Doctors blackballing NPs/DNPs

[mslinzyann]

Lately I've been on a particular board dedicated to doctors and student doctors and there has been a lot of talk about/ a lot of fear about DNPs and NPs in general. Many of the doctors and pre-med students on the board have even discussed the idea that doctors should band together to not hire NPs, and hire PAs again.

I find this to be dismaying for me personally, as the fields I am interested in are all primarily geared towards NP rather than PA- peds, nurse midwife, neonatal, ect. However, I want to know what the nurses take to this is- are nurses going to be so aggressive that they turn the 'big dogs' of medicine against them? Will NPs attempt to expand their scope of practice beyond what is safe for patients?

I feel there is a place in medicine for midlevels, but midlevels aren't doctors, either.

[Corey Narry, MSN, RN, NP]

I think that regardless of whether our educational preparation stays at the master's level or advances to a doctoral one, there will always be a sector of medical students, residents, and attending physicians who will be threatened by the NP role. There is so much misunderstanding and false impressions by physicians about NP's and it surely doesn't help that the publicity on DNP developments have further clouded physicians' perceptions of our role and intentions.

It is up to practicing NP's and those who want to become future NP's to set the facts straight in their own practice settings and work environments. I have worked with not one but many physicians including staff intensivists who were intially struck by the fact that our group of NP's have so much autonomy in the ICU. I can tell that their initial reaction is to put us down and control what we can do. If we stay collegial and show what we are able to accomplish, sooner or later, they realize our value and accept that it's all about patient care and achieving good outcomes.

I have seen residents, fellows, and physicians become believers of the NP cause. We've had residents rotate through our service and thank us in the end for the learning and support they got during their rotation. We've had attending intensivists who have expressed that they feel good about leaving the ICU to attend to activities such as research and faculty roles because we are in the ICU and they know that the patients are in good hands.

We can all make a difference in our own way. The NP profession has not lasted this long only to be shut down by a group of misinformed and confused individuals.

[Corey Narry, MSN, RN, NP]

Just as an FYI...although some physician groups do express concern over developments in the NP arena, many physicians who hold high positions in these groups do not share the same feelings about NP's. The current AMA president and the current American College of Cardiology president are staff members in my hospital. Their respective departments employ mid-level providers including NP's.

[core0]

her program was the drnp not the dnp. i understand columbia has recently or will soon switch the drnp title to dnp. she is not speaking for any national organization that i am aware of. i don't think you will find nonpf, aanp or other np organization providing support either overtly or covertly. she is representing her program and her self only.

a good analogy would be the md "dr. anthony colatonio" who is talking about a long island hospital - and of a physician assistant accused of botching invasive procedures killing 3 patients. the article was in the ny post and a while later he was on fox news saying the same thing. should we now feel that all mds have determined that pas botch invasive procedures? any review should quickly provide a better understanding, dr. colatonio is not supported by the hospital, peers or any other sane person that i could find. we need to understand the source of the discussion and respond appropriately.

except according to her she does represent dnps. she is a board member of the american board of comprehensive care which has stated they will be the certifying organization for dnps. you can find it here:

http://www.abcc.dnpcert.org./index.html

i find it kind of funny that a group can appoint themselves as the certifying body without any other input. of course its also kind of funny that they are using a test for medical students that primarily focuses on inpatient medicine to validate themselves. this is really indicative of nursing in general not having a consistent voice.

david carpenter, pa-c

[core0]

Just as an FYI...although some physician groups do express concern over developments in the NP arena, many physicians who hold high positions in these groups do not share the same feelings about NP's. The current AMA president and the current American College of Cardiology president are staff members in my hospital. Their respective departments employ mid-level providers including NP's.

They are supportive now but how supportive are they going to be when a board member of a certifying agency for NPs is saying that NPs should have all the priveleges of physician including independent practice and specialty practice. The experience of the CRNAs should show that the support can rapidly dry up when directly challenged.

David Carpenter, PA-C

[prairienp]

Except according to her she does represent DNPs. She is a board member of the American Board of Comprehensive Care which has stated they will be the certifying organization for DNPs. You can find it here:

http://www.abcc.dnpcert.org./index.html

I find it kind of funny that a group can appoint themselves as the certifying body without any other input. Of course its also kind of funny that they are using a test for medical students that primarily focuses on inpatient medicine to validate themselves. This is really indicative of nursing in general not having a consistent voice.

