DNP's failing the test????

ANPFNPGNP · Mar 22, 2009

Are allopaths/osteopaths perfect? No way. We make mistakes, and we kill people. We get tired, we do dumb things. But that doesn't mean that you replace us with a lesser trained nurse with less knowledge, that just makes no sense whatsoever. If we're making mistakes in diagnoses, imagine the mistakes that you're going to make.

I've always said that NP's need more clinical experience as a NP and NOT as a RN! The RN and NP roles are very different and RN experience is not a substitute for NP training. It's a joke that FNP programs are requiring 500-800 clinical hours...THEY SHOULD REQUIRE A MINIMUM OF 2,000 hours! I believe that all NP's should become FNP's first and then subspecialize with 1,000 hours of training in a specific field like pediatrics or gerontology. Of course, the "specialty" NP's should also get paid more, just like the doctors who specialize.

Another thing, why is it that the DO's scored so much lower than the MD's on that test?

menetopali · Mar 26, 2009

I've always said that NP's need more clinical experience as a NP and NOT as a RN! The RN and NP roles are very different and RN experience is not a substitute for NP training. It's a joke that FNP programs are requiring 500-800 clinical hours...THEY SHOULD REQUIRE A MINIMUM OF 2,000 hours! I believe that all NP's should become FNP's first and then subspecialize with 1,000 hours of training in a specific field like pediatrics or gerontology. Of course, the "specialty" NP's should also get paid more, just like the doctors who specialize.
Another thing, why is it that the DO's scored so much lower than the MD's on that test?

no argument that more clinical training for the NP would be a good thing - perhaps in a system that provided exposure to a wide variety of cases under the eye of a mentor in the field while being shielded from a significant amount of liability and while receiving a stipend from the taxpayer immediately following completion of school.

perhaps you will join me in support of a funded NP residency system (before the anti-nursing bunch cries poor)?

menetopali · Mar 26, 2009

So here's where you're kind of wrong-- when nurses start practicing medicine, this tends to grab the Board of Medicine's attention because you didn't jump through the hoops that you were supposed to, you didn't go through the rigorous training that everyone else did, and now you're saying that you're just as qualified to manage patient care with probably 1/3 of the training because you have "better communication skills."
I have to say, kudos to nursing because you guys are fantastically organized, something which medicine is not. You gals/guys have pretty much managed to practice medicine (with a few limitations) under the guise of nursing without anyone really caring until this whole DNP thing came around with Mundinger and her incentive to really push nurses into the domain of physicians-- true and complete independence. You really want to take over complex patient care without the training, without the knowledge, and in some cases, without the liability of a physician. Personally, I don't think you have a clue what you don't know. Go to med school for a year and you'll learn very quickly how little you know.
Are allopaths/osteopaths perfect? No way. We make mistakes, and we kill people. We get tired, we do dumb things. But that doesn't mean that you replace us with a lesser trained nurse with less knowledge, that just makes no sense whatsoever. If we're making mistakes in diagnoses, imagine the mistakes that you're going to make.

newsflash: nurses have been providing primary care to the poor and undeserved for almost a century - it is only when they become an economic threat that medicine gets its ire up. as long as nurses only care for those who can't line medicine's pockets the Board of Medicine doesn't care. Just as an FYI: nurses have successfully fought claims of "practicing medicine without a license" for at least 28 years and have been held to the same standard of care for 24 years with the associated liability. NPs have been providing care comparable to primary care physicians for at least 45 years, CNM have provided Ob care with outcome comparable to and frequently better than physician counterparts for 80 years or more, CRNAs have been providing safe anesthesia for more than a century (and yes the first physician anesthetists a.k.a. anesthesiologists went to nursing school to learn how to do it).

now as to the crack about "managed to practice medicine under the guise of nursing" - i hate to point it out but we are practicing nursing, not medicine. for example - if a nurse puts an IV in, it is nursing while a physician doing it is practicing medicine; if a dentist provides sedation - it is dentistry, if a physician does it - it is medicine, and if a CRNA does it - it is nursing.

as for the push for independence, NPs are already independent in 11 states - as in there is no requirement for physician involvement in care; zero, zip, nada. as for taking on a "complex case" - guess what, cases are 'complex' based on the experience of the person treating the patient (not the "case") - insulin resistant patients that are 'complex' to the family physician may not be very complex to the nurse practitioner who is experienced in diabetes management. Just as i wouldn't go to an NP for heart surgery, I wouldn't go anywhere near a CV surgeon for primary care.

last but certainly not least, the claim "you don't know what you don't know" is oft repeated as if medicine is immune to the same logic. physician led care has failed the American people over and over because they don't know what they don't know. physicians are not taught basic care coordination, teamwork, interpersonal communication, inter-disciplinary care, or even to realize what other professions know or don't know. do physicians learn to speak with pharmacists about multiple medication management (after all the pharmacist has a lot more knowledge about a much wider range of drugs than the physician) or to consult a diabetic nurse educator before jumping straight to drug therapy (after all that is what these nurses do all the time and the physician may only do occasionally)?

