DNP versus MD?

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PainDr said:
"Trying desperately to cling to a tradition that does not have a foundation any longer"? Hmm...I suppose that's one way of spinning it. I'm still not sure what value a DNP adds? No one seems willing...or able...to answer this question.
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Sorry PainDr. I did not see your earlier post. I was too busy hitting other balls lobbed at my head to hit yours (figuratively speaking of course) :laugh:

A PhD in nursing is more academic based - a thesis, published research, etc. - it is designed for the academic setting.

a DNP is another 2 years (in some programs) of a mainly clinical based study - call it a residency if you will (I will try to ignore the screams of outrage because I dared to use a Medical school term :)).

I have not gotten the complete details from the University I am hoping to attend since I am not prepared to do this for a few years yet. Ys, indeed, some of the theory classes can be long distance, but you do have to show up for a certain length of time for oral and written evaluations. But most importantly you have to have a set amount of clinical hours with a preceptor - usually a physician, but it can be a DNP - but since these are few and far inbetween, it will usually be a MD. In my case it will be a physician or several of them since I have a few to pick from at my work!:D

I am not entirely certain how many hours, around 1500 minimum I am told - I need to check that. But the catch is...paid work does not count. So, same as the NP program. ALL Clinical hours that count must be unpaid, 'volunteer' work - any paid hours do not count. I am not in a financial position to do that at this time - my kids are small and it was bad enough getting my NP.

My clinic is very eager for me to do this though....they get almost a year of free labor out of me... :lol: joke's on me.
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fab4fan said:
I also have a problem with nurses always being expected to devalue or hide their accomplishments.
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I don't think anyone here has suggested that they should. Some participants have put a negative spin on things in support of their own agendas, but that doesn't mean that we should go around putting words in each others' mouths.

But heaven forfend if the nurse puts that on her badge, because then you guys start mocking her for that ("Stupid nurses with all that alphabet soup behind their names...").
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I don't see anything wrong with having "DNP" after your name on an ID badge. Has anyone else said that they did? :confused:
 
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horsenurse25 said:
a DNP is another 2 years (in some programs) of a mainly clinical based study - call it a residency if you will (I will try to ignore the screams of outrage because I dared to use a Medical school term :)).
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Since you appear hell-bent on confusing everyone as much as possible, I consider it par for the course. :rolleyes:
 
KentW said:
I
I don't see anything wrong with having "DNP" after your name on an ID badge. Has anyone else said that they did? :confused:
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So now I am confused. You said that DNP should not tell the patients that they are doctors because it might confuse them. But we are allowed to put DNP on a badge. What on earth are we supposed to tell the patients when they ask??

"Ummm, it means Dumb Nurse Person, o'kay?" (Some of you might wish :p)

If we are not allowed to tell patients the D word, then what it the point of putting it on a badge??
 
PainDr said:
I never said more training was a bad thing, but you didn't answer my question. What additional training do DNPs have that NPs don't have.
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What do you want, a comparison of the curriculum of an MSN program v a DNP program? Or are you just stirring the pot? More knowledge never hurts, period. You've basically got your knickers in a twist because the degree allows the recipient to use the title "Dr."

Remember, if you go back and look at my many posts on this, I never said I was fully supportive of this. It makes me uneasy at best. I don't think a DNP is equal to an MD/DO, but keep this up and I may get irritated enough to swing over to the Dark Side just out of spite.
 
horsenurse25 said:
You said that DNP should not tell the patients that they are doctors because it might confuse them. But we are allowed to put DNP on a badge. What on earth are we supposed to tell the patients when they ask??
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Well, personally, I'd probably make up something funny, and say that first. Then, I'd tell them what it really meant. But, that's just me. ;)
 
DogFaceMedic said:
I Really shoud be out cleaning the BBQ and getting ready for the thick pork ribs with a cold beverage, but I couldn't resist.

Don't misunderstand me: know one knows everything but me (couldn't resist that either.) But, pts have expectations when someone calls themselves Dr and DNPs do not meet it. It is viewed as hubris at best, and viewed as dishonest at worst. Pts expect a Doc to have a certain amount of education and experieince -- i.e., specialized residency -- that DNPs do not have.

Go ahead and intro youself as Dr to students and pts, then judge the different reactions. Students will respect the education, pts will be suspicious because they know MDs/DOs have more experience. Again, do not misunderstand me: I did not say smarter or wiser, just more training and experience and are usually, not always, better diagnosticians/clinicians.
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I really need to get outside too, They day is too gorgeous to sit looking at a stupid computer. At any rate...

I am not a DNP yet. I actually have only met one and she was amazing.

I think the perception of more training/better diagnosticians is a subjective one at best. Unless you have seen any statistics about this or seen any case studies, it is all simply supposition.

As I have said over and over...I am a nurse first. DNPs are nurses first. It is a very different philosophy of care than a physician. A lot of the same tasks/skills, very different approaches. I suppose time will tell about the viability. So far, it is all going well. There are dozens and dozens of studies supporting the use of NPs. And as far as I can tell, not a single one with negative results. I expect similar results for DNPs. I don't know what other barometer you can go by. Personal feelings are not arguable, by saying them a person is merely pontificating.

I understsnd the concern, I am certain there are of potential DNPs who are out to prove something. But I would think (and hope) the vast majority are out there simply because they want to do the best job they can and have the most training they can get, simply for the love of the job and the education.

I do...
 
KentW said:
Well, personally, I'd probably make up something funny, and say that first. Then, I'd tell them what it really meant. But, that's just me. ;)
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:D :D

Cute. You would be amazed at how many amusing things you can come up with from 'NP'. But then again, maybe you wouldn't....:D :D

now I really am going outside.
 
As a moderator, you can't tell me you've never seen the legion of posts/threads about nurses and their "alphabet soup" badges. Perhaps you personally never commented on them, but you can't tell me you've never read them.

It really doesn't matter. I'm convinced that there will always be varying degrees of antagonism when it comes to medicine v nursing. It's like we speak different languages at times. It's a shame.

