“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Understand the Paths to Becoming a Nurse Practitioner

Trying to become the best nurse practitioner you can be is a difficult task to achieve with so much educational material on the market. There are countless online courses, CME, DNP programs and post-graduate certifications.  It can become overwhelming and stressful. Where does one start?

The first thing you need to realize is that the results you deliver to your patients matter more than anything else. If you can fix the way a patient feels, they do not care about your DNP or post-graduate certification you paid $25,000 on. All they care about is feeling better.

It is time to stop wasting your money and time on educational material that does not deliver results to the patient and to you for that matter.

So how do you improve patient outcomes? How do you produce the results you want with patients? It must be through practical education.

The DNP folks will say they can deliver better “evidenced based care” and utilize the critical thinking ability developed during their program to help shape health care policy blah blah blah…

Post-graduate certifications allow you to branch out into another clinical area such as psychiatry or acute care.

CME will provide you with a structured educational course that awards CME credit that goes towards licensure/certification.

Self-study gives you the ability to learn what you want, when you want, and how you want. CHEAPLY.

Hence, which one is best in terms of providing real life results? Well let’s go over each way a nurse practitioner can increase their clinical knowledge and ability.

DNP Degree

Ah, the Doctor of Nursing Practice. Our “terminal” degree… Such a disappointment in terms of creating tangible real-world results. The DNP is 2-3 years of leadership, nursing informatics, quality improvement, patient safety, integrative evidenced based practice, management of systems, scholarly writing, ethics, and more adjectives and fancy bullshit words.

Where is advanced pathophysiology? Pharmacology? Microbiology? Differential Diagnosis? You know, actual science and clinically relevant information? Classes that help you be an excellent clinician whom understands the physiology of the human body.

Where are the advanced practicums? Many DNP programs have the nurse practitioner student finish all their clinical work in the first 2 years and the last year is focused on research. GREAT IDEA! You are totally going to be ready to practice when your done…

Why not just skip the research project and have an in depth 2000-hour clinical practicum? That would produce results! Throwing a bunch of words in a hat and shaking them up and inserting them into a hypothesis statement does not. Sorry.

If there was a significant clinical component to it, it would have utility that produces results. It simply does not do this. If your DNP did, great! You are a minority.

The predominant result a DNP will provide you is the ability to teach nursing at a higher level. If that is your goal and the result you desire, then the DNP is for you.

If you want to increase your clinical ability and generate real life results, there are far superior options.

Nurse Practitioner Certification

Post-graduate certifications are about the best source of result producing education you will get from nursing academia. These programs are practical, have clinical components and award a certification at the end. After you take your boards and obtain your certification it allows you to bill insurance companies for psychiatric care, acute care, etc…

Are they necessary though? It totally depends on what your goal is. If you are family practice and want to move into more comprehensive psychiatric care, then sure, getting your psych certification would produce those results if that is your goal. But here is the issue, it mostly comes down to insurance reimbursement and certain state requirements.

Try to get a practice credentialed for mental health as an FNP without a psych certification. It won’t happen. I have tried. But what if you are comfortable treating the majority of psychiatric problems such as ADHD, anxiety, depression, substance abuse and bi-polar disorder as an FNP? You will have to do so through primary care unless you have that psych certification. Therefore, your rates are different and insurance could potentially deem your services as not covered. Ahhh, being a slave to insurance is awesome!

I know adult nurse practitioners who cannot treat anyone under the age of 18 due to insurance restraints and state regulations. It is a barrier to their practice even though treating a 12-year-old for strep is not rocket science…

What about the countless FNPs like myself who work in the emergency department? Insurance companies, Medicaid and Medicare are getting stricter with reimbursement and some hospital systems are requiring you have your acute care certification. Really? Will that produce better results vs the real life experience of working years in the ER? I doubt it. Others that went back and got their acute care certification thought it was a waste of their time and money. But they had to do it if they wanted to keep their job. Utterly ridiculous…

Overall, post graduate certifications are another way to nickel and dime the nurse practitioner. If it is an absolutely necessity for your livelihood then get one… But if it is not and you are contemplating going back to school for one, please put deep thought into it and ensure it aligns with your long-term goals and produces the results you desire.

Nurse Practitioner Continuing Education

A necessary evil! We all are required to have a certain amount of CME hours each year for our licenses and when we renew our certification. I agree that it is important that we all continue to learn throughout our careers to be competent medical providers. It is essential for long term career growth.

