What do you think of this? Needing a PHD for NP?

[Chronic Student]

Appreciate the restraint.
But did the same approx. five minute search of accredited PA schools as I did for the DNP:

From Marrieta college in their FAQ(and actually quite fair descriptions I think)

Q: What is the difference between a PA, NP, RN, etc.?
A: PAs and NPs receive education that is competency based. Both are mid-level practitioners that in the family of medicine are between a physician and a nurse. Physician assistants are individuals trained using the medical school model, which has an expectation of strong basic science background and clinical experience of between 1,500 to 2,000 hours during their educational program.​

Then some study from 2004 from The Internet Journal of Academic Physician Assistants TM that states" NP students and PA students undergo differing paths of educational and clinical experiences. NP students only averaged 619 clinical hours as compared with what is typically one full year or over 1500 hours of clinical training for PA students "​

and finally looked up my UCD and it's 1720 total clinical hours.​

I certainly believe your school and all those you mentioned were the 2400. Okay. Perhaps that's even now a general trend. Don't misunderstand either the point or my intention.​

Clearly however many hours PA students, and for that matter current NP students, are getting is adequate to the role as we don't have dire outcomes spreading across the medical community from those already practicing.​

I'm just over this quiet acceptance of these #'s as 'fear' facts, irrespective of the dubious intention of the source, when clearly it's a misrepresentation in general and worse, not even necessary to further the agenda of those concerned for the "patients' because of NPP preparation or lack therof.​

That's it. I'm not exactly shy about the still quite low numbers for both.
I may even agree with the premise, but let's at least be honest w/the talking points and keep 'em somewhat accurate.​

Wow--so only twice and it bugged you? Yay me! I've been watching that 1000 one for months. This Humboldt vacation must be workin​

Fair enough. I guess I just busted my tush on rotations.

As EMEDPA states I did way more than the minimum in ER, general surgery and one of my electives, neurosurgery. Lets see in ER I did >200 there, general surgery was around 320 and NS was 340 or so for 860 or so just for those three rotations.

I guess I'm an overachiever and I can see where a lot of programs can vary as well as individual students and I have a feeling that they are lowballing it.

You are also correct about it bothering me. It has been an extremely long stretch of call and I am plum worn out along with my temper.

Peace, sista.

---

Members don't see this ad.

 

[Farmer Jane]

I'm with fab4fan, no surprise there. I find it truly bizarre to be so secretive for no reason.

But what really strikes me as strange, Taurus, is that you persist in acting as if the nurses *here* are marching in step with the ANA drumbeat. We're not, and have said so clearly, many times.

 

[Therapist4Chnge]

(although for the young 'uns out there, no, that avatar is not my picture).

 

[Taurus]

But what really strikes me as strange, Taurus, is that you persist in acting as if the nurses *here* are marching in step with the ANA drumbeat. We're not, and have said so clearly, many times.

I have nothing against the nurses on this forum who don't agree with Mundinger.

However, you're not my target audience.

My target audience is the lawmaker, AMA president, ASA president, etc who wants to quickly get up to speed on this issue. He/she does a google search, runs across SDN, and sees my posts. I want to expose that person to all the dirty little secrets about DNP's that Mundinger fails to mention like how they only have 1000 hours of clinical training vs >12,000 for an MD, how DNP can be done online and part-time, etc, with supporting links.

Consider this. Over 80% of CRNA's work in the ACT model, yet the AANA is the most militant nursing group out there, putting out lies after lies after lies. That is why the ASA supports the AA's and why they have been successful in pushing AA legislation in many states. If the AANA members would just rein in their own members, then that wouldn't happen. The ASA actually had to file a lawsuit against the BON in Louisiana to stop CRNA's from doing pain. Because the moderate CRNA's won't control their own militant leaders, the AANA is going down a road that is actually hurting their members by allowing a competitor to flourish with the support of the ASA.

You can make a similar analogy to DNP's. If most nurses don't support the DNP, then it's their responsibility to rein in their own leaders like Mundinger. It's not enough to say I don't support DNP; that won't stop Mundinger et al from trying to grab more scope. If the nurses won't stop Mundinger et al, then the medical establishment will find other ways, ie, support PA's, legislation (such as restricting who can call themselves "doctor" in clinical setting), lawsuits, etc.

 

[Finding Chi]

I tend to agree with Taurus (BTW I am a 2nd yr IM resident). I am now in 23rd grade, and am constantly overwhelmed and surprised by what I don't know... even in the PCP clinic setting. I feel that spending the time during the wee hours seeing the rare and esoteric diseases and cementing the bread and butter cases in my mind is what has made me a diagnostician and given me the ability to tease apart the horse from the zebra. Innumerable early morning discussions with staff, with other residents, with nurses have made me moderately competent at properly treating these illnesses. It took a few years prior to all that to learn the science I needed to really comprehend it all. To be a competent clinician, it just takes time and patient exposure that 1) can't be learned online 2) requires a critical mass of total patient exposures ... on the scale of years, not hours.

I also wonder why there is such a push for creating a diagnostic and treatment based specialty within nursing. I have the greatest respect for nurses. Your function is beyond essential, and I recognize that it is not easy work. It is also a very different role than that of the MD, as it is not based in diagnosis and treatment of illness as much as administration of treatment and watchful, skilled patient care. It seems on this very forum many RNs are wary of the move towards DNP, maybe for this reason.

I ask this in all earnestness... what is the pull of the DNP? Is it better pay? If so, are there not equivalent salaried positions within "traditional nursing"? Is it autonomy? This is what worries me for the reasons stated above... to quote one of my profs in med school "you don't know what you don't know." Is it that you regret entering the more traditional tracks of nursing?

