Doctor of Nursing Practice?

[PublicHealth]

What is the latest on DNPs? Are they the nursing equivalent of a "primary care doctor?" Where exactly are these degrees offered? I find it interesting that nursing has pursued mid-level training programs in advanced nursing practice (NPs), and now they want to go to the doctoral level. The medical profession has had limited effect on what the nursing profession has done. NPs have independent practice in some states. What is the "agenda" of the nursing profession?

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[zenman]

Well, for one thing nurses need to back up and correct the entry level problem before they work on the other end. Three entry levels..how screwed is that?

 

[guetzow]

Anything with 'Doctor' in it that's not an MD is just asking for trouble. Docs 'hate' that title. How can they tout their 'cost-effectiveness' over MDs, then demand the same reimbursement (WTF!?).

 

[nitecap]

My history, english, math and chem and pys, and Anatomy profs are all Phd doctorate prepared. Sorry the title doctor is not limited to the Medical profession.

 

[guetzow]

Your remark is Totalllllllly out of context. In Clinical Medicine, the title makes a BIG difference.

 

[nebrfan]

Anything with 'Doctor' in it that's not an MD is just asking for trouble. Docs 'hate' that title. How can they tout their 'cost-effectiveness' over MDs, then demand the same reimbursement (WTF!?).

Which is exactly why I don't think it will catch on - why use a DNP when you could pay nearly the same for the real deal.

 

[drdan]

Your remark is Totalllllllly out of context. In Clinical Medicine, the title makes a BIG difference.

If a nurse gets a doctorate than they should have a "Dr." placed in front of their name. It doesn't matter what the clinical setting is like. Maybe the general public doesn't know the difference but they can slowly learn. We don't need to hide someones identity as a Dr. just because in the clinical setting the patients are to ignorant to understand the difference.

 

[PublicHealth]

Which is exactly why I don't think it will catch on - why use a DNP when you could pay nearly the same for the real deal.

In some areas of the US, there simply aren't enough of the "real deals" to go around.

 

[rn29306]

Not everyone wants this title. I agree with Zenman, nursing has enough cards on the table that need sorting out before going gonzo on this project.

This DNP does not apply to NPs only, it extends to CRNAs also. And I can't think of anyone at our facility that wants this load of BS. We have to comply, but for what reason? It expands the knowledge, clinical practice, and pay of the clinical CRNA exactly ZERO and makes us look like pompus fools. I don't even want the title. If they grandfather me in, then so be it, but I'm not spending any money on this or going back to school for it.

The proponents of the DNP will stone me for saying this, but:

If anyone besides a physician (MD/DO) calls themselves a Dr. in a clinical setting, they should be sued for fraud.

 

[lawguil]

See what education in a capitalistic - Free enterprise model will do. Colleges and Universities will continue to worry about the bottom line while professional organizations will go to any length to promote and market their organization. It's absolutely maniacal!

"Hi, I'm Dr. Smith and I'm the nurse that will be taking your vitals today".

 

[Adcadet]

I don't understand how a DNP will be sufficiently different from an NP or CRNA. Broader scope of practice? Totally autonomous practice? I understand nursing PhDs and those make sense to me. But if you want your practice to be as broad and deep as an MDs, then I think you need to go to medical school.

 

[rn29306]

I don't understand how a DNP will be sufficiently different from an NP or CRNA. Broader scope of practice? Totally autonomous practice? I understand nursing PhDs and those make sense to me. But if you want your practice to be as broad and deep as an MDs, then I think you need to go to medical school.

A DNP is one more step in the respective field of NP, nurse midwife, or CRNA. It is not a new field within itself.

DNP - Doctorate of Nurse Practice. Some are understandably confused with it being exclusive to NPs given the fact that DNP has "NP" within the title. Very confusing I agree. I wonder if this was their intent?

A DNP for CRNAs is just further education (whether real-world academics or not) above the current master's prepared CRNA. I'm all for clinical education. Whether is pans out to be more theory crap from the nursing big-wigs has yet to be seen. This DNP has ALOT of baggage that comes with it.

