups, understanding how to work with other research/practice teams to affect care in significant ways, and act as role models for our new nurses coming into practice.  

We must move past the old discussions of entry into practice and focus on growing in our own practices through the opportunities that further education provides.  We must also acknowledge that economic stability in our practice is important and that we as ANPs deserve to be reimbursed for 100% of our care.  The DNP degree has the potential to establish an equitable view of advanced nursing practice with medical practice in Congress where these reimbursement issues  ultimately decided.

(By the way, I am 50, raising a family, work with two practices, and still have time to go to school part-time.  You can do it too!)

mary , senior care - FNP, Journeys Health Clinic January 17, 2009 5:27 PM
Tucson AZ

I can remember years ago whe the "Doctor of Osteopathic" was not considered equal to the "MD". However, over time it became accepted in the medical community as is the MD today mainly due to exposure from oseopathic hospitals. There is no better time for the DNP to be rolled out than now because of the lack of primary care in this country where DNP's can step right into that gap. Primary care can be an excellent venue where DNP's skills are seen by the community. We can forget about being accepted by the AMA. It is the community, that is composed of every day persons, politicians, legislators, churhces, schools, etc. who will see the contributions NP's make that will eventually accept the DNP as a legitimate option in health care.

Timothy, Nephrology/HTN - FNP January 16, 2009 11:08 PM
Detroit MI

First, I'm an NP the "nurses" talk is totally uncalled for. Second, NPs don't WANT to be PAs.  Third, NPs don't WANT to be MDs. Fourth, AMA's plots against the ANA... they are only this... PLOTS...I would spat at the AMA. Fifth, AMA providers treat patients like ****.  

Sheryl , AOCN, FNP January 16, 2009 9:46 PM

Hey Tony,%0d%0agood to find you in these pages. I agree with you completely.%0d%0aOf course you would give much thought to the DNP issue and put forth interesting insights.%0d%0aI am not worried about this anymore, am not as energetic anymore as in my younger years, and pleased with being semi-retired and doing PT work in addictions.%0d%0aSend me an e-mail when you can. Your former class mate, Ingrid

Ingrid Fetkoeter, Psych. - RN/NPP, MARC January 16, 2009 8:47 PM
Poughkeepsie NY

I am currently a Nurse Practitioner practicing in an outpatient setting.  Was I deciding this, I would go for marketing than this program.  The focus is independent practice decision-making.  This academia not endorsing $$$$$$$ made was relocated to another program.  They increasingly frustrated with the DNP. I am very disappointed this program has begun to graduate DNP.

Anonymous , NP, BC January 16, 2009 8:15 PM

ADN, BSN programs have a sector geared entirely towards nursing - with very little medical component.  The cost of the ADN, BSN was outrageous I was withdrawing loans $$$$$21000/per term.  re: DNP I am looking for some area to wallow as I accrue more debt.  I can't afford to throw money out the window when concerned about rent.  I'm living on a tight  budget, not exactly the livelihood.  I'm not cognizant of the current tuition re: board of nursing - ADN BSN have an academia link on the main page.

Anonymous , ADN, BSN, NP January 16, 2009 3:32 PM

I foresee us consumed with control with the non-existent financial incentive to further a corrupt system consumed with searching for their wallets.  Will this increase my reimbursement?  Where is the financial incentive to further nursing academia when I will not be reimbursed in the same manner as the medical community?  Will it increase my reimbursement?

Anne , NP January 16, 2009 1:03 PM

Nursing as a discipline has been divided on the question of entry into practice for RN's and now for NP's. With this lack of unity I would expect other disciplines question our ability to regulate ourselves if we can't make up our minds what constitutes adequate preparation for our profession.

I am concerned about the availibility of nurse practitioners once the DNP is required for entry level into practice. How will this impact the number of available providers in a system that already has a shortage of primary care providers?

Also how will this affect the cost of health care? A DNP will likely command a higher salary and increase the expense of health care even more but will it improve outcomes?

Sherry , FNP January 16, 2009 12:58 PM

WHAT!!! This comment is uncalled for....."You'll be delighted with what you might learn! And, oh yeah, you might just provide better care and have a better practice if you got a DNP. . ."