Also what makes it superior to say a PA or other mid-level requiring physician oversight?

I really am not trying to be snarky with these questions. I want to better understand the different perspectives in this argument. As it stands now, I am pretty leery of the whole DNP movement.

 

[fab4fan]

Chi, most of us have no idea what the need is for DNP.

 

[mig26x]

the DNP is another sorry excuse of becoming something that nurses arent!! online courses, one week per semester at campus!!??? come on, you got to be kidding me!!! when med students are 10-12 hours at SCHOOL learning and residents are close to 80 hours in the hospital hands down on practice.

I got a lot of respect for nurses that understand their role in medicine, but to acquire a doctorate by online courses, 7 days a week visit to campus and then treating SICK people (this is not about reparing computers or fixing cars) this are people we are talking about.

 

[fab4fan]

the DNP is another sorry excuse of becoming something that nurses arent!! online courses, one week per semester at campus!!??? come on, you got to be kidding me!!! when med students are 10-12 hours at SCHOOL learning and residents are close to 80 hours in the hospital hands down on practice.

I got a lot of respect for nurses that understand their role in medicine, but to acquire a doctorate by online courses, 7 days a week visit to campus and then treating SICK people (this is not about reparing computers or fixing cars) this are people we are talking about.

Although a good mechanic can mean the difference between life or death, too! (Think bad brake job.)

 

[Noeljan]

I think the DNP thing is ridiculous. What I am most bothered by is the blatantly false claims by that Mudlinger?? (sorry for spelling). She is basically trying to trick people in thinking that DNP and MD/DO are the exact same course work/knowledge, and that the DNP has more. It is a 100% blatant lie. If you want to be a doctor, go to medical school.

The PhD in nursing is another thing. That degree is important and meant for nursing research and educators, which we need. I think the requirments (MS) for NP is appropriate, as they fill an important role. I don't understand the goals of some of these people (the DNP pushers)

 

[mig26x]

Although a good mechanic can mean the difference between life or death, too! (Think bad brake job.)

and even they (mechanics) dont have to rely so much on online courses!! its hands on experience!!! LOL.

 

[wisconsindoctor]

and even they (mechanics) dont have to rely so much on online courses!! its hands on experience!!! LOL.

A mechanic needs to hear the sounds to know what the potential diagnosis is. You can't really learn that from an online course. You learn this from working on cars.

 

[fab4fan]

and even they (mechanics) dont have to rely so much on online courses!! its hands on experience!!! LOL.

For crying out loud, it was a joke. Lighten up, or I'll start siding with the DNPs out of spite.

It wouldn't surprise me if there were online mechanic schools out there. Try explaining to younger people why hands-on is important--the vacant stare you get back is seriously scary. I work with someone just like that. I try to stay far, far away from her, particularly when she's looking for someone to cover her patients when she wants to go to lunch. You're usually left with a boatload of badness if you make that mistake.

 

[dfk]

For crying out loud, it was a joke. Lighten up, or I'll start siding with the DNPs out of spite.

It wouldn't surprise me if there were online mechanic schools out there. Try explaining to younger people why hands-on is important--the vacant stare you get back is seriously scary. I work with someone just like that. I try to stay far, far away from her, particularly when she's looking for someone to cover her patients when she wants to go to lunch. You're usually left with a boatload of badness if you make that mistake.

hey fab,
just for you..
and this was a mere brief peek on google..
caveat emptor~
http://www.mechanicschools.com/online-training.html

 

[guetzow]

I'm a 4th year MS and an RN for 20 years I really think this is nursing going too far once again!



A PHD now to be a NP! Whats next by the Nurses?

Total crap, indeed. "Midlevels" are not doctors.

 

[mig26x]

For crying out loud, it was a joke. Lighten up, or I'll start siding with the DNPs out of spite.

It wouldn't surprise me if there were online mechanic schools out there. Try explaining to younger people why hands-on is important--the vacant stare you get back is seriously scary. I work with someone just like that. I try to stay far, far away from her, particularly when she's looking for someone to cover her patients when she wants to go to lunch. You're usually left with a boatload of badness if you make that mistake.

mine was a joke too, dont you see the LOL at the end?

 

[foreverLaur]

To think... I picked my nursing school because of the high quality on-site labs they have and some people want to forgo that completely...

What I learned from anatomy would have been useless if I hadn't been able to see it on human cadavers. I'm sure this is true for many courses...

 

[chapaquito]

I'm a 4th year MS and an RN for 20 years I really think this is nursing going too far once again!



A PHD now to be a NP! Whats next by the Nurses?

They should create a degree like: MD MD to distinguish doctors from NP and DrNP,I can not believe the shame that all this new nurses titles are causing to the already Doctors in Medicine,is a totally shame ,what kind of crap is this ,is only for egotistical gratification?,is this for more monetary gain?,it is totally absurd,every physician has to outcry and complain about this,this has to be stopped before is too late,the whole thing is an akward ,UNETHICAL,IMMORAL situation,what they want to create ,an hybrid?.

 

[Lamictal]

Taurus, I think you should do more reading than that of just Mundinger. Not all DNP's (in fact most) do not profess to be MD wanna be's. In fact, DNPs are nurses and want to be advanced practice nurses, not "medical" doctors. Heck, if nurses wanted to go to medical school, they would. They CHOOSE not to. Not a hard concept to grasp.

