NACIQI - DETC - 5 Years and Scope Expanded for Professional Doctorates

Re: DNP

Jeremy, you bring up some excellent points!
A health care provider certainly has to make a committment to study and learn for the rest of one's career. The DNP is just the beginning of that committment.

 

Re: DNP

Nursing is far afield from my training but my two Nurse Practitioner friends have told me that evidenced-based practice required by managed health care organizations is driving nurses into research. In other words, research about the efficacy of treatment options has generated an explosion in nursing-related research.

It looks like there will finally be some real doctors in the hospital after all... ;-)

Dave

 

DNP / DPT

I work in health care, in a large multi-specialty, multi-site clinical setting and these are pretty common discussions of value / need of advanced degrees.

I applaud anyone that furthers their education and additional avenues to do that are always welcome.

That being said, here is what I see / hear:

1. From a financial point of view, there is no difference between what and how much a NP can bill for compared to a DNP.
2. Ditto for Doctor - Physical Therapy.
3. Regardless of their credentialling level, both serve a set purpose in our healthcare delivery system and I don't see that changing. Maybe a more progressive system can find a way to structure and use this increased credential.
4. The DPT is often derided as extremely unneeded.
5. In a clinical setting, "Doctor" means MD. Period. Ask any MD.

Right now there is not a perceived need or value in these credentials here.

On an individual employment level, it makes sense that a DNP of equal qualifications might have an edge over an equally qualified NP, but I don't know. There is also the potential that you might be considered overqualified.

Just one perspective.

 

Another point I'd like to make on the more credentials is better front is what happened to the accounting profession / CPA.

Old School =
Bachelors degree
Brutal CPA exam to become a CPA (It had a much lower pass rate than the Bar exam at one point, and it was not uncommon to take it 3-5 times or never pass.)

New School =
150 hours needed to sit for CPA exam (Most go MBA)
Easy, piecemeal CPA exam that can be taken 1 part at a time as opposed to all 4 required to be taken concurrently.

So basically, they replaced a tough CPA exam with the ability to gain additional credits (butts in seats!), and devalued both the MBA and CPA in the accounting field in the process.

But the professional groups can laud the credentials of their accountants.

 

Re: DNP / DPT

Naturally, the MD will tell you that, but such an answer only reveals a much deeper cultural ignorance of what the term doctor really means.

 

With the healthcare bottleneck caused by an aging baby boom and reimbursement for healthcare services squeezing the bottom line of most healthcare systems, somebody better step up to the plate and provide midlevel medical care to the sick and injured. If not nurses, then I'd like to hear somebodies brilliant plan for who will fill this need.

If DNP degrees better equip nurse practitioners to assist in the mission of health systems, then I think that's great. The success of such programs will not be determined by PhDs from other disciplines, stuffy academics or bone-head MDs, it will be determined by the quality and utility of the research performed by the DNP as well as Medicare and other insurers willingness to pay health systems for the care provided by such nurses.

 

Re: Re: DNP / DPT

Bingo!

Dave

 

Still unanswered ...

But this is a premise that has not been amply supported by anything stated thus far. Simply adding some courses doesn't automatically translate to "more skilled."

In fact, look at the structure posted earlier from the Columbia DNP program. As a doctoral level healthcare provider curriculum it seems mighty light. And remember as an DNP, the practitioner is no longer "mid-level". According to the AACN, by 2015 they intend the DNP to be the qualifying degree for nurse practitioner qualification -- eliminating Master's level NPs.

If someone is ostensibly going to put in the same effort as an MD, why are people assuming such a graduate would still be interested in filling one of the "undesirable" positions currently being abandoned by MDs?

Two problems here:
1) the DNP is not being advocated to fill some vast provider void, the midlevel PA/NP already accomplished that. One could argue nursing schools, seeking another revenue stream, as pushing a credential of dubious value with no obvious marketability and questionable utility.
2) "Medicare and other insurers" could give a big steaming pile about "the quality and utility of research." They will want to see one thing and one thing only, lower levels of reimbursement. PhD/PsyD psychologists face an uphill battle for professional status because they already are paid 60% of a psychiatrist and (as other have repeatedly pointed out) midlevel mental health providers then make 60% of what a doctoral psychologist makes.
Do you think DNPs are seriously going expect MSN salary?

 

Re: Re: DNP / DPT

I hear what you are saying. It was meant tongue-in-cheek. Here (and maybe other clinical settings), the only persons referred to as Doctor are ONLY MD's. PharmD, Optometrists, etc. are Mr. / Ms.

Anyone attempting to be put in the same class in terms of title, benefits, or stature would take some lumps.

