Dr Nurses in Surgery (Anybody know this DNP in ENT at UMDNJ?)

[engineer24]

http://www.npr.org/templates/story/story.php?storyId=100921215

http://www.umdnj.edu/umcweb/marketing_and_communications/publications/umdnj_magazine/fall2008/12.htm

"I can just imagine a patient of mine walking into my exam room and saying, 'Now Dr. Smith, are you a doctor doctor, or are you a doctor nurse?'"



"I am a doctorally prepared nurse," says doctor nurse Ray Scarpa. A doctor, he says, "is a doctorally prepared physician."


Scarpa works in the department of surgery at University Hospital in New Jersey. "I am not here to practice medicine, I am here to practice nursing," he says. "And I practice it at an advanced level, and I have earned the right to be called doctor."


For nursing students who begin right after college, it can take about six years to get the degree. While there is some overlap in knowledge, Scarpa says, doctors diagnose and treat while nurses have a wider focus including family, support and community

Scarpa believes the DNP degree will improve the stature of APNs in the workplace. “Nursing has changed so much over the past few decades,” he says. “What has been slower to change is how APNs are perceived. As nursing and medicine are separate professions, we’d like to see APNs functioning as equal members of the healthcare team, reporting to their peers. This will lead to better patient care.”

http://njms.umdnj.edu/departments/surgery/divisions/otolaryngology/faculty.cfm

This DNP thinks he's a surgeon and equivalent to a physician. He works in the ENT dept at UMDNJ.

Any residents there care to comment?

Why is this foolishness being tolerated? Where is the program director? Why are the faculty standing idly by why this punk makes up all kinds of unsubstantiated claims?

Does the program director Dr. Baredes call this NURSE a "doctor" in front of patients and residents? Do the other members of the faculty, Drs. Kohen, Han, Jyung do the same? I wonder what they think about this NURSE calling himself a doctor in front of THEIR patients?

Who does this guy think he is? He's a NURSE, and thats all he'll ever be, is a NURSE. He'll never be a surgeon or a physician, I dont care how many stupid letters he has after his name.

UMDNJ ENT residents, speak up and get this clown kicked out of the program. I hope for damn sure he isnt "precepting" any of you.

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[Dimoak]

I looked at both articles you posted, and not one of them mentions Dr. Scarpa calling himself a "surgeon". In fact, in all of them, he talked about how he's a Nurse Practitioner, which is his official title and his job.

You want the UMDNJ ENT department to kick out a highly skilled NP with over 28 years of experience, why? Because he got a doctoral level degree?

 

[engineer24]

I looked at both articles you posted, and not one of them mentions Dr. Scarpa

He's not a real doctor man. He's a NURSE.

 

[Dimoak]

He's not a real doctor man. He's a NURSE.

The only way I would have a problem with this is if Dr. Scarpa was going around intentionally misrepresenting himself as a surgeon to patients. Do you have evidence of this taking place? The individual in question appears to be quite clear with those he works with (and the media) that he is a doctoral level nurse that works in the ENT department and not a physician. Just about every major surgical (and many medical) departments and services employ one or more NPs or PAs. Does earning a doctoral level degree make Dr. Scarpa guilty of something the aforementioned aren't doing? What about NPs and PAs who earn PhDs? Do you take issue with history PhDs calling themselves doctor? What about DVMs or DPTs? Or do you have an issue with the possibility of laymen misconstruing someone with a doctoral degree as a physician?

 

[Dimoak]

Are you for real? Of course the issue is of misrepresentation. The use of the title Doctor in academia versus a medical setting cannot even be compared. Jesus man, pull your head out of the sand.

My issue was with the OP stating that Dr. Scarpa should be thrown out for being referred to as doctor. The guy refers to himself as a nurse practitioner, and his patients know he is a nurse practitioner.

 

[Winged Scapula]

You seem to have some axe to grind. I also see no evidence that he refers to himself as a surgeon.

Since this topic has been hashed and rehashed in multiple venues and is not surgical in nature, this thread is being moved to the TIH forum.

 

[ChandutheMagici]

My issue was with the OP stating that Dr. Scarpa should be thrown out for being referred to as doctor. The guy refers to himself as a nurse practitioner, and his patients know he is a nurse practitioner.

