The Down and Dirty on the DNP

Three-quarters of the way through my Adult-Gerontological Acute Care Doctorate of Nursing Practice/Clinical Nurse Specialist program (AGAC-NP/CNS), I found myself googling, “What is a DNP?” Yes, at this point in the game I do have a pretty good idea of what I signed up to do, but when I started and prior to admission I had no clue. This is my favorite link from the University of Michigan decreasing the confusion of all of the advanced nursing degrees, read it here before continuing this post.

So, my goal is not to necessarily explain exactly what it is, which you can read in the provided link above, but to tell you why I did what I did and enlighten you about the struggles I’ve had while obtaining the degree in hopes that you won’t make the same mistakes.

Why did I decide on my particular program?

Well, it’s important to note that I am 100% a glutton for punishment, “Go hard or go home” has always been my motto. I knew I wanted to become a nurse practitioner and work in an ICU; I was ready for a more autonomous career and wanted to independently manage my patients. I also knew that I might want to teach some day, lobby, or become a leader in the nursing field. Therefore, the fact that the DNP is terminal and could provide me with all of those options was appealing. Also, my particular program gives the option to sit for both the NP and CNS board exams at the end. I’m still not sure what state I will be living in post-graduation, all state laws for advanced nursing practice are different (some benefit NP’s more, some CNS’s more), so I decided this would be another good option to have. Finally, I did not want a completely online version of the degree because I learn better in a classroom setting. Also, I wanted to be in an area with ever-advancing medical care. Once again, this is just me, it may not fit your life.

I applied to several schools, they were all great, but ultimately decided on my current, east coast, top 5, public, university. Since moving across the country for this degree, I have made so many mistakes, but I wouldn’t change any because they have made me a better person and provided me with invaluable life experience (I know this sounds cliché, but it is undeniably true).

However, all of this being said, you have so many choices. You could go to a Master’s program and then get your DNP while you’re working. There are many on-line options for both. You don’t have to uproot your life or change jobs and honestly, staying in a familiar environment with a support group would be extremely beneficial. Whatever you do, this country needs more advanced practice nurse leaders, so any route to getting your DNP is the correct route.

You have to implement research… really, I’m serious

Pardon my ignorance. When I interviewed for my current program, I had a panel or phone interviewers. Flustered, after working a night shift and the call being almost an hour late in a different time zone, the first question was, “What is a DNP?”

Crickets.

I felt like I was silent forever. Then, even worse, I tried to talk and stuttered. Then I stuttered again. Then, I asked to start over and explained that I was nervous and had just gotten off night shift etc. However, I never really gave them a great answer.

So, the biggest surprise in this program to me was the research aspect. This is what I wish I fully understood before beginning and it took me a couple years into it before I grasped the concept. If you take nothing from this post, take this:

• To simplify, you will be learning how to implement current research into an area of practice. You will not be doing original research.

• If you have a passion clinically, revolve all of your projects in research classes around this passion, it will save you work in the long run.

• The more clinical contacts you have the better. If you want to implement research, you need stakeholders to be onboard. Thus knowing people is very helpful.

• Even if you do all of this, your DNP project may not work out like you expected, but nothing is ever wasted.

For instance, I always had a passion for palliative care and I am an ICU nurse. When I moved out east I was working in a CVSICU and was hoping to implement an aspect of palliative care into the ICU. However, I unfortunately had to give that job up and lost several of my contacts there, so doing a project on that unit wasn’t going to happen. Luckily, I made contacts from various clinical experiences and made friends in my program. Now, my project revolves around palliative care for heart failure patients. It’s not exactly what I thought I would be doing, but I’m still very passionate and it’s been an extraordinary experience working with so many amazing people.

You will want to quit, frequently

Pending everything in my life continues at a relatively steady state, I will finish in May 2018 (fingers crossed) – that’s four years total. This has by far been the hardest thing I have ever done. The classes are tough, the clinicals are tough, and balancing them with family and work commitments is nearly impossible. Eighteen months in, I completely burned out, running an inhuman schedule and working full-time. I had to cut back to 30 hours per week and even then, I was struggling. At this point, I’m working 20-30 hours per week in a less stressful research job and working PRN in a general ICU.

I have friends who are taking more classes and working more than me, and some who are doing less of both. Either way, you must know your limits. After my burnout, I learned my lesson. For my mental and physical health, I needed to work in a less stressful environment on dayshift only and have one day per week off. I miss my CVSICU job and friends so much, but doing it all, just wasn’t possible. I have learned it isn’t honorable to push yourself past inhuman limits. If you are working so hard that it is affecting your health, something has to change and you shouldn’t ever feel bad admitting you can’t do it – even if your friends can (comparisons are poison).

So, this brings me to the fact that you will want to quit. A DNP in acute care is absolutely no joke. These are things you will inevitably tell yourself:

• Why didn’t I get my Master’s and start working earlier?