 

Re: Still unanswered ...

You have a valid point!
One concern I have is that the DNP requirement by 2015 will actually cause fewer RN's to be interested in pursuing an advanced practice role which in turn will defeat the purpose of providing more primary health care providers.

 

Re: Still unanswered ...

Medicare shouldn't care about the research, the local Health System should. In healthcare, if you can't generate revenue then you sure as hell better add value.

 

Therein (once again) lies the rub

Well, no one has indicated how DNPs would be able to generate revenue (other than tuition for the nursing programs).

PA/NPs seem to have a very clear demarcation with MDs, hence, the label "midlevel practitioner."
But from the AACN's materials, they appear to seek professional parity with MDs.

1) You'd better believe MDs are going to fight that tooth and nail (witness the warm welcome psychology has gotten with prescription privileges);
2) If DNPs are able to carve slice from the healthcare pie, the medical profession (and/or the insurance industry) would, likewise, make sure that DNPs make a fraction of what MDs do.

So, what would be the motivation for pursuing a DNP if it requires an equal investment of time, effort, and money to obtain as an MD only to locked into a lesser income potential? It would seem to only make sense if the DNP was easier (and cheaper) to obtain, which brings us back to issue of what is the added value of DNPs in the healthcare provider milieu?

 

Re: Therein (once again) lies the rub

quoted by PsychPhD


As I pointed out in an earlier post, the DNP curriculum at least today, appears to be more oriented toward a quasi doctorate of public health. To say it is equal to an MD curriculum is simply not true.

Example DNP curriculum from Rush Univ:

2 NUR 556 - The Leader as Catalyst for Change
2 NUR 568 -Organizational Analysis and Evaluation 2 NUR 563 - Financial and Business Planning 2 NUR 581 - Affecting Change through Effective Communication
2 NUR567 - Understanding Financial and Business Concepts 2 NUR 566 - Data and Decision-Making in a Rapidly Changing Environment 2 NUR 569 - Outcomes Management 2 NUR 555 - The Leader and Policy, Politics, Power and Ethics
1 NUR 550A - Project Planning 1 NUR 550B - Project Planning 1 NUR 550C - Project Planning 1 NUR 550D - Project Planning *
Total 5 credit hours 5 credit hours 5 credit hours 5 credit hours
2 2 NUR 564 - Human Resource Management 2 NUR 583 -Implementing Change 2 NUR 584 - Evaluating Change 1 NUR 597 - Role Transformation
2 NUR 582 - Planning for Change 4 NUR 591 - Practicum 4 NUR 591 - Practicum 2 NUR 598 - Capstone Project *
1NUR 550E - Project Planning
Total 5 credit hours 6 credit hours 6 credit hours 3 credit hours


Example DNP from Univ of Maryland

First Semester (Fall) Course Title Credits
NDNP 804 Theoretical and Philosophical Foundations
of Nursing Practice 3
NDNP 802 Methods for Evidence-Based Practice 3
NDNP xxx Specialty Elective 3
NDNP 810 Capstone project 1
Total 10
Second Semester (Spring) Course Title Credits
NDNP 805 Biostatistics for Evidence-Based Practice* 3
NDNP 807 Technology and Information for the Improvement
and Transformation of Health Care* 3
NDNP xxx Specialty Elective 4
NDNP 811 Capstone project 1
Total 11
Third Semester (Summer) Course Title Credits
NDNP xxx Specialty Seminar 1
NDNP 809 Complex Health Care Organizations* 3
NDNP 812 Capstone project 1
Total 5
Fourth Semester (Fall) Course Title Credits
NDNP 815 Leadership and Interprofessional Collaboration* 3
NDNP xxx Specialty Elective 8
NDNP 813 Capstone project 1
Total 12
Total Credits Total Credits
Total Credits 38

Univ of Arizona

Total Degree Units: 44

Fall Term 2006
Spring Term 2007
Summer I & II 2007

NURS 730 Quantitative Methods in Clinical Nursing Research

NURS 631 Advanced Statistics for Health Sciences

NURS 731 Qualitative Methods in Clinical Nursing Research

NURS 751 Evidence Based Practice Methods

NURS 750 DNP Role

NURS 752 Patient Safety & Quality Management

EPID 573a Epidemiology

NURS 753 Emerging Diseases, Genetics & Health Trends

NURS 738 Translational Research

NURS 930 Supplemental Registration*

NURS 922 Practice Inquiry

Final Defense

I don't see how you think this is comparable to an MD program.

 

My point exactly

Delta, thanks for doing the leg-work, but you've proven what has been my point all along. I do not think it is comparable -- that is my point.