I can't understand comments like this and then we wonder why nursing as a whole has such a bad rap.  I am a practicing FNP and I can say that with each level of nursing education I have grown as a nurse and a practitioner.  To me education/knowledge is power but it's all what you take from it.  Does all knowledge come from formal education? No.  So to say that having a DNP will make me provide better care and increase my practice I feel is unfounded.  I have had some of my best learning with my cancer patients I cared while working as a RN. Truthfully, if I were to go back to school I would go back to become a physician because I do many of the same things they do on a daily basis but don't get the recognition or pay that they do, however my patients are very grateful and appreciative.  Granted when I have a very (and let me express the word very) complex case I do consult them.  I am certain that many FNP's would agree with this statement. So does changing it to DNP really make that much difference?  In my practice, no.  

Mari , FNP, BC January 16, 2009 12:55 PM
WI

How can we be required or pressured into obtaining a DNP when nurses are still being allowed to become licensed with an Associate of Nursing degree? There was always plenty of talk in the past that the terminal nursing degree would be a BSN. So why are there still ADN programs? Those RN's are not being forced into pursuing a BSN are they? they receive the same pay with an ADN as a BSN nurse does. Now those of us practicing as NP's with a Master's degree are being pushed by academia towards the pursuit of yet another degree. The only reason I can think of is $$$$. This degree is not going to increase my salary but only put me in debt attempting to pay the high costs for yet another degree. I have been an RN with a BSN since the early 1980's and received my MSN 7 years ago as a Family NP.  Is having the DNP going to make me provide better care to my patients?  I do many of the same things on a daily basis that physicians do but get no recognition, reimbursement or salary that they do. So with this in mind, just what really is going to change? Maybe we should all just go to Med School and be done with it.

P, Family Practice - Family NP January 16, 2009 10:55 AM
Lake Charles LA

This is not market driven, purely academia clouding the waters again when we have come so far. The decreases in medical schools enrolment (primarily FP), reduced reimbursement, access to healthcare crisis and longer hours are fueling the environment of success for NPs. I agree the current administration could take us further than this  "DNP" fiasco.

I too have seen many of the younger "entitlement" generation coming out of NP programs with no experience. Academia should be concentrating on nationally standardizing existing NP programs and requiring clinical experience.

If "they" feel they must stir it up, educate the medical community and the public that NPs are currently trained at the doctorate level and call us what we are DNP. Really, academia is needed and you are important, so get over it.

Mike, NP January 16, 2009 10:41 AM
TX

I'd like to make 2 points:

1)  One of the MOST TELLING questions asked in my MSN program in reference to "Nursing Theory" was "Does any other medical profession require theory classes?"  Our instructor could think of none. To me, the requirement of TWO nursing theory courses at the graduate level was part of nursing academia's desperate attempt to make nursing somehow more professional. (I kept thinking, isn't there something more important that this that we can all be spending our time/money/efforts on???)  By the time I got around to getting my MSN, I'd been a BSN/certificate- prepared NP for over 20 years. (My OTHER Master's is in Business). The theory classes are compete bunk (and were a re-hash x 10 of my BSN classes 20 years prior) and those responsible for requiring them then are the same people who decided that we all need doctorates.  

2)  Was this decision EVIDENCE-BASED?  I think not.  As many of you have pointed out, study after study shows that NPs provide equivalent, if not superior care to that of MDs. WHAT the hell are we doing????

I call for those of us in the trenches to appeal to our nursing leaders to RE-THINK this decision.

I predict:  This requirement will shrink the numbers of NP graduates to approx one QUARTER of those currently graduating. A 2 year commitment is "doable" for many of us in the thick of our busy lives, but the prospect of a doctoral program will prove too daunting to a large number of RNs contemplating furthering their education.  We are committing professional suicide.

In this critical time, Americans NEED a "less expensive" alternative to medical care.  We APNs are the answer.  Our leaders should be spending their time jumping up and down getting Obama's attention as the saviors of the healthcare system, not shaking things up by implying that the way we are currently training our NPs is not good enough.