I have to say, when I read this kind of stuff, it colors how I feel about students and interns/residents. I'm still nice to them, I still help them, but in the back of my mind, it's there..."Why should I go out of my way? They're just going to wind up being like the rest of them."
 
fab4fan said:
Like I said, I have "issues" with it. But I also have a problem with nurses always being expected to devalue or hide their accomplishments. Doctors aren't gods. Why shouldn't a patient know the nurse taking care of him/her has a doctoral degree? But heaven forfend if the nurse puts that on her badge, because then you guys start mocking her for that ("Stupid nurses with all that alphabet soup behind their names..."). There have been threads devoted to that. Then you get threads devoted to stupid nurses who have nothing but two years of college who don't know how to perform a competent patient assessment.

See what I mean? We can't win for losing.
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Who expects nurses to devalue or hide their accomplishments? I know lots of people with doctorates in pharm or psych and their credentials are always clearly noted on their badges, but they don't go around calling themselves Dr. So and So, for fear they might be mistaken for a physician...something they DON'T want to happen. I could care less if you stand in the hallway with a sandwich board and microphone telling everyone within earshop, "I'm Sally and I have a doctorate in nursing...see it's right here on my badge!" All I'm saying is, it's not right to purposely confuse pts.

So no...I really don't see what you mean.
 
horsenurse25 said:
What exactly is your definition of medicine??? " The practice of medicine is defined under the MPA as the "cure of diseases and the preservation of the health of man, including the practice of the healing arts with or without ..." The term "healing arts" is defined as "the science and skill of diagnosis and treatment in any manner whatsoever of disease or any ailment of the human body." " [Taken from the Medical Professional Act - boolds were added by myself] .
Hmmm. Sounds like something nurses (and many other health professionals) do every day. Medicine is not the exclusive domain of physicians. Sorry to tell you that. Let's look at some examples…
Nurses give vaccinations, administer PRN medications (how do you think they determine when they are needed?), attend home palliative care.
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Medicine is diagnosis of disease and development of treatment plans. Nursing is the execution of that treatment plan and day-to-day care of the patient. So your examples of nursing are valid, ie, vaccination, medication administration, palliative care. They are distinct roles and each one is equally important.

I honestly would prefer one overarching board that encompasses both medicine and nursing rather than having two separate ones. If we had one board, they would never have allowed the proliferation of so many overlapping providers which leads to confusion by the patient.

I suspect that the nurses hope that the DNP degree will eventually be the gateway to medical subspecialties. I don't believe for one second that DNP's are content with primary care and working at clinics in Wal-Mart. They will try to branch out to more lucrative fields such as cards, derm, GI, etc. As part of the DNP curriculum, they already concentrate in a particular field such as neuro. It's just a matter of time before they tack on a real residency instead of their final year "residency".

If the nurses want to follow the example of the DO's and develop similar training to MD's, then they will have more credibility than what they have now. That would mean standardized curriculum (no online degree programs), a rigorous licensure exam process, and residency. However, then the DNP would no longer be a shortcut. :)
 
fab4fan said:
What do you want, a comparison of the curriculum of an MSN program v a DNP program? Or are you just stirring the pot? More knowledge never hurts, period. You've basically got your knickers in a twist because the degree allows the recipient to use the title "Dr."

Remember, if you go back and look at my many posts on this, I never said I was fully supportive of this. It makes me uneasy at best. I don't think a DNP is equal to an MD/DO, but keep this up and I may get irritated enough to swing over to the Dark Side just out of spite.
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Keep what up?!?!?! Asking for information? What do I want? What I asked for...a comparison between MSNs and DNPs. Is that too much to ask? Certain individuals seem to feel it's crucial that pts know they have doctoral level training, so what does that training entail? I mean, it must be clinically relevant, right? Otherwise why would it matter? Also, when pts come to me, asking why their nurse referred to themselves as "Dr.", I'd like to know what to tell them.

I'm not targeting you and know you have mixed feelings about the issue. However, everyone keeps talking about the importance of the title. Shouldn't we all know what...exactly...we're talking about?

See...that's what happens when you're a doctor. You must be able to justify EVERY SINGLE THING YOU SAY and you're accountable for every single word. You can't just spout garbage and then get mad when others confront you. You must be able to defend your position and I'm not just talking about physicians. Anyone who's completed doctoral level training knows this. If you want to start calling yourself doctor, you have to start acting like one.
 
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fab4fan said:
So you would demand the same of a doctorally prepared psychologist?
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No - i somehow deleted part of my original post while i was editing before. I intended to say that the patient has full knowledge of a meeting with a specialist, a psycologist, a child life therapist, etc. You tend to know what that person is a doctor of. They say "if it looks like water, smells like water, and feels like water, it's not always water. (my favorite lab tip)" Well, if it looks like the physician, smells like a physican, and feels like a physician (and introduces itself as a Doctor in a medical setting), the patient usually assumes that it is, in fact, a physician.

A friend of mine was just injured on the job and worker's comp had her visit a Dr. ____ who happens to have an office nearby (well, shes part of a practice). She went through it all and was very upset with the level of care. Turns out, that "doctor" is a doctor of nursing. There were numerous issues with her care that I'm not going to blame on the NP's training... but I will say that the fact that the NP didn't go to medical school makes those mistakes seem pretty avoidable. The patient, of course, had no idea that her care was in the hands of a nurse whereas she would have preferred it to be in the hands of a physician. She recently switched to a new doctor (physician) who asked "who was the doctor that recommended this surgery?" she very angrily replied "i didnt have a doctor... i had a nurse."
 
horsenurse25 said:
You would be amazed at how many amusing things you can come up with from 'NP'. But then again, maybe you wouldn't....:D
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I actually had one patient ask me, "So, what do the letters 'MD' actually stand for, anyway?"

I told him "Massive Debt." :laugh:
 
fab4fan said:
As a moderator, you can't tell me you've never seen the legion of posts/threads about nurses and their "alphabet soup" badges. Perhaps you personally never commented on them, but you can't tell me you've never read them.
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I honestly haven't. Maybe they happened before I became the forum mod (only a couple of months ago). Prior to that, I didn't read every thread.

