Petition to limit the scope of DNP practice

[concernedms4]

I have written a rough draft to petition congress to limit the scope of practice for DNPs. I put a lot of time into incorporating WingedScapula's critique of a letter written by Scrub's 421 and would appreciate it if you could take a few minutes to read it, and provide some thoughtful criticism before I submit it.

http://petition2congress.com/2/create/?gclid=CIKppPKYraECFUtX2god7nRoAQ

2. Give your petition a title
Defining the scope of medical practice

3. Add a 1 sentence description
This bill wants to ensure that when a patient sees a physician, he/she is seeing a medical doctor (MD/DO) who is board certified in that field

We are concerned about the growing efforts of Doctors of Nurse Practitioning (DNP) and other nurse practitioners (NP) to expand their scope of practice to include the same practice rights and reimbursement rates as physicians while demonstrating lower levels of education, training, and medical liability. Currently, they are petitioning in 28 states for the right to practice medicine independently, without physician (MD/DO) oversight. Unfortunately, this is not the role NP’s are designed to fill, and this is reflected in their significantly less clinical training. NP’s are “physician extenders,” their role is to assess patients and present the pertinent findings to a licensed physician so he/she can more efficiently treat the patient, thus optimizing the number of patients they can care for each day. They are not trained to practice as independent physicians.
We oppose expanding the rights of NP’s because the length and depth of their training is not equivalent to physicians. To qualify as a board-certified physician, one must complete 4 years of undergraduate training, 4 years of medical school (MD or DO), and 3-7 years of residency. To sub-specialize, physicians must train an additional 1-3 years. In comparison to the 11-18 years of higher education that physicians must complete, DNP’s require only 8-10 years. DNP’s must spend 2-4 years to receive a nursing degree , 2 years to receive a Masters of Science in Nursing, and a variable number of years, usually 2-4, to receive a DPN, a degree which can be completed entirely online without ever attending a class in person (i.e. Ball State University). However, where the difference in training is most obvious is in the huge discrepancy between number of clinical hours required for certification as a DNP compared to a board-certified physician. In the instance of family medicine, certification for an NP to practice family medicine requires a minimum of 500 hours with a nationwide mean requirement of 686 clinical hours (Bray, CO, Olson KK. Family Nurse Practitioner Clinical Requirements: Is the Best Recommendation 500 Hours? J. Amer. Acad. Nurse Prac. 2009;21: 135-139). An MD/DO family medicine residency requires 9,555 clinical hours* If an NP student were to work 65 hours a week, like the average MD/DO resident does, it would take only 8-11 weeks to complete their training, while it takes a physician 3 years. The disparity in clinical knowledge suggested by the 14 fold greater amount of clinical training that physicians receive is demonstrated by the 50% failure rate of DNPs who took a modified version of the United States Medical Licensing Exam (USMLE) Step 3.
Within the last two years, an entirely optional, DNP certification exam based off of the USMLE Step 3 exam was created in an attempt to prove the equivalence of DNPs to physicians. Since 1916, the National Board of Medical Education (NBME) has assessed the abilities of physicians-in training to demonstrate an appropriate level of medical competency. The current standard is the USMLE, a series of 3 exams, known as “steps,” that all physicians are required to “pass,” as part of the stringent process for licensure to practice medicine unsupervised in the United States (Dillion, GF, Boulet, JR, Hawkins, RE, Swanson, DB. Simulations in the United States Medical Licensing Examination (USMLE). Qual Saf Health Care 2004;13:i41-i45 doi: 10.1136/qshc.2004.010025). Step 3 is the final step in the medical licensing sequence of examinations. It is designed to assess whether the physician-in training not only possesses, but can appropriately apply the medical knowledge and understanding of clinical science considered essential for the unsupervised practice of medicine (Andriole, DA, Jeffe, DB, Hageman, HL, Whelan, AJ. “What Predicts USMLE Step 3 Performance?” Acad Med. 2005 Oct;80(10 Suppl):S21-4). 94% of all physicians “pass” Step 3 on their first attempt. However, 50% of DNPs who chose to take a modified version of Step 3 that required a lower percentage of correct answers to “pass” in addition to being stripped of any questions designed to assess competency in fundamental science, clinical diagnosis, or clinical skills, failed (http://www.ama-assn.org/amednews/2009/06/08/prl10608.htm). The goals and standards that an individual must meet to be licensed to practice medicine unsupervised has already been established: a 4 year undergraduate degree, successful completion of a 4 year LCME or AOA accredited medical school, successful completion of USMLE Step 1, 2, and 3, and at minimum, completion of 1 year of an ACGME accredited residency. There is no logical rationale for why anyone with demonstrably substandard education, training, and skills should be allowed to circumvent this time-tested path to practice medicine unsupervised.
The signers of this petition understand that while NPs and other physician extenders play an important role in healthcare delivery, they are not equivalent to physicians, and as such should not be allowed to practice without supervision or be reimbursed at the same rate as physicians. If this is allowed to happen, the quality of medical care available to the public will noticeably suffer as the likelihood that a serious condition that would be noticed by a physician will be missed by DNPs, who only have 7% of the clinical hours possessed by the physicians that they wish to emulate. As a result, grave conditions that would be caught by physicians at an earlier, more treatable stage will go unnoticed by the less trained DNP and will be allowed to progress. DNPs are seeking false credentials that will confuse the public into thinking that they are physicians. The path to becoming a physician is already established and we, the signers of this petition, do not support the establishment of a short-cut path so that less qualified and less knowledgeable individuals can reap the financial and social benefits of being a “physician” at the expense of the public’s wellbeing.