Susan, Women's Health - NP January 16, 2009 2:38 AM

All subjective comments aside. These are the facts right now:

Getting A DNSc won't increase reimbursement to us.

We still have laws to prevent us from independent practice.

So who pays for the required furthered education, when there is no financial incentive to do this? Education is not free.

It's a big issue with me, I can't afford a DNSc.

Anonymous , Internal Medicine - NP-C January 15, 2009 11:25 PM

With all these years of additional schooling, I'm in a smoky fog.  Should I utilize my nursing experiences, additional PA school enrollment prerequesite, enroll in PA school, become a graduate of an affiliated program, pass the certification, as many state, NCCPA process, certify, license, and register..... academia feedback?

P. Esper , RN, AOCN, NP-BC January 15, 2009 10:40 PM

I am currently finishing the DNP program at the University of WA.  It has taken me three years while continuing my practice as a family nurse practitioner.  I have been a nurse practitioner since 1979 and have worked in primary care since that time.  My perspective as an NP is quite broad as we fought for perscriptive authority, the right for equal pay for equal work, medicare reimbursement, hospital priveleges and of course independent practice.  This very arguement, Master's vs doctorate, was being played as I entered a master's program in 1977 only it was certificate vs. master level.  The master's has only helped the NP role.  The DNP will do the same.  

Going back to graduate school there was little clincally that I wasn't already doing, however I was able to concentrate on other subjects that matter, such as understanding health systems and redesigning those system so that we give quality health care to populations and not just individual patients.  These are thing NP's of the future must know and understand.  

I also see a great future for NP's with the advent of the DNP.  I have had the pleasure of counseling several bright and talented students who have graduated from academically challenging liberal arts colleges and who looking at both MD and DNP pathways.  That they would choose to become nurse practitioners might not happen without the DNP - they are our bright future.  

I do not believe that those who choose to be grandfathered into practice will be less of an NP or be without jobs.  The anomosity between PhD and DNP is ours to create but frankly the DNP research is the implementation peice of new knowlege.  What the PhD and DNP can bring  partnered as a team could be quite awesome.  

I could have quite easily retired in my profession with my Master's degree.  But I am so darn proud of what we do that it seemed fitting to take it to the next step.

Terri Wolber January 15, 2009 9:39 PM

In the mid 1970's, many applicants were recruited to the MEDEX programs.  These MEDEX programs are thriving.  I spoke to one of the MEDEX programs if I could enroll in one of these MEDEX programs and serve in their underserved areas, the reply was no.  MEDEX program prerequesites Corpsman, AF practictioners, and Army affliated practitioners.

Beatrice , FNP January 15, 2009 9:35 PM

I'm completely oppossed any mandates for Midlevel Provider's to obtain "Doctoral" entry level degrees.  The beauty of going into either the NP or PA profession instead of Med School was to fast-track becoming a provider, having a great quality of life and help out our MD's/DO's.  

What's the logical thinking for someone to pursue either profession (PA/NP)?  Just bypass and attend Med School, (duh).

By having "entry level" NP's go to DNP degrees by 2015, it will trigger similar required "Doctoral" education for us PA's, it will happen.

I guess all of the E-schools will be laughing all the way to the bank...  what-a-mess!

Nick, OH - PA, ARMY January 15, 2009 9:11 PM
PBA AR

I have been a nurse for over 30 years and an NP since 1999.  I decided not to get my DNP after my MSN because many of the DNP students in the program were nurses that followed the "bridge" program- RN-BSN-MSN-NP-DNP without any experience as a nurse or very little, I mean less than one year.  These students are going to be the "experts". I see academia only out for one thing-Follow the money!  I told my administration that until they fix that problem in admitting students into the DNP programs our future experts, without experience I would not participate. I think that is the problem with  some NP's not rapping their arms around this idea.  I also mentor students.  I currently am mentoring a student that has had no (I mean none!!!) nursing experience and she is an NP student- second career from English.  She told me that one of her faculty told her that without experience they could "mold" her and not have to deal with old nursing habits that experienced nurses have.  Can you believe that!  I continue to be frustrated with nursing for all these reasons. These are some reasons that NP's and soon DNP's have a hard time to develop credibility in the work place.        