I tire of reading of these types of posts because they seem so one sided and closed minded. It seems sad to me when educated people do not seem open to hearing both sides of a discussion. I lose energy just thinking about it.
DNP is a clinical doctorate, PhD is a research doctorate. There is a lot of information for NP's to learn that goes beyond the timeframe that can truly be learned in a Master's degree timeframe. In addition, many of the competencies that are important for advanced practice nurses to know, take time to learn. It's a shame that Mundinger says that NP's want to be just like MD's- not so- I think that that gives a bad rap to most NPs out there who are proud of what advanced practice nurses do (I hate the term mid level because we are not doing things "mid way")- nurses do things that set us apart and make us different. Take the time sometime and actually ask our patients.

 

[Taurus]

Taurus, I think you should do more reading than that of just Mundinger. Not all DNP's (in fact most) do not profess to be MD wanna be's. In fact, DNPs are nurses and want to be advanced practice nurses, not "medical" doctors. Heck, if nurses wanted to go to medical school, they would. They CHOOSE not to. Not a hard concept to grasp.

Then you don't have a problem with the AMA resolution that restricts the use of the title "doctor" in a clinical setting so that it doesn't confuse the patient? Then you oppose nursing's push for expanded autonomy and script privileges in more states? Then you oppose nursing's push to try to be reimbursed at 100% as physician's? Then you oppose nursing's push to get insurance companies to reimburse autonomous NP's instead of working with physicians? Then you oppose DNP's wanting to call themselves "doctor" in the clinical setting? Then you oppose the new NBME exam for DNP's?

Then you should support my contention that APN's are in fact practicing medicine and need to be overseen by the state boards of medicine.

I am more widely read than most people on this board on this topic. I just post the most interesting links.

 

[Lamictal]

I'm not sure I agree with your conclusion about posting the most "interesting" links or posts.

Also, I don't know how you come to the conclusion that I would agree with all of your statements.

What is it that is so threatening to you about advanced practice clinicians? I practice in a state where I am independent and can Rx freely. I have yet to hear a good argument why APC's in other states should not. You have yet to provide one (but thanks for trying).

I can appreciate both sides and I enjoy working with MD's. Most of the ones I work with appreciate what I bring to the table and know that I will go to them with questions and referrals when I need to- it's called mutual respect and knowing my limits. It's not a game or competition. Why should it be or need to be? They are different roles.

As to being called doctor- DNPs can be called dr.... but not like a medical doctor. Heck as an NP I get called doctor a lot. Do I correct them? yes. As a DNP would I correct them? yes. I would clarify it. Why not? There IS a difference.

 

[Taurus]

What is it that is so threatening to you about advanced practice clinicians?

The CRNA's, the most militant "advanced practice" nurses currently, is a prime example. Never satisfied and always putting out propaganda. And patients do suffer and die. Here's a very interesting summary of the case of CRNA's, with the support of the BON and AANA, claiming to be qualified to do pain medicine after two weekend classes. Pain medicine is a fellowship after anesthesiology, PM&R, or neurology residency. The issue has gone all the way to the Louisiana Supreme Court and CRNA's have lost every legal battle.

Louisiana Court Considers Whether Interventional Pain
Management Is Within the Traditional Scope of Practice of a Nurse Anesthetist


Mundinger is molding the DNP's after the CRNA's and trying to make them just as militant. Putting out propaganda is her first step. She's taken the next step by paying the NBME to create an exam for DNP's. NP's have never taken hold like the CRNA's because a) clinical medicine is more intellectual and requires extensive training and experience b) PA's have been effective counterbalance.

My wish is to see APN's regulated by the state boards of medicine. I know that if it just went to court and the AMA supported it that it would be very easy to convince a judge to make the change. The AMA needs to stop playing so nice with the nurses.

You may think that this is all nothing because you're an NP or whatever. However, the other medical students, residents, and attendings can see my point of view. They need to be made aware of the gravity of what's happening because many of them are too busy to follow these things. Btw, I'm not here to convince nurses anything because of their obvious conflict of interest.

 

[Farmer Jane]

There's not as much conflict of interest as you think Taurus. I actually think the advanced practice push is undermining nursing as a whole. Mundinger and others are essentially saying that if you're not advanced practice, you're nothing. I resent that. I love being a nurse. I will be pursuing a MSN in nursing education so that I can teach others how to be nurses. There is a huge but unseen implication of emphasizing the AP role as the epitome of nursing--it discredits and devalues nursing itself.

 

[prairiedog]

The CRNA's, the most militant "advanced practice" nurses currently, is a prime example. Never satisfied and always putting out propaganda. And patients do suffer and die.

Hmmm, are you seeking a surgical career? You sure seem to have the personality.

 

[Noeljan]

There's not as much conflict of interest as you think Taurus. I actually think the advanced practice push is undermining nursing as a whole. Mundinger and others are essentially saying that if you're not advanced practice, you're nothing. I resent that. I love being a nurse. I will be pursuing a MSN in nursing education so that I can teach others how to be nurses. There is a huge but unseen implication of emphasizing the AP role as the epitome of nursing--it discredits and devalues nursing itself.

 

[LizUMD]

There's not as much conflict of interest as you think Taurus. I actually think the advanced practice push is undermining nursing as a whole. Mundinger and others are essentially saying that if you're not advanced practice, you're nothing. I resent that. I love being a nurse. I will be pursuing a MSN in nursing education so that I can teach others how to be nurses. There is a huge but unseen implication of emphasizing the AP role as the epitome of nursing--it discredits and devalues nursing itself.

It's funny... just about anyone I know right now in a nursing program, from my cousin in the local community college to my brother's fiance getting her BSN at private college, talk about being either an NP or a CRNA as their ultimate career goal. Based on my unscientific anecdotal observations, I'd say most young nurses and nursing students have no interest in actually being an RN (or should I say "just" an RN) anymore. Coincidence?