* assuming an average of 65hr/wk x 49wk/yr x 3yr. 65 hr average was calculated by myself but looking at the avg number of hours worked by FM residents in FL, CT, and CA.

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[PlutoBoy]

Very good but I think that we shouldnt be mentioning reimbursement because this is not the primary concern and because it makes everything else looks hypocritical. Any rational person will understand the point without the references to reimbursement.

 

[concernedms4]

Very good but I think that we shouldnt be mentioning reimbursement because this is not the primary concern and because it makes everything else looks hypocritical. Any rational person will understand the point without the references to reimbursement.

That's a good point, and I will be sure to change that. Please, does any one else have any feedback? I'm disheartened by the absence of responses.

 

[tandski]

That's a good point, and I will be sure to change that. Please, does any one else have any feedback? I'm disheartened by the absence of responses.

Don't feel disheartened, your post hasn't been up for very long and there are many threads already on this topic.
I am in favor of this petition and agree with the statement by Plutoboy. I would also switch some of the organization to improve the flow. Consider starting the 3rd paragraph describing the board exams.

Perhaps in this order:

"Since 1916, the National Board of Medical Education (NBME) has assessed the abilities of physicians-in training to demonstrate an appropriate level of medical competency. The current standard is the USMLE, a series of 3 exams, known as “steps,” that all physicians are required to “pass,” as part of the stringent process for licensure to practice medicine unsupervised in the United States (Dillion, GF, Boulet, JR, Hawkins, RE, Swanson, DB. Simulations in the United States Medical Licensing Examination (USMLE).
Step 3 is the final step in the medical licensing sequence of examinations. It is designed to assess whether the physician-in training not only possesses, but can appropriately apply the medical knowledge and understanding of clinical science considered essential for the unsupervised practice of medicine (Andriole, DA, Jeffe, DB, Hageman, HL, Whelan, AJ. “What Predicts USMLE Step 3 Performance?” Acad Med. 2005 Oct;80(10 Suppl):S21-4). 94% of all physicians “pass” Step 3 on their first attempt. Within the last two years, an entirely optional, DNP certification exam based off of the USMLE Step 3 exam was created in an attempt to prove the equivalence of DNPs to physicians......50% failed...etc..."

 

[deleted87716]

Please, does any one else have any feedback? I'm disheartened by the absence of responses.

You're wasting your time petitioning Congress. Scope-of-practice is legislated at the state level.

 

[J-Rad]

This can continue in TIH.

 

[Dr Oops]

Well I see your point , but you should google the latest recommendation from the Institute of Medicine for the practice scope of NPs DNPs. The studies they reviewed and upon which they based their recommendations - for independent practice - clearly points out that the PRIMARY care provided by NPs/DNPs is equal to that of physicians. It is simply a fact that you cant deny. Physicians may have longer training, but honestly, how much of the general training do you really get to use in primary care setting?? How much of the surgical or ICU experience do you really get to use in primary care office?? So if you substract that from your total how much of your total training relates to your specialty - eg family practice??

NPs have 4 year training as RNs that includes clinical hours caring for patients assessing patients and making sure physicians dont make medication errors. After that they spend another 2-5 years (NP/DNP) training specializing in their are of specialty- eg Family medicine acumulating further clinical hrs. And programs such as the one at Columbia have 1 year full time residency equivalent to the 1 year residency that some physicians do. That is 5 years of training at selected specialty. So I am not saying that DNPs should or could replace physicians , but they can definitely provide equal quality care for pts in primary care. Specialties such as surgery or cardiology etc is of course not the case- I agree with that.
So if you want to talk about training inadequacy at the level of DNP I think you are really off. But I agree that education at the level of NP is insufficient to practice independently. However at the DNP level it is different story.