David Carpenter, PA-C

David, I have been to the website(the day it was released) and reviewed the board members and exam information. They are offering a new exam for DNPs, they cannot simply appoint themselves as the agency doing the DNP certification. The board members don't appear to be current leaders in the NP or DNP movement other than Columbia. I really think they will just go away as NPs become more informed.

Would you say Dr. Anthony Colatonio represents MDs at Mercy Hospital? I am quite sure you would not. There is video where Dr. Anthony Colatonio is being interviewed by a daughter of a patient who died. A TV show, looks like a New York or New Jersey cable public access channel. They feed each other on patient safety, how at risk the public is in our current system. In reality, the public show further exposed Dr. Colatonio as a self serving MD, not representing the vast majority of MDs who understand the role of PAs and NPs, or at least not misrepresenting the PA or NP role.

[core0]

David, I have been to the website(the day it was released) and reviewed the board members and exam information. They are offering a new exam for DNPs, they cannot simply appoint themselves as the agency doing the DNP certification. The board members don't appear to be current leaders in the NP or DNP movement other than Columbia. I really think they will just go away as NPs become more informed.

Would you say Dr. Anthony Colatonio represents MDs at Mercy Hospital? I am quite sure you would not. There is video where Dr. Anthony Colatonio is being interviewed by a daughter of a patient who died. A TV show, looks like a New York or New Jersey cable public access channel. They feed each other on patient safety, how at risk the public is in our current system. In reality, the public show further exposed Dr. Colatonio as a self serving MD, not representing the vast majority of MDs who understand the role of PAs and NPs, or at least not misrepresenting the PA or NP role.

I agree with you that Dr. Colatonio doesn't really represent anyone but himself. However, nobody has stated that Dr. Mundinger's group does not represent DNPs. The only comment by a NP organization (NONPF) to the WSJ article essentially affirmed her position. Given the fractitious nature of NP certification, there is no reason that the abcc will go away. Instead either the abcc will become the voice of DNPs (and with passage of time NPs) or other competing voices will develop. It really is indicative of not only the lack of a clear voice but also a lack of planning by leaders in nursing education. While its true that originally the certification came after the educational program, the fact that no NP group has done even the most basic of planning has allowed a group with a specific agenda to hijack the process.

If I considered this a competition ie between PAs and NPs I would be happy. Unfortunately the more likely outcome is that some very talented NPs will become casualties along the way.

David Carpenter, PA-C

[prairienp]

I agree with you that Dr. Colatonio doesn't really represent anyone but himself. However, nobody has stated that Dr. Mundinger's group does not represent DNPs. The only comment by a NP organization (NONPF) to the WSJ article essentially affirmed her position. Given the fractitious nature of NP certification, there is no reason that the abcc will go away. Instead either the abcc will become the voice of DNPs (and with passage of time NPs) or other competing voices will develop. It really is indicative of not only the lack of a clear voice but also a lack of planning by leaders in nursing education. While its true that originally the certification came after the educational program, the fact that no NP group has done even the most basic of planning has allowed a group with a specific agenda to hijack the process.

If I considered this a competition ie between PAs and NPs I would be happy. Unfortunately the more likely outcome is that some very talented NPs will become casualties along the way.

David Carpenter, PA-C

For example this passage isn't real supportive "Nurse practitioners aren't the same as doctors, nor do we purport that DNPs will be. Patients who see nurse practitioners will tell you the difference and express their satisfaction with nurse practitioners, who have a different approach to managing patients while using the same evidence-based standards of care used by physicians. Nurse practitioners will continue to provide person-centered, high-quality care to the patients we serve. Doctoral education will enhance our already important clinical contributions. "

Joanne Pohl, Ph.D. APRN, BC, FAAN

President

National Organization of Nurse Practitioner Faculties

Ann Arbor, Mich.

Dr. Pohl's first sentence is clear, and quite different from Dr. Mundinger's Colombia's position. To suggest a lack of planning isn't very fair, the planning may not be overt, how do you know there has been "no basic planning"? NONPF has many gifted members, nursing as a whole usually plans everything to death. The problem is often we have too many plans.

