About One DNP

I earned my "terminal practice" degree in nursing from the University of Tennessee Health Sciences Center in a journey of excitement and challenge. It inspired me to advocate for an all encompassing clinical credential rather than continuing the hodgepodge of nonsensical initials. I hope these entries will provide entertainment and insight into the Doctor of Nursing Practice experience, which will soon be the entry standard for all advanced practice nurses.

Monday, December 12, 2011

Finals Done and Final Thoughts

The last full week of on-campus learning has come and gone. I find myself both excited and wistful about graduation in May.  Perhaps I have overdosed on sappy Christmas movies and am feeling overly-sentimental, but I feel enormously lucky to have met the peers and mentors I have through the course of the program. But without further blubbering, here is the on-campus week in review:

Psych Seminar
This seminar was aimed at getting folks to narrow down their capstone and start drafting an abstract for APNA. In a move that labeled me teacher's pet, Dr. Cunningham shared the abstract I submitted for 2011 as an exemplar and talked about my prowess as a writer.  Apparently, writing 200 words a day is a prescription for improving writing skills - the blogging comes in handy in more ways than I thought! Since I cannot re-use my own work, I am investigating ideas for how to integrate Traditional Chinese Medicine modalities in to Psych Nursing practice. Based on the feedback I received on the APNA forum, it looks like a practice roundtable might be in order for 2012.

Health Care Economics
Never a dull moment, I did not have to attend this session for the 2.5 points, but I just love the debates that always crop up when Dr. Thomson and Dr. Carter are at the front of the room. While most of us agree that primary care should not be done by physicians and some sort of interdisciplinary comprehensive healthcare exam would be useful for parity purposes, I am in the camp that believes the American Board of Comprehensive Care (aka the third step of the USMLE) is NOT the appropriate answer. One of my pediatric NP classmates was quite persuasive on the matter of differing education and role between MDs and NPs that makes the ABCC test prejudicial in favor of physicians. As she pointed out, many pediatricians cannot pass the PNP board exam.  Moreover, NP education focuses on prevention and primary, community based care, whereas MD education focuses on tertiary, hospital-based acute-care.  It would be far more logical to embed a standards-of-care module into the respective exams for independent healthcare providers with a uniform minimum pass-rate. Whoever can design that will make a fortune.

Evaluation of Practice
A few bumps in the road on this course, which is expected given this is the first year of the re-design. I know from being at the front of the classroom that there are some brands of student that feel the first draft of the syllabus is a sacred tomb not to be altered for anything less than plague, pestilence, or flood. Me, I roll with the changes to make the changes work for me. I also do not  interpret that which is not graded as that which is necessary, and there were a number of ungraded assignments in this course. The end result found me reviewing my Improvement Science project with Dr. Mona Wicks, Associate Dean of Research, who not only provided enormous encouragement and essential edits to my project, but taught me a valuable lesson in professional reflection. I must remind myself I do NOT need a PhD no matter how tempting it sounds!

Clinical Management of Mental Health Disorders
Despite reviewing strategies on how to get out of doing our presentations, we all went backed-down and went through with it.  All of the consultation process were unique and well done. Here is ours for any future students in need of some ideas:


  1. Hello- I have read your blog with great interest. I find the DNP quite fascinating as a person who went to nursing school before going to medical school. I must take exception to your claim that Physicians are not educated primarily in prevention and primary care. In fact that is the traditional basis of medical training and remains so. Every freshly minted Physician is in fact a "General Practitioner". It is a shame that the General Practitioner is now ignored and fading into memory in favor of other providers with less training and less demanding qualifications but the reality is that all Physicians are primary care providers (GPs) in their beginning and quite well educated and qualified in that regard. Calling the ABCC test "AKA" USMLE is not nearly a fair assessment at all. It actually requires much less expertise in primary care to pass that exam. It utilizes retired USMLE questions, not current ones, and it is in fact adapted to DNPs. It is simply a lower standard. I just took a DNP assessment test out of curiosity and in fact made 100%, and I am an MD. Currently the pass rates for the ABCC test are hovering around 50% and have done so for years. That is a dismal statistic. I would think one would want to question why that is the case.

    Currently I am a professional medical educator and train people to pass USMLE and COMLEX. I would be quit happy to take on any students that are having trouble with the DNP exam and could virtually guarantee they would pass. There is in fact NO tertiary care on the exams I teach for, USMLE and COMLEX are in fact 100% primary care exams on all 3 Steps and on the clinical exam. As a person who has been working professionally since 2008 in medical review I can make these statements with great confidence. I have personally taught and tutored over 2,000 students for these exams.

    Again, I have both nursing training and medical training. Unless one has been to through both I find it hard to believe they can comment with any authority on both.

    It is my hope that my comments would not be interpreted in any way as adversarial against DNPs or any nurses of any level. We need people to provide care. But I have to wonder why we are educating so many people as PAs, NPs, DNPs, etc while there are so many MDs in this country that have passed all three Steps of USMLE but never got a residency. They can't practice, yet they are more highly trained, more highly educated, and more highly skilled in primary care than the other professions that are replacing them. And they are already fully trained, not one cent more would be required to get them into the work force sing primary care patients. How and why this is happening is certainly a mystery and distressing.

  2. Thank you for such a detailed perspective. Just to clarify, there is no such thing as a DNP exam - the ABCC exam is optional for family NPs and make little sense for those in other clinical disciplines (midwives, mental health, anesthesia) or in the other practice
    areas of education and administration. Certainly MDs are generalists at the independent level of practice whereas nurses are generalists with a narrow scope of independence at the RN level and specialists at the advanced level. Check out my post on the guide to the gray area - it is not that medical education ignores primary care (how could it when it is the most comprehensive healthcare degree), just that delivery of a quality care does not require a general medical education.