My trolldar is going berserk. Your post is laughable. ESPECIALLY the part I bolded, so the 500 or so hours the DNP does in a year is equal to the 10,000 a resident does? At the DNP it is the same story just a different name (one made to confuse the general public into thinking these people are doctors).

 

[shopsteward]

Petitions to politicians and political institutions get responses based on the momentum provided by numbers of signatures and sexiness of the subject. It's a big job to do if done seriously, so getting some professional/campaigning organisation for physicians on board to run it is the best idea. Plus, can you get physicians and physician supporters in the organisations you are petitioning to talk it up and take it on?

Getting lots of signatures means going outside the usual suspects for signing up to such things. That means making signature a no-brainer to most of the people who come across it, which means making it shorter, snappier and easier to read (technical stuff goes in backing material). It also needs to appeal to the widest possible interest, which in this case means orientating it away from doctors' interests and towards protection of the public. The following follows your wording but with some cutting and re-ordering (do please consider whether or not it is still accurate, though).

"We are concerned about the growing efforts of Doctors of Nurse Practitioning (DNP) and other nurse practitioners (NP) to expand their scope of practice to include the same practice rights as physicians while demonstrating lower levels of education, training, and medical liability.
​

Nurse practitioners are petitioning in 28 states for the right to practice medicine without physician (MD/DO) oversight. Unfortunately, this is not a role NPs' training qualifies them to fill. NPs are trained to assess patients and then present the pertinent findings to a licensed physician so the doctor can more efficiently treat the patient, thus optimizing the number of patients the doctor can care for each day. NPs are not trained to practice as independent physicians.
​

The length and depth of NPs' clinical training is nowhere near equivalent to that of physicians. To qualify as a board-certified physician, a doctor must complete 4 years of undergraduate training, 4 years of medical school (MD or DO), and a further 3-7 years of clinical training after medical school. An MD/DO family medicine residency, the clinical training needed to become a family doctor, requires 9,555 clinical hours. Certification for an NP to practice family medicine requires only a minimum of 500 clinical training hours after nursing school, with a nationwide mean requirement of 686 clinical hours. If an NP student were to have 65 hours clinical training a week, as the average MD/DO resident does, it would take only 8-11 weeks to complete their clinical training, while it takes a family doctor a minimum of 3 years.
​

The disparity in clinical knowledge between doctors and NPs is demonstrated in their final examination results. The standard for testing the training of doctors is the USMLE, a series of exams that all physicians are required to pass as part of the stringent process for licensure to practice medicine unsupervised in the United States. Step 3 is the final exam, and is designed to assess whether the physician-in training not only possesses, but can appropriately apply, the medical knowledge and understanding of clinical science considered essential for the unsupervised practice of medicine. All doctors are required to pass Step 3 before they can practise independently, and 94% of all doctors in training pass Step 3 on their first attempt. Within the last two years an optional DNP certification exam based on a modification of the USMLE Step 3 exam has been created. The exam has been stripped of any questions designed to assess competency in fundamental science, clinical diagnosis, or clinical skills, and requires a lower percentage of correct answers on the remaining subject matter. Even though it is only an optional exam for DNPs. 50% of the DNPs who chose to take this modified Step 3 exam failed.
​

[?Add paragraph on lower levels of medical liability?]
​

The signers of this petition understand that NPs and other physician extenders play an important role in healthcare delivery. But their training is not equivalent to that of doctors, and does not fit them to practice medicine without supervision. Conditions that would be caught by physicians at an earlier, more treatable stage would go unnoticed by the DNP and allowed to progress. Serious conditions would be missed by DNPs who only have 7% of the clinical training of a qualified doctor.
​

We, the signers of this petition, consider that the qualifications and clinical training for physicians are the standard needed in order to practice medicine unsupervised while protecting the health and wellbeing of the public. Less qualified and less knowledgeable individuals should not be allowed to confuse the public into thinking that they are physicians, or that they have the necessary qualifications and training to practice medicine without the supervision of a fully-qualified doctor.”
​

 

[altap]

IMHO, this is an uphill battle for physicians. NPs can always point out the lack of PC physicians. But there are things that PC physicians can do to push back: 1. Do not hire midlevels instead hire a nurse and teach her to do hx and pe. 2. Do not teach midlevel students (I scratch my head whenever anesthesiologists complain about crnas taking their jobs yet they continue to teach nurse anesthetist students how to perform MDA's job).

 

[JaggerPlate]

IMHO, this is an uphill battle for physicians. NPs can always point out the lack of PC physicians. But there are things that PC physicians can do to push back: 1. Do not hire midlevels instead hire a nurse and teach her to do hx and pe. 2. Do not teach midlevel students (I scratch my head whenever anesthesiologists complain about crnas taking their jobs yet they continue to teach nurse anesthetist students how to perform MDA's job).