 

[fuegorama]

If a nurse gets a doctorate than they should have a "Dr." placed in front of their name. It doesn't matter what the clinical setting is like. Maybe the general public doesn't know the difference but they can slowly learn. We don't need to hide someones identity as a Dr. just because in the clinical setting the patients are to ignorant to understand the difference.

The "difference" is between the meaning of the titles 'doctor' and 'physician'. In the clinical world, the title of doctor means physician.
Nurses who obtain a doctoral degree are not physicians unless that degree is a DO/MD. PhDs and DNPs are not trained in clinical medicine to the physician level. They may carry the Dr. prefix before their name in venues outside that of the working clinical environment, but to go by the title 'Doctor' in the hospital or ambulatory setting is fraudulent and unsafe.
I hope drdan, that you think more of patients than your post suggests. I am certain you would not want them believing they were seeing a physician when a nurse who has an academic degree introduces himself as "Dr".

 

[50960]

I am not a fan of the DrNp thing, but I am a Dr working in hospital and medical settings as a clinical psychologist...try sue me for Fraud..I am on the medical staff!!

 

[fuegorama]

I am not a fan of the DrNp thing, but I am a Dr working in hospital and medical settings as a clinical psychologist...try sue me for Fraud..I am on the medical staff!!

And I'm just betting you introduce yourself as Dr. Psisci clinical psychologist. Eh?

 

[fuegorama]

And what is it that makes you 'not a fan' of the DNP? Maybe you can illustrate the issue better than me.

 

[PublicHealth]

For what it's worth, there was some androgenous "chief of nursing" on the show ER, who asked Kovac (the Croation doc) to refer to her as "Doctor" because she had a Ph.D.

I think the DNP is equivalent to the DPT in physical therapy. No real difference in scope of practice, just trying to show that the level of clinical training is "doctoral-level" in order to compete in the healthcare marketplace. Sure it sounds funny now, but once it's around for a several years, no one will even think twice about it: "Oh yeah, I go to Dr. Jones, a nurse practitioner in town, he's really good."

 

[group_theory]

I don't even want the title. If they grandfather me in, then so be it, but I'm not spending any money on this or going back to school for it.

A big misconception about grandfathering. A DNP is a degree. Must be earned through academic coursework approved by an accredited school. Grandfathering only means you can still work as an advance nurse without having to go back to school to get your doctorate. Look at PharmD and the DPT. The people who were pharmacists and physicial therapists before their respective doctorate became the required entry level degree are still practicing as pharmacists and physical therapists. If they wanted that PharmD or DPT degree, they had to go back to school to earn them (granted, it was just a few courses and mostly $$$ for schools)

Also, scope of practice is determined by state laws and its interpretation/administration through the state board (and courts). It doesn't matter if a school's site will claim that this degree will allow holders to have broader scope of practice - it's up to the states.

I'm sure most NPs with doctorates don't introduce themselves as physicians, but this aspect is codified in law

Pennsylvania
§ 21.286. Identification of the CRNP.
(c) A CRNP who holds a doctorate should take appropriate steps to inform patients that the CRNP is not a doctor of medicine or doctor of osteopathic medicine.

Authority
The provisions of this § 21.286 issued under section 15(b) of the Medical Practice Act of 1985 (63 P. S. § 422.15(b)).

Source
The provisions of this § 21.286 adopted November 17, 2000, effective November 18, 2000, 30 Pa.B. 5943.

http://www.pacode.com/secure/data/049/chapter21/s21.286.html

 

[nebrfan]

In some areas of the US, there simply aren't enough of the "real deals" to go around.

Why should we believe that DNPs with newly acquired autonomous practice rights will choose to practice in rural/underserved communities any more than current masters-level educated midlevels do?

 

[fuegorama]

For what it's worth, there was some androgenous "chief of nursing" on the show ER, who asked Kovac (the Croation doc) to refer to her as "Doctor" because she had a Ph.D.

