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Advanced practice nursing and the 2015 DNP

The word is definitely out. Maybe since it’s now 2011, the rumor mill is churning more. The Internet and the bedside seem to be fraught with opinions, questions and down right confusion. From my own circle of the world it seems that everyone wants to know ‘what is up’.

Let me clear the air and maybe shed just a shred of light on the subject of the DNP role and how it affects the world of Nurse Practitioners past, present and future.

Facts:

  • In 2004, the American Association of Colleges of Nursing (AACN) published a ‘position’ paper on the transition from the current Master’s degree prepared requirement (MSN) for Advanced Practice Nurses to the Doctor of Nursing (DNP) terminal degree requirement (via AANP.org). (actual position statement from AACN is here)
  • This position statement stemmed from a previously released Institute of Medicine (IOM) comprehensive report concerning medical errors and patient safety. (Yes the very same organization that released : The Future of Nursing: Leading Change, Advancing Health in 2010)
  • A PhD is not a DNP. I do not know or think that the PhD is suitable for ‘substitution’ of the DNP degree. The DNP degree is clinically based, where the PhD is theoretic-academic based. Forgive me for such a loose description.
  • I believe it will eventually apply to all Advanced Practice Nursing degrees, which includes Nurse Practitioners, Nurse Mid-Wives, and Nurse Anesthetists (CRNA). I read somewhere this may also include Clinical Nurse Specialists at some point (CNS specialty).
  • This is a joint-task effort on the national and state level. The National Council of State Boards of Nursing as well as other organizations not mentioned are following in-line with these new requirements.
  • The DNP program is active in many schools across the nation already. Many MSN programs are being phased out completely to make the way for the new standard. So applying for a Master’s in Nursing is actually not possible at some institutions.
  • Current MSN students will complete their program and then will be required within a certain time frame (no I don’t know how long) must attend a ‘bridge MSN-DNP program’ and attain their DNP. The may start actively practicing as an advanced practice nurse (given they possess all their needed certifications), but will eventually have to have the DNP degree.
  • Currently active practicing advanced practice nurses (NP & Nurse Mid-wives mostly) can continue to practice, but they too must enroll in a ‘bridge MSN-DNP program’ with the same specific standards as the new MSN graduate. Once again I do not know the time frame allotted for completion.
  • This process is not immediate. The transition is being displaced over a number of years. This transition also addresses current MSN students as well as currently practicing Advance Practice Nurses (NP, Nurse Mid-Wives, etc.)
  • The DNP program is a concentration in nursing clinical practice and will require a great deal more clinical time, education, training, and skill. This of course will include rigorous efficiency in evidenced based research.
  • The ‘requirement’ to possess the DNP has not been set in stone (or on paper) as of yet. All of these changes are with the intent and assumption that it will be by 2015.
  • While the DNP is of course more intense and has many more hours required, the total time in a specific program is only lengthened from generally a 2.5 year program to a 3.5 year program (this is just a loose estimate).

This of course is not an all inclusive list. I don’t have expert knowledge on the inner workings of the framework. What I can tell you is this is happening whether you like it or not, whether you agree with it or not. I used to tell myself this DNP requirement was like the rumor about all RN’s will be required to have their BSN. That all hospital based degree programs and all ADN programs were disappearing.

Unfortunately we are talking about advanced nursing practice, not basic nursing skills 101.

The truth of the matter is, and the evidence supports this : the higher the education level the safer the level of patient care. Sorry folks, for some that is a hard pill to swallow. Whether it be an advanced certification or the advanced degree, possessing more knowledge benefits our patients.

And honestly, isn’t that all that really matters?

Additional resource:

Position Statement on the Practice Doctorate in Nursing

If you have anything to add please leave a comment below. What did I miss?