1. No, of course he shouldn't be thrown out.

2. You're joking with that nurse practitioner thing right? Patients are ALWAYS confused about this. I worked hand in hand with an NP for almost a year and no one had any idea what she was, her scope of practice, etc. They always called her doctor (which she always corrected). These were patients who had seen her for years. My point: patients don't have an in depth knowledge of mid levels. So no, his patients don't know he is an NP (well, some might).

3. So who do we call doctor? It's easy, when there is a real medical emergency with complex pathology behind it, and someone calls out, "I need a doctor in here!" ................... they're not looking for the guy(or gal) with the online DNP. This point I believe was made in the article, albeit more nice like

That being said, there's nothing wrong with being a NP. They're very needed and fill a vital role in the hospital. However, this whole..."I'm a doctoral of nursing" crap is just that, crap. I mean seriously...how often do you think this guy says..

"Hello, I'm your doctorally prepared nurse."

Or does he say..

"Hello, I'm Doctor Scarpa."

Everyone knows it's the second one. And that's fine if he wants to call himself that, I could really care less. I mean hell, call yourself Wolverine if it makes you feel better.

What I do care about though is confusing the patients. I think they have enough to go through without tacking on doctorally prepared nurses' insecurities. General Rule: Confusion = bad.

 

[ChandutheMagici]

What about DVMs or DPTs?

My wife is a practicing OT and has worked with numerous DPT's. I have yet to meet one that has introduced themselves to me or a patient as Dr. so and so. I'm sure they would be mercilessly made fun of if they did.

What about NPs and PAs who earn PhDs? Do you take issue with history PhDs calling themselves doctor?

It really depends on what their doctorate is in. If a dude has a PhD in philosophy, then yeah..I take a little issue with it. I certainly understand the OP's point. Which is, people commonly think of doctors as physicians (MD/DO). It's disingenuous to represent yourself in the hospital as a "Doctor" when you are in fact a NP. Just as it would be if the chaplain of the hospital came in and said, "I'm Doctor Chaplain" because he received a doctorate in religious studies. Regardless, it seems that the only people who really care about this are nurses.

 

[ChandutheMagici]

Scarpa believes the DNP degree will improve the stature of APNs in the workplace. "Nursing has changed so much over the past few decades," he says. "What has been slower to change is how APNs are perceived. As nursing and medicine are separate professions, we'd like to see APNs functioning as equal members of the healthcare team, reporting to their peers. This will lead to better patient care."

I would honestly like to know how this would lead to better patient care. I'm being serious, can anyone give me a reasonable argument as to why it would?

 

[Dimoak]

You're joking with that nurse practitioner thing right? Patients are ALWAYS confused about this. I worked hand in hand with an NP for almost a year and no one had any idea what she was, her scope of practice, etc. They always called her doctor (which she always corrected). These were patients who had seen her for years. My point: patients don't have an in depth knowledge of mid levels. So no, his patients don't know he is an NP (well, some might).

Like I mentioned in a previous post, I would have an issue with this particular scenario if the DNP was purposefully misrepresenting himself or herself as a physician. In this particular case, it sounds like the NP was doing just that, which points to potential inferiority complex or ego issues on her part. How do you know that his patients don't know he's an NP? The guy tells his patients that he's an NP, and if they ask what a DNP is, he explains it accurately. It's not like he's going around telling his patients that he's an ENT surgeon.

3. So who do we call doctor? It's easy, when there is a real medical emergency with complex pathology behind it, and someone calls out, "I need a doctor in here!" ................... they're not looking for the guy(or gal) with the online DNP. This point I believe was made in the article, albeit more nice like

It's a question of semantics. If there's an ATLS emergency, someone calls for a doctor, and a DNP without the appropriate skillset comes running out, then it's misrepresentation which is problematic. My thoughts on DNPs are already available on SDN forums in other threads. My point is that I don't see a reason to automatically project people's negative opinions of DNPs on Dr. Scarpa, as I don't think anyone in this thread has worked with him and so cannot comment for certain on his demeanor nor his interactions with patients and physician. I am confident, however, that if he was constantly behaving in a problematic manner, the ENT department would take the appropriate actions.

What I do care about though is confusing the patients. I think they have enough to go through without tacking on doctorally prepared nurses' insecurities. General Rule: Confusion = bad.

If it's adversely affecting patient care, then it's a problem. But so far, I have yet to read any reports of patients being distressed or having a negative outcome because of this. I've found that patients care more about whether they're receiving competent care from people qualified to do what they are doing, and less about what that individual's title happens to be.