 

[core0]

There's not as much conflict of interest as you think Taurus. I actually think the advanced practice push is undermining nursing as a whole. Mundinger and others are essentially saying that if you're not advanced practice, you're nothing. I resent that. I love being a nurse. I will be pursuing a MSN in nursing education so that I can teach others how to be nurses. There is a huge but unseen implication of emphasizing the AP role as the epitome of nursing--it discredits and devalues nursing itself.

Its not just you. Mundinger really devalues all nurse practitioners that don't have a doctorate. You can read this from the president of the NAPNAP:
http://www.napnap.org/userfiles/File/CM_Response_to_WSJ_Apr_2_08_Final.pdf

The interesting thing is that Mundinger isn't even an NP. She is dean of nursing and her doctorate is in public health. Those who can't .....

David Carpenter, PA-C

 

[dfk]

Its not just you. Mundinger really devalues all nurse practitioners that don't have a doctorate. You can read this from the president of the NAPNAP:
http://www.napnap.org/userfiles/File/CM_Response_to_WSJ_Apr_2_08_Final.pdf

The interesting thing is that Mundinger isn't even an NP. She is dean of nursing and her doctorate is in public health. Those who can't .....

David Carpenter, PA-C

i just have to say that i don't get mudringer, nor do i want to.
bad label for the profession in general for sure.

 

[Jawbone]

Holy crap Taurus..... How do you get all those med school clinical and class hours in when you're on here doing your anti-midlevel cheerleading at all hours of the day?? I can barely find time to come here to SDN in between all those class and clinical hours they have me doing.....;>P

You must have all your standard replies saved so you can copy/paste them into each and every post! Some things you say make me laugh at their "assininity." (Is that even a word??) (I probably don't know because I'm a nurse, right?)

I am a NP student who chose a brick-and-mortar advanced practice education over an online one. I wanted to ensure that I would be as prepared as possible for my future career as a midlevel provider, and I have to say that I am happy with my decision.

I do not see myself going on for my DNP, as it in no way expands my scope of practice. I also do not agree with the grandiose generalizations of Mary Mundinger. I do however, have the sense to recognize that she is not the mouthpiece for advanced practice nursing. I also do not believe that any board of medicine should regulate advanced practice nurses. Every attending, fellow and resident I've spoken to on the issue agrees with me that there's no point to go on for the DNP. But every one of them works willingly alongside several midlevels with professionalism and respect without reducing them to scut-monkeys, or "those nurses."

You keep saying that "we" nurses are not your target audience, yet you keep showing up in these midlevel forums chanting the same mantra. Write to your senator, and instead, start offering support and constructive advice to this forum. Until you have as many clinical hours under your belt as some of the nurses, PAs and NPs on this forum, maybe you should take a break from your psychosis-inducing rants.....

 

[oldManDO2009]

Suppose you had a migraine and had to be at your brick and mortar class. Sorry, you got to be there. Good luck concentrating. No problem with online class: do it anytime. With my online class I can view the video over and over; your professor will probably not repeat what he said once before. With online class, I don't have to sit and listen to a few students ask questions they should already know the answers to nor do I have to waste time driving to class and trying to park. Online is also great for us in the international community as we might have viewpoints from all over the world.

Part time? Let's see. If I have to do 80 hours a week I'm probably tired and don't remember half of the patients I see nor can I retain half of what I learn. Seeing patients 2-3 days a week I'm rested and can go home and pour over the journals on the conditions I learned that day and retain more more.

So, part time and online wins. Try to grasp it. I have many friends in education...you lose if you think differently.

The problem is medical school is not part time and nobody cares if you have a headache - suck it up and get to work. All this part-time, work experience, and convenience just degrades the education and what is required to learn to deal with diseases. The DNP's want to to be on par with physicians but do not want to meet the same educational standards. So they will do more harm then good and I will continue to maintain job security. I was a nurse and none of my experience, desire to work during medical school, or the inconvenience of class attendance lessened the years and countless clinical hours I have put in to date!

As for PhD - we need more of them. I talk to countless nursing students who had to wait years on list to get into their local nursing program due to a lack of instructors. The DNP does nothing to resolve this dilemma - it is another attempt by nurses to hijack medicine (CRNA's have been hugely successful)

This subject has been beaten to death! Yet I am easily pulled back into the argument

 

[oldManDO2009]

Taurus, I think you should do more reading than that of just Mundinger. Not all DNP's (in fact most) do not profess to be MD wanna be's. In fact, DNPs are nurses and want to be advanced practice nurses, not "medical" doctors. Heck, if nurses wanted to go to medical school, they would. They CHOOSE not to. Not a hard concept to grasp.

I tire of reading of these types of posts because they seem so one sided and closed minded. It seems sad to me when educated people do not seem open to hearing both sides of a discussion. I lose energy just thinking about it.
DNP is a clinical doctorate, PhD is a research doctorate. There is a lot of information for NP's to learn that goes beyond the timeframe that can truly be learned in a Master's degree timeframe. In addition, many of the competencies that are important for advanced practice nurses to know, take time to learn. It's a shame that Mundinger says that NP's want to be just like MD's- not so- I think that that gives a bad rap to most NPs out there who are proud of what advanced practice nurses do (I hate the term mid level because we are not doing things "mid way")- nurses do things that set us apart and make us different. Take the time sometime and actually ask our patients.

This must be an uniformed opinion because it lacks fact. The NP program includes a year of "advanced" path and pharm and then a bunch of nursing "theory". The DNP adds very little to this already shaky foundation. It is mostly non-clinical courses with a few clinical electives. How can one add more clinical experience to a degree program that lacks clinical exposure??

