Monday, May 31, 2010

The DNP for Me

It seems these days, anyone and everyone is willing to share their thoughts and opinions about the Doctor of Nursing Practice (DNP) degree. These include non-nurses and nurses alike. Well, I thought I'd take a stab at it as well since I am now 2/3 through my pursuit of the DNP. If you were to strictly listen to some of those opinions, you would have a very poor view of just what exactly this academic degree is and what it can (and can't) do. Perhaps I can dispel or at least clarify some of these points, at least from my view.

  • First, no one is "forcing" anyone to go back to school to get this degree. The 140,000+ already practicing NPs will continue to practice without the need to return for formal academic education. However, starting in 2015, it is presumed that MS programs will transition to the DNP.

  • Second, there is some variation in the DNP program types. This is incredibly frustrating to me since not all programs are created equal. The DNP is not synonymous with nurse practitioner only practice, creating further confusion. For some great fact gathering, look at the AACN - Doctor of Nursing Practice section. One must throughly research the program and decide if it is congruent with their own practice philosophy, learning & lifestyle.

  • Third are the financials - it does indeed cost a significant amount of money for doctoral education. However, there are loans and grants available for those willing to search them out. In keeping in line with the financial aspect, no one really knows what the additional education will translate into when it comes to salaries. I'd say, if that is your main motivating factor, the DNP probably isn't for you. (As an aside, I've started reading the book, "Drive" by Dan Pink and he asserts that autonomy, mastery and purpose are the real long-term successful motivating factors rather than financial incentives when it comes to non-task oriented work). I don't think I know one NP who became one for the money (because the reality is, some RNs are making significantly more than NPs). Of course, one would want to know what their return on investment would be but it just isn't that simple. I believe that it is safe to assume that somewhere & sometime, a doctorally prepared clinician can make more than one who is not and will have a number of new opportunities at their door.

So, why did I decide to return to school for a DNP? Here is a little background: I have been an FNP for 10 years and have held a variety of positions in correctional health, college health, men's health, retail health and occupational health. I've seen many patients in many different settings and I've been able to build upon each experience. However, I was growing increasingly frustrated with conflicting published data, major dysfunction of the health care and system and at the end of the day, wanted to be able to provide the absolute best care for the patients I served. I vehemently refused any additional "residency" type of education. In fact, I had very mixed feelings when I first heard about the creation of the DNP. Not to be coy, but I already had the education and training to take traditional care of my patients in the family practice setting. I could manage my patients with asthma, diabetes, and hypertension just fine. But I felt that I wasn't using the latest proven evidence in my care. The research classes I took as a student were generally pretty dry and seemed to have little applicability to direct practice. For me, it was critical to take my practice to a new dimension. This is the essence of the DNP for me and I was fortunate to find a program that I believed would take me where I needed to go.

The last two years of doctoral education has been both grueling and exhilarating. I am viewing my patients, their health concerns and the health system through different lenses. Didactic coursework included health policy, informatics, economics, legal/ethical, and teaching/learning/mentoring. One may look at this sampling and say that it isn't very "practice" based. I'd say that is quite a naive view of health care today. It would be easy to "just" take care of patients' health issues and ignore the rest since patients are multi-dimensional and never just present as an illness or disease. In addition to subtle differences in pathophysiology, patients bring their own cultural, societal, and beliefs to each and every encounter with a provider. The key is being able to navigate these complex intertwined systems and team together to best care for the patient for that time and place.

I am now onto the practicum portion of the program and am excited to take all of this new knowledge and integrate it into a patient care initiative. For the summer, I am part of a group that will be conducting a systematic review of the current evidence (related to diabetes care) utilizing the Joanna Briggs Institute method of systematic review. We have met and will continue to meet with the practice locations' key stakeholders (including patients) to implement an evidence based, culturally congruent practice improvement plan that will be assessed and reassessed. We are hoping to uncover some great evidence and have it affect our patients in a positive way. I am also hoping for a few publications from this process as well!

I am going to try chronologize some of the general themes over the next year and post them here.

To sum, the DNP will make me a more adaptive clinician. I will still see the same patients that I've already been seeing and will still collaborate in a multidisciplinary environment. What has changed is a truly evidence-based, patient-centered approach. Pink's concepts of autonomy, mastery and purpose resonate with me and are in alignment with my philosophy. At the end of the day, I want to be able to care for patients in the way that they should be cared for. I believe I am on the right track.


Syndal said...

I'm in a DNP program in MN and I've already faced some drama regarding the degree! so nice to read an well thought out post!

Ms Fish said...

Great post, and great articulation of the value of a DNP. I will graduate with my DNP in Dec. and share your reasons for our education.

Good luck with the diabetes project. I am not familiar with the Joanna method. I will look into it.