There are “official CME” and “unofficial CME” products. Official CME are those that have been “certified” by organizations such as the ANCC and AANP for a fee. You must meet their requirements, pay them anywhere from $500-$5000, and boom! The CME is certified! Hallelujah! The CME now awards hours that goes towards certification. Money racket? You decide.

On the other hand, unofficial CME is self-study essentially. It often has the same caliber of educational material and will produce the same if not better results. We will get to that point further down.   

If you look at the reality of it however, does official CME produce substantial results? It depends.

Many CME programs are filled with a bunch of fluff that never benefits you. There can be a few interesting topics but often there are topics thrown in the mix that are a total waste of time.

I recently finished a men’s health CME and there was a long 2-hour lecture about classifying prostate cancer and the subsequent treatment options for each. It was interesting but this does not help me in my day to day clinical practice. It was a waste of time. My job is to refer that to the urologist. Not treat it.

Look at the buprenorphine waiver course for nurse practitioners. This course allows you to prescribe buprenorphine/Suboxone to opioid addicts. It is an 8-hour course for the MD/DO. It is 24 hours for the NP/PA…. Yep, we dumber… The first 8-hour portion is the practical clinical training component. The actual needed component for practice. The other 16 hours? FLUFF!

There are some great CME programs out there though!

In my strong opinion one of the best investments you can make towards your CME requirement as well as improving your clinical skill set is using Audio Digest. There are THOUSANDS of interesting lectures from the top minds of medicine that offer practical real-world advice.

Easily 50% of what I know about testosterone replacement therapy came from Audio Digest. Same can be said with most of my clinical knowledge. This information is priceless and to the point. I learned more from Audio Digest then I did in my MSN program.

If you are not aware of what Audio Digest is, it is simply recorded lectures from experts in any specialty you could imagine. The lectures are typically part of a conference therefore the information is relevant, engaging and allows you to start implementing the information immediately into your clinical practice. This produces results while giving you an enormous amount of CME hours! My last certification renewal hours were 80% Audio Digest and 20% fluff courses so I could just go on tax free vacations.

Self-Study NP

Reading guidelines, medical books, articles and published studies is what I consider “self-study” and “unofficial CME.” Going this route does not award any type of CME credits but its advantage is that you study what you want. It is like Audio Digest but much cheaper and often times free.

When I opened my men’s health clinic, I purchased books that were specifically tailored to men’s health and testosterone replacement. They did not award CME or were certified by some organization but were RELEVANT to what I was doing. Some were written by fitness specialists and others by physicians. I read multiple guidelines, listened to podcasts and scanned message boards relevant to testosterone replacement.

That is what is so great about self-study! Multiple perspectives and “outside of the box” approaches. The material I digested and assimilated in my mind from my men’s health self-study cannot be found in any other book on the planet. This provided massive results! $20,000 a month in revenue PART TIME kind of results. Tell me how a DNP, post-graduate certification or a CME can do that?

When it comes to self-study though you need to be very picky with what material you could utilize. There is a lot of sketchy information online so you must use your best judgement. The best route to take is to utilize sources from reputable individuals. Do your research! If it sounds to good to be true, then it is. If the science or clinical aspect sounds outrageous, then it probably is.

I remember reading an article from some “doctor” in Mexico utilizing apple seeds to treat certain types of cancer and was having amazing results and cure rates. Really? You probably need to skip that one…

Physicians read and study new practice protocols, guidelines and trends all the time. They implement this into their practice without issue. So can you! I have seen emergency medicine physicians watch a video on YouTube about a certain clinical procedure and then go do it! I learned how to do cervical muscular releases, trigger point injections, elbow injections, and various other procedures from YouTube videos as well. Use your clinical judgement. That is how we grow!

Conclusion: DNP vs Certifications vs CME vs Self-study…Which is the best?

If you want to be a professor, then get your DNP. It will produce the result you want.

If you want to open a psychiatry practice and bill insurance, then the psych post-graduate certification will give you your desired result.

Scrambling for CME hours because you slacked off the past year? You better take some CME courses so you can maintain your certification/license!

But if you want to create a side business and define your niche skill, then self-study is by far the best and cheapest option. Self-study allows you to focus your attention on gaps of knowledge that you have that you know for a fact will help your patients and build your business/practice.

If you can combine it with CME also, then you are gold! Audio Digest is the way to go my friends. (I have no ties with Audio Digest by the way.)