Anne, Dermatology - MSN-FNP, private office January 15, 2009 9:02 PM
OH

Puh-lease!  It's all a paper chase!  Anthony Pucek's comments on expert status questions "nursing" or medicine?  The PAs and MDs never think we provide quality care, why else would they push us towards "nurses" -- this degree has been forced down our throats, and soon we will be the laughingstock of the medical community, "Look, those wannabe nurse "doctors".

Lori January 15, 2009 8:38 PM

I am a diploma RN who went to a Cerficiate program for my FNP.  

I think that our goal is not to be a paper pusher, but to take care and ensure that patients get proper quality care.  It is not about whether or not I am as good as a doctor.  I do not want to be a"doctor".  If I had I would have gone to medical school.  I truly care about my patients and families.  I feel that we should progress our education individually, and not make everything above what is necessary to qualify for our status.  

Kim, Pediatrics - FNP, Wee Care January 15, 2009 7:57 PM
Cicero NY

NPs, I've very squirmish about this issue and mixed thoughts about the DNP.  Mark and Mike, I could see how this would clearly be not-that-bad, and very bad for the nursing community.  Keep the dialogues running, NPs.

Lisa , Internal Medicine - PA-C January 15, 2009 6:08 PM

I do consult with PAs, the PAs with years of on the job experience tend to be very knowledgeable in their practice, consult with colleagues when needed - the PA works in geographically isolated region - they tend to spend more time with the patients than NPs, trained with AMA affliation - I've to ponder why I would be throwing my money out, ANTHONY PUCEK.  

Carol , NP, BC January 15, 2009 5:30 PM

Mark

Spoken like true academia! Once again, the current requirements to become a post masters NP is equivalent to those you have mentioned. That is the bottom line. You missed the point. The arguments you provide (LVN to ADN etc.) are not relevant to this discussion. This is what holds us back; "everyone" is a nurse. No wonder the rest of the healthcare community is confused, we eat our own.

How about LVN = aid, ADN = tech, BSN = RN, MSN = admin, PhD = educator, and NP is already a doctorate level in comparison to what you have mentioned. Be done with it, we've been fighting this battle with ourselves for decades.

Mike January 15, 2009 5:23 PM
TX

It's good to have an opposing point of view of why nursing should not advance and progress. I've heard the same arguments for LPN's to RN's, ADN's to BSN's, and for requiring BSN as minimal entry for NP and for MSN as minimal requirement. If we want to advance as a profession, we need to move forward. We are already behind the eight ball on this. Physical therapists and pharmacists have already moved toward doctorate degrees for minimum entry. I'm planning on going back to school for DNP completion and look forward to the recognition. We will not advance toward independent practice as long as the AMA, legislators and public expect a doctorate level practitioner to care for their patients.

Mark, Family - NP, ED January 15, 2009 5:02 PM
Grand Rapids MI

WHAT!!! This comment is uncalled for....."You'll be delighted with what you might learn! And, oh yeah, you might just provide better care and have a better practice if you got a DNP. . ."

I can't understand comments like this and then we wonder why nursing as a whole has such a bad rap.  I am a practicing FNP and I can say that with each level of nursing education I have grown as a nurse and a practitioner.  To me education/knowledge is power but it's all what you take from it.  Does all knowledge come from formal education? No.  So to say that having a DNP will make me provide better care and increase my practice I feel is unfounded.  I have had some of my best learning with my cancer patients I cared while working as a RN. Truthfully, if I were to go back to school I would go back to become a physician because I do many of the same things they do on a daily basis but don't get the recognition or pay that they do, however my patients are very grateful and appreciative.  Granted when I have a very (and let me express the word very) complex case I do consult them.  I am certain that many FNP's would agree with this statement. So does changing it to DNP really make that much difference?  In my practice, no.  