I have to say, when I read this kind of stuff, it colors how I feel about students and interns/residents. I'm still nice to them, I still help them, but in the back of my mind, it's there..."Why should I go out of my way? They're just going to wind up being like the rest of them."
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I wouldn't let it bother you too much. They're in the minority, no matter how vocal.
 
fab4fan said:
As a moderator, you can't tell me you've never seen the legion of posts/threads about nurses and their "alphabet soup" badges. Perhaps you personally never commented on them, but you can't tell me you've never read them.

It really doesn't matter. I'm convinced that there will always be varying degrees of antagonism when it comes to medicine v nursing. It's like we speak different languages at times. It's a shame.

I have to say, when I read this kind of stuff, it colors how I feel about students and interns/residents. I'm still nice to them, I still help them, but in the back of my mind, it's there..."Why should I go out of my way? They're just going to wind up being like the rest of them."
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I fully agree with your frustrations about bad MDs; they are an embarrassment to the MD profession specifically and the healthcare professions in general. They often have lawyers on speed dial.

That you make the effort to help teach MD students & residents speaks of your professionalism.

Each profession has its share of *****s, which I can list for RNs, paramedics, PAs and MDs, etc. Their behavior is simply a manifestation of their character.
 
PainDr said:
Keep what up?!?!?! Asking for information? What do I want? What I asked for...a comparison between MSNs and DNPs. Is that too much to ask? Certain individuals seem to feel it's crucial that pts know they have doctoral level training, so what does that training entail? I mean, it must be clinically relevant, right? Otherwise why would it matter? Also, when pts come to me, asking why their nurse referred to themselves as "Dr.", I'd like to know what to tell them.

I'm not targeting you and know you have mixed feelings about the issue. However, everyone keeps talking about the importance of the title. Shouldn't we all know what...exactly...we're talking about?

See...that's what happens when you're a doctor. You must be able to justify EVERY SINGLE THING YOU SAY and you're accountable for every single word. You can't just spout garbage and then get mad when others confront you. You must be able to defend your position and I'm not just talking about physicians. Anyone who's completed doctoral level training knows this. If you want to start calling yourself doctor, you have to start acting like one.
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If you truly wanted to know, you could simply do a search of an MSN NP program and then a search of a DNP program and compare them. Why should I do that for you? If you really are genuinely interested, you would be seeking the answers to the questions you have for yourself.

That is why I think there's more to this than just wanting to seek information.
 
PainDr said:
Keep what up?!?!?! Asking for information? What do I want? What I asked for...a comparison between MSNs and DNPs. Is that too much to ask? Certain individuals seem to feel it's crucial that pts know they have doctoral level training, so what does that training entail? I mean, it must be clinically relevant, right? Otherwise why would it matter? Also, when pts come to me, asking why their nurse referred to themselves as "Dr.", I'd like to know what to tell them.

I'm not targeting you and know you have mixed feelings about the issue. However, everyone keeps talking about the importance of the title. Shouldn't we all know what...exactly...we're talking about?

See...that's what happens when you're a doctor. You must be able to justify EVERY SINGLE THING YOU SAY and you're accountable for every single word. You can't just spout garbage and then get mad when others confront you. You must be able to defend your position and I'm not just talking about physicians. Anyone who's completed doctoral level training knows this. If you want to start calling yourself doctor, you have to start acting like one.
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http://www.aacn.nche.edu/DNP/pdf/Essentials.pdf

Here it is. The bottom line if the program follows the guidelines are these requirements (BTW all the nurse speak is the reason that my sole and only attempt at nursing ended at nursing theory):
To ensure sufficient depth and focus, it is mandatory that a separate course be required for each of these three content areas:
advanced health/physical assessment, advanced physiology/ pathophysiology, and advanced pharmacology (see Appendix A).

In addition you need:
In order to achieve the DNP competencies, programs should provide a minimum of 1,000 hours of practice post-baccalaureate as part of a supervised academic program.

So minimum if they follow the academic model is probably about 130 hours of classroom and 1000 hours of clinicals.

David Carpenter, PA-C
 
fab4fan said:
So a PhD psychologist seeing pts in the hospital isn't allowed to be addressed as "Dr." according to your rule.

Okey dokey.
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Every hospital setting I've seen....this hasn't been the case. There is always (or should always be) a clear understanding, "Hello, I am Dr. Therapist4Chnge, your Neuropsychologist." I think what is slightly confusing to the pt is Dr....followed by Nurse; to them, these seem like contradictory terms. I think as long as everyone introduces themselves appropriately, it should be fine.

As an aside, for a long time MDs were physicians and not doctors, they adopted the term 'doctor' from academia, which is why I find this whole "Dr" debate somewhat ironic. I think as long as people make it clear who they are....it shouldn't be a problem.

-t
 
PainDr said:
What I asked for...a comparison between MSNs and DNPs.
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It is still a new area, and I think a lot of people still have many questions about what is involved (myself included). I have learned most of the degrees/accreditations/licenses, but am not sure how some are differentiated (DNP included).

-t
 
Therapist4Chnge said:
As an aside, for a long time MDs were physicians and not doctors, they adopted the term 'doctor' from academia, which is why I find this whole "Dr" debate somewhat ironic. I think as long as people make it clear who they are....it shouldn't be a problem.

-t
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According to Oxford English Dictionary (considered by many in academic ethymologist to be the standard reference guide in ethymology of the English language), the term "doctor" to denote the highest degree holder first appeared in written form around 1375. The term "doctor" to denote a medical practitioner first appeared in written form around 1377. The TRUE holder of the first "doctor" title were church leaders or religious scholars, with the term first found in written form around 1303.

Oh ... the term "physician" (to described medical practitioners) was first used (in written form) around 1646. The term physician (meaning physicist or expert in the natural sciences) was first used in 1225.

*these are just history of the words. English is a dynamic language and changes with time.


