Nurses, physicians weigh in on new doctoral nurse degree - page 18

New Degree Creates Doctor Nurses-And Confusion All Things Considered, February 22, 2009 No one wants to badmouth Florence Nightingale, but a new degree for nurses is causing bad blood between... Read More

  1. Visit  Ranier profile page
    2
    There are lots of other reasons European doctors get paid less compared to those in the US. Not only do they go to school for fewer years and have no student loans (higher education essentially free) but they also work fewer hours and have fewer overhead expenses. Most European doctors work the equivalent of a US physician's part-time schedule (35-45 hours per week) and take far more vacation (up to 12 weeks per year). They also have no personal administrative overhead since they work in an NHS and have no malpractice insurance premiums.

    If you take an average PCP's income in the US, subtract out monthly student loan payments and some kind of opportunity cost calculation for training for more years, and then subtract out the overhead and malpractice premiums, and finally cut the remaining amount by at least 1/3 (to adjust for the hours worked)... it would come darn close to being less than or equal to their European counterparts' incomes.
    dgenthusiast and wooh like this.
  2. Get the hottest topics every week!

    Subscribe to our free Nursing Insights newsletter.

  3. Visit  dgenthusiast profile page
    1
    Quote from Ranier
    There are lots of other reasons European doctors get paid less compared to those in the US. Not only do they go to school for fewer years and have no student loans (higher education essentially free) but they also work fewer hours and have fewer overhead expenses. Most European doctors work the equivalent of a US physician's part-time schedule (35-45 hours per week) and take far more vacation (up to 12 weeks per year). They also have no personal administrative overhead since they work in an NHS and have no malpractice insurance premiums.

    If you take an average PCP's income in the US, subtract out monthly student loan payments and some kind of opportunity cost calculation for training for more years, and then subtract out the overhead and malpractice premiums, and finally cut the remaining amount by at least 1/3 (to adjust for the hours worked)... it would come darn close to being less than or equal to their European counterparts' incomes.


    I see a lot of people saying that DNPs have "earned" the right to be called doctors. The question really comes down to whether or not the DNP curricula offers enough to warrant being a doctorate degree. To be honest, the DNP curricula has a significant amount of courses that are pretty useless clinically and it seems relatively easier to obtain than any other doctoral degrees (ie. it takes years to get a PhD, an intense several years for an MD/DO, etc.).

    No one's telling you that you cannot have a doctoral degree. If you really do want to be called a doctor in a clinical setting, however, the least you could do is develop a decent curriculum that's at least somewhat standardized (which it is currently not at all), etc. So really, instead of assuming I'm just attacking DNPs because I'm a nurse-hater or something, take a look at the curricula and honestly ask yourselves, is that worth a doctorate degree or is it really just a glorified MPH?
    wowza likes this.
  4. Visit  cruisin_woodward profile page
    1
    Contrary to popular belief, the purpose of the DNP is NOT to make "mini Docs". We are NURSES. We are trained from a nursing model, NOT a MEDICAL model. We focus on caring for the pt, family, and community. We look at pt's spiritual, and mental well being, not just their disease.

    The Doctor of Nursing Practice (DNP) was recommended by the American Colleges of Nursing (AACN) in 2004 in an attempt to further the profession of nursing, address the need for advanced practice, form a link between research and clinical practice, and to educate future clinical leaders (Loomis, Willard & Cohen, 2007). The DNP encompasses nursing theory and research and brings evidence based practice to the bedside. The advanced degree offers more education in order to improve patient outcomes.
    Nelson, (2002) indicates that nursing has been historically perceived as a technical trade rather than a respected profession. She suggests that this view is owed to the lack of educational qualifications. Many other health related fields require a doctorate for entry level; these include audiology, chiropractic, psychology, pharmacy, optometry, podiatry, as well as medicine and osteopathic medicine, and many more. It is logical then, that in order to command the same level of respect, APRNs should have the same level of academia, advanced training and knowledge.