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Sean Dent

Sean Dent is a second-degree nurse who has worked in telemetry, orthopedics, surgical services, oncology and at times as a travel nurse. He is a CCRN certified critical care nurse where he's worked in cardiac, surgical as well as trauma intensive care nursing. After five years practicing as an RN, Sean pursued and attained his Masters of Science in Nursing. Sean currently practices as a Board Certified Acute Care Nurse Practitioner (ACNP-BC) in a Shock Trauma urban teaching hospital. He has been in healthcare for almost 20 years. He originally received a bachelor's degree in Exercise and Sport Science where he worked as a Certified Athletic Trainer (ATC).
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22 Responses to Advanced practice nursing and the 2015 DNP

  1. Deb, RN

    Patients need excellent bedside nurses.

    The only bitter pill I’ve swallowed is watching some of the best RNs leave the bedside the minute they obtain an advanced degree. Many are able to affect patient care indirectly once choosing high level management spots within the institutions (assuming they didn’t leave the hospital environment altogether to obtain more personally fulfilling causes… lecturing, public speaking, etc.), but find their educated and eager hands tied by the budget constraints placed opon them by greedy corporations. Then, they become “one of them” because they need to support their families and pay off those student loans.

    I feel that one can never have enough education. However, when I hear that one must obtain a higher degree in order to perform better direct patient care, it does leave a bitter taste. I am only familiar with Purdue andc some other local colleges…. their higher degree programs teach very, very little related to direct patient care skills along with the wonderful instruction they do offer.

    Some of us have no interest in performing indirect patient care. Safety is directly at the bedside.

    • Sean Dent Scrubs Blogger

      @ Deb I’m glad that we all can agree on the safety of the patient, no matter where the care is applied. Thanks for sharing your thoughts.

  2. Mary Notrica

    THANK YOU!

  3. Eileen O’Grady covers some of the similar nitty gritty about the DNP standard. But she also covers important issues like the need to have national certification policies instead of the hodge podge state based system that we currently have. As many of you know–when you move form state to state the scope of practice and and who is control of curriculum standards vary greatly. Check it out at: http://tinyurl.com/4pxfjev

  4. Hello,

    Could you send me a hard copy of the more information packet about school of nursing and
    brochures of the DNP program via my post? Thank you!

    Sincerely,

    Nguyen Van Thanh
    362/94 Nguyen Dinh Chieu St.
    Ward 4 District 3
    Saigon HCMC
    Vietnam 84.

  5. D. Hyden

    What you are missing is the motivation. The colleges need money. Like an infant bird with the mouth always open to be filled. As fewer college grads fine sustainable work, the sale for more education gets harder. They are looking to those already employeed to sustain the colleges systems by ‘ increasing degrees’. When was the last time you saw an instructor in the clinical area. I do not understand why health care administrations have not sued the colleges for fraud. How many times have we heard; “I am not comfortable doing that……I can’t do that…….I was not shown that” What did they learn in college. Why should hospitals pay grads and train them also. And now we want to add more of Non-Training requirements and letters for additional education. The last time I looked it was all pretty much dicated by the reimbursement as to what gets ordered and paid for. I don’t need a DNR in the clinical area. I need a good aid with common sense and a good work ethic who shows up on time; doesn’t eat breakfast at the desk or talk about her life for hours; can take vital signs without instructions; and plans to stay for the whole shift..in the clinical area working.

    • Sean Dent Scrubs Blogger

      @ D. Hyden I seem instructors in the clinical areas as often as needed. Unfortunately your problem you are stating is not related to the blog post at hand. I do hope you find the balance you are seeking.

  6. Tim

    As a current nursing student with the hopes of obtaining an advanced degree after I graduate, I am not happy about this. To me, it really just looks like more student loans I’m going to have to take out. I feel like by requiring more school, it really limits how many people can pursue the degree. It’s a class issue, at least from my point of veiw. Hopefully, by graduating in ’13 I’ll be able to squeeze into grad school and be grandfathered in.

    • Sean Dent Scrubs Blogger

      @Tim Sorry you feel that way. I wish you the best of luck in your career, hang in there.