I think the DNP is equivalent to the DPT in physical therapy. No real difference in scope of practice, just trying to show that the level of clinical training is "doctoral-level" in order to compete in the healthcare marketplace. Sure it sounds funny now, but once it's around for a several years, no one will even think twice about it: "Oh yeah, I go to Dr. Jones, a nurse practitioner in town, he's really good."

I would appreciate some definitions and answers. What is the "scope of practice for DPTs and DNPs? Are they PCPs? Are they the clinical equivalent of a DO/MD?

What is doctoral level? Does a thesis make something 'doctoral'? If all that's required for a doctorate is 5 semesters of post-graduate theory w/ a thesis and a smattering of clinical time, why would/should anyone go to the trouble of a bachelor's + 4 years of medical school + 3-8 yrs residency and all the associated boards?

And how do you define competition? Are these new degrees directly competing w/physicians for market share? Can they self refer? Should they?
Thanks.

 

[nebrfan]

For what it's worth, there was some androgenous "chief of nursing" on the show ER, who asked Kovac (the Croation doc) to refer to her as "Doctor" because she had a Ph.D.

I think the DNP is equivalent to the DPT in physical therapy. No real difference in scope of practice, just trying to show that the level of clinical training is "doctoral-level" in order to compete in the healthcare marketplace. Sure it sounds funny now, but once it's around for a several years, no one will even think twice about it: "Oh yeah, I go to Dr. Jones, a nurse practitioner in town, he's really good."

Are you aruguing that a DNPs education is equivalent to that of a MD/DO?

 

[zenman]

What about the real life physician who's last name was "nurse?"

"Hello, I'm Dr. Nurse."

 

[50960]

And I'm just betting you introduce yourself as Dr. Psisci clinical psychologist. Eh?

Yes I do, as do the MD and midlevels when referring to me. I have postdoctoral residency and training in medical psych so I do ALOT of med consults, and always state that i am not a psychiatrist. Nurses are nurses.

 

[lizzied2003]

Yes I do, as do the MD and midlevels when referring to me. I have postdoctoral residency and training in medical psych so I do ALOT of med consults, and always state that i am not a psychiatrist. Nurses are nurses.

I introduce the clin.psych phd as dr. So and So to my patients and if I refer them to the practice I also say Dr.

When my colleagues refer to the Clin. Psych they also use the term Dr. So and So.

I don't think there is anything wrong with that.



When a nurse refers to me as DR. I will clarify immediatley as I do for my patients. Especially with patients this gives them the option and the forum to discuss my background and training and choice to have my physician counterparts interject. If i also see an order i've written with the term 'DR' I write the correct title underneath and cross out the Dr. piece.
I think with most patients when they head 'DR' they never ever question if in fact they are qualified to provide proper care. It is the assumption that comes with the title.

Oh, back to the clinical psychologist...


I think it is a petty argument and that if I prefaced the introduction with a : "pssst he's not really a doctor" would only undermine my patient getting the proper help they need.

 

[guetzow]

Absolutely. Just tell the patient what he/she "IS". Like......a psyschologist, a NURSE PRACTITIONER, etc..........

 

[lizzied2003]

Curious...

In 'real life' (not the SDN world) when you are faced with a professor who also holds a Doctorate do you
a. call them by their first name
b tell them they're not really a doctor
c. ask them why they insist on using a title they shouldn't and refer them to the SDN threads on this topic
or
d. call him whatever he asks...you need the grade.

 

[guetzow]

This is a clinical forum. "Real Life" is the CLINICAL WORLD, not some university lecture gig. You start calling people MDs, or even inferring they are MDs (When they are Counselors, NPs, whatever), you should get hauled off in a paddy wagon. In the clinical world, NOT academia, calling someone Doctor (Anything) is ~ MD, no ifs, ands, or buts.

 

[jwk]

Yes I do, as do the MD and midlevels when referring to me. I have postdoctoral residency and training in medical psych so I do ALOT of med consults, and always state that i am not a psychiatrist. Nurses are nurses.

Maybe on the left coast that's common. In most places it's not acceptable, nor should it be.

The average patient, in a hospital, when they hear "doctor", assumes that word to mean physician. Not nurse of any flavor, not PhD, not psychologist, not physical therapist. It doesn't matter if they have a doctorate degree or not.