My wife is a practicing OT and has worked with numerous DPT's. I have yet to meet one that has introduced themselves to me or a patient as Dr. so and so. I'm sure they would be mercilessly made fun of if they did.

Yes, but that doesn't mean there aren't DPTs who introduce themselves as doctor from time to time, just as not all DNPs introduce themselves as doctor. Certainly, non-physicians who may be strutting around hospitals and clinics trying to misrepresent themselves as physicians should be reprimanded, but there is no evidence presented that Dr. Scarpa is one of them.

It really depends on what their doctorate is in. If a dude has a PhD in philosophy, then yeah..I take a little issue with it. I certainly understand the OP's point. Which is, people commonly think of doctors as physicians (MD/DO). It's disingenuous to represent yourself in the hospital as a "Doctor" when you are in fact a NP. Just as it would be if the chaplain of the hospital came in and said, "I'm Doctor Chaplain" because he received a doctorate in religious studies. Regardless, it seems that the only people who really care about this are nurses.

What about PsyDs who work in inpatient Psych and are referred to as "Doctor"? Should these individuals be required to always remind their patients that their doctorate is in Psychology and that they're not a Psychiatrist? Should ODs who work in Ophtho departments or services be required to inform all of their patients that they're Optometrists and not Ophthalmologists? Many members of the laypublic don't even know the difference, so in that case, being picky on who gets to call themselves doctor would cause even more confusion. As I wrote earlier, people who try to misrepresent themselves as physicians violate healthcare statutes and are subject to recourse. But there are many healthcare fields where non-physician practitioners, who often work with physicians, can get a doctoral level degree (PhD Rad Dosimetrists and Rad-Oncs also come to mind). I think we should be careful with blanket statements and delegating who can get what kind of degree and who can't.

 

[ChandutheMagici]

Like I mentioned in a previous post, I would have an issue with this particular scenario if the DNP was purposefully misrepresenting himself or herself as a physician. In this particular case, it sounds like the NP was doing just that, which points to potential inferiority complex or ego issues on her part. How do you know that his patients don't know he's an NP? The guy tells his patients that he's an NP, and if they ask what a DNP is, he explains it accurately. It's not like he's going around telling his patients that he's an ENT surgeon.

Dude, you know as well as I do that patients are not the most informed bunch of people. They might know he's a NP, but a good majority of them don't know what that is. And unless he is the least busiest guy in the healthcare universe, I doubt he's taking the time to explain to every patient that's he a doctorally prepared nurse.

I just wanna know how many times in the hospital does anyone think this guy calls himself a nurse? Like I said, if he's in an article which clearly makes the point that he is a "doctor", he's probably introducing himself as Dr. Scarpa.

If it's adversely affecting patient care, then it's a problem. But so far, I have yet to read any reports of patients being distressed or having a negative outcome because of this. I've found that patients care more about whether they're receiving competent care from people qualified to do what they are doing, and less about what that individual's title happens to be.

You probably have yet to read anything because this is a fairly new issue, yes?

Yes, but that doesn't mean there aren't DPTs who introduce themselves as doctor from time to time, just as not all DNPs introduce themselves as doctor. Certainly, non-physicians who may be strutting around hospitals and clinics trying to misrepresent themselves as physicians should be reprimanded, but there is no evidence presented that Dr. Scarpa is one of them.

I guess that's my point. I have yet to want to see another allied healthcare professional WANT to be called doctor.

What about PsyDs who work in inpatient Psych and are referred to as "Doctor"? Should these individuals be required to always remind their patients that their doctorate is in Psychology and that they're not a Psychiatrist? Should ODs who work in Ophtho departments or services be required to inform all of their patients that they're Optometrists and not Ophthalmologists? Many members of the laypublic don't even know the difference, so in that case, being picky on who gets to call themselves doctor would cause even more confusion. As I wrote earlier, people who try to misrepresent themselves as physicians violate healthcare statutes and are subject to recourse. But there are many healthcare fields where non-physician practitioners, who often work with physicians, can get a doctoral level degree (PhD Rad Dosimetrists and Rad-Oncs also come to mind). I think we should be careful with blanket statements and delegating who can get what kind of degree and who can't.

There are certain career fields that people call doctor, you are most certainly correct.