Oh, thats right under graduate nursing courses are th framework for your clinical experience? Again, completely inadequate.

Nurse do not do things that make you different - give me a break. Not the "we spend more time with our patients" argument - when the ER is hopping I spend the same or less time then the resident because I actually have less responsibility for the patient. My job is very different than that of the physician (I work as an RN in an ER for extra money) so your "we are different and special" falls on deaf ears!

 

[zenman]

The problem is medical school is not part time and nobody cares if you have a headache - suck it up and get to work. All this part-time, work experience, and convenience just degrades the education and what is required to learn to deal with diseases.

Are you getting my point? How much do you retain on a good day when you are rested? How much do you retain when your slap worn out?

So why degrade part-time study where you might even retain more than the warrior pushing through 80 hours a week?

Should be an easy call.

 

[oldManDO2009]

Are you getting my point? How much do you retain on a good day when you are rested? How much do you retain when your slap worn out?

So why degrade part-time study where you might even retain more than the warrior pushing through 80 hours a week?

Should be an easy call.

Well, after seeing it for the 100th time quite a bit. It is an iterative process - as I become comfortable with the information I just learned - a lot more is then piled on. That is why it takes so long - not because we "learn" everything - because we learn to distinguish horses from zebras. I may not know what the zebra is but I do know it is not a horse....

I have to "treat" a CHF patient numerous times over many years to effectively deal with all of the problems associated with the disease and its co-morbidities. Nothing is scripted and heart failure on top of CHF adds additional complexities and that can not be dealt with using an algorithm - it must be learned and practiced.

 

[farnsworth]

Hence, why I don't bother responding to specific requests. Waste of my time to argue and debate. Inside everyone, there lives a conspiracy theorist.

Why don't you check out my public profile?

Group Memberships
(1) Public Usergroups:

* ASA Members

​

Last time I checked, you can't be a member of ASA unless you're at least a med student.

I just want to say as a medical student, I appreciate Taurus's posts and mostly agree with him - I think most med students would. I am very dedicated to my profession and have serious concerns about what other groups are doing to it. If they want a fight, they'll get one. It's too bad it's come to this, as I'd like nothing more than to work cohesively and respectfully with various health professions, but the gravity of what's at stake can't be ignored.

 

[mig26x]

I just want to say as a medical student, I appreciate Taurus's posts and mostly agree with him - I think most med students would. I am very dedicated to my profession and have serious concerns about what other groups are doing to it. If they want a fight, they'll get one. It's too bad it's come to this, as I'd like nothing more than to work cohesively and respectfully with various health professions, but the gravity of what's at stake can't be ignored.

exactly. the old docs might embrace some help from nurses to help them round in the hospital etc etc, but we the young doctors know the risk we are taking with this because they are crossing boundaries here. the Mundinger (whatever her name is) essay calls for DNP's to be doctors and even more calling them to be better than doctors, if this is not calling for war I dont know what its then!!

 

[Taurus]

Thank you to all the nurses, med students, residents, and attendings for your support and seeing the heart of the issue. I posted this on a different thread but it's still very pertinent.

If NP's had maintained their original scope and purpose, to be physician extenders, to work with physicians to deliver the best possible care, then I would be fine with that. If DNP's had followed the DO example of adopting the medical education model, then I would have been fine with that.

However, the DNP represents to me and many others nothing more than a short-cut to practice full-scope medicine. Not only is the DNP training 1/12 that of even a FP, it is a much easier path, with nursing school not nearly as difficult to enter or to pass as medical school, that DNP can be done part-time while they work, and in some programs completely all online. And yet you have to creator of the DNP, Mary Mundinger, writing in Forbes and WSJ that DNP's are equivalent to PCP's and that they should be allowed to work autonomously in all clinical settings, outpatient, inpatient, and ER. To further insult physicians, Mundinger and deans of many nursing schools have paid the NBME to create an exam for DNP's that is loosely modeled after Step 3. You will no doubt start to hear the term, "board-certified DNP" pretty soon.

If the DNP model would provide the same high quality care as physicians, then I would have no problem, but I am dubious about that claim. The best and brightest go into medicine and even after 5000 hours of clinical training during medical school I wouldn't trust them with my life. Yet, you have people with lesser credentials and abilities going to nursing school, give them much less training, and we would allow them to see patients independently? Something doesn't add up.

Furthermore, if we allow DNP's to achieve their goals, then we are putting physicians at a huge disadvantage. FP, IM, peds have to go to school longer, take on more debt, and have a higher level of scrutiny and regulation to work in the same capacity as DNP's. Why are forcing physicians to compete against DNP's with basically one hand tied behind our backs?

If the DNP's want to practice medicine, then they should practice under the oversight of state medical boards. They have the mechanisms to ensure competency and safety of the people who practice medicine.​

 

[dilated]

HI also do not believe that any board of medicine should regulate advanced practice nurses.

What exactly is it that you think they are practicing when they see patients, make diagnoses, order tests and refer patients? How about when they push for admitting privileges and equal insurance reimbursement?

The board of medicine regulates people who practice medicine, not people who have an MD degree. I seriously cannot understand how they can say they're not "practicing medicine" with a straight face. It's like physicians putting on braces and claiming it's not dentistry because they're physicians or something.

 

[Jawbone]

What exactly is it that you think they are practicing when they see patients, make diagnoses, order tests and refer patients? How about when they push for admitting privileges and equal insurance reimbursement?

The board of medicine regulates people who practice medicine, not people who have an MD degree. I seriously cannot understand how they can say they're not "practicing medicine" with a straight face. It's like physicians putting on braces and claiming it's not dentistry because they're physicians or something.