As for the clinical aspect of the DNP's education ... why not just call it "clinical rotation" or "clinical clerkship" instead of "residency"? Yes, physicians will be up in arms about it, but that's mainly due to the HELL they went through in "residency". Also, the terminology can be even-more confusing if you choose to use the term "residency" for the clinical rotation aspect while in school ... does that mean a newly minted DNP graduate is a "residency-trained doctor"?
 
horsenurse25 said:
Naturally.
And perceptions only change when people are willing to be educated or to educate. Bottom line is that SOME (and by no means the majority) of physicians (and wanna-be physicians) are trying desperately to cling to a tradition that does not have a foundation any longer...
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And what kind of perceptions are you trying to change? That DNP's are equal to physicians and should be treated as such? That it's okay for nurses to go around impersonating physicians and confusing the patients? That nurses have the same credentials and training as physicians after two years of post college training? Give me a break. This whole DNP argument devalues our medical education, it makes it a complete joke, and that makes me mad. I remember when I was working as a tech and I questioned the authority of a nurse how pissed off he got at me; well guys, that's how doctors feel when nurses start trumping on their turf.

I have news for you: there is a hierarchy in medicine. Is there a team? Absolutely. But there is also a hierarchy, and at the head is the physician; he/she makes the calls because he/she has the most training and is the most qualified person to do so. So suck it up, and if you want to be called "doctor," go to medical school.
 
I know that the AMA is taking this DNP issue very seriously. At their annual meeting this June, I know that at least resolution is on the table. We shouldn't depend on the AMA for the future of our profession though. Organizations tend to be slow to respond and often conflicted by politics. Exhibit A: the ASA has been unable to respond to CRNA's adequately because many anesthesiology chairs financially depend on CRNA's as cheap labor. All physicians should be made aware of the issues and become personally active. I've already stated my position in how I plan to support my profession.
 
silas2642 said:
I have news for you: there is a hierarchy in medicine. Is there a team? Absolutely. But there is also a hierarchy, and at the head is the physician; he/she makes the calls because he/she has the most training and is the most qualified person to do so.
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....and the most liability.

-t
 
group_theory said:
As for the clinical aspect of the DNP's education ... why not just call it "clinical rotation" or "clinical clerkship" instead of "residency"? Yes, physicians will be up in arms about it, but that's mainly due to the HELL they went through in "residency". Also, the terminology can be even-more confusing if you choose to use the term "residency" for the clinical rotation aspect while in school ... does that mean a newly minted DNP graduate is a "residency-trained doctor"?
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No problem. Clinical rotation is what it is actually called. I was just in a hurry and couldn't think of the word. That was MY choice of words, not any program's.

And that would mean that the DNP graduate is a clinically trained doctor of nursing practice.
 
silas2642 said:
And what kind of perceptions are you trying to change? That DNP's are equal to physicians and should be treated as such? That it's okay for nurses to go around impersonating physicians and confusing the patients? That nurses have the same credentials and training as physicians after two years of post college training? Give me a break. This whole DNP argument devalues our medical education, it makes it a complete joke, and that makes me mad. I remember when I was working as a tech and I questioned the authority of a nurse how off he got at me; well guys, that's how doctors feel when nurses start trumping on their turf.

I have news for you: there is a hierarchy in medicine. Is there a team? Absolutely. But there is also a hierarchy, and at the head is the physician; he/she makes the calls because he/she has the most training and is the most qualified person to do so. So suck it up, and if you want to be called "doctor," go to medical school.
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Oh, go untwist your panties. :sleep::sleep:

If you read carefully, the DNP is 2 years AFTER the two year masters. So the DNP has had a total of 8 years of education and around 2000 hours clinical work AFTER the BSN program - which has several thousand in itself.

Be angry if you wish. Feel that you are the only ones who know anything if it makes you feel better.

The perception that I am talking about changing, if you would bother to read before you spout off a diatribe, is that Nursing is a profession and is just as valid as medicine. That there CAN be higher learning after Bedpan Cleaning 101, and that a doctor of nursing practice has much of the same education and many of the same skills as family practitioner.

I cannot comment on the specialties as family medicine and specifically gerontology is what I am most familiar with.

The DNP is here and coming near you. So suck it up and deal with it.

Further, no DNP is impersonating a physician. They are doctors in their own right - doctors of nursing practice and they can tell their patients so. The only people that seem to be confused is yourself. If a DNP is not clarifying thier degree then they are in error. But I believe that most, if not all, DNPs will be very clear about who they are to every patient they meet. Believe it or not, most of us DO NOT WANT to be a physician. We are very happy being nurses. Thank you.
 
horsenurse25 said:
Oh, go untwist your panties. :sleep::sleep:

If you read carefully, the DNP is 2 years AFTER the two year masters. So the DNP has had a total of 8 years of education and around 2000 hours clinical work AFTER the BSN program - which has several thousand in itself.

Be angry if you wish. Feel that you are the only ones who know anything if it makes you feel better.

The perception that I am talking about changing, if you would bother to read before you spout off a diatribe, is that Nursing is a profession and is just as valid as medicine. That there CAN be higher learning after Bedpan Cleaning 101, and that a doctor of nursing practice has much of the same education and many of the same skills as family practitioner.

I cannot comment on the specialties as family medicine and specifically gerontology is what I am most familiar with.

The DNP is here and coming near you. So suck it up and deal with it.

Further, no DNP is impersonating a physician. They are doctors in their own right - doctors of nursing practice and they can tell their patients so. The only people that seem to be confused is yourself. If a DNP is not clarifying thier degree then they are in error. But I believe that most, if not all, DNPs will be very clear about who they are to every patient they meet. Believe it or not, most of us DO NOT WANT to be a physician. We are very happy being nurses. Thank you.
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1. How do 2+2=8???????

2. Only the most ignorant/arrogant half wit would actually think they are "the only ones who know anything". I'm sure you're an intelligent person but that chip on your shoulder is making you look like a real tool.

3. You're deluding yourself.

4. I hope this is true but suspect it's not.
 
silas2642 said:
And what kind of perceptions are you trying to change? That DNP's are equal to physicians and should be treated as such? That it's okay for nurses to go around impersonating physicians and confusing the patients? That nurses have the same credentials and training as physicians after two years of post college training? Give me a break. This whole DNP argument devalues our medical education, it makes it a complete joke, and that makes me mad. I remember when I was working as a tech and I questioned the authority of a nurse how pissed off he got at me; well guys, that's how doctors feel when nurses start trumping on their turf.