    Critics of the DNP argue that there is too much research and theory, and not enough of a clinical focus. The DNP encompasses specific clinical specialty areas, and prepares students for certification in that specialty. It also offers more clinical hours in the form of the clinical inquiry project, where the focus is on a particular area of interest for the doctoral candidate. According to the American Association of Colleges of Nursing, (2004) higher levels of nursing education have been shown to improve patient outcomes. Another criticism is that there are already several nursing doctorates, so there is no need for another. the DNP will focus on implementing research into every day practice, whereas the PhD and DNS are research intensive. In other words, the DNP will be educated to evaluate research, and put it into practice. With higher education, comes better critical thinking skills, and clinical judgment, thus leading to improved patient outcomes.

    The DNP program IS being regulated. The AACN has implemented criteria that must be met by the schools, and in order for a BSN to DNP graduate to sit for certification, that program MUST be accredited. The program is 4 years...plus 4 years of undergrad...so, it's 8 years all together, I'm really not certain why people feel that this is not enough time? I understand the need for more clinical time, and I agree that it should be offered. HOWEVER, shouldn't we also consider the clinical hours put in as a nursing student and an RN? Obviously, it is NOT the same, but PA's and physician's keep claiming that we do not get enough clinical hours, I think those hours do count for something. If I've been a critical care nurse for 6 years, and I go on to be an ACNP in the ICU, then I think those hours count quite a bit!!


    As far as the right to be called "Doctor", I think that argument has been so well covered, that I think it is a waste of time to continuously say the same thing. Personally, I don't care what I'm called. I just want respect for what I have earned. So far school has been very tough, and after I finish, I know that I will have earned the right to be called, "Doctor". Whether or not I am is not my concern at this point. I think patients are pretty smart, and if they are properly introduced to the nurse practitioner, then they will understand their roles. I also think that if there was a pathologist and a DNP standing next to each other, and the patient coded, they'd be much happier to have the DNP run the code than the pathologist....
    wooh likes this.
  5. Visit  dgenthusiast profile page
    0
    Quote from dnpstudent
    contrary to popular belief, the purpose of the dnp is not to make "mini docs". we are nurses. we are trained from a nursing model, not a medical model. we focus on caring for the pt, family, and community. we look at pt's spiritual, and mental well being, not just their disease.

    the doctor of nursing practice (dnp) was recommended by the american colleges of nursing (aacn) in 2004 in an attempt to further the profession of nursing, address the need for advanced practice, form a link between research and clinical practice, and to educate future clinical leaders (loomis, willard & cohen, 2007). the dnp encompasses nursing theory and research and brings evidence based practice to the bedside. the advanced degree offers more education in order to improve patient outcomes.
    nelson, (2002) indicates that nursing has been historically perceived as a technical trade rather than a respected profession. she suggests that this view is owed to the lack of educational qualifications. many other health related fields require a doctorate for entry level; these include audiology, chiropractic, psychology, pharmacy, optometry, podiatry, as well as medicine and osteopathic medicine, and many more. it is logical then, that in order to command the same level of respect, aprns should have the same level of academia, advanced training and knowledge.

    critics of the dnp argue that there is too much research and theory, and not enough of a clinical focus. the dnp encompasses specific clinical specialty areas, and prepares students for certification in that specialty. it also offers more clinical hours in the form of the clinical inquiry project, where the focus is on a particular area of interest for the doctoral candidate. according to the american association of colleges of nursing, (2004) higher levels of nursing education have been shown to improve patient outcomes. another criticism is that there are already several nursing doctorates, so there is no need for another. the dnp will focus on implementing research into every day practice, whereas the phd and dns are research intensive. in other words, the dnp will be educated to evaluate research, and put it into practice. with higher education, comes better critical thinking skills, and clinical judgment, thus leading to improved patient outcomes.