Mari, FNP, BC January 15, 2009 4:23 PM
WI

Thank you all for your very thoughtful comments. However those that have suggested that I am whining about education have missed the point, Its not about education which I support wholeheartdly it is about politics, timing, money, statutory collaboration and supervision language in practice laws, etc...the idea of dividing nursing "again" without having a clear understanding of how these things are perceived by other health players, legislators and insurance panels....it will aid and comfort the foes of advanced practice nurses and will use this as an argument why Masters level practitioners were never qualified...and as a result stand in our way to eliminate mandatory collaboration/supervision language that exist in many state statutes.  Please keep the comments and dialogue coming.........!!!!

Anthony Pucek, Psychiatry - NPP January 15, 2009 3:55 PM
LaGrangeville and Chappua NY NY

To MJ,

WHere is the evidence that DNPs provide better care?

I am a teacher and an NP.  I personally started off as a diploma nurse and found the education I rec'd in that program far superior to that I rec'd at Penn State.  Basically, I was throwing money to the wind. I find that I am doing the same thing now as I pursue my doctoral degree...paying for a piece of paper.  I have learned so much more by participating in local and statewide research and community projects with our local non-profits.  

Back to the quality...and proficiency, it is well researched that the diploma, ASN and BSN nurses "equal out" with experience.  I believe the same will be true of the MSN and DNP.

As far as the PhD versus DNP--YES!! The competition already exists as it does for those in education who hold doctor of education degrees rather than a PhD.  PhDs at the campus I work at, and my husband's (who holds a doctorate in ed)  always makesure to point out that they have a PhD as if it is so much more valuable.  In addition, nurses who argue that a PhD nurse is more research oriented is devisive, destructive, and not necessarily factual.  The DNPs...and MSNs for that matter..that I know have participated and authored equal or more research than the PhDs.  I'll admit that I still, after years of teaching and being a student, still find that those who sit around thinking of nursing theories add little to no value to the profession.  Clinical research, on the other hand, has provided considerable value.  Leave the process theories to those our profession has often stolen them from:  business and psychology.

I agree with those who noted, as was argued by those who supported DNP for entry level, that the MSN programs ALREADY meet doctoral requirments.  So, why demand more money from me.

I work in FP and I work in academia. I find that the 2yr associate degree program is equal or superior than the

Bridget, Family Practice - NP-C January 15, 2009 3:51 PM
PA

Instead of requiring more classroom-based training, the NP profession would benefit from more clinical-based training. NPs should have a program similar to internships and residencies.

Megan, NP January 15, 2009 3:51 PM

I agree with the author. What is a nurse? In Indiana, apparently anyone can call themselves a nurse if they provide care to someone else.  Registered Nurse (RN) is a restricted licensed title, like that of a Nurse Practitioner. The public is confused enough without further mudding the waters with new titles. The doctoral programs I have reviewed carry little impacted over my practice. I recently attended a national PA conference and found this debate of MSN vs. DNP to receive much mockery from our PA counterparts. In fact, many of the PAs’ in attendance proudly professed they were masters prepared, “just like NPs”.  It was explained, the difference between a masters prepared PA vs. one with a BS degree was they were required to write a single paper. I understand to become a DNP would require more then just one paper.  I fail to see how this further alphabet soup of titles will change my practice.  We as NPs continue to struggle to educate the public, government, and insurance companies on the vast individual and global health benefits NPs offer. It will not serve us well to confuse the public, government, and insurance companies on what is a Nurse Practitioner. I ask for restraint by my fellow Nurse Practitioners to not run full speed ahead and blindly follow academia into the new improved alphabet soup.

JohnAllen, Family/ acute care - Family Nurse Practitioner, Acute/ Primary care January 15, 2009 3:39 PM
Indianapolis IN

    Truely a money making proposition for acadamic insitutions.  Perhaps if they offered a Doctorate with a medical concentration that requires medical rotations instead of classes dealing with the  unreal world of nursing idealism, it maybe actually benefit our patients and make us better clinicians.  

  I have precepted 3 doctorate students who are 1 yr away from graduation and have VERY limited medical knowledge.    I reviewed the doctorate  curriculum and found it amusing that there were so many "NURSING classes" with little or no emphasis on medicine.  

  Also, for those of us who do not have hospital reimbursement and  working to serve the underprivledged or at a family practice office, we cannot afford to go back to school again just to be called doctor.    