I have news for you: there is a hierarchy in medicine. Is there a team? Absolutely. But there is also a hierarchy, and at the head is the physician; he/she makes the calls because he/she has the most training and is the most qualified person to do so. So suck it up, and if you want to be called "doctor," go to medical school.
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From everything I've heard, DNP's have 4 years of training after their bachelors, not two (that would be an NP). Furthermore, unlike MD training, the first four years are clinically relevant. As long as they take the premed courses, a medical student can have a degree in art history. By the time the nurse has their bachelors they've taken at least superficial anatomy, pathophysiology, pharmacology, and all the applied nursing skill stuff.

I'm not saying they are equivalent, but we should be honest about what we're dealing with, and it's not just a floor nurse with a two year degree. It's somewhere in the middle, not nurse, but not doctor.
 
Taurus,

I understand your frustration, but your arguments might seem more credible if you refrain from misrepresentation. You have repeatedly implied that it's possible to become a nurse practitioner via an entirely online program. Numerous schools allow students to take didactic courses online, but clinicals are still required; one cannot simply earn the degree from home without ever setting foot inside a classroom or clinical environment. Online instruction has been proven cost-effective and efficient. It doesn't suit every situation or every student, but it's frequently a great option; online doesn't equal inferior. I'm a pharmacist, and I would like to have had the option to take some of my first and second year courses online. Indeed, I wouldn't be at all surprised if, within a few years, some pharmacy and medical curriculum is offered online. In 2006, Harvard Medical School began podcasting lectures that students can download and listen to via their Ipods. Granted, this is supplemental rather than alternative instruction, but it nonetheless demonstrates how technology is changing the course of education across all disciplines.

I agree that advanced practice nurses are not the equal of physicians, but you would have us believe that nurse practitioners are entirely incompetent underachievers. As for turf wars and respecting other's roles, physicians are as guilty as anyone. There are numerous physicians who operate dispensaries within their office; they prescribe and dispense medications to their patients. Prescribing is the physician's domain, dispensing is the pharmacist's. Physician dispensing raises numerous ethical and safety concerns, yet it's tolerated. Frankly, I would argue that physicians should not prescribe either; they should diagnose and confer with a pharmacist, who would then select the most appropriate drug therapy based upon the diagnosis and lab data. (But that's another debate.)

As for quality of care, much depends upon the individual's effort. I've encountered clueless nurse practitioners and clueless physicians. I've also encountered nurse practitioners and physician assistants who provide care that's superior to that of their supervising physicians. Medical school is rigorous, but it's not perfect. Physicians are vastly undereducated in regard to pharmacology. In short, no one knows it all. As long as physicians are increasingly abandoning family practice and internal medicine for more lucrative specialties, mid-level practitioners are needed.

I find it interesting that the persecution of doctorate educated nurses by physicians has become so intense only after implementation of the DNP and DrNP degrees. Nurses have been earning doctorates for decades; granted, they were primarily research focused. No one seemed to have much to say about a nurse practitioner with a PhD, but now everyone is upset over the clinical doctorates. Many allied health professions offer doctorates now (DPT, DrPH, PharmD, PsyD); it's a natural evolution of the nursing profession.
 
PainDr said:
I never said more training was a bad thing, but you didn't answer my question. What additional training do DNPs have that NPs don't have.
Click to expand...

Here's a comparison of the FNP and DNP programs at Columbia:

FNP Curriculum

Core Credits
Health and Social Policy: Context for Practice and Research 4
Assessing Clinical Evidence 4
Interpersonal Violence & Abuse 1
Management in Advanced Practice 1
Total 10

Sciences
Advanced Physiology 3
Pathophysiology of the Adult 3
Advanced Pharmacology 3
Incorporating Genetics into Advanced Nursing Practice 3
Total 12

Specialty
Family Primary Care Nursing I 2
Advanced Clinical Assessment 3
Advanced Assessment Practicum 2
Diagnosis and Management of Illness: Family I 4
Family Primary Care Nursing II 1
Family Primary Care Practicum I 4
Diagnosis and Management of Illness: Family II 3
Family Primary Care Nursing III 1
Advanced Practicum in Family Primary Care 4
Family Theory 3
Total 27
Total Credits 49


DNP Curriculum

Support Core 17
Translation and Synthesis of Evidence for Optimal Outcomes
Quantitative Research Methods
Epidemiology and Environmental Health
Legal and Ethical Issues
Clinical Genomics Advanced Seminar
Practice Management
Informatics

Clinical Core 13
Doctor of Nursing Practice I and II
Didactic
Clinical
Didactic and Clinical
Chronic Illness Management

Residency/Seminar 10

Total credits 40

Upon completion of all course work and field experiences (the first 9 months), the student will enter the Residency. In this mentored experience, the students will assume a mentored and supervised full time position where DrNP competencies can be mastered. The DrNP Residency must provide access to and authority for expanded scope practice. Students are encouraged to negotiate a paid position. The Residency must be in an approved setting which may or may not be in the New York metropolitan area. However attendance at scheduled seminars at Columbia is required during the Residency year. During the Residency year, the portfolio is developed and submitted as a required criterion for degree completion.
The above information is current as of 1/07 and is subject to change at any time.
 
I want to keep this professional, and some of the attacks on NPs/RNs are really silly and emotional. I just have doubts about the efficacy of DNP education.

Now the history lesson: in the US in the late 19th century the term Dr became more common to distinguish formally trained physicians with medical doctorates from the charlatans that received their 19th C equivelent of correspondance medical education and were not much more than an EMT. Calling yourself a Doc is a statement of qualifications, about which the pt has expectations. So, Doc is deeply engrained in American culture as a medical doc.

Perhaps this could change if DPTs, PsyD, and DNPs want to finance a public education campaign to say they should be called doctor too. But, demanding a title is usually out of character in the American tradition -- unlike Europe.

Therapist4Chnge: I'm curious if introducing yourself as a doc of neuropsychology is clear to the pt that you are not an MD neurologist? The difference is profound. Survey your pts to see if they understand the difference and their reaction if they learned you are not an MD.