    the dnp program is being regulated. the aacn has implemented criteria that must be met by the schools, and in order for a bsn to dnp graduate to sit for certification, that program must be accredited. the program is 4 years...plus 4 years of undergrad...so, it's 8 years all together, i'm really not certain why people feel that this is not enough time? i understand the need for more clinical time, and i agree that it should be offered. however, shouldn't we also consider the clinical hours put in as a nursing student and an rn? obviously, it is not the same, but pa's and physician's keep claiming that we do not get enough clinical hours, i think those hours do count for something. if i've been a critical care nurse for 6 years, and i go on to be an acnp in the icu, then i think those hours count quite a bit!!


    as far as the right to be called "doctor", i think that argument has been so well covered, that i think it is a waste of time to continuously say the same thing. personally, i don't care what i'm called. i just want respect for what i have earned. so far school has been very tough, and after i finish, i know that i will have earned the right to be called, "doctor". whether or not i am is not my concern at this point. i think patients are pretty smart, and if they are properly introduced to the nurse practitioner, then they will understand their roles. i also think that if there was a pathologist and a dnp standing next to each other, and the patient coded, they'd be much happier to have the dnp run the code than the pathologist....
    thanks for the response.

    i really don't understand how nps/dnps can get away with practicing medicine under the guile of nursing. it seems like every np/dnp on this board fighting for independent rights says that they do the same things as a doctor and then, go on to say that they practice advanced nursing, not medicine. maybe someone can clear up exactly why nps/dnps are under the bon rather than the bom when they're practicing medicine? is it because you take a bunch of nursing theory and nurse activism courses?

    also, it doesn't take 4 years to get a dnp, especially as a stand-alone. maybe some programs that are part-time or something might be that long. however, there are many programs that are much shorter than that including several direct-entry programs that require no prior healthcare experience at all. here's an example from duke: http://nursing.duke.edu/wysiwyg/down...t_mat_plan.pdf. it's a bsn-dnp program. also, i understand that dnps want to implement research into everyday practice, but do you really need 5 or 6 courses (which make up a significant portion of the dnp curricula) in order to simply understand how to evaluate studies and apply them? a basic understanding of statistics, epi, etc. is all that's needed. so the argument that the dnp is too research focused does seem relevant here: what's the point of so many research-related courses if you're not going to do research?

    regarding prior nursing experience, sure it helps. but it's not a replacement for medical clinical hours. there's a difference in thinking between practicing nursing and practicing medicine and as far as i know, you are not taught to think like a doctor in nursing school. so, yea, while i agree that prior nursing experience will help, i stand by my statement (and a lot of people, both in the nursing and medical communities, seem to agree with it) that it's not a replacement for clinical hours practicing medicine.

    and about your example regarding a dnp being better at coding a patient than a pathologist, i hope you realize that coding is just following an algorithm; there's not much thinking needed there. if both the pathologist and the dnp follow the algorithm, the outcome will very likely be the same.
  6. Visit  CASTLEGATES profile page
    0
    This is AWESOME! In real countries nursing was one step closer to being a doc. Now it's a reality! We're that much closer should we choose it! No more going off to separate schooling; we just continue on!

    Yesssssssssssssssss!
  7. Visit  elkpark profile page
    2
    Quote from CASTLEGATES
    This is AWESOME! In real countries nursing was one step closer to being a doc. Now it's a reality! We're that much closer should we choose it! No more going off to separate schooling; we just continue on!

    Yesssssssssssssssss!
    I'm not sure what you mean -- nursing and medicine are separate, distinct disciplines. If an NP chooses to go to medical school, there are no shortcuts or exceptions made for them, even those with DNP degrees. They start from scratch, just like everyone else. People with DNPs are still NPs, not physicians.
    lamazeteacher and BBFRN like this.
  8. Visit  CuriousMe profile page
    1
    Quote from silas2642
    Are you kidding me? I get confused as to the roles of who is the physician and who isn't in the hospital, and I'm a med student. <snip<"
    Really???? I'm not sure I would go around saying that so proudly. Are you really saying that you don't know what the folks that work around you do?