Lets continue the analogy with Dr. Colatonio. What major MD organization has said he does not represent MDs?

I am giving credit to the major MD organizations, they are considering their responses. With time outliers disappear, simply a blip that needs to be disregarded. With healthcare changing so rapidly, with Socialized medicine being discussed with increasing potential, nobody should be blackballing anybody.

[Corey Narry, MSN, RN, NP]

They are supportive now but how supportive are they going to be when a board member of a certifying agency for NPs is saying that NPs should have all the priveleges of physician including independent practice and specialty practice. The experience of the CRNAs should show that the support can rapidly dry up when directly challenged.

David Carpenter, PA-C

I see nowhere in the press releases, even the ones that quote Dr. Mundinger herself, that independent specialty care is being sought after by the DNP movement including the one ABCC is proposing. This is another way rumors are being spread out to scare physicians and confuse them on the issues. NP's in primary care have already been able to establish independent practice in some states even before the advent of the DNP. Admitting priviledges and the ability to consult specialty physicians (as the Wall Street Journal article mentions) is a primary care role. There is nothing this DNP certification business by ABCC is adding to the mix other than the fact that this new certification program is totally ignoring the other advanced practice nursing groups and does not take into account the fact that there are various NP specializations and some are not in primary care or cover all age groups.

If primary care in the FNP model is the goal of ABCC's DNP certification, then more power to them. We need more primary care providers who will go to areas where physicians refuse to be present. We need a comprehensive health care provider who will be cost effective and will do the job just as good as the physician. I challenge any physician to speak up and say that they disagree with this proposal. Many physicians where I work have said for the record that family practice can be dealt with just as well by a non-physician provider.

We NP's in acute care should not feel threatened in my opinion. We are not going to be casualties as you have mentioned. I have not come across any NP who works in an acute care setting or a specialty practice who is not part of a physician-NP collaboration model. These relationships have been established for a long time. I don't see our physician collaborators being swayed otherwise and turning against us just because of political issues like this. We care for our patients enough that fracturing that relationship is not worth it.

[LTNurse]

I don't understand the big issue about the DNP because it's the best thing I have heard in years which will add further credibility to the profession. DNP's aren't and will never be MD's but I do feel that for a profession such as NP it's important to have a Doctors degree. Many other professions such as Pharmacy adopted the Doctors degree as a requirement and it wasn't a big deal. Why does it have to be a problem for NP's? I eventually hope to get a DNP and I feel very proud to be a part of such a pioneering initiative. I read a comment at another site that DNP isn't a four year degree and it isn't if a person already has a MSN because they take it into account the years spent to complete the MSN but if starting out with a BSN it's in fact a four year degree just like medical students who go to school for four years after their BS. I'm not comparing NP's to MD's; I'm just trying to validate the degree.

There will always be people who don't agree with this degree or many other things, for example I just recently heard an MD at the break room saying that DO's get to do too much and they shouldn't because they weren't MD's. Isn't this absurd? As far as I know DO's are physicians just like MD's (again I'm not comparing MD's and DO's to NP's; I'm just trying to make a point that there are always people who will disagree). Anyways I hope you get my point.

[amzyRN]

What would happen if a NP or any other mid level did the 2 years of medical curriculum med students do? If all practitioners had that base, maybe there wouldn't be the big strife there is now. All that would be different would be the clinical rotations. Maybe NP school could do 2 years of med school curriculum and 1 year of nursing stuff, and the last year a residency.

[traumaRUs, MSN, APRN]

No offense jzzy88 but the first two years of med school are not the same type of education that that is provided to APNs. The whole concept is that advanced practice NURSES are not wanting to by PHYSICIANS. If I had wanted to be a physician, I would have gone to med school. As it is, I wanted to be a nurse, so I went to nursing school. There is no strife between nurses and physicians unless folks are looking to make trouble. Physicians and nurses do different jobs and TOGETHER they contribute to the total care of the patient.

[Corey Narry, MSN, RN, NP]

What would happen if a NP or any other mid level did the 2 years of medical curriculum med students do? If all practitioners had that base, maybe there wouldn't be the big strife there is now. All that would be different would be the clinical rotations. Maybe NP school could do 2 years of med school curriculum and 1 year of nursing stuff, and the last year a residency.

I have another idea, let's call that program medical school.