DNP is degree-inflation for NP. My wife and I investigated PA vs NP and she chose PA because it was more clinical, less filler, but NP still had much to offer. The ~2000 hrs of clinical time in NP programs is 25-30 weeks of MD residency and the science foundation is considerably less. These are not enough for the role DNPs want to take of being independent.

In the end it does not matter what the AMA or others think. Rather, the pts and their lawyers will expect a certain level of experience from their providers. If a DNP or PsychD give advice beyond their experience, it is malpractice.
 
pharmdch said:
I would argue that physicians should not prescribe either; they should diagnose and confer with a pharmacist, who would then select the most appropriate drug therapy based upon the diagnosis and lab data.
Click to expand...

You can't be serious.
 
horsenurse25 said:
Oh, go untwist your panties. :sleep::sleep:

If you read carefully, the DNP is 2 years AFTER the two year masters. So the DNP has had a total of 8 years of education and around 2000 hours clinical work AFTER the BSN program - which has several thousand in itself.

Be angry if you wish. Feel that you are the only ones who know anything if it makes you feel better.

The perception that I am talking about changing, if you would bother to read before you spout off a diatribe, is that Nursing is a profession and is just as valid as medicine. That there CAN be higher learning after Bedpan Cleaning 101, and that a doctor of nursing practice has much of the same education and many of the same skills as family practitioner.

I cannot comment on the specialties as family medicine and specifically gerontology is what I am most familiar with.

The DNP is here and coming near you. So suck it up and deal with it.

Further, no DNP is impersonating a physician. They are doctors in their own right - doctors of nursing practice and they can tell their patients so. The only people that seem to be confused is yourself. If a DNP is not clarifying thier degree then they are in error. But I believe that most, if not all, DNPs will be very clear about who they are to every patient they meet. Believe it or not, most of us DO NOT WANT to be a physician. We are very happy being nurses. Thank you.
Click to expand...

How are you not impersonating a physician? You're running around the hospital in a long white coat introducing yourself as "Dr. Sally." How on earth is a sick patient not going to get confused and mistake your clinical advice with the advice of a true physician? Give me a break here. Nurses who pursue DNP degrees are content being nurses? Somehow I have a difficult time believing that-- they pursue a severely watered down version of what they consider to be medical school and do their version of residency and then at the end, proclaim themselves to be "doctors" at the end. Come on, give me a break, who do you think you are fooling?

I agree that nursing is a profession that is just as valid as medicine-- but nursing was not made to take the place of medicine. I've said it once, and I'll say it again, Sally, if you want to practice medicine independently, go to medical school. Otherwise, make sure you're practicing under the supervision of a qualified physician because your education is not adequat despite the fact that you think it is. You simply do not know what you do not know.
 
pharmdch said:
You have repeatedly implied that it's possible to become a nurse practitioner via an entirely online program. Numerous schools allow students to take didactic courses online, but clinicals are still required; one cannot simply earn the degree from home without ever setting foot inside a classroom or clinical environment.
Click to expand...

I realize that. I was just saying it tongue in cheek.

My school goes a step further and digitally records its lectures. We can download it to our computers and watch it. However, I doubt medical schools will use online courses. There is a ton a material between the lecture notes and slides. In 2 weeks, we can easily have 300 pages of material. It is not simple to just put all that material online and try to make sense of it. It is very helpful to have someone stand at the front of the class and explain things. We also have activities that expose us to clinical work even during the preclinical years. So we have to be around physically. Moreover, medical schools don't want to be viewed as a correspondence school.

Nursing has multiple access points and this can be viewed both positively and negatively. If someone had problems academically for whatever reason, they can still work their way up the nursing chain by "bridging". The problem with this is that it is very hard to achieve a consistent quality with this approach. It's like a patchwork system. Do you want a DNP taking care of you who did a lot of coursework at a community college or from online classes? With physicians, patients can expect a consistent product more or less because acceptance to medical school is very difficult and the curricula across all the accredited schools are uniform.

pharmdch said:
I find it interesting that the persecution of doctorate educated nurses by physicians has become so intense only after implementation of the DNP and DrNP degrees. Nurses have been earning doctorates for decades; granted, they were primarily research focused. No one seemed to have much to say about a nurse practitioner with a PhD, but now everyone is upset over the clinical doctorates. Many allied health professions offer doctorates now (DPT, DrPH, PharmD, PsyD); it's a natural evolution of the nursing profession.
Click to expand...

There is a difference between clinical and academic settings. It is appropriate for nurses with PhD's to be addressed as "Dr" in academic setting, but not clinical one. Other professionals such as DPT's, PharmD's, etc don't practice medicine so there is no confusion. It confuses the patient when someone wears a white coat, introduces themselves as "Dr", and performs some tasks that a physician would normally do. That's impersonating a physician.
 
Please stop feeding Taurus. He will just continue to grow...
 
DogFaceMedic said:
Perhaps this could change if DPTs, PsyD, and DNPs want to finance a public education campaign to say they should be called doctor too. But, demanding a title is usually out of character in the American tradition -- unlike Europe.
Click to expand...

Clinical Psychologists are already, and yes...in a hospital/clinical setting.

DogFaceMedic said:
Therapist4Chnge: I'm curious if introducing yourself as a doc of neuropsychology is clear to the pt that you are not an MD neurologist? The difference is profound. Survey your pts to see if they understand the difference and their reaction if they learned you are not an MD.
Click to expand...

Yes, one runs a bunch of assessments and writes a report based on a plethora of data, and the other looks at a brain scan for 5 minutes, and then gives a Dx. ;) (kidding btw, I've dealt with some awesome neurologists)

In that example, it would be Dr Therapist4Chnge, your NeuroPSYCHOLOGIST, not Doc of NueroLOGY or NeuroLOGIST. I have never seen this as a problem; I just think people are being over-sensitive.

-t
 
Therapist4Chnge said:
Clinical Psychologists are already, and yes...in a hospital/clinical setting.

Yes, one runs a bunch of assessments and writes a report based on a plethora of data, and the other looks at a brain scan for 5 minutes, and then gives a Dx. ;) (kidding btw, I've dealt with some awesome neurologists)

In that example, it would be Dr Therapist4Chnge, your NeuroPSYCHOLOGIST, not Doc of NueroLOGY or NeuroLOGIST. I have never seen this as a problem; I just think people are being over-sensitive.