That RN could easily take some online courses and become an NP ...

only hire PAs. Anesthesiologists (MD-A is a term created by CRNAs) should work with/hire AAs exclusively.

 

[bronx43]

The medical liability is a salient point, indeed. If they wish to take on MD roles, they need to be willing to take on MD responsibilities.
However, with respect to the expansion of the "scope" of their practice, there would obviously have to be studies done to show parity in outcome in certain subset of practice between MDs and NPs.

 

[altap]

The danger in letting non-physicians practice medicine (let's face it they are practicing medicine) is that they now think it can be done without the med. education and training since they are already doing it without even going to med school. With all due respect, letting non-physicians practice medicine will hurt patients and destroy medicine. Still in doubt? The ophthalmologists, anesthesiologists, PC physicians, dermatologists and psychiatrists are busy parrying the "attacks" of non-physicians (some anesthesiologists are even thinking of going to Canada to practice).

 

[taraflorida]

That RN could easily take some online courses and become an NP ...

only hire PAs. Anesthesiologists (MD-A is a term created by CRNAs) should work with/hire AAs exclusively.

To say RNs can easily take some online course an become an NP is like saying medical students can simple go to some random medical school in the Caribbean and become an MD-it's ludicrous. Regardless of what school you attend, you still have to pass a national certifying examination. Most NP schools range between 2-3 years and are not online.


I don’t understand that your solution is to hire PAs when your complaining about NPs supposed lack of education when there are PA programs that are Associates degree programs and bachelors. The minimum level of education for an NP is master’s level until 2015 when it will be either PhD or DNP.
If we are going to comment about these things we should get our facts straight.

 

[taraflorida]

IMHO, this is an uphill battle for physicians. NPs can always point out the lack of PC physicians. But there are things that PC physicians can do to push back: 1. Do not hire midlevels instead hire a nurse and teach her to do hx and pe. 2. Do not teach midlevel students (I scratch my head whenever anesthesiologists complain about crnas taking their jobs yet they continue to teach nurse anesthetist students how to perform MDA's job).

Anesthesiologists do not usually train student CRNAs-other CRNAs do!
I think your missing the point also that alot of ARNPs are involved in the training of medical students, interns and residents. I don't know where you have done your rotations at, however here in Miami at the teaching hospitals, the felllows barely want to be bothered with the interns, let alone the medical students. The ARNPs in the ICU end of doing alot of the procedures with the interns as well as giving them TPN, sepsis and patient management training. The medical students also do some of the ER rotations with the ARNPs.

I believe writing this petition is in complete lack of the understanding of collaborative practice that ALL healthcare specialities have with each other. NO DNP prepared ARNP in their right mind would ever try to pass themselves off as an MD or state that their education is the same as an MD-it is a completely different focus. I would also point out that if the person writing this is a medical student-then you have not had much experience collaborating with other disciplines in medicine and as such have a vary narrow view point of medicine.

So maybe we should target PharmDs next because they have a doctorate and they call themselves doctor, because we wouldn't want patients confusing them with an MD-as well as Archeologists, dentists and podiatrist. MDs and DOs do not own the title "Doctor"

 

[deleted6669]

][/COLOR]
I don’t understand that your solution is to hire PAs when your complaining about NPs supposed lack of education when there are PA programs that are Associates degree programs and bachelors. ]

a pa with an associates degree has TWICE the clinical education of a dnp(3000 hrs vs 1500).
it's not about degree inflation or fluff courses, it's about actual time spent doing clinical education...the pa certification is competency based....

 

[Makati2008]

IMHO, this is an uphill battle for physicians. NPs can always point out the lack of PC physicians. But there are things that PC physicians can do to push back: 1. Do not hire midlevels instead hire a nurse and teach her to do hx and pe. 2. Do not teach midlevel students (I scratch my head whenever anesthesiologists complain about crnas taking their jobs yet they continue to teach nurse anesthetist students how to perform MDA's job).

If memory serves me correctly your a nurse. You cant call yourself a doc(your post doc header) in the usa because you didnt/cant match....unless you did this year. I would not want a nurse doing my PE and HP due to them missing and not knowing so much.

Maybe you should go back and restart med school/pa school here in the usa so you can practice medicine instead of nursing imho

 

[Makati2008]

Anesthesiologists do not usually train student CRNAs-other CRNAs do!
I think your missing the point also that alot of ARNPs are involved in the training of medical students, interns and residents. I don't know where you have done your rotations at, however here in Miami at the teaching hospitals, the felllows barely want to be bothered with the interns, let alone the medical students. The ARNPs in the ICU end of doing alot of the procedures with the interns as well as giving them TPN, sepsis and patient management training. The medical students also do some of the ER rotations with the ARNPs.