while physicians often claim otherwise (without evidence I might add) that they know best - the reality is that they do not know everything about health care or frequently even know that there are people who know more about certain things than they do. everyone has the "you don't know what you don't know" problem - the solution is to break out of the silos and see what other people in health care do well and what they don't do well. for example if i want a surgical solution - see a surgeon, lifestyle change - see a nurse, through drugs at it - see a physician, talk it through - see a psychologist, manage a patient among specialties - see a care manager.

primary care can be, and has been, provided by nurse practitioners for decades over the objections of the AMA who have always claimed "quality concerns" with no evidence in 40 years to back the claim and notation by health policy groups (including the federal government) that the objections to NP independence by physician groups are directly tied to the economic interests of those groups as no evidence exists that care provided by NPs is substandard.

CraigB-RN, MSN, RN · Mar 26, 2009

I'm sorry calling an apple an orange doesn't cut it. It's still practicing medicine, no matter what we call it.

Now back to the origional topic. Once I did some research, 45% was actually pretty good. First time test, first time student. No one knew what either side was doing. I can also remember certificatio/licensing exams that were proud of only having a 50-60% pass rate.

I would be curious to see what the test actually asked. Now if they use the info to direct the further course development, then kewl. I don't see the need a different exam, but then again, I admit up front I don't get half of what the hubub is.

menetopali · Mar 26, 2009

I'm sorry calling an apple an orange doesn't cut it. It's still practicing medicine, no matter what we call it.
Now back to the origional topic. Once I did some research, 45% was actually pretty good. First time test, first time student. No one knew what either side was doing. I can also remember certificatio/licensing exams that were proud of only having a 50-60% pass rate.
I would be curious to see what the test actually asked. Now if they use the info to direct the further course development, then kewl. I don't see the need a different exam, but then again, I admit up front I don't get half of what the hubub is.

surely you aren't saying that a physician who starts an IV is practing nursing? or are you saying sedation provided by a dentist is medicine? or a nurse who does diabetic foot checks is practicing podiatry?

the practice of a profession is determined by the profession. while professions may have overlapping functions and may share standards of care (ie the same standard of care for sedation applies whether it is the practice of dentistry, medicine, or nursing) - the "practice of..." has been determined by the courts to mean those things that are performed by members of that profession. the practice of nursing, practice of medicine, practice of dentistry, practice of podiatry, practice of psychology, et al, all include acts of diagnosis and treatment defined by each of those professions. an NP who diagnoses major depressive disorder is practining nursing, a physician who does it is practicing medicine, and a psychologist who does it is practicing psychology - all use the same diagnostic criteria, same diagnosis & billing codes, etc....

CraigB-RN, MSN, RN · Mar 26, 2009

I still hold to my apples and oranges. You can call something anything you want. Going to an extreme then if the automechanic does an appendectomy in his shop, he's practicing autorepair? I know this is an extreme. If someone is doing "THE EXACT SAME THING" calling it something else just doesn't work. If that is the case why do nurses have such hearburn with having paramedics in the ER starting IV's and giving medications under the appropriate supervision. MD or RN.

I think that this stand is one reason were we are today.

menetopali · Mar 28, 2009

I still hold to my apples and oranges. You can call something anything you want. Going to an extreme then if the automechanic does an appendectomy in his shop, he's practicing autorepair? I know this is an extreme. If someone is doing "THE EXACT SAME THING" calling it something else just doesn't work. If that is the case why do nurses have such hearburn with having paramedics in the ER starting IV's and giving medications under the appropriate supervision. MD or RN.
I think that this stand is one reason were we are today.

I think one of the reasons we are in this position is the "turf war" that continues. the arguement that procedure X (IV start / suturing) can only be done by profession Y (nursing / medicine) has lead to the problem of "that is pacticing Y without a license". the reality is that there is overlap between professions and we all need to recognize that fact.

the auto mechanic example is a poor one as there is little (if any) overlap and i would be shocked if either the professional organization of auto mechanics or legislature would include appendectomy as part of their scope of practice (let me know if you find one).

the paramedic example is an excellent one - in that example, nurses are claiming the same "turf encroachment" that nurses accuse medicine of claiming. in that case i would argue that a paramedic practicing within the scope outlined by that state is just as capable of performing in a hospital as they are in the back of a rig (placing IVs, administering meds that they are authorized to administer within that state, etc) and should be held to the same standard as anyone else in that role (ie ED nurse) while they would be practicing their profession under whoever authorized their authority to practice in the first place (department of health services i think - but sombody can correct me on that one).

CraigB-RN, MSN, RN · Mar 28, 2009

I know tha auto-mechanic analogy was a real bad one, but I was trying to make a point.

When I'go back and did some research, this whole turf war thing isn't new to nursing and medicine. If you go back and look at the early guilds and the tradesman system, it was there from the start and sometimes violently so.