    I'm a second year nursing student, and I can't think of a clinical experience where I didn't know who was in the room with me. I might not have remembered their name, but I knew their role.

    Maybe it's just my school, but it's really stressed to us that we are part of a health care team. How do you work on a team if you don't know who's in what role?

    Just my .02
    lamazeteacher likes this.
  9. Visit  CuriousMe profile page
    2
    Quote from silas2642
    Not a lost med student-- I know the confusion of the role of nurses, NP's, PA's, physicians, CNA's, and cafeteria workers because I've been there. When you have a chronically ill grandfather who you spend day after day in the hospital holding his hand, a chronically ill sister who you spend night after night in the hospital watching after, and a mother with breast cancer looking after, you get familiar with hospitals. From the family's perspective, from a patient's perspective, the faces start to merge together. People start to look like bodies in scrubs and white coats. I once got my grandfather's hospitalist mixed up with the cafeteria worker who was handing out menus because he was dressed up in a white coat and had a beard. When you're tired, have been sitting around all day staring at the walls and each other you get confused.

    And not everyone gets what you're talking about, even after the almighty compassionate nurse has explained it when the big, bad physician has left the room. This has happened countless times with my grandfather. I understand the roles of nurses-- when a nurse does his/her job right, there is nothing better in the world. However, there is nothing worse in the world than a bad nurse.

    You want me to call a nurse with a doctorate degree, "doctor?" Fine. Then you guys need to clean up that DNP degree and actually make it worth something, as another poster mentioned. What are all these classes in nursing theory and leadership? How does that make you a more efficient and better clinician? How is that going to help you understand the pathophysiology of the diseases that you're diagnosing better?
    Uhhmm....this is starting to sound like a recurring issue for you, I wish you luck with it. Do you know know who folks are, that you've been involved with, outside of the hospital as well? Or is this a selective limitation?

    Honestly, I've sat with my Mom as she fought cancer for over 10 years before she passed away. I, pretty literally, grew up in hospitals. My Mom always knew who her oncologist was, who the physician on duty was, who her nurses and nurses aids were, who her PT was, etc....and once I was a teenager or so, so did I. And to the best of my knowledge, I've never confused a someone who works in the cafeteria with a healthcare professional, or vice versa.

    I'm gonna just give you a pass on the good nurse/bad nurse comment. It's to easy to get into a good physician/bad physician comment and what happens at either end of that spectrum.

    I say all this only to say, it's really not that hard
    wooh and BBFRN like this.
  10. Visit  wowza profile page
    0
    I have to agree with the silas quote that CuriousMe posted.

    If the DNP really wants to be a doctorate, it should start by improving the curriculum to resemble a clinical doctorate. As it stands now it more closely resembles a Masters of Public Health with some clinical courses thrown in. Furthermore, if they really want to do what they say, they will be practicing medicine and should fall under the BOM rather than the fractionation that is the BON
  11. Visit  lamazeteacher profile page
    0
    Quote from curiousme
    really???? i'm not sure i would go around saying that so proudly. are you really saying that you don't know what the folks that work around you do?

    that sounds like the typical teaching hospital's dilemma. if it would help, perhaps lab coats in different colors could be instituted, as name tags are usually unreadable, due to the casual nature with which they're worn (even near the crotch, which i find separates the professionals from the nonprofessionals - hint, hint). if it's near the collar, the picture on it can be compared with the face wearing it, which accomplishes the goal of picture id.

    in smaller hospitals, after someone's been working in one location at least 6 months, it's expected that they'll know with whom they work. in teaching hospitals where there's a constantly revolving cast of characters, not so.

    i'm a second year nursing student, and i can't think of a clinical experience where i didn't know who was in the room with me. i might not have remembered their name, but i knew their role.

    how? that may have been a smaller setting than the average large university based teaching hospital. if you got most of your clinical experience on the same unit, that would be a reasonable expectation.