Which brings us back to the question of why develop the DNP in the first place?

The AACN clearly states that the DNP is intended as a clinical practice degree. As I have said before, there are legitimate reasons for nursing doctorates for research, teaching, administration and the like.

But the AACN wants a doctoral practice degree.

There already exist APNs with a scope of practice roughly 50 - 60% of a physician. So why develop/advocate the DPN other than seeking professional parity with MDs? Again, the AACN indicates its wants the DNP to be the degree for APNs.

I think Ted hit it on the head when he mentioned "credential creep." The more information that has been presented the clearer the picture that this is an attempt to bolster the prestige of the Master's level APN by adding a couple of classes and perhaps a practicum and a project and now calling them Doctors of Nursing Practice.

Absolutely! But we already have someone with that level of training -- MDs.

As Delta has illustrated, the DNP curriculum actually is more of a melding of a MSN with an MPH. So you it appears you would actually have a lesser trained but now doctoral clinician.

"Where's the beef?"

 

Re: My point exactly

The only point or opinion I have read from your posts is that for some reason you despise the fact the nursing profession has evolved to a doctoral level. Get over it, it has happened. So what's the beef?

 

Re: Re: My point exactly

There are several salient issues that can be gleaned from this discussion.

Primarily the nursing profession is evolving in response to the increasing sophistication of state-of-the-art medical interventions, medical care and medical systems resulting in the need for higher levels of nursing competencies in myriad nursing related skill areas. The doctorate in nursing appears to reflect the increasing responsibilities and skill sets in myriad areas required by this profession . In addition, the doctorate reflects the enhanced and complex role nurses play within the medical team and is an important acknowledgment of their level of contribution to the medical care of patients as well as to their professional identity and standing in the medical community. This evolution is occuring with other health related professions as well such as Physical Therapy and Audiology and will probably be more commonplace with other allied professions in due time.

The second point is that your response to PsychPHD is right on target and has historical precedence! As was observed in another thread PsychPHD commenced "world war three" on this forum regarding his contacting a faculty member of an unaccredited school in a provocative challenging manner regarding his use of a (c) next to his Ph.D (meaning that he was a Candidate). PsychPHD went on and on ad infinitum regarding this issue that was irrelevant and meaningless. In regard to this thread regarding the doctorate in Nursing, PsychPHD once again is making inflammatory and demeaning comments about this profession and argues his "position" without any substantive data but HIS/HER perspective that implies that ONLY he/she should be a doctorate and only his/her profession is deservant of this high level academic credential. However, when challenged to provide substantive supportive evidence to his/her perspective that master level mental health clinicians are not on par with doctoral level Psychologists in terms of treatment intervention outcomes and that the mental health profession is not inundated with Psychologists due to the overwhelming number of mental health professionals inundating the job market, the only response received is complete silence. In sum this poster appears to be unable to process how other posters feel regarding his/her hostile and belittling comments and totally disregards their needs as professional nurses who are seeking to enhance their status, recognition and professional identity.

As noted in the previous thread it is best to ignore this poster's provocative posts because all they do is lead to anger and flame wars. No more, no less.

 

The pot returneth

If you had bothered to actually read this thread ... the only time it become "provocative" was when YOU arrived.

The rest of us have had a productive, if passionate, discussion.

 

Clarification (again)

I am sorry if that has been your perception because that is not my motivation or sentiment.

I have never sought "belittle" the nursing profession or insinuate that there is no need for nursing doctorates (PhD, EdD, DNSc)-- for research, teaching, administration.

But -- as has been illustrated several times -- the DNP is specifically a practice degree, the AACN's choice for THE qualification for advanced practice nursing, and by your own statement more of a public health degree than a clinical practice qualification.

The "beef" is when the heatlh care system is already dysfunctional on so many levels, what is the purpose/benefit of adding the DNP?

Does it really add clinical competence? No (see the curricula Delta posted)
Does it fill an underserved niche? No (the Master's level PA/NP already does that)

Again, this is not about denying nursing the ability to advance their education to the doctoral level.

This is about the retooling of that education into something that has no clear purpose or value.

But, as simon has now inserted himself into this and succeeded in convincing people this is a personal issue and not a professional debate -- there will likely be little substance added to this thread.

 

Re: The pot returneth

It has been an interesting thread... I have enjoyed reading your posts in this thread, as nursing education is not my strong suite.

In my experience, people sometimes resort to ad hominem attacks when they can no longer intelligently defend their positions. Still, if they are a troll, or mean-spirited, they may just attack right away, because they are not here to discuss anything.

Dave

 

Re: The pot returneth

PsychPHD: "The only time it became provocative was when you (Simon) arrived".