I just wonder the motivations of getting these terminal degrees in some fields. For instance, Physical Therapy is, or has mostly made the move, to be an entry level doctorate before practice. The same is true of OT and masters degrees. Both of these fields had been bachelors degrees for some time. However, they said they were motivated to have students participate more in research. I personally think that's a croc, but that was their reasoning.

However, if I'm reading this correctly (and I like to think that I am <-- Ocean's 11 Line )

Scarpa believes the DNP degree will improve the stature of APNs in the workplace. "Nursing has changed so much over the past few decades," he says. "What has been slower to change is how APNs are perceived. As nursing and medicine are separate professions, we'd like to see APNs functioning as equal members of the healthcare team, reporting to their peers. This will lead to better patient care."

It seems as if the only motivation is to be on the level, so to speak, with physicians. He all but says, separate but equal. Well, that's just not true. Nurses do not have equal training, privileges, prescription powers, etc.

I would argue that this move is purely political and has NOTHING to do with patient care. Even if it's not detrimental (as you suggested), how is it beneficial?

 

[Taurus]

He all but says, separate but equal. Well, that's just not true. Nurses do not have equal training, privileges, prescription powers, etc.

I would argue that this move is purely political and has NOTHING to do with patient care.

"Separate but equal" is a good description of how nursing wants the public to perceive the DNP. They say that they aren't physicians, but in the same breath they say they want the same scope and privileges as physicians. They want to play both sides of the field because they are afraid of being labeled as practicing medicine and hence being under the regulation of BOM's.

I would be interested to know if this fellow goes around introducing himself as "Dr. Scarpa". Does the department chair know and approve of this? I wish that some ENT resident there would contribute.

 

[Aznfarmerboi]

I just wanted to point out that if there was a medical emergency on the plane and the pilot asks if there is any doctors on board, a DNP should raise his/her hand. Sure they are not real physicians and do not have the extensive training, but that training might not be needed in this situation. Of course, a physician should be utilized first and the DNP should state that he/her is a nurse who can provide care.

Just pointing out that it was a bad example.

 

[meister]

This thread title is horrible and pretty much a lie. This dude is not initiating or closing in surgeries, and he doesn't call himself a surgeon.

Yes a lot of DNPs are annoying but what did this guy do to draw your ire?

 

[meister]

I just wanted to point out that if there was a medical emergency on the plane and the pilot asks if there is any doctors on board, a DNP should raise his/her hand. Sure they are not real physicians and do not have the extensive training, but that training might not be needed in this situation. Of course, a physician should be utilized first and the DNP should state that he/her is a nurse who can provide care.

Just pointing out that it was a bad example.

Yeah the PhD poet "analogy" is pretty terrible. And by terrible I mean 100% wrong. So wrong that it makes physicians look bad to equate NPs with PhD poets. What the **** was he thinking?

 

[Dimoak]

Dude, you know as well as I do that patients are not the most informed bunch of people. They might know he's a NP, but a good majority of them don't know what that is. And unless he is the least busiest guy in the healthcare universe, I doubt he's taking the time to explain to every patient that's he a doctorally prepared nurse.

I just wanna know how many times in the hospital does anyone think this guy calls himself a nurse? Like I said, if he's in an article which clearly makes the point that he is a "doctor", he's probably introducing himself as Dr. Scarpa.

We're talking about the same thing here. But even if he comes in to every single room, says "Hi, I'm Dr. Scarpa", does a bedside procedure or somewhat, and leaves; as long as he does his procedure accurately, does it really matter whether the patient thought he was a physician or a nurse? If the patient really wants to know, they can ask, and at that point he will obligatorily tell them that he's an advanced practice nurse. Like the article says, it seems that the patients who have prolonged and repeating contact with him all know that he is an advanced practice nurse, and he is not purposely deceiving them into thinking he's a physician. Competence is valued above title.

I just wonder the motivations of getting these terminal degrees in some fields. For instance, Physical Therapy is, or has mostly made the move, to be an entry level doctorate before practice. The same is true of OT and masters degrees. Both of these fields had been bachelors degrees for some time. However, they said they were motivated to have students participate more in research. I personally think that's a croc, but that was their reasoning.