 

[50960]

It's common everywhere. I find it funny that the only people who get fired up about this are non-doctoral level practitioners. MD/DO's do not care.

 

[jwk]

It's common everywhere. I find it funny that the only people who get fired up about this are non-doctoral level practitioners. MD/DO's do not care.

Not common at all in the south or midwest.

 

[Squad51]

Yes I do, as do the MD and midlevels when referring to me. I have postdoctoral residency and training in medical psych so I do ALOT of med consults, and always state that i am not a psychiatrist. Nurses are nurses.

You'd be fired for referring to yourself as "doctor" to a patient in the hospital where I am training. It happened to a PharmD last year. And the people who get fired up over this are those who have sen the havoc reeked by some midlevels or even non-medical doctors who have bandied the title about and directed treatment ot the patient's detrement. Now I am not saying that ALL non MD/DO doctors do this, but it only takes a few to really cause a problem.

 

[50960]

The difference is I am a full member of the hospital medical staff, I do direct patient care (admit, orders etc..), and I have a clinical license to practice independently unlike a PA, NP, PT, OT etc...

 

[fab4fan]

What about med students introducing themselves/allowing themselves to be inroduced as "Doctor"? Where's the outrage for that?

 

[Squad51]

The difference is I am a full member of the hospital medical staff, I do direct patient care (admit, orders etc..), and I have a clinical license to practice independently unlike a PA, NP, PT, OT etc...

I could see where that might prove the defining line. Are you authorized by your institution to run a code should you be the only provider in the area? Just a curiousity question as codes are often the "disaster" model offered when writing policies to disallow non-MD/DOs to refer to themselves as "doctor" in the clinical setting.

 

[Squad51]

What about med students introducing themselves/allowing themselves to be inroduced as "Doctor"? Where's the outrage for that?

Should be HUGE! I know that if I pulled that I would likely be sent home by my resident... AND I HAVE A PH.D!

 

[lizzied2003]

I could see where that might prove the defining line. Are you authorized by your institution to run a code should you be the only provider in the area? Just a curiousity question as codes are often the "disaster" model offered when writing policies to disallow non-MD/DOs to refer to themselves as "doctor" in the clinical setting.

In our institution the PA's run the codes. The doc/hospitalist team is usually tied up in the ER. The PA's serve as house officer. They run the code, another will place a line/intubate...etc.

The NP's in our institutions have all privledges except 'admitting'. So my PCP's get admitted under my partners name and I manage them. He wouldn't know them if he fell over them.
the Np's and PA's are formal, dues paying members of the medical staff. We, share the bathroom , the coffee maker, the complaining, and the food. NP's do not need a physican to cosign or follow up on them. If something comes under question from any member of the medical staff it is handled in the same way regardless of PA/NP/MD/DO.

Also, in our area the Pharm D has a local radio spot and introduces herself as Dr.W. SHe provides a huge public service to the general public and when I wrote and asked that she recall many patients recieve care from midlevels as well as doctors (as she kept saying 'ask you doctor') she took the feedback and now prefaces a lot of what she says with a 'provider' type of mention. Oh, and if I met her in person, I'd call her Dr. wheter IN or OUT of the hospital.
She is knowledgable and demands that respect.

 

[fuegorama]

What about med students introducing themselves/allowing themselves to be inroduced as "Doctor"? Where's the outrage for that?

It really bugged me at first. As a male nurse I had a mantra that sounded like "I am your nurse...no really...I mean it I am Fuegorama your nurse! I am not your doctor. Your doctor is the mildly distressed looking woman over there."

But I gotta say that being introduced as 'Student Physician', 'Student Doctor', or 'Dr. Fuegorama, a student on the **** service' opens a lot of doors for my education. This really came to light on my OB rotation when my first 3 deliveries left me outside the door listening for the squealing of some "miracle" as the signal for me to start all the fun note writing. These occurred after my dear nursing colleagues blocked my experience by giving great introductions like "there's a medical student out there...I hate to ask...but would you let him in on your delivery?"