They are practicing medicine under the "supervision" of a resource physician. While able to practice independently, APNs always have a physician available to refer to, and use as a resource.

People need to take Mundinger and her cronies at face value..... You all think every DNP's going to light up our torches and start calling ourselves doctor (which we CAN, as long as we make the distinction known). In reality, even DNPs will STILL need to have that physician resource to practice independently. Even NPs in medical practice groups practice "medicine" autonomously, yet are supervised/mentored by physicians within the group.

The one constant is the collaborating physician.


I appreciate the passion you med students are showing for protecting your profession. Please do not let this issue poison you before you've even had a chance to practice. Midlevels are not evil, we're not out to steal your job. We don't want to be treated as uneducated scut-monkeys either. We want to be treated as professional colleagues. We all know what each of us brings to the field of healthcare.

 

[Taurus]

For information about the scopes of NP's in each state, here are some excellent links:

Pearson Report 2007

Chart Overview of Nurse Practitioner Scopes of Practice in the United States) (2007)

In particular, look for states where NP's have "No MD Involvement Req'd", "Explicit Authority to Diagnose", "Authority to Prescribe w/o MD Involvement". If an NP is able to open a clinic, work autonomously, and get reimbursed at 100% rate as a physician, what's the difference between that NP and a physician?

The NP model is what I call the cherry-picking model. On the one hand, they want to siphon off all the easy, routine, healthy patients off physician's schedules. It's the easy money. They want to collect all the reimbursement and work for themselves on these cases. On the other hand, they don't want the hard, complex cases. Those cases take more time, have more liability, require more expertise. This is when they "refer" the patient to a physician. Yet, those complex cases get reimbursed the same as a routine, healthy patient with no problems. That's what NP's refer to when they say that they want physician collaboration. The problem is that diseases can have very subtle presentations and unless you have someone with enough training they can't tell that the patient's signs and symptoms are pointing to something more serious until much later on.

Mundinger et al plans are simple. They want that above scenario true in all states, not just a handful of barely populated Western states. They are hoping that the DNP will push the rest of the states over.

Overview of Nurse Practitioner Scopes of Practice in the United States – Discussion (2007)

Rescind Board of Medicine rule-making authority.

The interests of Boards of Nursing and Boards of Medicine inherently conflict. The professional development of NPs will consequently be ******ed by the perpetuation of joint rule-making authorities, because, naturally, Boards of Medicine tend to block all legislation perceived to have the slightest possibility of impinging physicians' financial interests. Overly prohibitive NP scopes of practice, in turn, obstruct access to care.
​

Overview of NP Scopes of Practice in the US – Discussion

NP scopes of practice continue to lag behind NPs' professional development. Theoretically, education and training should correlate with scopes of practice. Realistically, however, NPs are overtrained for the narrow range of services they are permitted to provide. The stunning systemic inefficiencies caused by this dichotomy between clinical ability and legal authority flagrantly contradict patients' interests. Reconciliation may begin by the relaxation of rigid, arcane laws that blanketly require NPs to defer to physicians.
​

 

[prairiedog]

For information about the scopes of NP's in each state, here are some excellent links:

The NP model is what I call the cherry-picking model. On the one hand, they want to siphon off all the easy, routine, healthy patients off physician's schedules. It's the easy money. They want to collect all the reimbursement and work for themselves on these cases. On the other hand, they don't want the hard, complex cases. Those cases take more time, have more liability, require more expertise. This is when they "refer" the patient to a physician. Yet, those complex cases get reimbursed the same as a routine, healthy patient with no problems. That's what NP's refer to when they say that they want physician collaboration. The problem is that diseases can have very subtle presentations and unless you have someone with enough training they can't tell that the patient's signs and symptoms are pointing to something more serious until much later on.

Are you supporting MDs in these new minute clinics? As I understand the current structure minute clinics are staffed by a NP seeing the "Easy" stuff. The complex stuff is turfed to a MD. I am also wondering about e/m codes, my understanding the more complex the case the higher the reimbursement.

 

[Taurus]

Are you supporting MDs in these new minute clinics? As I understand the current structure minute clinics are staffed by a NP seeing the "Easy" stuff. The complex stuff is turfed to a MD. I am also wondering about e/m codes, my understanding the more complex the case the higher the reimbursement.

If the health clinics prove successful, don't you think that will get the attention of physicians? Who wouldn't love being able to see a patient for 15 minutes and charge $50 cash? NP's do not own the "health clinic" concept and physicians can easily crash the party.

However, I doubt that the health clinic model of being staffed by autonomous NP's will become that popular.

Health Clinics Inside Stores Likely to Slow Their Growth

But in recent months, retail health-clinic operators based in New York, Nevada, Indiana and Alabama have closed their doors, shuttering 69 clinics in 15 states...

In a strategy that combines both elements, Wal-Mart plans to partner with hospital systems to open as many as 400 co-branded store clinics by the end of 2010, up from about 50 sites in operation now. That approach is a departure from an earlier strategy under which Wal-Mart leased space to operators like CheckUps that weren't associated with hospital systems.​

The consumer apparently still recognizes the value of having a physician involved directly. The arguments we make here about diseases being subtle and you need someone who has received thorough and rigorous training are not lost on the consumers. That's why you aren't seeing droves of people going to them.

Health clinics will become more popular because they're more convenient. But in order for the clinic to have credibility with the public, there will have to be physician involvement.