You want to open the largest allergy practice in town? Think a DNP will help you with that? Hardly… You know what will? Self-studying the immunology and allergy societies guidelines about allergy testing and treatment. Reading patients’ stories on message boards. Buying an immunology book and understanding the science behind what you are doing. Watching free educational videos. Read the allergy board reviews the doctors use! Self-study just like they do! It is not difficult; it just takes perseverance and discipline.

Imagine how much you could learn if you spent the 2 years it takes to go back to DNP school self-studying practical, marketable and self-improving skills instead? You would increase your clinical ability SIGNIFICANTLY. And for a fraction of the cost!

I am a self-taught NP in many aspects. I estimate 80% of what I know has been achieved by self-study and a few focused courses, NOT A COSTLY STRUCTURED EDUCATIONAL DEGREE/CERTIFICATION. I have never had a bad outcome in my entire career. I am damn proud of that fact too.

If you want to become an elite nurse practitioner, you must do it yourself. No one else will. It takes hard work and dedication to study. It is exhausting at times. Football and a beer is far more enjoyable…

You do not need to waste your money or time on nonsense that lines the pockets of academia’s administrative team.

If you are thinking about DNP school, please think again

Thinking about that post-graduate certificate? Think again…

Thinking about dropping $5,000 on some hormone replacement or functional medicine CME? Think again…

Really sit down and evaluate what your long-term goals are. Will it help you produce the results you desire? If it does not, skip it. If it does, dive right into it with full force regardless of what it is!

23 Responses

  1. Love your articles. I’m in the DNP/FNP program. You are correct about the DNP…it is fluff , a waste of time, and a waste of money….but I want to teach (part-time). I have many of the same thoughts about much of the BS of academia and the money funneling for various things. Self study IS where it is at for sure. I teach myself waaaay more than I’m being taught at the University of Suck My Wallet Dry. Keep up the good work and no BS blog. Freaking love it!

    1. Hey, if you want to teach then the DNP is a must. You gotta do what you gotta do. But I am glad you see the BS with it. It is a nickel and dime scheme in my opinion. Thanks for the support Phil. Rock on brother.

    2. I totally agree! The main reason I have not enrolled in a DNP is that it is not about making you a better practitioner-as you say more advanced pharmacology, genetics, neurology, etc.-which would help us to be as qualified and knowledgeable as doctors. The programs need to change big-time to deliver what makes you a better NP. We can get quality, informatics, etc. elsewhere-what we need is medical knowledge specific to our practice.

    3. I have been an NP for 40 years and totally agree with this article. 80% of my knowledge was learned in various CME’s official and unofficial ones.

      At my age I can’t see the benefit of DNP and the expense or 20,000 to 40,000 dollars when I am over 60 years old. I will never recover that monies spent. And it will not affect my practice ethics, guidelines, and treatment of patients.

      Thanks for a great article!

  2. I totally agree with the fluff of our educational tract. If we are going to gain respect from the medical world, it is not going to be by taking more classes on theory or leadership. We need more science, more and better hands on training from experts in the field. Send us out prepared to actually take on this role instead of making excuses why we struggle our first year. We struggle because we aren’t prepared properly. And the only reason I resist getting my DNP is because it won’t help me be a better NP, or even a better instructor if I want to go into academia. I complained about the flush in the bachelor program and the NP program, and I fail to see how paying for more fluff will help me or my patients.

    1. Because it won’t help you or your patients. All it helps is the bank accounts of the academic administrative team and puts you more in debt.

  3. Do you purchase the Platinum or Gold AudioDigest, or do you do the focused specialty? Some of these can get pretty pricey. Do you work a full-time job that pays for CME?

    1. I work a part time job that has a CME allowance. So they reimbursed for the expense. If you have a business it is a totally tax deductible expense. If your part time job reimburses you, even better 😉 I believe it was the platinum that allows you to listen to whatever lecture you want and it also came with a $1000 amazon gift card. I believe the total price was $1700ish. Totally worth it. I listened to new lectures daily while working out. I learned more than a DNP, I can guarantee that.

