2015 is it official? YES

tgedward · Apr 10, 2010

As far as the titles used, I have a slight issue with nurses being called DR. near patients. I understand the hard work nurses have to undertake for their degree. However, I don't want patients to get confused who the physician is and who the nurse is. Which can lead to patient confusion and lower quality of care.

loveanesthesia · Apr 10, 2010

Which can lead to patient confusion and lower quality of care.

Patient confusion I agree, but how would it lead to "lower quality of care". It is very important to me that patients understand I'm an advanced practice nurse, because I provide high quality care.

allnurses Guide · Apr 10, 2010

As far as the titles used, I have a slight issue with nurses being called DR. near patients. I understand the hard work nurses have to undertake for their degree. However, I don't want patients to get confused who the physician is and who the nurse is. Which can lead to patient confusion and lower quality of care.

Physicians don't hold a monopoly over the title of Doctor. Physicians can start introducing themselves as physicians first and then Dr. so and so next. I have worked with CRNAs and other nurses that had their doctorate and none of them called themselves Dr. X around patients mainly because they didn't want to spend the time educating patients on the difference between Doctor/physician and Doctorate/Nurse. In 20yrs time the majority of providers in the hospital are going to be doctorally prepared. It is asinine to believe that calling your pharmacist/occupational therapist/NP/CRNA/physical therapist/speech therapist etc. Doctor X is going to lead to lower quality of care (I would like to see that study). Some patients maybe confused, but it is up to us as healthcare providers/nurses to educate patients about the differences. I still educate patients that think I must be the physician just because I am male, and over the years I have noticed patients in general are getting better with idea that nurses can be males and physicians can be females too.

Class2011 · Apr 10, 2010

I have an issue with some MD's being near patients.

tgedward · Apr 10, 2010

The only reason I mentioned that the quality of care could be reduced is on the patient self care side. If the nurse is a doctor and the therapist is a doctor and so on and so on, the possibility of the patients confusion will grow. Who does the patient listen to? Our elderly patients could get so confused that they simply won't follow any orders or get them mixed up. The old saying about too many cooks in the kitchen could apply here. Don't get me wrong, I am all for advancing the level of training for ALL healthcare workers and they should be recognized for that additional training and expertise. But, lets not be caught up in titles. We should focus on whats most important, our patients!

allnurses Guide · Apr 11, 2010

The only reason I mentioned that the quality of care could be reduced is on the patient self care side. If the nurse is a doctor and the therapist is a doctor and so on and so on, the possibility of the patients confusion will grow. Who does the patient listen to? Our elderly patients could get so confused that they simply won't follow any orders or get them mixed up. The old saying about too many cooks in the kitchen could apply here. Don't get me wrong, I am all for advancing the level of training for ALL healthcare workers and they should be recognized for that additional training and expertise. But, lets not be caught up in titles. We should focus on whats most important, our patients!

So educate your patients.... This is exactly the propaganda that AMA/ASA is trying to make people believe. It is absurd to believe there is going to be any real change because another healthcare provider calls themselves Doctor that isn't a physician. There have been doctoral prepared healthcare providers other than physicians for decades, and I have yet to see it effect patient care yet. A physician can still be in charge if that is who providing the care for a particular patient instead of an APN. It is the responsibility of healthcare provider to educate their patients if they choose to call themselves doctor.

Doctoral prepared healthcare providers are a fact and patients need to educated to reality of an ever changing healthcare environment and not left in a paternalistic physician run healthcare system of a bygone era.

Class2011 · Apr 11, 2010

With all respect, it sounds to me like you're the one caught up in titles.

loveanesthesia · Apr 12, 2010

The only reason I mentioned that the quality of care could be reduced is on the patient self care side. If the nurse is a doctor and the therapist is a doctor and so on and so on, the possibility of the patients confusion will grow. Who does the patient listen to? Our elderly patients could get so confused that they simply won't follow any orders or get them mixed up. The old saying about too many cooks in the kitchen could apply here. Don't get me wrong, I am all for advancing the level of training for ALL healthcare workers and they should be recognized for that additional training and expertise. But, lets not be caught up in titles. We should focus on whats most important, our patients!

I'm still not sure of your point. Are you advocating against a doctoral degree for APNs, or are you advocating against APNs with a doctoral degree introducing themselves to patients as 'Dr. Smith, Nurse Anesthetist'? Personally I will never introduce myself to a patient as Dr. I feel strongly that I want my patients to understand that I am a CRNA, I give great care and I want my profession to get credit for that.

As for 'Who should the patient listen too?' nurses have always played a large role in patient and family education. I don't expect this will change.

tgedward · Apr 13, 2010

Only the idea of a non physician wanting to be addressed as Dr from the patient. In the non hospital setting, I would not mind. There is no harm in telling the patient that you have a doctorate in nursing..ect as long as they are completly aware that you are not a physician. Call me a traditionalist, But I think the only ones on the floors being addressed as doctor should be a physician.

Class2011 · Apr 18, 2010

US News and World Report

The New Doctors in the House

By Bernadine Healy, M.D.

