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To “DNP…or NOT to "DNP” June 1, 2010
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Kimberly Spering, MSN, FNP-BC About the Author
Kimberly Spering, MSN, FNP-BC

Clinician 1Provided by Clinician 1

There has been a plethora of information, opinions, and “hype” about Nurse Practitioners obtaining the DNP, or Doctorate of Nursing Practice degree. It will be the “terminal” degree for all NPs by 2015, and the degree can be obtained by all advanced practice nurses, whether they are CRNAs, Clinical Nurse Specialists, Certified Nurse Midwives, or Nurse Practitioners. From the opinion pieces I’ve seen and heard (by blogs, online, news media, etc.), this is one of the KEY issues that “big medicine” has with us...that, my word, we NURSES will be called DOCTOR! Never mind that college professors, psychologists, physical therapists, audiologists, etc., have also used the term. No matter that many states have laws that state we must also identify our NP titles in any verbal or written communication, and we must state that we are NOT “Medical Doctors.” I think we ALL know WHO we are...and so do patients. So what if doctorally-prepared NPs want to be called “Doctor?” They should be...they earned the title.

However, I admit...personally, I have very mixed emotions regarding the DNP degree.

What bothers me the most is the lack of consistency between university programs. I’ve looked at the curriculums for several colleges...BIG difference in their programs. How would I know what constitutes a “great” DNP program? We as a collective cannot even agree about “entry-level” nursing degrees (thus, the diploma, associate, and bachelor’s degrees)...and now here comes academia, stating that all NP terminal degrees should be the DNP.

I agree, the typical Masters program for NPs has more credits than the average Masters program (compared to education, etc.). Other fields of study (pharmacy, etc.) all have doctorates as terminal degrees. So, why NOT us, too? We certainly deserve recognition for what we bring to the table.

However, a rarely-mentioned point is that we have seen studies pointing out our value, as Masters-prepared NPs, and similar or better outcomes than doctorate-prepared physicians. So those studies are not valid? Our cost-effectiveness notwithstanding...I have no doubt that many DNP programs are rigorous, and well-prepare NPs for clinical practice. However, are there any studies showing that DNP-prepared NPs are better than MSN-prepared NPs? Or, oooohhh, would that kind of study step on too many toes? Um, yeah. MINE and many others’.

Another thing that NO ONE has addressed (to my knowledge) is insurance reimbursement. Currently, Medicare reimbursement requires an NP to be board-certified...which requires the Master’s degree. Other insurances have followed suit. Who is to say that, at some point, that insurers will ONLY reimburse DNP-prepared NPs, and NOT pay Masters-prepared NPs in a few years? Will we spite ourselves by condoning this DNP?

What I have seen so far is that most of these programs NOW are mostly post-Masters programs that assume candidates already have their Master’s degree. I would “assume” that, by 2015, these programs will be modified for the NP student who enters as a non-Masters candidate, and have different requirements than those of us who already HAVE the MSN or MS degree. Hopefully, in their quest for “advanced” practice, the programs ensure that graduating DNPs continue to focus on the clinical skills, as well as the “DNP” things they now promote.

Explain to me, as a working NP in private practice, exactly HOW I will benefit in spending $30,000 to $50,000 (rough estimate) to do EXACTLY what I do now, in my current position...which I happen to LOVE. My collaborating physician, as wonderful as he is, will NOT (guaranteed) pay me more money simply because I have the DNP vs. an MSN.

Personally, I have two boys to help raise and put through college. I have no extra time or money to work toward the DNP degree at this point in my life. I have no desire to call myself “Doctor,” even if I would somehow have a windfall of cash and time and pursue this degree. I would continue to identify myself as “Kim Spering, the Nurse Practitioner.”

And, quite honestly, I want to keep doing EXACTLY what I do now. My “terminal” degree does not make a difference to me. Hopefully, that fact will not hurt me down the road...as academia has made their choice for all of us.

Kim SperingKim Spering is a family nurse practitioner who currently works at Brndjar Medical Associates, P.C., a family practice in Emmaus, PA. Her past experience includes the fields of medical/surgical ICU, open heart/trauma ICU, labor and delivery, nursing education, nursing supervision, and as a nurse practitioner in both family practice and OB/GYN settings. She currently serves as a NP preceptor for her graduate school alma mater, DeSales University, as well as for local baccalaureate programs. She is passionate about patient education and helping patients understand that they are ultimately responsible for their own health. She also firmly believes that the public needs to be educated on the value of NPs and PAs in meeting the health care needs of the next decade and beyond. In her free time, Kim enjoys family vacations with her optometrist husband, Mark, and her two sons, Matthew and Connor.