    maybe it's just my school, but it's really stressed to us that we are part of a health care team. how do you work on a team if you don't know who's in what role? exactly! you have to stay on a job for some time, before that's possible; and everyone needs to be on the same page with their roles, especially when a patient decompensates.

    just my .02
    your school sounds right on goal! it's why educations obtained in smaller communities can be better than those wherein you're just another face in a crowd. of course there's something to be said about the experience one gets in large city institutions, where experience with rare conditions can be attained. then you can go back to a smaller place as a larger "fish in a small pool", or you can stay a small "fish in a large pool". there's a lot to be said about each environment.

    as far as the dnp situation is concerned, i find it typical of physicians' personalities, that those who criticize nurses who go for their doctoral degree, think they have sole ownership and the right to determine the veracity of others claiming the prefix of dr. until nurses climbed to that top limb of their profession's figurative tree, medical doctors were the only ones who could get seated at restaurants sooner when they misuse that title.

    it used to bother me when someone said, "you're too bright to be a nurse, why haven't you gone to medical school?" i usually say, "because i don't want more money, i gain satisfaction in my work as a nurse". actually, for most of my life, in my generation i expected to have a husband whose ego would be more intact because he'd be the major earner. well, beware of what you wish.......

    the fact today and any day, is that maximum learning needs to be recognized, which is why doctoral programs originated - but those programs weren't in nursing until recently. while doctors of psychology have their issues with psychiatrists, most doctoral degrees don't take issue with each other. does the dr. of poetry bemoan the dr. of history's right to have that honor?

    well, once nurses had the interest and financial capability (access to funding) to further their academic achievements, the traditional "doctor's handmaiden" image of nurses started to crumble. it had been different than that for a longer time, but it just didn't show to the average well person. hierarchy in nursing meant to those outside the profession, that you were a "head nurse", or even earlier, a "private duty nurse". most people realize that the more initials that follow a professional's name, the more educated they are, but seldom are those degrees recognized in the workplace.

    i've had a string of "alphabet soup" after my name, which enabled me to teach prenatal classes, counsel breastfeeding mothers, and get jobs wherein those skills were utilized and my education recognized. self appreciation is my key to satisfaction in my work, and it is through following the principles of nursing that i've been taught and work best, that i can serve people best. if having a doctorate is necessary, i'll be thankful that my career happened before that was necessary. physical therapists' requisite for their work, is heading in that direction. to me that implies that they'll be less top heavy, and that's necessary for the actual work to get done.
    Last edit by lamazeteacher on Oct 16, '09 : Reason: addition, clarification
  12. Visit  Jubilayhee profile page
    0
    If this DNP thing takes off I feel bad for the regular NP's. All the jobs will say DNP prefered, much like they do with BSN's today.
  13. Visit  ivanh3 profile page
    1
    Quote from curiousme
    i'm a second year nursing student, and i can't think of a clinical experience where i didn't know who was in the room with me. i might not have remembered their name, but i knew their role.
    i can think of plenty. it has been lamented by both staff and patients that sometimes it is hard to tell who is who. some hospitals require that various staff types wear certain color scrubs for example. i have had plenty of patients tell me in the icu that as specialists (and their staff) come and go, the patients often don't know who is who. on more than one occasion i have had people come up to me, start asking me questions about a patient, and my reply has been, "can i ask who you are?". i do so with tact and without sarcasm, because in some hospitals it is that busy. i have also been a patient, and a family member of a patient, and no, i can't honestly say i knew the title of everyone that came in the room. so just because you as a second year nursing student haven't experienced it, doesn't mean others haven't. that little tidbit applies to many areas of nursing, and its yours for free.