Posted April 15, 2010

Nightingales are soaring. Gone are the days when medical etiquette had nurses standing at attention when doctors entered the room or silently bowing their white-capped heads when their own experience called a physician into question. Nurses have broken the bounds of their crisp, white aprons to assume substantial authority. Witness today's nurse practitioner addressing the critical shortage of primary-care physicians in the United States and other developed countries. These registered nurses, armed with advanced degrees in specialized areas like pediatrics, women's health, or adult disease management, care for a wide range of common medical conditions and wield a prescription pen with virtually the same independence as any M.D.

The founder of the modern nursing profession, Florence Nightingale, would be pleased. It was the unmet needs of soldiers dying like flies on foreign soil during the Crimean War that in 1854 led this young, highly educated British nurse and her team of like-minded women to volunteer their services at the war's front lines. More soldiers were dying from infectious diseases like typhus and cholera than from battlefield injuries. Nightingale systematically improved their diet, sanitation, clothes, and bedding and tended to their emotional needs. She became known as the Lady with the Lamp because of her nightly rounds to tend to her wounded charges. Mortality rates plummeted, and the nurses won the heartfelt respect of their patients, skeptical military doctors, and the public back home.

Need also propels today's evolution of nursing. We simply lack sufficient primary-care doctors to attend to the growing ranks of aging baby boomers and patients of all stripes who increasingly demand support with wellness and disease prevention. This shortage is particularly prevalent in rural America, where populations in more isolated areas can find barely half of the number of primary-care physicians they need. Nurse practitioners have stepped in to help fill this void.

This century has seen a steady increase in the number of N.P.'s--now more than 150,000 out of the 2.6 million registered nurses nationwide. Their ranks are sure to swell in numbers and stature: Nurse practitioners, along with physician assistants, figure prominently in healthcare reform as a way to increase access and lower costs. More and more nursing schools are offering doctoral-level training for N.P.'s. Today, 23 states authorize N.P.'s to work without physician involvement. Expansion of the doctor of nursing practice degree will probably make that 50.

Advanced care. Trained to take medical histories and perform physical examinations, N.P.'s screen for disease risks and diagnose and treat the common complaints that make up 80 percent of primary care. They can manage chronic diseases like asthma and high blood pressure, with outcomes similar to physicians'. N.P.'s can work as midwives or lead home health or hospice teams. Others with advanced training in cancer or heart disease might work in specialists' practices overseeing treatments and attending to patients' primary-care needs.

As in most fields, advanced training brings higher salaries. R.N.'s can earn between $45,000 and $95,000 a year; nurse practitioners, between $80,000 and $120,000. As with nursing generally, the hours are regulated and controllable, with flexible shifts that accommodate personal life.

Some M.D.'s will be threatened by this new breed of doctor in the medical house. But with fewer medical students choosing primary care, nurses are moving into a gap rather than pushing out existing physicians. And as we've seen with midwifery, there are patients who prefer the care of an N.P.

As in the past, nurses are recasting their profession to meet pressing needs, not by morphing into M.D.'s but by being nurses plus. Their inbred professional focus on team collaboration and their attention to the whole patient and to the surrounding environment of home and community are well suited for primary care. If physicians are uncomfortable ceding territory to their new colleagues, like the military doctors facing the Lady with the Lamp, it will be so only at first. The need for N.P.'s is great, and nurses have long shown how to shine.

http://www.usnews.com/articles/education/best-medical-schools/2010/04/15/the-new-doctors-in-the-house.html

Gerlich8 · Apr 21, 2010

When I was interviewing at LSU for the CRNA program we discussed the big push to make CRNA entry level a doctoral, but they said it wouldn't happen till 2025. In preperation for that change they now offer a Doctorate in Nursing Anesthesia. I also heard the same thing when I interviewed with Wesleyan in Texas. :nurse:

msn10 · Aug 8, 2010

Don't get me wrong, I am all for advancing the level of training for ALL healthcare workers and they should be recognized for that additional training and expertise. But, lets not be caught up in titles. We should focus on whats most important, our patients!

From the AANA FAQ:

"There is no credible evidence that nurses who currently hold doctorates use their credential and title in a way that misleads patients. In addition, ethical concerns require that CRNAs identify themselves appropriately as 'Certified Registered Nurse Anesthetists' in the clinical setting, no matter what their level of education."

Also:

"While the AANA Board's position statement supports nurse anesthesia programs moving to a practice-oriented doctoral degree by 2025, this is not a mandate. At this time it is difficult to determine how moving to a doctoral degree might impact practice requirements."

It will be interesting to see how this trend eventually goes. I am all for additional schooling, but after finishing one master's in nursing, I thought I might obtain my DNP. For me it wasn't the right tract, an MBA and PhD are however. It saddens me that universities are actually getting rid of master's and replacing them with DNP's. Master's programs are a crucial step for PhD work. This link will be gone if we only do DNP. I think both options could easily be available. I sit on the curriculum committee at a university I work at and it is a big challenge to go from a master's program and change not only requirements and admission procedures, but also overhaul the curriculum (usually undergrad work gets affected also to prepare them) but then become accredited when many of the board members still have questions.

Additional schooling is a great idea, I just would prefer they keep both options for APN.