 

[mig26x]

I appreciate the passion you med students are showing for protecting your profession. Please do not let this issue poison you before you've even had a chance to practice. Midlevels are not evil, we're not out to steal your job. We don't want to be treated as uneducated scut-monkeys either. We want to be treated as professional colleagues. We all know what each of us brings to the field of healthcare.

sorry, but im not a medicine student and I oppose 150% this joke of a doctorate called DNP. online courses? one week per semester at campus?? Are patients going to be told how they got that doctorate?? Is that's not going the easy way then I dont know what's easy. Its this the future of medicine?? People trained online??? LOL. that's so lame.

Go to the general residency forum, its not only med students voicing their opinions, you have residents, attendings and even RN's who are against this joke of a doctorate.

 

[farnsworth]

They are practicing medicine under the "supervision" of a resource physician. While able to practice independently, APNs always have a physician available to refer to, and use as a resource.

People need to take Mundinger and her cronies at face value..... You all think every DNP's going to light up our torches and start calling ourselves doctor (which we CAN, as long as we make the distinction known). In reality, even DNPs will STILL need to have that physician resource to practice independently. Even NPs in medical practice groups practice "medicine" autonomously, yet are supervised/mentored by physicians within the group.

The one constant is the collaborating physician.


I appreciate the passion you med students are showing for protecting your profession. Please do not let this issue poison you before you've even had a chance to practice. Midlevels are not evil, we're not out to steal your job. We don't want to be treated as uneducated scut-monkeys either. We want to be treated as professional colleagues. We all know what each of us brings to the field of healthcare.

I don't think any of us think midlevels are evil, their function is valuable in the clinical setting. But when you read propaganda talking about how a CRNA = anesthesiologist, a DNP = internist, sometimes with the added insult of saying "....plus more!", it's pretty hard to argue that they're not harmful to us, or after our jobs.

Keep in mind that for every med student who's prematurely concerned about expanded scope of midlevels, there's a midlevel prematurely ambitious about the same propaganda, likely spreading it to friends and family members who ask them "why didn't you go to medical school". It happens. It's unfortunate.

The bottom line is that you're trying to convince everyone that a lesser-trained population of providers should be able to replace a better-trained one. You say you're doing it to serve "better patient care", we say we're resisting to serve "better patient care". The burden of proof is on you to prove you should have the rights of a physician, and that's going to be tough. The only reason I can see for our system making this compromise is financial. Do you really want to be given practice rights purely because you were the "budget option" for a miserly government? It's just a little sad that these groups are taking advantage of the healthcare crisis to gain ground, because I'd like to think that decisions like these would be made largely based on patient care and fairness, not political shrewdness and unending ambition. I'm hoping that this whole thing blows over, but in the meantime physicians need to be aware of what's going on and how much it could pervert our profession. We've got a lot of strong, intelligent leaders in our physicians - let's protect what we love and believe in.

 

[Therapist4Chnge]

I think NPs fill a vital role in the healthcare system, and I believe the current relationship of having a collaborating physician best utilizes both the skills of the NP and the additional training of the physician (when needed).....why change this now if there isn't a huge shortage or need in the area?

It doesn't seem like there is a shortage of physicians willing to consult with NP's....and there doesn't seem to be a huge need for more autonomy for NPs, so why the push?

Autonomy is both about responsibility and training. I think being able to collaborate helps everyone involved. The community member gets services, the NP can provide care, and the physician can consult when needed, while not needing to get pulled for run of the mill stuff.

 

[prairiedog]

.

Keep in mind that for every med student who's prematurely concerned about expanded scope of midlevels, there's a midlevel prematurely ambitious about the same propaganda, likely spreading it to friends and family members who ask them "why didn't you go to medical school". It happens. It's unfortunate.

.

That may be as accurate a statement as I have seen in this thread. I would include an equal # of DNPs and MDs who also make the same mistake. Seems as if every profession has their "wackos"

 

[184013]

Great topic~ I stumbled across this article from the ama-assn regarding the DNP 'certification' test that has been jointly created.
They identified many of the things you have been talking about - but neither 'side' added any real 'scope of practice' just talked about problems they assume will rise.
http://www.ama-assn.org/amednews/2008/06/16/prl10616.htm

 

[oldManDO2009]

I don't think any of us think midlevels are evil, their function is valuable in the clinical setting. But when you read propaganda talking about how a CRNA = anesthesiologist, a DNP = internist, sometimes with the added insult of saying "....plus more!", it's pretty hard to argue that they're not harmful to us, or after our jobs.

Keep in mind that for every med student who's prematurely concerned about expanded scope of midlevels, there's a midlevel prematurely ambitious about the same propaganda, likely spreading it to friends and family members who ask them "why didn't you go to medical school". It happens. It's unfortunate.

The bottom line is that you're trying to convince everyone that a lesser-trained population of providers should be able to replace a better-trained one. You say you're doing it to serve "better patient care", we say we're resisting to serve "better patient care". The burden of proof is on you to prove you should have the rights of a physician, and that's going to be tough. The only reason I can see for our system making this compromise is financial. Do you really want to be given practice rights purely because you were the "budget option" for a miserly government? It's just a little sad that these groups are taking advantage of the healthcare crisis to gain ground, because I'd like to think that decisions like these would be made largely based on patient care and fairness, not political shrewdness and unending ambition. I'm hoping that this whole thing blows over, but in the meantime physicians need to be aware of what's going on and how much it could pervert our profession. We've got a lot of strong, intelligent leaders in our physicians - let's protect what we love and believe in.

Do not count on this "blowing over" - just look at the CRNA's they are here to stay.

I find this idea that NP's collaborate with physicians a bit of a stretch on their part since they have lobbied for independent practice rights. If their intention was to collaborate then they would not have pushed such legislation - how disingenuous.