It was amazing what walking past the RN to the bedside holding out a hand, cracking a joke and then saying "Hi. I'm Fuegs a student physician working w/ Dr. ++++ tonight. Can I ask you a few questions?" Bam! I have a relationship w/ these folks. They eye my name badge that says both student doctor and medical student (just to have it all covered). I establish trust and they know the real guy is my resident and/or attending.

I never lead nor allow anyone to believe I am a resident or attending physician, but if the physician title w/ a 'student' prefix gets me into that procedure or delivery...I'm using it.
There is nothing disingenuous about this. In fact it is accurate. I once was a 'student nurse'. Now I am a 'student doctor'. (somebody outta start a website w/this title) I am not fooling anyone into thinking I'm a fully trained physician. I am using it as an appropriate moniker and a semantic preparation for the title I will be lugging around for the next few decades.

And oh yeah, to stay on point. If my attending calls me Dr. Fuegorama I will not interrupt. Not only does he own me for 6 weeks, this is a clinical environment and I am a physician in training. When he leaves and me and my pt. settle in for an exciting H&P, I let them know straight-away with whom they are talking. On IM, Cards, Surg. and FP this has always included the phrase 'medical student'.

And Fab-It is only my attending that introduce me as Dr. Fuegorama. It has never come from me or my resident/intern/secretary and sure as he7l never comes from a nurse.

 

[fab4fan]

It's wrong to let a pt. believe you're a doctor when you're still a medical student. No ifs, ands or buts. I'm glad you clarify things when your attending does that.

As for imputing false motives on the nursing staff, they're probably not ID'ing you as a student to be mean-spirited; they're actually looking out for you and themselves legally by not letting a pt. believe you're a doc when you're not (yet). You, as former nurse, should know the kind of crap a pt. can give you, and I am not going to be on the receiving end of someone's tirade because he found out his "doctor" was still a med student. Uh uh...no way. Don't get paid enough for that. Not to mention that it also keeps you out the whole "He said he was a 'Doctor' but he's just a student. I wanted a 'real' doctor" fracas.

Shame on your attending for introducing you as a doctor. He should know better. (And yes, I work at a teaching facility, so we have plenty of students, 'terns and residents.)

 

[50960]

A PhD in what Squad51???? Most PhD's know they do not run codes no matter where they are ....that is the job of the medical doc and or PA. I am consulting staff; I can admit, write orders, discharge, and fully treat (assuming the attending agrees). What are you doing??

 

[Adcadet]

I cringe when referred to as "Dr Adcadet" or even "Student Doctor Adcadet" just because those hard of hearing could misunderstand. Hence, I always say "medical student" just like my name tag and hospital badge say. But I totally name drop when I can ("I'm the medical student working with Dr. AllMyPatientsLoveMe"), which also makes me feel reassured that the patient understands that I am being supervised.

 

[Squad51]

A PhD in what Squad51???? Most PhD's know they do not run codes no matter where they are ....that is the job of the medical doc and or PA. I am consulting staff; I can admit, write orders, discharge, and fully treat (assuming the attending agrees). What are you doing??

I'm an MD/PhD student about to enter my fourth year of MD training. At my institution you do your first two years of MD, then your PhD work for 3 years, and lastly your MD clinical years. In my case I was able to finish and defend my thesis within those three years (some odd ~70% of the MD/PhD candidates here manage to finish in that time) so I was hooded in May 2005. My PhD is in health policy. As for codes, I was a firefighter / paramedic prior to starting medical school.

And I don't run codes at the hospital... (yet! )

 

[PublicHealth]

I'm an MD/PhD student about to enter my fourth year of MD training. At my institution you do your first two years of MD, then your PhD work for 3 years, and lastly your MD clinical years. In my case I was able to finish and defend my thesis within those three years (some odd ~70% of the MD/PhD candidates here manage to finish in that time) so I was hooded in May 2005. My PhD is in health policy. As for codes, I was a firefighter / paramedic prior to starting medical school.

