Should DNP's be able to practice on their own? How do you feel about midlevel encroachment

  1. I am recently learning about the healthcare field and I saw the MD's perspective of why DNP's shouldn't have their own independent practices.

    From your point of view, why should they?
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  2. 16 Comments

  3. by   Rose_Queen
    Welcome to AN- I see this is your first post. Generally, the expectation is that you start the discussion. So, what are your thoughts on NPs practicing independently?
  4. by   curiousobserver
    My understanding is the following:

    MD's who are greedy/in areas without many MD's use DNP's/PA's to run large practices that would otherwise be impossible with a single MD.

    So the people who are doing a lot of work autonomously feel like they should be able to run their own practices. This seems fair to me in that regard.

    But at the same time, it cannot be denied that nurses have much less training than doctors. So, when a patient goes to a clinic run by a DNP, what kind of care will they get? Should these clinics be limited to small procedures that even a nurse can do without insane knowledge?

    I personally feel like there is a role for DNP's having independent clinics as it will allow rural areas to get medical care but at the same time, it can be dangerous as their knowledge base is much smaller than doctors.
  5. by   Rose_Queen
    Quote from curiousobserver
    the same time, it can be dangerous as their knowledge base is much smaller than doctors.
    And yet, if you look at studies comparing outcomes of patients of MDs and patients of NPs, the outcomes are comparable. Here's one article as an example; you should be able to find plenty more. Medscape: Medscape Access
  6. by   jaycam
    I don't really agree that NPs have a smaller knowledge base. It's a different knowledge base. Different doesn't mean inferior. Let's compare education of two of my friends. One friend is a new MD, one is a new DNP, both graduated around the same time. The MD didn't get a BS degree, they got their school's requirements and were a few credits short of it. The DNP had a BSN, B.S. Biology, and B.S. Chemistry. The MD student didn't see patients outside of volunteer work until her second year. The DNP started clinical his first semester. The MD only did school. The DNP practiced as a CNA, then an LPN before becoming an RN. They worked as a floor nurse while going after their DNP. In the end, they had a lot more experience with patient interaction, and it shows. It bothers the DNP when people ask them why they didn't just go to medical school, because he likes being an NP, and feels he gets to know his patients on a more personal level. The MD, she's very good at what she does but has a very different mindset.

    I live in a state that allows independent practice for NPs. It's working out pretty well for us. We have NPs who work in the ER. They are important parts of the team. We have NPs who work in clinics. We have FNPs who have their own practices. We have NPs who round in our hospitals. I really like working with them, because most of them have been nursing assistants and they've all been nurses at some point. It helps to integrate the healthcare team when you have someone who relates to both the nurse and provider side.
  7. by   Buyer beware
    DNP is an academic degree.
    So what again is the question?
  8. by   Rocknurse
    So tired of the APRN bashing. Everyone loves to criticize yet everyone wants to be one. *sigh*
  9. by   Aromatic
    AT least for primary care I would not really be against NPs having the ability to gain autonomy. I am still on the wall about it but after a few years experience they should be able to sit for some sort of exam and be able to, especially in rural areas. But without having a few years under their belt and passing at least one additional exam and possibly an oral exam it should not happen. It would fill primary care gaps and also weed out those who should be continually supervised by physicians, but would give those who shine a chance to do it on their own.
  10. by   OllieW
    I live/work in a state where NPs are supervised, but I do not feel like I am supervised. They see their own patients and I see mine. They will tell me if they see something particularly interesting just to share, but never get involved with any decisions or care provided. They are available for questions and generally tell me what they may do, but always express that it is my decision how I treat. I enjoy being part of a group and learn so much from them but never feel restricted by my states approach.
  11. by   Jules A
    Quote from jaycam
    I really like working with them, because most of them have been nursing assistants and they've all been nurses at some point.
    But unfortunately at many schools there is no longer a requirement to actually work as a nurse prior to becoming a prescribing NP.
  12. by   Jules A
    Quote from OllieW
    I live/work in a state where NPs are supervised, but I do not feel like I am supervised. .
    In no way directed at you or your skills however if the point of allowing NPs to go through a short program based on the criteria in some states to have supervision it is concerning to me that this rarely happens. It was my experience also prior to gaining full practice authority. Nothing changed except I didn't need an attestation agreement and although I'm happy for the autonomy the truth is its kind of scary that it didn't really make any difference in my day to day operations.
  13. by   OllieW
    Quote from Jules A
    if the point of allowing NPs to go through a short program based on the criteria in some states to have supervision it is concerning to me that this rarely happens. .
    I think the whole supervision issue has more political ties than anything else. The AMA does not want NPs creeping into their territory. As long as they control the medical care by not allowing independent practice my NPs they keep us in check.

    I have other friends in other states where they are micromanaged by their collaborating physician. I am thankful I do not have that. I am however glad to have my docs around to provide advice and teach because they really are smart cookies and my patients benefit by the association.
  14. by   FranFNP13
    jaycam, ASN, RN, please consider that this is not a comparison of apples to apples. Nursing and medicine are two separate houses on the same block. Working as a CNA, practicing as an LPN/RN are vastly different from having the responsibility and practicing as a NP. RN's who go on for advanced practice have at least a BSN-bachelors in nursing which involves taking chemistry, anatomy/physiology, biology in addition to core nursing courses. Would-be physicians can enter medical school provided they meet the criteria, with any bachelor degree. So in truth the student nurse begins working with patients in school from the first semester, and the medical student begins clerkships in year three I believe which involve hundreds of hours per semester. Upon graduation and completion of boards, the RN will work with patients in that role. Some choose to return back to complete graduate level course work in advanced pathyphysiology, pharmacology, physical examination, etc. After approximately 500 clinical hours, coursework completion and a graduate degree, the NP will be certified to work with the population in which they specialized. The physician becomes an intern after graduating from medical school, and must complete additional training, thousands of hours, before they can work independently. Now the practice of the NP and MD/DO share some similarities, they cannot be compared equally. Just because a physician can take a BP and talk to a patient, they are not a nurse and just because I can diagnose and treat infectious mononucleosis as a NP, I am not a physician. Each specialty-each house-brings their own set of knowledge and skills to the party in the service to the patient. They can't take our board exams, and we can't take theirs unless we complete the specialty training involved with each distinct profession.

    And BTW-the DNP is a degree, not a role. A nurse who holds a DNP, but is not a nurse practitioner, cannot do what nurse practitioners do. As nurses we need to be more proactive about what we call ourselves and clear about what that means. But that is another thread...

    Please forgive any unintentional inaccuracies in my depiction of medical students/physician education.

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