 

[Taurus]

Found this on another thread.

I've always thought that it was suspicious that these NP's and CRNA's with just their 2 years could claim that they were just as safe as a residency-trained physician. Now we now it was just smoke and mirrors and they were doing to try to expand their scope.

http://www.nurseweek.com/news/Features/05-03/Malpractice.asp

Nurses once were, for the most part, outsiders in the physician-led fight to reduce malpractice insurance rates. Sheltered no more, nurse practitioners are finding their annual malpractice costs tripling, nurse-midwives are facing annual premiums as high as $35,000, and only one company is willing to write policies for nurse anesthetists, says Janet Selway, RN, DNSc, CRNP, instructor at Johns Hopkins University School of Nursing, Baltimore.

Selway, a state affiliate representative and board member of the American College of Nurse Practitioners, was among the nurse leaders who, out of concern, quickly convened a recent meeting in Washington on the topic.
"We wanted to have a dialogue between the insurance industry and representatives of the major national nursing organizations, just so we had a clear idea of what was going on," Selway says.

Nursing industry legal experts, representatives from the American Association of Nurse Anesthetists and American College of Nurse Midwives, as well as representatives from three nurse practitioner malpractice insurers, met to discuss the problem of rising rates and why rate hikes are hitting advanced practice nurses. Representatives from several nursing associations attended, including the American Association of Critical Care Nurses, the National League for Nursing, and the Emergency Nurses Association.

The meeting was successful in that representatives of the national nursing organizations in attendance are now armed with information to take back to their memberships, Selway says.

Some key points from the roundtable:

• Malpractice suits against advanced practice nurses are rising in number and increasing in severity, according to malpractice insurers. APNs need to learn about the basics of malpractice, including their liability, options with malpractice coverage, and legislative issues like tort reform. Associations, colleges, and societies are often good resources.
• Some 20% to 30% of nurse practitioner care is delivered by phone, exposing APNs to a liability that they might not have previously considered.
• In deciding these cases, courts must establish what's reasonable for a prudent APN. They establish "reasonable" by looking at policies and procedures and the literature existing at the time of the event, then look at national standards and causation: Was the action or inaction actually caused by the APN?
• APNs named in lawsuits should consider calling the American Association of Nurse Attorneys for counsel or advice even if they are covered under their employers' malpractice policies. Nurse attorneys might have a better grasp of the legalities involved with nursing practice.
• Malpractice insurers' profitability in covering APNs has dropped, perhaps because more nurses are being sued these days.
• APNs working in practices and clinics should ask to see their employers' malpractice policies to make sure they're named in the documents. They should consider having their own policies as well, especially if they moonlight.
• APNs should be aware that if they practice with a physician who is under- or uninsured, the nurse might become the deep pocket — the one who is covered for the highest amount and, therefore, is the more attractive to name in a lawsuit. Lawyers representing the injured have been known to go after anyone who might have provided care to the patient — anyone whose name is on the chart.
• Factors resulting in more malpractice claims and higher premiums aren't all due to big jury awards — experts say the nursing shortage is putting undue stress on hospital staffs, increasing the chances for drug errors and medical mistakes. What's more, fewer physicians are going into practice nowadays, which means a bigger patient load for current health care workers. The greater the patient load, the greater the chance for error and, ultimately, liability.

Sadly, state boards of nursing may be underreporting unprofessional behavior and incompetence to the National Practitioner Data Bank, according to one government representative who spoke at the meeting. APNs who've had a lot of claims against them and have settled out of court can often work in different states without fear of retribution because of confidentiality agreements.
In short, the Washington roundtable was an eye-opener for many nurses. Selway herself is quick to admit to that. "I think I have a better understanding of why the premiums are going up, and it's not just greed," she says. "The sad fact is that [because of increased lawsuits] we're not a profitable group to insure anymore."

 

[mig26x]

so the DNP is to cover for the physician shortage, but who's going to cover the existing nurse shortage in this country? If the DNP becomes the norm less people will want to become nurses and the shortage of nurses will be worse.

I truly believe this DNP thing is nothing more than a power/money driven movement by some (mundinger, whatever her name is)!!

 

[Jawbone]

sorry, but im not a medicine student and I oppose 150% this joke of a doctorate called DNP. online courses? one week per semester at campus?? Are patients going to be told how they got that doctorate?? Is that's not going the easy way then I dont know what's easy. Its this the future of medicine?? People trained online??? LOL. that's so lame.

Go to the general residency forum, its not only med students voicing their opinions, you have residents, attendings and even RN's who are against this joke of a doctorate.

Not all of the DNP programs are online. Many classroom/clinical programs exist. This is exactly the problem I have with the DNP. It does nothing to expand my scope of practice, does not guarantee me more money, and is not a standardized program.

I agree that the idea of getting your DNP online is lame.

I guess I'm still a little taken back by the vitriol shown towards midlevels by some of the medical students, residents and junior physicians here. Up until joining this BB, my personal experience of working closely with physicians in the midlevel role (as a student) had always been a positive and collaborative one. There was no turf war. No one felt their job was in jeopardy. There were enough sick people to go around.

I get that the DNP is viewed as a threat to physicians. I don't get why midlevels practicing safely within state-board mandated guidelines, certified in their specialty are viewed as unsafe and threatening.

 

[prairiedog]

so the DNP is to cover for the physician shortage, but who's going to cover the existing nurse shortage in this country? If the DNP becomes the norm less people will want to become nurses and the shortage of nurses will be worse.

I truly believe this DNP thing is nothing more than a power/money driven movement by some (mundinger, whatever her name is)!!

Is this your position on immigration also?