However, when if I'm reading this correctly (and I like to think that I am <-- Ocean's 11 Line )

You probably have yet to read anything because this is a fairly new issue, yes?
It seems as if the only motivation is to be on the level, so to speak, with physicians. He all but says, separate but equal. Well, that's just not true. Nurses do not have equal training, privileges, prescription powers, etc.

I would argue that this move is purely political and has NOTHING to do with patient care. Even if it's not detrimental (as you suggested), how is it beneficial?

The DNP is indeed a new degree type and there is not sufficient data available to evaluate its complete impact on the healthcare field. The motivation behind the NP community's desire to implement the DNP is a different conversation. I certainly do hold, that in following the tradition of EBM, it is up to the NP community to demonstrate the benefit and merit of raising standards for what the entry-level NP degree should be. However, this is essentially up to the community itself to propose and implement. On the same level, the conversion of MPT to DPT and RPh to PharmD was not met with so much scrutiny and protest, probably because PTs and Pharms were not suspected of doing so for political, scope, and turf reasons that would irk physicians.

 

[ChandutheMagici]

Competence is valued above title.

Couldn't agree more. Personally, I just felt the article made the guy come across as a little pretentious.

Also, I think the competence is valued above title argument should be thrown at someone who says...

"I am not here to practice medicine, I am here to practice nursing," he says. "And I practice it at an advanced level, and I have earned the right to be called doctor."

 

[Dimoak]

Couldn't agree more. Personally, I just felt the article made the guy come across as a little pretentious.

I can see how it could come across that way. I personally just did not find anything particularly wrong with that statement.

"I am not here to practice medicine, I am here to practice nursing," he says. "And I practice it at an advanced level, and I have earned the right to be called doctor."

He earned a doctoral level degree and so feels that he has earned the right to be called doctor. As long as he's not claiming that he has earned the right to practice medicine as a result of that particular doctoral level degree, I have no issue with that. Now, if he came out and said that his DNP degree made him an equivalent to the ENT physicians he practices with and claimed that he should have the right to do anything that they do, I'm sure many more would have a problem with such a statement.

 

[ChandutheMagici]

Now, if he came out and said that his DNP degree made him an equivalent to the ENT physicians he practices with and claimed that he should have the right to do anything that they do, I'm sure many more would have a problem with such a statement.

Well, maybe he doesn't do this, but the article sure says it. The article is very careful and yet insidious about making that point. I say this because...

"What has been slower to change is how APNs are perceived. As nursing and medicine are separate professions, we'd like to see APNs functioning as equal members of the healthcare team, reporting to their peers. This will lead to better patient care."

That quote speaks volumes. In short...

1. A DNP changes the way nurses are perceived.
2. Nurses should be equal members of the healthcare team (equal to what?).
3. This perception change will lead to better patient care.

I'm sure 1 is true. 2 just demonstrates massive insecurities (everyone fills a role in the hospital, roles are different, not equal). 3 is complete bull**** if I've ever read it.

I personally think this whole Doctor of Nursing thing is a way for nursing schools to make money. The actual degree itself is meaningless and doesn't change a NP's scope of practice at all (the same is true for DPT for the most part). But hey, if you're willing to shell out the money to be called "Doctor"...more power to you.

Chandu

P.S. - I personally find it hilarious that in the first article they're making the point that he is a doctor, but then the second and third parts of the piece are entitled respectively...

Doctors Feel Threatened
A Role Doctors Can't Fill

 

[Dimoak]

"What has been slower to change is how APNs are perceived. As nursing and medicine are separate professions, we'd like to see APNs functioning as equal members of the healthcare team, reporting to their peers. This will lead to better patient care."

I took this quote to mean that they want to be treated as equals in terms of having them running the scope of how a patient would be nursed and not to have to report to the physician on their nursing practices (those that didn't pertain directly to medical orders). It seems like this is more along the lines of NPs wanting to feel like they're at the apex of nursing practice and to be perceived as equals to physicians rather than subordinates. The article is fairly selective with its choice of words, but I don't believe that at any point it demonstrates that Dr. Scarpa is trying to acquire ENT scope practice (at least not for procedures that NP aren't already allowed to do on an ENT service).

 

[maceo]

Nurse practicioners and DNPs are all suspect anyway. these are people who went into NURSING,field in dire need of competent people, not to mention people in general because of the shortages, and then abandon the field to become more like doctors. I think it really is a shame. If they wanted to do this initially there is a field called PA. Its mind boggling that the politcians dont see this.