 

The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

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John, NP (Texas) on 28 May 2014 at 11:12 pm

Just perusing the internet and found this discussion. My 2 cents... The DNP is not worth the time, effort, or cost to obtain. If you peruse the curriculum there are absolutely ZERO courses that will impact patient care. At an average cost of 50,000 for the DNP degree you will have to work an additional 6 years to pay off the debt at zero interest (which is unlikely). Besides if you have any negotiation skills you can adjust your salary without the additional 50,000 dollar investment and pocket the extra cash.

The push for this to be the terminal degree is soley from the American College of nursing because they can't replace the PhDs they are losing to the more profitable NP route.

The saddest part is those NPs that are attaining the DNP mostly aren't becoming professors anyways because the salaries are so poor and the vast majority of University's do not recognize the DNP as a tenureable degree. So persuing an academic career with the DNP is foolhardy.

authur gorman BSN, PHN, PCCN, FNP student (redding ca) on 25 Apr 2014 at 12:45 pm

Education is only a personal goal for a RN to pursue a higher degree. The NP and DNP will never make more money than an acute care RN. I have look for several year to find a job that would be equal or better than the job I have at dignity health and several other big corporations. If its joey and benefits you want say a RN, if its education and titles for a personal goal then go for the NP and DNP.

Anonymous (boston) on 16 May 2013 at 10:49 am

The big question is competition between NPs and DNPs and salary and variety of positions. In my opinion it is only worth while to obtain the DNP if there is a substantial increase in salary. In fact, there should be a substantial increase in salary between BSNs and NP. I have been a nurse with a BSN for 25 years. Believe me, nurses better learn to speak up for their rights and salaries or they will always be walked all over. Employers want their cake and eat it too, and so does the government

Kip (Missouri) on 16 Sep 2012 at 4:44 pm

The DNP would be nice, but most of the available programs still model their programs on a Ph.D. chassis. I personally would like the extra educational opportunity, but I am and will be paying off student loans probably to my demise! Moreover I have noticed that in regard to the AANP DNP statement put out several years ago, that many Master's prepared APRNs are not being directly discriminated against within organizations and planning structures, but are just being left out or not chosen for many leadership positions so that the "DNP" is being put at the forefront of title usage. We now have a National organization of Doctorate of Nursing that are having their 5th annual DNP Conference in St Louis this month. We non-DNP providers are told that we are all in the struggle for barrier removal so we can give better access to our patients, but conferences like this tend to provide another professional tier to Nursing that is unwelcome due to its exclusion or lack of inclusion to many of us Master's only prepared practitioners. I've always tried to do my part to promote our honorable profession and always will, but when I went into it...the Master's was the "terminal degree". Thanks for letting me put my 2 cents in.

Deb , DC, RN, BSN, CLNC (Atlanta, GA) on 07 Aug 2012 at 10:22 am

This is an old post, but I would like to revive it. I hold many degrees and I am somewhat a professional student as I love to be continually challenged in education. I received a BSN in 2010 and will now begin my MSN track for NP. Since I have practiced for 20 years as a doctor of chiropractic, the doctor portion of the NP is quite redundant for me and useless. I think the push to make all NPs obtain a DNP is obsurd. As you point out very well, the degree level will NOT change what you are already providing for your patients. Nothing will change! I agree with you that no one will really care that you are a DNP vs NP. When the smoke clears you are still a Nurse Practitioner period and the doctor title does not entiltle you to practice any differently. As I pursue this next step in MSN, I do worry that I will be forced to obtain a DNP. I am getting older and after this MSN degree, I don't think I will have the energy, time or care to finance another round of education. Especially if that degree is not going to put me any higher on the totem pole. I am hoping that the DNP will be only a choice for higher education and not a requirement. The only people benefiting from this degree is the educational institutions and their falculty.

Catherine Bishop, DNP, NP, AOCNP (Northern Virginia) on 07 Jun 2010 at 10:55 am

Kim,
It is difficult to explain the benefits of returning to school to earn your doctoral degree. For many it is a personal goal--to earn the highest level of education as a APRN. I think in the last two paragraphs of your commentary you have given the rationale (for you personally) why you will not seek this doctorate. There is evidence that DNPs earn approximately $8000.00 additional over a MSN prepared NP. Just because your collaborating physician will not increase your pay does not mean it is not out there to be had. We should all be paid for additional education and training.
Additionally, I think the DNP is a work in progress. All of your points are well taken, but none will be able to be addressed immediately. The DNP will take time to mature and so will the benefits.

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