Linda, NP January 15, 2009 3:28 PM
Pittsburgh PA

I think the PA profession needs to examine this issue critically.  Not every doctoral degree is right with every profession.  

Being fully cognizant of what PAs are of capable on-the-job I think the AAPA, and PAs would benefit from a less devisive profession, and more CRITICAL view of the doctorate.  re: Dave Rodriguez, PAs are outnumbered by physicians, and NPs.  Work on AAPA unity, the ways in which you can improve the way you practice, and don't focus so much on fluffed up degrees!  

The medical community lacks empathetic, experienced providers.  There are elements of practice PAs do not learn in academia - and certainly not any provider, not an NP can learn in academia.

Sejal January 15, 2009 3:04 PM
NP

Different perspectives on change are always helpful and thought provoking.  I appreciate Anthony'sthoughts.

I am struck by the similarities between the debate going on now about the DPN  and the debate in the 60's over baccalaureate entry into practice, the closing of diploma programs,and  the advent of the "technical nurse" from the Associate degree programs.

I am also struck by the activities of other professions.  As a doctorally prepared nurse, practicing in advanced practice.  Every referral I get back now from PT/Audiology/Naturopathy/Podiatry/

Chiropratic / Optometry etc refers to the provider as Doctor.  I am finding the system increasingly confusing.  I wonder how folks not involved in healthcare can possibly sort it all out!

In re: expert status, I will fall back on the Benner definition.  As a seasoned NP I am certain that Anthony is an expert- no one can take that from him, it is a product of his experience and education.

Financial concerns and job oportunities hopefully will not ever be an issue.  Employers are looking for experts as are consumers.

I tend to think that independent practice is a product of long term demonstration of collaboration and expertise and has little to do with titles.  Independent practice is a legal definition, that would allow NPs more latitude in providing care.  Realistically, no one practices independently.  We are all reliant on each other for expertise, just as the collaborating physician I work with relies on the cardiologist for his experitise I rely my collaborating physician for his expertise in pathophysiology and he relies on me for my insights into family dynamics, availability of sytems to provide patient support and for the judgements and care I provide each day.

We are living in a time of transition-on many fronts-it will be fun to think, dialogue and debate our next moves.  No one is all right or wll wrong!

Rosemary Dale, Primary Care - APRN, UVM January 15, 2009 2:31 PM
Burlington VT

I think everyone has an opinion about this topic.  Ultimately, I believe that it is up to the individual to make the discussion that is right for them about going back to school to pursue a higher degree.  I think that the DNP degree can change your way of thinking about certain healthcare issues and potentially create better clinical and financial outcomes for our patients.  The nursing profession needs to have better communication between the educators and the clinicians because each has much to offer to help make our profession be the leaders in the healthcare community.

Anita January 15, 2009 2:15 PM

I read the many comments with interest, and would like to offer my thoughts as a DNP student.  First of all, having a MSN, post-MSN certification and now doing doctoral work, I could probably be accused of being a professional student, and maybe I am--never liked to turn down a challenge.%0d%0a%0d%0aHowever, having finished my first semester of coursework (12 hours in all), I appreciate the skills I have polished, particularly that of thinking critically.  About everything.  It becomes a habit after a while.  %0d%0a%0d%0aI decided to undertake the DNP program simply because I wanted to do it, and it is not easy.  During my admission interview, I told the committee that I did not think that every NP needed a doctoral level education, but having precepted a half dozen NP students in the past 5 years, I have serious concerns about the decision making abilities, communication skills, and practice safety of a few I encountered.  %0d%0a%0d%0aAm I obsessed with being called a "doctor" after graduating?  Not really, because I don't want to misrepresent myself to anyone, however I will gladly explain my educational background to anyone that asks and many patients do so.  In my opinion, addressing anyone (be it your minister, chiropractor, or economics professor) as "doctor" is a socially acceptable method of expressing your respect for the qualifications and abilities possessed by that person.  Nothing more, nothing less, and Medical doctors are misguided in believing and perpetuating the myth that they have cornered the market on being called "MD". %0d%0a%0d%0aIn closing, even as a student who remains happy and satisfied with doctoral level education, I remain firm in my thinking that it should not be required as entry level for nurse practitioners--but I do think that colleges of nursing need to tighten their admission requirements for practitioner students.  And by the way, I have no plans to head for the nearest ivory tower of academia after obtaining my degree.  I am a nurse.  I take care of patients, and perhaps I will simply do it a little better than once I did.%0d%0a%0d%0a

Susan January 15, 2009 2:00 PM

I agree with the author. Here are my thoughts, in addition.