• I can’t do this anymore.

• I want to quit, no I don’t, yes I do, no I don’t, yes I do

• I’m going to lose my mind, no, I’m really going to lose it and need to be committed.

• I hate this degree, it has to be better elsewhere, while Googling other programs

• Why does the AACN want us to do this anyway?

• I just want to be a practitioner, I don’t want to waste my time with research

• I can’t do this, yes I can

Your mind will do anything to perpetuate your self-doubt, so you have to do anything to shut it down. My brilliant cousin said to me on one of my worst days, “If you quit right now would you be disappointed in yourself?” My answer to this point has always been yes, so I carry on.

Your grades don’t matter

Okay, so within reason your grades don’t matter. Of course, you need to pass your classes and study, but do not let them define you or create competition amongst yourself and your peers. In the beginning, there were some young whipper-snappers in my class who carried 4.0’s for a couple years. They were semi-isolated from some of my other classmates because of the frivolous competition they created amongst themselves and the rest of us. I’m fairly certain, even though they no longer carry 4.0’s, they would tell you the camaraderie and supportive relationships they have with their peers is far more important than a perfect GPA.

I study what I think I need to know as a practitioner. UptoDate is my best friend for studying diseases and provides the most current research for treating them. Your professors will give you tests that are impossible to ace – they just will and that is just how it is, but you will get through as long as you do the best you can.

Another PEARL:

Your relationship with your classmates is imperative.

I can’t speak for my classmates with significant others or children, but you will feel very alone at times. While your other friends are traveling, going out, and experiencing life, your experiences will be different. You may miss activities with your family or the birth of your best friends child. You may muster out of the house once in awhile only to find you feel guilty because you know you have an assignment to do. For the entirety of the program, this will linger in your mind, even on breaks. The only people who will understand you are likely sitting right next to you in class. Do not build walls between yourself and them.

I thank god everyday for my classmates. There are a whopping 17 of us left and we do nothing but support each other (#noDNPstudentleftbehind). I have heard horror stories from my friends in medical school about the intense competition and loneliness leading to high suicide rates. It is easy to see how it can get to this point – don’t let it.

Anyway, that’s my soapbox, but on a lighter note…have you ever worked with someone who earned a 4.0 in nursing school? I’d take a nurse who earned a 3.7 any day, just saying.

You will not be defined by the letters behind your name (at first)

The DNP is a newer degree and not many advanced practitioners have it. You may even be achieving a higher degree than some of your professors have. Preceptors, peers, co-workers, and other advanced practice nurses will do anything to tear it down and tear you down. Much of this comes from insecurity that you, a student and bedside RN, will have higher educational credentials than many nurse practitioners with years of experience.

You will not make more money because of your DNP and it doesn’t automatically mean you’ll be a better practitioner. Yes, sometimes a degree from a fancy university or a name tag from a top 10 hospital can take you places, but they are also easy to hide behind. Anyone can do anything, but not many can be anything. That is the difference.

Just because you graduate with a DNP doesn’t mean you will trump someone with 10 years of experience and a Master’s degree, but that also doesn’t mean they get to tear you down for achieving a terminal degree – if they want it, they can go back to school too.

It is important to understand this quirk of achieving a BSN-DNP. Respect is warranted on both sides. It is your job as a DNP educated practitioner to be it. If you feel you have not graduated with the clinical skills you need, work hard to increase them. Likewise, if you are weak in the research department, be better. Make yourself invaluable to employers and define your worth so upcoming DNP’s do get raises for their credentials. The dirty work has to start somewhere.

It’s really expensive

I’m not going to say much here except that I never dreamed how expensive it would be. When you are calculating costs be sure to include all of the following in addition to tuition costs and fees:

• Increased cost of living in whatever city you have to move

• Plan on decreasing your work hours

• Decreasing your work hours means a decrease in retirement savings

• Decreasing your work hours means obtaining health insurance elsewhere

• Plan for emergency medical bills, roommate crises, and having to take time off (just in case)

• The longer it takes, the more you lose money. Meaning, I wish I had done the three-year track of my program instead of stretching it out to four. The earlier I would have graduated, the faster I could have been making an NP salary even if it meant working less the last year.

• If you take out student loans, plan to be living on a serious budget for a few years after to pay them back.

You will be graduating with 80 class credit hours and 1100 clinical hours and it definitely doesn’t come free.

Finally…

This is what worked for me because I have made it work for me. Have I made mistakes? Yes, about 10,000. Could I have done things differently and made the transition smoother? Yes. Would I change it? No.

I also want to clarify, if you’re getting your master’s to become an NP, I think that is great. The DNP isn’t for everyone and I don’t think it should be required for everyone. I stand by anyone advancing their education in whatever way they are doing it.

As always, thank you for all you do.