    Quote from lamazeteacher
    as far as the dnp situation is concerned, i find it typical of physicians' personalities, that those who criticize nurses who go for their doctoral degree, think they have sole ownership and the right to determine the veracity of others claiming the prefix of dr. until nurses climbed to that top limb of their profession's figurative tree, medical doctors were the only ones who could get seated at restaurants sooner when they misuse that title.
    i think that we must be careful about these over generalized statements that do nothing to decrease the adversarial aspect of the nurse-physician relationship. my question would be exactly how many physicians have been heard criticizing an actual rn for obtaining a doctorate? it must be high if it is behavior deemed "typical". i have worked around literally hundreds and hundreds of physicians, and i can't say the topic has even come up, much less hear one of them criticize an rn for getting their doctorate. i am not saying that this type of criticism doesn't occur. i am sure it does, but i wonder about the "typical" declaration.

    anecdotally, i have worked in three situations where there was a doctorate-prepared rn (phd in all three cases). in two of the cases, the rn/phds were in mid level management positions with direct oversight of clinical areas. they were both referred to as "doctor", and there were never any issues or grief from anyone, including physicians. the third case was an rn/phd who was the chief nursing officer for the hospital. she was referred to as "doctor". again, this individual was treated with respect by the staff including physicians.

    personally, i am still deciding about the dnp. we already have a respected terminal degree with a rigorous curriculum: the phd. i want to know if the dnp will bring anything new to the table. in terms of advanced practice, we have the msn. i would like to see the advanced practice master's degree beefed up some more clinically. that could mean less classes regarding theory or even business as it relates to owning a practice. i am not saying these are not important classes, but one, i don't feel they belong at the expense of other more relevant training and education, and two, they can be obtained by other means. for example, an np can always go back for post graduate training in research and business. only about 2-4 percent of nps own their practice anyway. a new grad np really should be focusing on honing their skills. later, if one want to go into business on their own, great. seek out the appropriate training and charge forward! the point is, there are post grad opportunities for learning about research and business.

    in terms of title and who should be called "doctor". that is easy. once again, the answer is anyone who has earned a doctorate. if that is problem for some physicians (i doubt the numbers would be high enough to be categorized as "typical"), i am sure they will get over it. the burden really is on those who have a problem with it, while the rest of us move on to other (extremely) more important issues like health care reform, h1n1, deaths from nosocomial infections, etc.

    however, i do think there is some debate whether certain doctorates live up to the standards of a doctorate. is there valuable training in the dnp? i am sure the answer is yes. is any of this training duplicated elsewhere? again, i am sure the answer is yes. is the dnp a clinical degree? no. the dnp is a "practice" degree. the meaning of practice has now been expanded to cover leadership and educational roles. as well it should. can a phd expand clinical knowledge? most assuredly and vigorously i say yes.
    some the most important contributions by the phd prepared rn affect clinical practice.

    ivan
    Last edit by ivanh3 on Nov 22, '11
    lamazeteacher likes this.
  14. Visit  lamazeteacher profile page
    1
    Ivan, I would have put dozens more thanks/kudos there, if that was permitted!

    You've just updated a seriously "out of the academic loop" septagenarian...... Now I realize why this thread happened. Before, I thought it was a doctoral degree like any other, but now through your post, I realise that this is a 2nd one foir the same profession -

    So the actual problem with acceptance of the DNP, refers to curricula of that v PhD in Nursing, eh? (Had to get my Canadian in.) MDs don't usually (I won't say typically any more) have any idea what the curriculum has been for any advanced degrees for nurses. They just don't want us passing them in knowledge, possibly (if they have an itch about the DNP).

    However, the age-old "I'm a better nurse than you are", seems to be sneaking its insidious self into higher academia, a throw back to way back when most nurses were RNs with 3 years of education at a hospital school of nursing, and resented the heck out of smart alecky university educated BScNs, who had much less bedside experience........

    It must be nurses like yourself, who work, study, and play in big time universities who really know enough about the courses of study, to state an informed preference. I didn't, so I'll say sorry, and back out with, I hope some dignity intact.

    I will say that making the top degree more inscrutable doesn't enhance communication with other disciplines, though.
    Last edit by lamazeteacher on Oct 17, '09 : Reason: KISS
    ivanh3 likes this.


Nursing Jobs in every specialty and state. Visit today and find your dream job.

Top