I believe writing this petition is in complete lack of the understanding of collaborative practice that ALL healthcare specialities have with each other. NO DNP prepared ARNP in their right mind would ever try to pass themselves off as an MD or state that their education is the same as an MD-it is a completely different focus. I would also point out that if the person writing this is a medical student-then you have not had much experience collaborating with other disciplines in medicine and as such have a vary narrow view point of medicine.

So maybe we should target PharmDs next because they have a doctorate and they call themselves doctor, because we wouldn't want patients confusing them with an MD-as well as Archeologists, dentists and podiatrist. MDs and DOs do not own the title "Doctor"

Tried to do your previous statement as a quote but couldnt. Your not a post doc in this setting so why does your header have post-doc? Maybe you should change it also most of the dnps/nps I have met are weaker than a 3 day old open coke when it comes to clinical practice(your so called masters and dnp colleagues). Its like the previous poster said-its in the training I would rather have a certificate(only reason i got my mpa was due to a state requirement in good ole ms) then a dnp and look like an idiot in the ER. also two post and she starts arguing i wonder if she is a troll? maybe a mod check for ip address is needed...

 

[JaggerPlate]

To say RNs can easily take some online course an become an NP is like saying medical students can simple go to some random medical school in the Caribbean and become an MD-it's ludicrous.

UHHHHHH .... There are various online DNP programs and medical students CAN simply go to some random medical school in the Caribbean and get an MD. Thousands of people do both each year.

Regardless of what school you attend, you still have to pass a national certifying examination. Most NP schools range between 2-3 years and are not online.

Most, huh?

DNPs want unrestricted rights and the ability to call themselves 'Dr' in a clinical setting ... I don't think patients would be overtly comfortable with the off chance that their 'doctor' went to school online.

I don’t understand that your solution is to hire PAs when your complaining about NPs supposed lack of education when there are PA programs that are Associates degree programs and bachelors.

Have you researched PA education? You can go to NP school for a decade, the clinical training and medical knowledge is no where near that of a PA program. PA programs are well organized, built toward a medical school-esque curriculum, and have far, far, far more clinical hours compared to DNP/NP programs (not to mention the relevancy of these hours is better).

In fact, I know of several people practicing some form of nursing with an AA and BSN ... but not a single PA with anything less than complete of a PA program.

Furthermore, PAs are under the BOM and work collaboratively with a physician (and their license) ... even if the educational difference between NP and PA showed NP dominance (it doesn't), PAs aren't asking for independent practice rights in fields like Anesthesiology, Derm, Cardiology, OB, etc, etc, etc.

The minimum level of education for an NP is master’s level until 2015 when it will be either PhD or DNP.

Again, you're way off about PA training, but changing the NP to a DNP is a joke and you (and everyone else) knows it. It adds NO clinical relevancy to the degree and essentially provides a doctorate in some health care admin type line of study, but appears simply to give the ability to be referred to as 'Dr.'

PhD??? Doubt it.

If we are going to comment about these things we should get our facts straight.

I agree. You should do a ten minute google search before you come huff and puff next time.

 

[JaggerPlate]

Anesthesiologists do not usually train student CRNAs-other CRNAs do!
I think your missing the point also that alot of ARNPs are involved in the training of medical students, interns and residents. I don't know where you have done your rotations at, however here in Miami at the teaching hospitals, the felllows barely want to be bothered with the interns, let alone the medical students. The ARNPs in the ICU end of doing alot of the procedures with the interns as well as giving them TPN, sepsis and patient management training. The medical students also do some of the ER rotations with the ARNPs.

I believe writing this petition is in complete lack of the understanding of collaborative practice that ALL healthcare specialities have with each other. NO DNP prepared ARNP in their right mind would ever try to pass themselves off as an MD or state that their education is the same as an MD-it is a completely different focus. I would also point out that if the person writing this is a medical student-then you have not had much experience collaborating with other disciplines in medicine and as such have a vary narrow view point of medicine.

So maybe we should target PharmDs next because they have a doctorate and they call themselves doctor, because we wouldn't want patients confusing them with an MD-as well as Archeologists, dentists and podiatrist. MDs and DOs do not own the title "Doctor"

Who do you think trained the CRNAs for years before they were 'competent' enough to teach one another? They leached off myopic physicians for years until a time when they could break free and proclaim to the world how superior they are to the MD-A (a CRNA derived term by the way).