-t
Click to expand...

I'm not discounting anyone's skills: I am suggesting that we direct our attention to the patient's perspective. Many well-educated people really do not understand the difference between a psychologist, psychiatrist, and a neurologist. I suggest you try an experiment with your pts to explicitly tell them you are not an MD but a PsychD or a PhD.

The fact remains that many patients are suspicious of the title of doc being used by anyone other than MDs. To the pt, the title of doc is a statement of qualifications to practice medicine and not an educational level of prestige. In fact, many people I know think college professors are silly for calling themselves Dr.

Insisting on calling one's self "Doctor" and wearing a longer white coat than the RNs runs the risk of losing credibility to a significant number of pts, regardless of what you and I might think.

By the way, how is a "neuropsychologist" different from a "clinical psychologist".
 
pharmdch said:
Frankly, I would argue that physicians should not prescribe either; they should diagnose and confer with a pharmacist, who would then select the most appropriate drug therapy based upon the diagnosis and lab data. (But that's another debate.)
Click to expand...


Yet another pretender trying to steal turf in the hopes that he can "play doctor" too. Lets call this obsession with PharmDs what it is: pure envy of doctors. I have seen how much of the PharmD board has posts like "can I script drugs like a real doctor" in the form of the incessant harping on "clinical" pharmacy.

You do realize that your proposal is based on ZERO precedent whatsoever. You are arguing for a wholescale revolution in healthcare delivery and a role for pharmacists that has NEVER existed in the United States or anywhere else.

Just be honest and dont bull**** me. Its not about "patient access" or "improving healthcare" its about artificially bumping up your prestige level so you can call yourself a "doctor" and make more $$$$. Thats all this is about and your attempts to get us to swallow this BS in the form of a "I just want to help patients" bull**** is a fraud and deception that midlevels, psychologists, and now pharmacists are trying to use in their attempts for ill-gotten gains.
 
MacGyver said:
Yet another pretender trying to steal turf in the hopes that he can "play doctor" too. Lets call this obsession with PharmDs what it is: pure envy of doctors. I have seen how much of the PharmD board has posts like "can I script drugs like a real doctor" in the form of the incessant harping on "clinical" pharmacy.

You do realize that your proposal is based on ZERO precedent whatsoever. You are arguing for a wholescale revolution in healthcare delivery and a role for pharmacists that has NEVER existed in the United States or anywhere else.

Just be honest and dont bull**** me. Its not about "patient access" or "improving healthcare" its about artificially bumping up your prestige level so you can call yourself a "doctor" and make more $$$$. Thats all this is about and your attempts to get us to swallow this BS in the form of a "I just want to help patients" bull**** is a fraud and deception that midlevels, psychologists, and now pharmacists are trying to use in their attempts for ill-gotten gains.
Click to expand...

Be Nice. It does not cost much, only a bit of our egos. Of course, that is a price too steep for some people.
 
Taurus said:
I realize that. I was just saying it tongue in cheek.

My school goes a step further and digitally records its lectures. We can download it to our computers and watch it. However, I doubt medical schools will use online courses. There is a ton a material between the lecture notes and slides. In 2 weeks, we can easily have 300 pages of material. It is not simple to just put all that material online and try to make sense of it. It is very helpful to have someone stand at the front of the class and explain things. We also have activities that expose us to clinical work even during the preclinical years. So we have to be around physically. Moreover, medical schools don't want to be viewed as a correspondence school.

Nursing has multiple access points and this can be viewed both positively and negatively. If someone had problems academically for whatever reason, they can still work their way up the nursing chain by "bridging". The problem with this is that it is very hard to achieve a consistent quality with this approach. It's like a patchwork system. Do you want a DNP taking care of you who did a lot of coursework at a community college or from online classes? With physicians, patients can expect a consistent product more or less because acceptance to medical school is very difficult and the curricula across all the accredited schools are uniform.



There is a difference between clinical and academic settings. It is appropriate for nurses with PhD's to be addressed as "Dr" in academic setting, but not clinical one. Other professionals such as DPT's, PharmD's, etc don't practice medicine so there is no confusion. It confuses the patient when someone wears a white coat, introduces themselves as "Dr", and performs some tasks that a physician would normally do. That's impersonating a physician.
Click to expand...

Actually you can do an entire FNP without ever having the school verify that you exist. You can do your entire FNP didactic online then arrange your own clinical and have someone sign off on the didactic. There is a RN on the allnurses that did this and then arranged clinicals with an american MD in Bangladesh. So someone can get an American FNP without ever setting foot in the US. I am waiting for someone to send their dog through. The only thing that prevents this is you have to have an RN license to get into NP school. Every other medical profession has an extensive verification and assessment program for away sites. Also they have regulation that prohibits programs from forcing students to find their own sites.

http://allnurses.com/forums/f34/online-np-degrees-how-do-they-really-work-220981.html

David Carpenter, PA-C
 
DogFaceMedic said:
Many well-educated people really do not understand the difference between a psychologist, psychiatrist, and a neurologist.
Click to expand...

It is out job as healthcare providers to make sure they *do* understand each person's role.

DogFaceMedic said:
The fact remains that many patients are suspicious of the title of doc being used by anyone other than MDs. To the pt, the title of doc is a statement of qualifications to practice medicine and not an educational level of prestige. In fact, many people I know think college professors are silly for calling themselves Dr.
Click to expand...

This sounds more like a projection than pt report.

DogFaceMedic said:
By the way, how is a "neuropsychologist" different from a "clinical psychologist".
Click to expand...
A neuropsychologist is a boarded specialty that requires a 2 year apa-approved neuropsych post-doc, and some additional requirements during training.

-t
 
KentW said:
My sentiments exactly. ;)
Click to expand...


Yeah. I am kinda done with this thread. No one really reads the posts they are supposedly replying to. They read what they want to read and refuse to have any sort of open mind. One person was so determined to undermine the DNP that they couldn't even add properly.