SIMON:

Comment: My initial post was directed specifically to Delta not to PsychPHD. However, Psych immediately interjected and responded with his/her hostile and condescending editoralizing completely missing the point I was making which was to show that the same level of questions PsychPHD was presenting regarding the need for a doctorate in nursing can be posed regarding the need for more doctorates in Psychology! This is due to the fact that for many years in the US the majority of Psychologists were at the Master degree level but over a period of time the doctorate became mandatory. In fact many Psy.D programs are graduating students who appear to be over inflated master degree clinicians with very marginal doctoral research skills or with any other distinct competences that provide them with clear cut advantages over master degree clinicians as measured by treatment outcomes.

psychPHD: "The rest of us have had a productive, if passionate, discussion".

SIMON:

COMMENT: "The rest of us"? I understand that you engage in projection but now you are in denial! Reread Delta's statement above and it quite clear that it is not "the rest of us".


PsychPHD: Quote 12/12

"OK, apparently nurses seem to need doctorates...

What's next, the New York Institute of Photography offering a DPP (Doctorate of Professional Photograpy)?

The Truck marketing Institute offering the MTS (Master's in Truck selection)?

HARDI having a D-HVAC- Doctor of heating, Ventilation and Air Conditioning"

SIMON:

COMMENT: The above quote clearly denotes sarcastic and demeaning innuendos, inferences and condescenion in comparing the issue of the doctorate for nurses with the other occupations he lists. This does not constitute a "productive discussion", as PsychPHD attempts to convince other posters but of contempt.


psychPHD: Quote 12/13

" What does seem to stretch credibility is the utility of a "doctor-nurse" as part of the direct care team; What more does the doctor-nurse bring to the table, other than confusing the nature of providing."

SIMON:

Comment: This is not a matter of "stretch(ing) credibility" or of "what more does the doctor-nurse bring to the table, other than confusing the nature of providing" as PsychPHD condescendingly notes. Such absolutely rediculous remarks on the part of this poster only reveals his/her deficits of understanding of the complex interplay of medical treatment team members from diverse disclipines in the provision of medical care to patients. Historically nurses have been downplayed and overtly mistreated by numerous doctors and until very recently not receiving sufficient remuneration for their efforts and considerable contributions to patient care. This has contributed to an inordinate level of burnout amongst nursed resulting in many leaving the field or shifting from one medical facility to another . This has also resulted in critical shortages of nurses in hospitals and medical facilities creating potentially dangerous scenarios for safe and viable patient care.

In addition the nature of many nursing functions and job tasks extend beyond direct patient care and include senior administrative, managerial and quality of care assurance responsibilities that are extremely demanding and complex that enable hospitals to function day-to-day as viable institutions. An intrinsic value of the doctorate in Nursing is the elevation of the status of nurses within the medical team constellation and medical system and to acknowlege the complexity of some of their roles and responsibilites that although are different from physcians are on par with their necessity because quite frankly without nurses hospitals would not function as viable institutions with serious deleterious implications for quality of patient care.

DELTA: (12/13)" In fact, it can be argued that Nursing is the oldest profession still in existence and the practice of medicine came many milleniuks after nursing"

PsychPHD Responds (12/13):

"C'mon do you really want to go there? Do I have to mention the "second oldest profession"? Will they be asking for doctorates next"?

"What has'nt been addressed is wha value is added with DNPs becoming integral participants in healthcare providing? Are we eventually going to evolve to the point where no one works in support roles?"

"Not everyone gets to be a general/admiral in the military.


SIMON:

Comment: Delta raised a valid point that was expeditiously responded to in a characteristically sarcastic and unproductive manner by PsychPHD by his/her making comparisons between nursing and prostitution!

In fact, contrary to what PsychPHD alleges, posters have "addressed" "what value is added with DNPS becoming integral participants in healthcare providing" BUT PsychPHD in his over inflated role of Grand Inquisitor refuses to acknowledge it!

It is interesting to note that PsychPHD states that not everyone can be a "general/admiral" with the exception of himself of course, a brilliant Psychologist who does not have to answer any questions pertaining to the necessity of doctoral level psychologists because in his/her mind only he/she can ask these questions in an interrogation-like manner and expect answers!

These and other comments made by PsychPHD underscore the condescension and demeaning tone of his/her perceptions of other professions other than his/her own. There is no indication that he/she understands the finer points and nuances involved in other medical practitioners wish to elevate their status, recognition and respect within the medical community. Imagine this poster claims to be a Psychologist, a profession which prides itself on its practitioners being highly trained in empathic and relational interpersonal skills. As I stated previously, UNBELIEVABLE!