The first justification I heard for the DNP is that the typical MS academic load is almost equal to a doctoral degree as it is. If that is so, whose fault is that? Why not 'grandfather' current master's prepared NPs into the doctoral degrees we SHOULD have received?

Second, the 'completion' programs I have looked into have little in the way of clinical content, and lots of political content, advanced statistics, etc. Perhaps someone will explain to me how that affects direct patient care. Until I get that explanation, I will not be likely to support the move, and will be even less likely to pursue that degree myself.

BTW, I am already hearing rumblings from PhD prepared nurses about the need to make a distinction between DNPs and 'research' prepared nurses when it comes to faculty appointments and tenure.

When will we quit forming circular firing squads?

CJ Ewell, primary care - FNP, Roosevelt VA January 15, 2009 1:55 PM
Roosevelt UT

As I was reading MJs comments I knew she either had a nDNP or was pursuing it before I got to the bottom where it said DNP student.  I started with an ADN, then a BS not in Nursing then BSN, MSN and Post Masters FNP.  During the time from ADN to FNP, I worked in Nursing for 13 years.  I heard it all as an ADN you have to have a BS, then you need for MSN.  My ability to care for patients was in the foundation of my ADN program, each level of education after that added a little to my practice.  I found along the way that each person at the higher level had a I am better than you attitude just as the one MJ puts out in her/his comments.  I think now is not the time for the DNP just because of that attitude and the impact it will have on MS and Post Masters prpared NPs

Kevin, Family Practice - APRN January 15, 2009 1:50 PM
MS

This issue of DNP raises lots of hot debate.  I think anyone should get a doctoral degree if he wants to go that route.  But will it actually be a recognized and accepted degree?  Many professions have doctorate level education and I wonder if they have benefited from such a degree?  

Physicians are not willing to let a DNP use the word "Doctor" because of role confusion.  Since physicians are key players in hospitals, insurance companies, healthcare policy and government policy, you have to wonder it nurse "doctors" will have an impact on health care.  Please understand that I believe anyone who has a doctoral degree should be able to use the title "doctor".

What we have here is a paradigm shift for healthcare providers.  I think if nurse practitioners are going to be credible, a doctoral degree is vital.  But I also agree that the degree has to have some real clinical substance and not a quasi-clinical/quasi-philosophical content.

Dave Rodriguez, MSN, FNP_C

Dave Rodriguez, family practice - nurse practitoner January 15, 2009 1:43 PM
Denver CO

 Regardless of which side of the coin you're on with this, there's still very little evidence-based research that shows that most professionals get much addl value with advanced degrees. Unless they're in some specialized, very narrow area of endeavor.

 In some cases, even, research shows an inverse relationship.

 In the med professions, esp those that deal with diagnosing and treating patients (including MDs)  day to day on-the-job training is by far the most important factor of all.

 So... it's not likely that those with the Drs degree will be any better at their jobs than those with the NP classification.

 Same thing is true of MD family practitioners  vs NPs. Most all research studies show that patient outcomes, and satisfaction are actually better with NPs than with MDs... or at least as good. Yet MDs have more education.

 Go figure...

Bill January 15, 2009 1:42 PM

The current academic/clinical hours to become a NP are equal to a doctorate in any other profession as it is! Look at the power PharmD’s and Physical Therapist have acquired in the past few years. Now compare the academic/clinical hours of each. The ANA will be penalizing those of us who took it upon ourselves to advance the practice of clinical nursing. Is academia trying to punish current Nurse Practitioners or force us back into the academic milieu? This is exactly why CRNAs distance themselves from other advance practice nurses.