For us in medicine it's easy to sort out the thinks like brain surgery, and IV's and such, they are easy and even a little common sense rules there.

It's the intangible that make it harder, even for those people in the trenches. The diagnosis area is were it gets sticky. We've tried to lable it different things, but in the end it's still diagnosing and treating. To continue with the paramedic analogy, I can remember 30 years ago when I first became a medic, sitting in class being taught that we didn't diagnose, we assessed. Ok When I see bone ends sticking out of someones arm, I assess that there is a possibility of a broken bone. Even thought I was in fact saying, There is a broken bone there. a diagnosis by most peoples standards. When I was an Independent Duty Medic in the middle of nowhere, we just avoided the issue and my soap notes said assessment, even though I was diagnosing strep and treating it it. ( I should have challenged the PA boards in '78 when I had the chance)

You may be rignt when you say if a nurse does it, it's nursing and if a MD does it it's medicine, but it's still the same thing. Hind site is 20/20, I wish we could have changed the path and what we call things many years back, maybe we wouldn't have this problem now.

I just wish we (nursing as an entity no individuals) didn't get so caught up in the "Dr" thing. Although I don't agree with it, here in the US, a Dr can call themselves Dr. But it is creating a large smokescreen that is hiding the truth. Nurses can and do primary care well, safely, and efficiently. Go back and look at all the posts here. We spend so much time tilting at windmills that Don Quiote would be shaking his head at us.

Dr. Tammy, FNP/GNP-C · Mar 28, 2009

surely you aren't saying that a physician who starts an IV is practing nursing? or are you saying sedation provided by a dentist is medicine? or a nurse who does diabetic foot checks is practicing podiatry?
the practice of a profession is determined by the profession. while professions may have overlapping functions and may share standards of care (ie the same standard of care for sedation applies whether it is the practice of dentistry, medicine, or nursing) - the "practice of..." has been determined by the courts to mean those things that are performed by members of that profession. the practice of nursing, practice of medicine, practice of dentistry, practice of podiatry, practice of psychology, et al, all include acts of diagnosis and treatment defined by each of those professions. an NP who diagnoses major depressive disorder is practining nursing, a physician who does it is practicing medicine, and a psychologist who does it is practicing psychology - all use the same diagnostic criteria, same diagnosis & billing codes, etc....

And I was starting to think i was alone. You have nailed the crux of the problem in which divides advanced practice nursing.

I would venture to say that most APN's strongly feel that what they do is considered the practice of medicine and not advance nursing. This is extremely detrimental to the profession of nursing as this reduces nursing to a spin off or a branch of medicine.

Essentially, by holding that what APN's do as the practice of medicine places APN's in a medical technician status in that physicians, within the field of medicine, dictate the scope of practice of those technicians. As a consequence, physicians--and not nurses (or medical technicians) may not dictate their future scope or direction. This is equivalent to how paramedics practice. Paramedics are not autonomous licensed individuals in that they may not operate without operating under the direction of a medical director somewhere under scope approved protocols developed and approved by a medical director.

As a paramedic, I may not practice without first becoming licensed by our state medical director and then I must be accredited by our local county or regional EMS medical director. Then whenever I operate as a paramedic from administering oxygen to doing IO, I operate only at the direction and under the supervision of the base hospital physician.

Unfortunately, the path that many APN's are taking with the assertion that their practice is indeed medicine and not nursing will result in the eventual disintegration of the identity of advance nursing and APN's will be replaced with medicine or medical technicians, assistants and technologists or those professions where medicine exclusively dictates and authorizes practice such as with PA's and anesthesia assistants and the like.

Although there is nothing wrong with a working as a medical technician (as I have worked as one over the last 20 years or so) I hope that senior nursing leadership takes action to prevent this from happening to nursing because I like belonging to nursing, which at least for the time being, is still considered an independent and autonomous profession.

By the way, to the orignial poster, what is the current pass rate by recent MD graduates on the NCLEX-RN? Just curious.

forpath · Mar 29, 2009

By the way, to the orignial poster, what is the current pass rate by recent MD graduates on the NCLEX-RN? Just curious.

Although I am not the original poster, I was lurking on this thread. MDs/DOs are not eligible to take NCLEX (or even a watered-down version of it), and so there would be no statistics available to answer your question.

Dr. Tammy, FNP/GNP-C · Mar 29, 2009

Although I am not the original poster, I was lurking on this thread. MDs/DOs are not eligible to take NCLEX (or even a watered-down version of it), and so there would be no statistics available to answer your question.

Thanks, so to date, no MD or DO has ever passed the NCLEX-RN exam. Is that right?

core0 · Mar 29, 2009

Thanks, so to date, no MD or DO has ever passed the NCLEX-RN exam. Is that right?

Given that between .5 and 1% of medical students are nurses you would be incorrect. You could argue that the pass rate for physicians that have taken the test is 100%. On the other hand the pass rate for RNs that have completed medical school is assumed to be around 95% (the norm).

David Carpenter, PA-C