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.

Tuesday, February 15, 2011

Updated DNP Explanation Link List

Say that 3 times fast!

After sending survey monkey out to my soon-to-be students for psych/mental health, I nearly pulled my hair out after reading some of the results to the question "If you plan to attend graduate school, what field of graduate study?" A number of people said "DNP" without naming an area and others answered things like "either CRNA or DNP" as though they had nothing to do with one another.

I had a talk with some of my current students in my clinical group for leadership, and received the same uncertainty when I asked them what the DNP was. My on-going explanation has been something like this:

The DNP is a clinical doctorate much like the MD, PharmD, DPT, DDS, etc - nursing is just the last one to the party. Instead of having a masters degree as the entry to advanced practice nursing, they are expanding the education and clinical experience to a doctoral level to be on par with our peers in other healthcare disciplines. Much as the MD signifies a type and level of education, it is useless without residency in specialization. Likewise, the DNP does not stand alone, but rather uses a core curriculum integrated with one of the four APRN foci: CNS, CNP, CNS, and/or CRNA. We are currently in transition as universities phase out the advanced practice MSN, states start creating grandfather clauses, and certification bodies start amending their requirements,  but the goal is to have this streamlined and uniform by 2015.

Sounds good in my head, but I am not sure I am communicating the message. Thankfully, there are a host of people specialized in this sort of explanation and interpretive dance.

Understanding the Doctor of Nursing Practice (DNP): Evolution, Perceived Benefits and Challenges
From the National Association of Neonatal Nurses - an excellent review of the why, what, where, and when of the DNP.

AACN Fact Sheet
Updated March 2010, this provides the current state of affairs on the profession. There is also a powerpoint presentation with greater detail.

APRN Consensus Model FAQ Sheet
This may be a bit off the point, but for folks who are trying to get into an MSN program and graduate before the 2015 deadline, the language used in here should give you pause. We here at OneDNP to take exception to item 5 on the grounds that multiple sets of initials makes one appear like they are trying to compensate for something 


Jaclyn Engelsher APRN, CPN, FNP-BC, PMHNP-BC, DNP (my anticipated 2012 credentials minus BSN, RN-BC,  MSOM, CAc, DOM . . . hard to take that seriously, isn't it?)

Thursday, February 10, 2011

Plagiarizing Blackboard Discussions

I am plagiarizing myself from my leadership and health policy class, so no honor code violations have been broken! I am most excited to see that the battle is back on for eliminating the anachronistic and undermining collaborative agreement between physicians (who are educated and practice in medicine, thus have no more basis to supervise nurses than they do any other health profession they themselves are not masters of) and advanced practice nurses, many of whom have been charged thousands of dollars a year by opportunistic physicians for the privilege of prescribing within their already given scope of practice. I guess when you make the kind of money primary care physicians don't make, you have to plunder every potential revenue source you can. Nicky the Stick would be jealous. 

I will have much more to say later, meanwhile, check out the LEO article MAD Money for the spicy pre-fight analysis. 

Last year in KY, a number of state and national nursing organizations put up a unified fight to get rid of the need for physician oversight of NPs in regard to prescribing. House Bill 556 (sponsored by May Lou Marzian, an RN) and Senate Bill 75 bill were written with the intention of compromising to exclude scheduled medications. The MDs on the board put up the usual objections to "giving a bunch of nurses the same privileges as an MD," but it managed to pass in the house committee.  Documentation showing APRNs received less complaints, made greater use of KASPER to decrease narcotic "doctor shopping," and equal outcomes as compared to primary care MDs were presented. A few handshakes and some bourbon on the rocks in the back office made the smear campaign that began shortly afterward sure to get the bills  stalled - nursing may have had the greater head-count, but the MDs had more bucks. 

The good news is, the fight is back on for 2011 and the passage of health care reform (whether you like it or hate it, use what you can of it to your advantage) has put APRNs in a much better bargaining position. The shortage of primary care physicians  is not going to get filled  because the pool of medical students willing to  spend their youth and money on education with a payoff of  less than $200K/year is getting smaller and smaller. MDs should use that education to  specialize and focus on disease care and pass the baton to ARNPs for the wellness care. This is going to be a nasty fight!

Drake, S. (2010). Courier Journal. Bill to expand nurse practitioner duties advances in Kentucky. Retrieved from http://www.spapn.org/blog/?p=171 

Shaw, S. (2011). LEO Weekly. Mad medicine. Retrieved from http://leoweekly.com/news/mad-medicine 

Thomson Reuters. (2010). 2010 Kentucky senate bill no. 75, Kentucky 2010 regular session. Retrieved from  http://www.midwife.org/siteFiles/legislative/Kentucky_bill_S_75_2010.pdf