Furthermore, that program that has AARNs teaching medical students should be submitted to LCME or COCA for review. It's fine to have midlevel providers share their knowledge (as they have plenty of experience and skills to teach), but medical students on clinical rotations need to study under physicians.

ADDITIONALLY, physicians have no problem with a team based approach ... the problem is that the NP/DNPs don't want to be a part of the team, they want to run the show. If you think that all NPs just want to play nice and chip in, you should write Mary Mundinger a letter and ask her to halt her smear/PR campaign, because your leadership is expressing the exact opposite of what you're saying.

Finally, the PharmD, PhD argument doesn't really hold water because the PhD wants to teach and the PharmD wants to practice pharmacy ... DNPs are nurses who want to practice medicine ... DO/MDs should have some clout there.

 

[taraflorida]

Tried to do your previous statement as a quote but couldnt. Your not a post doc in this setting so why does your header have post-doc? Maybe you should change it also most of the dnps/nps I have met are weaker than a 3 day old open coke when it comes to clinical practice(your so called masters and dnp colleagues). Its like the previous poster said-its in the training I would rather have a certificate(only reason i got my mpa was due to a state requirement in good ole ms) then a dnp and look like an idiot in the ER. also two post and she starts arguing i wonder if she is a troll? maybe a mod check for ip address is needed...

You are really showing your professionalism with your quote here about "troll". Isn't this suppose to be a forum where we can post our comments and opinions and not insult each other?

 

[taraflorida]

Who do you think trained the CRNAs for years before they were 'competent' enough to teach one another? They leached off myopic physicians for years until a time when they could break free and proclaim to the world how superior they are to the MD-A (a CRNA derived term by the way).

I think you are misinformed about the history of anesthesia. Nurses were actually the first ones giving anesthesia, which evolved into the CRNA role.

ADDITIONALLY, physicians have no problem with a team based approach ... the problem is that the NP/DNPs don't want to be a part of the team, they want to run the show. If you think that all NPs just want to play nice and chip in, you should write Mary Mundinger a letter and ask her to halt her smear/PR campaign, because your leadership is expressing the exact opposite of what you're saying.

Finally, the PharmD, PhD argument doesn't really hold water because the PhD wants to teach and the PharmD wants to practice pharmacy ... DNPs are nurses who want to practice medicine ... DO/MDs should have some clout there.

Yes DNPs want to practice medicine but from a nursing perspective not a medical model. Most NPs do want to be part of a team and collaborate with other health care providers. The reason it always seems as if there is a consent struggle of power because ARNPs are tired of MDs dictating ARNP practice and not letting ARNPs practice to the full extent of their license. Case in point-the DEA has ruled that ARNPs may prescribe narcotics, however in a few states such as florida it is not allowed due to powerful opposition from the AMA, although in most other states ARNPs have DEA numbers and no studies show that ARNPs have worse outcomes or get patients addicted to narcotics as the AMA claims. This is why it may seem as if NPs are always fighting with MDs. Believe me, we do not want to fight. I work in collaboration with an amazing trauma surgeon who has been nothing but truly inspirational as well as other ARNPs. Yes, I am a DNP and have the legal right to call myself Dr. Smith, however I would never introduce myself to another healthcare provider or patient as Dr. Smith and not state that I am an ARNP. I earned my doctorate degree and worked very hard for it and it was not online. I don't call other programs fluff because I have never experienced their program first hand. I believe until you have experienced it first hand then don't be so critical of other programs, because it's not yours.

I wish we could all work collaboratively the way I work here in Miami with my collaborating physicians and other ARNPs and not insult each other.

 

[Makati2008]

You are really showing your professionalism with your quote here about "troll". Isn't this suppose to be a forum where we can post our comments and opinions and not insult each other?

Normally people making attacking statements are usually doing it to stir up trouble hence the name troll. You have a post history of 2 and your attacking my profession. So YOUR professionalism is not the best either in this case is it?

 

[Makati2008]

Yes DNPs want to practice medicine but from a nursing perspective not a medical model. Most NPs do want to be part of a team and collaborate with other health care providers. The reason it always seems as if there is a consent struggle of power because ARNPs are tired of MDs dictating ARNP practice and not letting ARNPs practice to the full extent of their license. Case in point-the DEA has ruled that ARNPs may prescribe narcotics, however in a few states such as florida it is not allowed due to powerful opposition from the AMA, although in most other states ARNPs have DEA numbers and no studies show that ARNPs have worse outcomes or get patients addicted to narcotics as the AMA claims. This is why it may seem as if NPs are always fighting with MDs. Believe me, we do not want to fight. I work in collaboration with an amazing trauma surgeon who has been nothing but truly inspirational as well as other ARNPs. Yes, I am a DNP and have the legal right to call myself Dr. Smith, however I would never introduce myself to another healthcare provider or patient as Dr. Smith and not state that I am an ARNP. I earned my doctorate degree and worked very hard for it and it was not online. I don't call other programs fluff because I have never experienced their program first hand. I believe until you have experienced it first hand then don't be so critical of other programs, because it's not yours.