  4. While I agree with your take on the DNP, I don’t think you realize the education that PMHNPs have that other APRNs lack. I don’t care if someone is ‘comfortable treating’ mental illness, they really have NO idea what the difference between mixed depression and Bipolar Mixed is….. or how to differentiate between adhd, bipolar disorder and borderline personality disorder… just to name two. The research shows that keeping with any provider that is not fully trained in psychiatry (pcp, etc) lengthens the time to remittance. I don’t treat ANY medical aspect of my clients’ care (but I could!), why? I wasn’t trained as they were and leave that up to my fnp and other colleagues who have been educated specifically in that area. I challenge any non-Pmhnp to compare there results with mine. It’s silly isn’t it! It’s not about insurance or licensing but about expertise… and not picking it up in your own but being educated in psychopharmacology (as well as general pharmacology), the importance of the interview (not something even a new pmhnp finds easy), and a clinical only in psychiatry- nothing else (to name only a few areas that are significantly different from others’ training). Yes, we all need to be clinically focused and promote best care of our clients- but to practice without training because you ‘feel comfortable’? That’s just irresponsible.

  5. A lot of PCPs feel that they are comfortable treating behavioral health disorders, so the FMPs following in those foot steps is not that surprising. That being said, psychiatry is a specialty. It’s a disgrace in medicine that providers do not know how to stay in their own lanes. All MDs, NPs, and PAs have to learn about all aspects of medicine. As a matter of fact, NP programs require that all students take the same advanced pharmacology and advanced pathophysiology. Very similar to basic nursing school. Those of us that actually are educated in behavioral health sciences know that the 5%, of actual education in behavioral health science that the programs provide does not remotely prepare someone to diagnose, medicate, and treat psychiatric disorders. Those that are out there doing it are toeing the line of negligence. The amount of clients that come into my practice that have been treated by PCP and FNP is astounding. Statistics show that these patients are usually the ones that end up in a psychiatric crisis in the ER.

    We as a behavioral health community of providers always refer and collaborate with other medical specialists for the BEST effective treatment for our clients.

    Collaborative or Integrated care is the future!

  6. Great article. I totally agree with it. I too want to be the best Nurse Practitioner I can be.
    I would have loved to have a year of pathophysiology, maybe some gross anatomy.
    Took an outside pharmacotherapuetics class with several classmates as the NP instructor was not up to date with medications. Extra cost to me. I was hoping the DNP would
    expand on the clinical aspect of care not systems of care.
    I maintain ANCC certification as an ACNP, Oncology certification thru ONCC and genetics credentialling thru ANCC. I am getting close to retirement and worry about maintaining my ACNP certification. Otherwise would have to go back to school for the gerontology portion which I don’t want to do.

  7. I do find it interesting that as DNP programs continue to accept more and more people, and an ever increasing percentage of nurse practitioners are holding DNPs, that you would choose to alienate that group right off the batt.

    1. The information I provide is valuable regardless of what degree you hold. I am simply showing what I see in the real world. A DNP is great if you want to teach, but many do not feel it provides clinical utility.

  8. Excellent article on the practical aspect of DNP. I know those who obtained a DNP, they are university instructors. I contemplated this for awhile, but decided my heart lies in caring for people, and a post-graduate education would not change what I do. My certification as an adult/Gero ARNP has served me very well.

    1. Agreed. I do not believe the DNP has much clinical or practical utility. Continue caring for people and learning skills and knowledge on your own. I think those that do that are the best NPs out there!

  9. Have my BSN and trying to figure out APRN or go to PA school, everyone keeps telling me that PA’s have a better curriculum than NP’s, thoughts?

    1. PAs do have a better curriculum but they are also more restricted. You will always be an “assistant” where as a NP is an independent practitioner in over half the country. You get what you put into NP school, the curriculum can be just as intense if you dedicate yourself to it.

  10. Interesting comments. Completing my DNP/FNP which was three straight years and had adv patho, pharmacology, gross anatomy, etc. The last two years we had clinical every semester. I’ve seen that many programs only require 500 hours and we were closer to 900. The clear problem is the lack of uniformity in the programs out there. From what you’ve shared it’s easy to see why physicians are so critical of our educational preparedness. Agree there is a significant amount of fluff/BS we had to tolerate and I do hope that our representative organizations will eventually take a stand to make our education more rigorous. The increased number of lawsuits against NPs, I would believe, is because of inadequate training from this mill programs.

    1. 100% agree with you… Some programs are great, but the majority are not… I doubt our organizations will do anything about it though. They are profit driven.

  11. My Justin

    I did all of the above and still doing: DNP, FNP, PMHNP in progress, self study many other courses, and I am studying most of your courses.
    I am ready now to join your kingdom: entrepreneurship.

    1. Becoming an entrepreneur is the best thing you will ever do. You will obtain more fufillment out of starting your own thing then you ever will obtaining a DNP or another degree.

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