The ANA should be concentrating on the nursing shortage and entry into the profession. They have done nothing to secure the profession (ADN entry, BSN specialty, etc) in fear of hurting egos and feelings of those who do not take the initiative to improve their skills and the profession.  There is currently no encouragement to further formal nursing education other than personal drive. Secure the foundation of our profession before penalizing the top performers.

Mike, NP January 15, 2009 1:41 PM
TX

Nursing as a discipline has been divided on the question of entry into practice for RN's and now for NP's. With this lack of unity I would expect other disciplines question our ability to regulate ourselves if we can't make up our minds what constitutes adequate preparation for our profession.

I am concerned about the availibility of nurse practitioners once the DNP is required for entry level into practice. How will this impact the number of available providers in a system that already has a shortage of primary care providers?

Also how will this affect the cost of health care? A DNP will likely command a higher salary and increase the expense of health care even more but will it improve outcomes?

Sherry, FNP January 15, 2009 1:39 PM

I am a retired Adult NP, with initial NP education in a university sponsored certification program in 1977.  I successfully and safely practiced in emergency and internal medicine in a government system for more than 25 years, with a BSN as my highest degree.  My patients were often complicated, with multi-system disease, and health education was a critical part of my practice.  The national board certification was a tough exam, but I easily passed in the 1980's, before it was restricted to MSN,  and have maintained certification through continuing education.   My patients didn't care about my degree status; simply appreciated common sense, straight talk, and compassion to go with medications, testing and physician collaboration as needed.

I agree that the DNP has long term implications for practice and reimbursement that may not have been thoroughly investigated.

I also wonder why anyone contemplating patient care and/or the Advanced Practice role, who compared  a DNP to an MD would consider the DNP?  The time, effort and money invested in the DNP in order to enter the minefields of  insurance, reimbursement, collaborative practice and regulation versus the universally accepted title of MD to enter a field that has historically supported it's own members is a no-brainer.  If your true goal is patient care, it's much simpler to enter a field not perpetually fractured and divided.

Donell January 15, 2009 1:37 PM
Tucson AZ

I fear that MJ's comment  "And, oh yeah, you might just provide better care and have a better practice if you got a DNP. . ." is very devisive, not helpful at all, and I take personal umbrage at it.  I agree wholeheartedly with Anthony Pucek's  comments.  What he did not touch on is the issue of calling the NP, "Doctor"....another can of worms.

MC, Oncology - CRNP, MAnager, Union MemorilalHospital January 15, 2009 1:36 PM
Baltimore, MD

I strongly agree with you and have similar concerns and questions.  I am not sure who this benefits other than academia.  If you look at the DNP curriculums they don't look all that different from what we took to get our master degree in nursing.  And they do differ quite a bit.  I do hope that this is it the terminal degree and 'they" won't change 'their' minds.  Thanks for speaking your mild so succinctly and concisely.

Elissa, family practice - FNP, private physician owned practice January 15, 2009 1:15 PM
Quinton VA

This commentary reads like someone who is threatened by those with more education.  Haven't we heard this before; e.g. the old ADN vs. BSN argument?  Look around you; the doctorate has become the standard in advanced practice in Pharmacy, Audiology, and Physical Therapy, and without the whining. Grow up and go back to school.  You'll be delighted with what you might learn! And, oh yeah, you might just provide better care and have a better practice if you got a DNP. . .

MJ, Education - DNP Student January 15, 2009 1:10 PM
Cleveland OH

NPs have become so absorbed towards becoming a "business" I fear we're rapidly losing the support of better organized, less divisive communities.  We've been forced into so much friction, mayhem, and division, I question whether or not the benefits outweigh the costs.  

Sejal , NP January 15, 2009 12:02 AM

The AAPA needs to stop succumbing to this PRESSURE!  Why are your schools cranking out PA graduates as you are thriving/"will be lost?"  

This is a MISERABLE perspective, a miserable article, and does NOT offer me the slightest comfort in this miserable, mainstream career.  The nursing profession is damn restricted fending off criticism regarding this wrong move.

leigh , NP January 14, 2009 8:21 PM

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