I wish we could all work collaboratively the way I work here in Miami with my collaborating physicians and other ARNPs and not insult each other.

So were you able to work fulll time and do this program? If so how labor intensive could it have been??

 

[taraflorida]

So were you able to work fulll time and do this program? If so how labor intensive could it have been??

To answer the question- I was not able to work full time while I was in my NP program. I was only able to work while on Christmas break. The students in my program who tried working full time or close to that usually failed out.

 

[taraflorida]

Normally people making attacking statements are usually doing it to stir up trouble hence the name troll. You have a post history of 2 and your attacking my profession. So YOUR professionalism is not the best either in this case is it?

Who is attacking your profession? I'm only trying to provide some insight into an area that seems to be misrepresented on this forum. In order to have an educated discussion we should present all sides on the topic shouldn't we? I believe we can discuss this in a professional manner without name calling.

 

[Makati2008]

To say RNs can easily take some online course an become an NP is like saying medical students can simple go to some random medical school in the Caribbean and become an MD-it's ludicrous. Regardless of what school you attend, you still have to pass a national certifying examination. Most NP schools range between 2-3 years and are not online.


I don’t understand that your solution is to hire PAs when your complaining about NPs supposed lack of education when there are PA programs that are Associates degree programs and bachelors. The minimum level of education for an NP is master’s level until 2015 when it will be either PhD or DNP.
If we are going to comment about these things we should get our facts straight.

That is what I am calling an attack on our profession. It was the same weak argument used in MS by the NPs there trying to keep PAs out of the state and guess what-It didn't work and these docs have been hiring us since. What NPs tend to leave out is that an associate level PA program has the same level of clinical education as a MS level PA. Also they leave out that these AS PA's have previous degrees. It seems that NPs are so blinded by trying to gain independence that they cannot/will not realize that it is not the piece of paper that is important but the training of the individual provider. I will ask again-Why is there no NP to DO bridge if your cirriculum even at the master's level is so great? Also how often do/are NP's required to retake their national certification exam? Can you explain why NPs did so poorly on their version of the USMLE 3?

Furthermore,A PhD/DNP that is without any additional training in the clinical aspects of medicine is worth very little value(I say this if you are gaining with that expectation now if you are wanting to teach, Nursing admin, etc.. then no problem.) and is a disservice to our patients.

Also that is the basis of me calling you a troll. You have stirred a hornets nest in a peaceful portion of the forum with again a very small post history which seems to ironic to me. Put troll in the forum search to get a better understanding....

 

[rmsgolfer]

Yes DNPs want to practice medicine but from a nursing perspective not a medical model. Most NPs do want to be part of a team and collaborate with other health care providers. The reason it always seems as if there is a consent struggle of power because ARNPs are tired of MDs dictating ARNP practice and not letting ARNPs practice to the full extent of their license. Case in point-the DEA has ruled that ARNPs may prescribe narcotics, however in a few states such as florida it is not allowed due to powerful opposition from the AMA, although in most other states ARNPs have DEA numbers and no studies show that ARNPs have worse outcomes or get patients addicted to narcotics as the AMA claims. This is why it may seem as if NPs are always fighting with MDs. Believe me, we do not want to fight. I work in collaboration with an amazing trauma surgeon who has been nothing but truly inspirational as well as other ARNPs. Yes, I am a DNP and have the legal right to call myself Dr. Smith, however I would never introduce myself to another healthcare provider or patient as Dr. Smith and not state that I am an ARNP. I earned my doctorate degree and worked very hard for it and it was not online. I don't call other programs fluff because I have never experienced their program first hand. I believe until you have experienced it first hand then don't be so critical of other programs, because it's not yours.

I wish we could all work collaboratively the way I work here in Miami with my collaborating physicians and other ARNPs and not insult each other.

This is the worst argument used by NP's. Your telling me that NP's want to be called Dr.______ in any medical setting, they want equal practice rights and pay with only a fraction of an education covering useless topics like Leadership in Nursing and Advanced Nursing Theory, and all this is being done with the internal drive to maintain strong roots in the upbringing of nursing theory???? The NP's I see try to distance themselves from the nursing field like a bad case of the clap because they believe their abilities are far beyond those of a lowly RN.