If this is an example of the medical school method of assessment then that is a scary commentary. No wonder you guys have to have such huge malpractice premiums... :rolleyes:

And Core0 - the person you are referring to is Zenman who posts on this board. Why don't you ask him exactly what he is doing before you refer to his post. You might be suprised...
 
horsenurse25 said:
Yeah. I am kinda done with this thread. No one really reads the posts they are supposedly replying to. They read what they want to read and refuse to have any sort of open mind. One person was so determined to undermine the DNP that they couldn't even add properly.

If this is an example of the medical school method of assessment then that is a scary commentary. No wonder you guys have to have such huge malpractice premiums... :rolleyes:

And Core0 - the person you are referring to is Zenman who posts on this board. Why don't you ask him exactly what he is doing before you refer to his post. You might be suprised...
Click to expand...

Not sure if it changes what he states he is doing. I would be happy to listen if he has a different slant on this. The fact that he can do it and that it is accepted is what worries me. This is a profession that can prescribe medications and make medical diagnosis and treatment plans. As I have stated on allnurses I think that there is a serious lack of professionalism in some NP programs that is tolerated by nursing. I believe that there is also a lack of supervision and accountability in NP programs that is aided and abetted by the fragmented nature of NP education and NP certification. The DNP will hopefully fix some or all of this. I think that it will hopefully force the closure of some of the dodgier schools.

A profession needs to police itself. The Physician profession does an admirable job of policing itself for the most part. While many on this forum would consider residency and med school little more than indentured servitude, from an outside view the requisite organizations rarely hesitate to warn or place programs on probation that are outside their guidelines. While I have not heard of a medical school being closed, residency closures are not infrequent. On the other hand a search of the two NP accrediting agencies fails to show any programs that have ever been put on probation. I will admit that I cannot find any place that clearly shows probation status so I may have missed this, but once again this contrasts strongly with the LCME or AOA sites which clearly list which sites are in provisional or probationary status.

I have tremendous regard for the NP's that I see and work with on a daily basis. I have very little regard for the NP educational process. While there are many excellent programs, there are many that do the minimum with little oversight or supervision. The product they produce makes the profession an easy target. You will find similar comments on particular NP programs both here and allnurses.

David Carpenter, PA-C
 
MacGyver,

Given that this is a student doctor forum, I expected my opinions would be unpopular at best, but there's no need for the attitude. First, I'm a nuclear pharmacist, so any such proposed change would not affect my practice; I prepare doses of FDG. Contrary to popular belief, not all pharmacists are medical school rejects. I chose pharmacy because I love chemistry, and I don't particularly like people. I'm quite happy with my choice, and I have no desire to be a physician.

There has been much discussion here about advanced practice nurses working beyone their scope of practice with an inadequate education. I'm not going to comment on that. The point of my original post is that nurses are not the sole offenders; it's a problem across numerous healthcare disciplines. As I mentioned, there are physicians who encroach upon the territory of pharmacists by operating dispensaries (read pharmacies) within their offices. Clearly, it is not in the best interest of the patient for a physician to prescribe and dispense medication, but some do it. Likewise, there are pharmacists in numerous states who lobby for prescribing rights; I think that's a mistake. Pharmacists should not prescribe medications without interacting with physicians. Before you assert that I'm contradicting my earlier post, allow me to explain...

Pharmacists should not be allowed to prescribe medications as though they are the patient's primary care provider. They should not be able to initiate the process. What I meant in my original post is that physicians and pharmacists should be working together in the prescribing process. I have the highest regard for the education of physicians, but they don't know everything. No healthcare practitioner is an expert in every field. There is no denying that pharmacists are the authority in regard to drugs, so it only makes sense that they should be collaborating with physicians in deciding a patient's drug therapy. Of course the type of arrangement I envision is unprecedented; it would be a logistical nightmare to implement such a scheme. The fact that it's unheard of, however, does not mean that it's a bad idea. When an expert diagnostician (a physician) consults an expert in the field of pharmacology (a pharmacist) prior to ordering a particular therapy, the patient wins. And that should be our first concern.

Now, for final thoughts about nurses with doctorate degrees using their title in a clinical setting. I appreciate the difference between an academic and clinical environment. I understand that the public associates the term "doctor" with physician, particularly in a clinical context. Nevertheless, I think the prospect of confusing the patient is less a concern than many here would claim.

I agree that it would be deceptive for a DNP to refer to herself/himself as "doctor" without qualification. If handled properly, though, there is no need for the average patient to be confused. "Hi. I'm John Doe, I'm a Doctor of Nursing and a Certified Nurse Practitioner." I know we like to joke about how stupid our patients are, but most are not so clueless that they couldn't understand that sort of greeting. Provided that you wear a name tag that clearly indicates your degrees, and you introduce yourself in a responsible manner, I just don't think this is a credible problem. If I worked in a hospital setting, I would not hesitate to use my title. "Hi. I'm Dr. H. I'm a clinical pharmacist, and I've come to talk with you about the medications you're taking." For those few who intentionally mislead patients, it will catch up with them, and it'll be their problem. Frankly, if I were a physician in general practice, I'd be a lot more concerned about any political efforts by NP's to expand their scope of practice, rather than bickering over titles.

Optometrists and opthalmologists both work in a clinical setting (often in the same practice), and many patients do not understand the difference. Nevertheless, both are referred to as "doctor" without issue. So how is the nursing situation different?
 
pharmdch said:
I agree that it would be deceptive for a DNP to refer to herself/himself as "doctor" without qualification. If handled properly, though, there is no need for the average patient to be confused. "Hi. I'm John Doe, I'm a Doctor of Nursing and a Certified Nurse Practitioner." I know we like to joke about how stupid our patients are, but most are not so clueless that they couldn't understand that sort of greeting. Provided that you wear a name tag that clearly indicates your degrees, and you introduce yourself in a responsible manner, I just don't think this is a credible problem. If I worked in a hospital setting, I would not hesitate to use my title. "Hi. I'm Dr. H. I'm a clinical pharmacist, and I've come to talk with you about the medications you're taking." For those few who intentionally mislead patients, it will catch up with them, and it'll be their problem.
Click to expand...

Well said.

-t
 
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