  7. Laura

    I have been a nurse for many years. As I have become more and more proficient in my practice, I have been “promoted” to managerial and administrative roles, which have taken me away from direct patient care. I have never felt professional satisfaction from these roles; I am a clinician. As such, I have removed myself from any management role and am again providing patient care. However, the only way to advance myself professionally at this point as a clinician is to acquire an advance practice degree. I am currently enrolled in a NP program and look forward to using the knowledge gained in this program in providing hands-on care. As the healthcare paradigm shifts, as it surely will, NPs will be in greater demand to provide high quality care at a lower cost than physicians. This is already happening in the city where I live. There is value in every step we take in our nursing education; one never replaces the other, only enhances it.

  8. Sean Dent Scrubs Blogger

    @Laura Well said. Well said! So happy for you and your NP enrollment, best of luck to you!

  9. mandy

    I am currently in a Master’s program for nurse-midwifery, and found this while searching for content for a MSN/DNP role paper. While I am supportive of furthering my education, I breathed a sigh of relief when I read the American College of Nurse Midwives position on the DNP issue: ACNM does not support the requirement of the DNP for entry into clinical midwifery practice. Follow link here:
    http://www.midwife.org/index.asp?bid=59&RequestBinary=True&rec=79&cat=3
    I am a member, so this link may not work for all.
    I am only in my second quarter, and am dying for this to be over!

  10. Sean Dent Scrubs Blogger

    @mandy Thanks for the additional information. Best of luck with your program!

  11. Granny Rene, RN x 35 yrs.

    This is a ridiculous requirement. Why not just go on to medical school and become an MD? Then nurses would have the respect and power to REALLY treat patients effectively WITHOUT the supervision of another MD.
    Here in the Deep South, NPs have NOT been utilized as was intended. They were supposed to make up for a shortage of MDs in the rural areas but instead have had to function more like PA’s even though they have their OWN licenses! Georgia has a law, signed by the Governor in 2006, which FINALLY allowed APRNs to write prescriptions. Implementation of the law has been ‘held up’ by the Medicine and Pharmacy boards.
    Instead of pushing for MORE and MORE education what nurses REALLY need is ONE national license and a MUCH more ‘in touch’ advocacy organization.

  12. Sean Dent Scrubs Blogger

    @Granny Rene An interesting suggestion, thanks for sharing your thoughts.

  13. Debbie M

    I have been in nursing for 34 years. I started out as an LPN and worked hard to achieve an ADN, BSN and finally 2 Master’s degrees. If the profession of Nursing has not achieved the “mandate” of all RN’s having BSN’s, how do they propose to demand that all CRNP’s have DNP’s.? The institution I work at still hires RN’s from Diploma Programs and Community Colleges. If I were younger and considering a career in the medical field, I would look at the requirements for APN’s, laugh, and just put the time into getting a medical degree. With the aging of America and the shortage of professionals needed to deliver that care, who in the world is going to spend all of their time and money on a degree that will most likely not pay more than a Master’s prepared CRNP? I am glad I am retiring soon!

  14. Sean Dent Scrubs Blogger

    @ Debbie That is the beauty of our profession, is the amount of opportunity and options out there. Thanks for sharing your thoughts.

  15. christymel

    You’re article is fantastic. Just got accepted to an non nursing entry level masters and I will graduate near or in 2015 so I was very confused. This article helps clarify pretty much all of my questions.

  16. Darius - Aspiring NNP

    This post helps me a TON, there were many confusing and overlapping topics/issues relating to the whole thing and my dream job is to become a nurse practitioner but i wouldnt finish until after the 2015 initiation or whatever and it has left me with many unanswered questions. And as i am not yet on the degree track (just finished high school and on my AA track), I havent had many open resources to utilize without a lengthy process..
    So I say thank you!!

  17. stallon

    Good info. One thing is incorrect though. Current NP’s won’t be required to get a DNP. They will be grandfathered in as DNP’s. Much like the pharmacy programs that went to Doctoral requirements several years ago. All pharmacist with Masters degrees received Doctoral Diplomas from their respective colleges. I’m a new grad Acute Care NP with a Masters.