You are spot on that collaboration should remain the focus but come on, no one believes NP's are just looking to bring a nurses perspective to the practice of medicine. It is a power grab through legislative channels plain and simple.

 

[taraflorida]

Also that is the basis of me calling you a troll. You have stirred a hornets nest in a peaceful portion of the forum with again a very small post history which seems to ironic to me. Put troll in the forum search to get a better understanding....[/QUOTE]

Sorry, it was a peaceful forum because you only had one opinion, which is to misrepresent NPs and DNP programs. Shouldnt this be a forum where all views are represented? I have a very small post history because I just discovered this website. Why is that ironinc? Why the hornets nest? You seem very offended that someone would question your comments and the use of the word "troll" is just plain unprofessional, which shows a lack of professional experience. I am only trying to represent a view point of DNPs and advance practice nurses in this forum that is not represented. Other views should be welcomed here, not just your own.

Are you still a student? Just asking because if you are then you have had no work experience working with a multidisciplinary team in the medical field to see that all efforts are incorporated into patient care and to respect the opinions of other professions besides your own.

 

[Makati2008]

Also that is the basis of me calling you a troll. You have stirred a hornets nest in a peaceful portion of the forum with again a very small post history which seems to ironic to me. Put troll in the forum search to get a better understanding....

Sorry, it was a peaceful forum because you only had one opinion, which is to misrepresent NPs and DNP programs. Shouldnt this be a forum where all views are represented? I have a very small post history because I just discovered this website. Why is that ironinc? Why the hornets nest? You seem very offended that someone would question your comments and the use of the word "troll" is just plain unprofessional, which shows a lack of professional experience. I am only trying to represent a view point of DNPs and advance practice nurses in this forum that is not represented. Other views should be welcomed here, not just your own.

Are you still a student? Just asking because if you are then you have had no work experience working with a multidisciplinary team in the medical field to see that all efforts are incorporated into patient care and to respect the opinions of other professions besides your own.[/QUOTE]

I have been a PA for quite a while. I have worked with quite a few multidisc. teams and I have been asked by one of my professors at med. school to help teach American Heart and the like.

Sadly your mistaken about that lack of professionalism. Docs and Nurses alike both seem to love and my old job is footing my 200k bill for school. I just disliked how you came in here trying to build your profession up while trying to tear my old one down(which I am leaving here soon). I do like to talk to see where your colleagues are coming from (Sarsjay for example) and see what makes them tick but for you to come out of the blue and try to slide some of the same arguments that I heard about my profession in the past does not fly. If you came in and stated your argument without doing that then we wouldn't be having this discussion. If you notice I disappear and only speak occasionally.

Food for thought-Since I am in Med. school(and will soon not be a practicing PA) why would I care what you said about PA's unless I thought it was out of line. Also I said put troll in the search form to see what other initial posters said to get that label.

 

[MCAT guy]

Why don't nurses take the same tests that physicians have to take.

If they score the same then they are training well, but they don't score the same.

 

[RoseInTheMud]

Ever thought that maybe if we didn't worry about who was better than who, we can possibly focus on the patients more, thus resulting in better patient care? Just a suggestion.

 

[bucks2010]

was this bump really necessary?

 

[JaggerPlate]

Ever thought that maybe if we didn't worry about who was better than who, we can possibly focus on the patients more, thus resulting in better patient care? Just a suggestion.

Totally agree. We should focus on patient care and subscribe to the idea that patients are far better off receiving medical care from individuals who have graduated from medical school and completed a certified residency program. After all, wouldn't this be in the patient's best interest?

Insert a 'filling a void in primary care' diatribe in 3 ... 2 ... 1 ...

 

[Instatewaiter]

Why don't nurses take the same tests that physicians have to take.

If they score the same then they are training well, but they don't score the same.

There are a few issues with this. While I agree that if DNPs want to claim equivalance they need to pass similar tests, this alone is nowhere near enough. Most of medical training is found in the clinical hours. Any shmuck can read a harrisons or similar text and regurgitate it during a test. This is one reason why you often see IMGs scoring exceptionally well on the USMLE but often being poorly prepared for residency- they don't have the clinical training. The combination of knowledge and clinical hours is essential to have a competent provider.

So while the classroom hours (or reading) are definitely needed, most of medical knowledge comes from seeing patients and spending time in the field utilizing that knowledge and refining it. This becomes readily apparent when you meet an experienced clinician.

Not only does the DNP lack the classroom hours but it more importantly lacks the clinical time. Until the DNPs start going through thousands of hours of clinical experience they will never be able to provide similar care.

 

[Lokhtar]

This is not going to happen. Physicians need good scientific studies regarding outcomes on their side. If/Until that happens, you will not see any reduction in DNP practice rights.