And I don't run codes at the hospital... (yet! )

A former firefighter/paramedic with a PhD in health policy running a code!? I'd rather have a chiropractor help me out!

 

[guetzow]

There are quite a few institutions like that. Increased responsibility and compen$ation are great, but they don't excuse false representation.

 

[Squad51]

A former firefighter/paramedic with a PhD in health policy running a code!? I'd rather have a chiropractor help me out!

Hmm. You respect a chiropractor more than an MD/PhD? Wow, o.k... Even one with lots of experience in running codes prior to being in medical school? Your choice I suppose ...

But a chiropractor in a code? Yep, just ask that chiropractor to intubate!



BTW - I never claimed to run codes at my hospital. This tangent of this thread started when I asked Psisci if he/she could as a member of the medical staff. Also, even with my PhD, I introduce myself as "Mr. Squad, the medical student working with Dr. So-and-so" to my patients to prevent confusion. (Let's see a chiro swallow their title for the good of the patient )

You know something PublicHealth, you are the most disrespectful, misguided, and uneducated person on SDN. I can not believe, even for a second, that you are actually a second year DO student at an accredited DO school because that would create far too much cognitive dissonance for me given the respect I generally have for D.O.s.

 

[lawguil]

A PhD in what Squad51???? Most PhD's know they do not run codes no matter where they are ....that is the job of the medical doc and or PA. I am consulting staff; I can admit, write orders, discharge, and fully treat (assuming the attending agrees). What are you doing??

Clearly calling yourself DR isn't the only way to be respected. I think if you where in the hospital and said I'm Dr Psisci a psychiatrist here at the hospital, I might mistake you for a Psychologist simply because you introduced yourself as DR. I garentee your patients are confused because I would be!

 

[lawguil]

I can't even imagine being a PharmD or DPT and calling yourself Dr anywhere...I would be embarrassed to say I'm DR. Lawguil- you physical therapist. LOL, that's just funny. A PhD is called Dr. in academia and a MD/DO is called DR in the clinical setting - that's all it should be! After all, there really aren't any other types of doctor no matter what all these allied health organizations mandate! In my book, the next closest thing in clinical training to an MD/DO is a PA, but they don't call themselves doctor. Does a DPT or PharmD think they have exceeded the training of a PA because there respective organization mandated it in order for a school to keep its program accreditation?

 

[guetzow]

Doctor doctor

 

[Squad51]

Doctor doctor

A girl I went to high school with had the last name "Doctor". Her dad was a physician (ortho I think) and her goal was to go to medical school. I have no idea if she succeeded, but if she did, and went into practice with her father, they'd be...

The Doctors Doctor

 

[lizzied2003]

I Does a DPT or PharmD think they have exceeded the training of a PA because there respective organization mandated it in order for a school to keep its program accreditation?

I have to say that no I don't think a PharmD thinks thier training surpasses as pa. In fact I'd say their training has nothing to do with a PA. It's apples and oranges. However, I would not be going out on a limb by saying that the Pharm D in our hospital knows much more about pharmacokinetics and what not than MD/DO/PA/MD and usually is the first to note when the MD/PA/DO/NP has given a dose of vanco to kill a gorilla, or perhaps even the very common colchcine tid in someone with crappy kidneys...but hey the provider read it in their drug book.

I think overall it is very disrespectful that individuals use this forum to boost their own egos. It is always turned so negative and I'd even go so far as to say the original post was meant to start some antagonist discussion...and a lot of you fell for it.

Everyone is good at something for god's sake and everyone's training is different. Get out into the real world and practice. You'll see no man is alone working and the care starts (gasp) with that paramedic or EMT out in the field and continues on to include the darn nurses aide who may not even have college education.

Get off your high horse people and get along...now back in the sandbox and play nicely.

 

[Squad51]

I think overall it is very disrespectful that individuals use this forum to boost their own egos. It is always turned so negative and I'd even go so far as to say the original post was meant to start some antagonist discussion...and a lot of you fell for it.

I think that you are right, but so was the OP. There is no need for a Doctor of Nursing Practice (in the sandbox or anyplace else).