Nurses, physicians weigh in on new doctoral nurse degree

CuriousMe · Oct 14, 2009

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

wowza · Oct 16, 2009

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

lamazeteacher · Oct 16, 2009

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.

Jubilayhee · Oct 17, 2009

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.

ivanh3 · Oct 17, 2009

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.

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

lamazeteacher · Oct 17, 2009

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.

ivanh3 · Oct 17, 2009

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).

Thank you. The doctorate of nursing practice is a professional doctorate that was originally designed to augment advanced practice nurses. Or should I say clinical advanced practice nurses e.g. family nurse practitioner, pediatric NP, etc. This has changed somewhat. Now advanced practice has been expanded to also cover leadership and education. There are DNP programs for NPs, leader/admin, and educators. The idea is to have this program mandatory by the year 2015. At that point schools would offer BSN to DNP programs only, and the masters degree would be eliminated. As it stands now, most DNP programs are about 2 years (post master's), offer additional clinical time, and additional training in non clinical areas like research, etc. I am not sure what the non clinical DNP programs consist of.

So there are two areas of debate. One, do we need a DNP? There is room for debate here. I do see valid thought processes for and against a(nother) professional doctorate for nursing. As stated before, I am not for it. I file it under "duplication of services" although I am sure I am oversimplifying that. Two, there has been some grumbling by medical groups representing physicians (and I am sure some individual physicians as well) about the posibiltiy of workplace confusion regarding the title "doctor". I think it is silly to even entertain them. I am honestly not sure what physicians understand about the differences between a DNP and PhD in terms of content, but in terms of title, they should probably leave this one alone.

To me the real issue is the discussion about the essence of the DNP itself. I can't say I think it is a waste of time (any addition of knowledge is good), but does it add enough to warrant the additional barrier it raises to become a nurse practitioner? Considering the shortage of primary care providers that is only expected to get worse and the current financial state we are in I say it does not.

Ivan

lamazeteacher · Oct 17, 2009

".......To me the real issue is the discussion about the essence of the DNP itself. I can't say I think it is a waste of time (any addition of knowledge is good), but ..........does it add enough to warrant the additional barrier it raises to become a nurse practitioner? Considering the shortage of primary care providers that is only expected to get worse and the current financial state we are in I say it does not." quote from Ivan's post #234

AGREED!

As most things seem to end up being decided by the financial impact of any change, it appears that this will go that way, too. Given our President's leaning toward more accessible health care and education, it doesn't seem as far fetched as it otherwise might be, however. (Fingers crossed.)

piccnrse · Nov 22, 2011

Whether this "doctor" is pro or con DNP, here we come. I appreciate and respect genuine intelligence and competency. The physician making this statement is missing one or both of these attributes and is apparently insecure in his role. He and others like him may have an issue with trying to compete with competent healthcare providers vying for the same patient population. whatever the case, we cannot be discouraged or enraged by this type of condescension. Rather, we need to help form DNP programs to pull away from traditional nursing classes, such as, theory, family/community, and learning how to deal with patients from many nationalities. This is America, we get much of this in grade school. Cover it in the ADN program but leave it for electives if wanted in BS, MS and DNP work. We need to be putting out quality primary care providers, with focus on clinical management of disease processes - not writing papers in some theory class. We each have our own theory, let us put that theory to work in the clinical setting! Then we can better meet the demands imposed upon us with confidence, having a broad clinical background from which to draw from. Medical doctors get residency programs - DNPs get what? an in service, an orientation? No wonder we are met with such resistance maybe we have approached an area WE are not quite ready for as a whole.

Thanks for letting me vent a little.

Wayne

LPN2RN2BSN2MSN · Nov 26, 2011

If a patient were on an airplane having an acute MI then their outcome would likely be better if there were a master or doctoral prepared cardiac or ER NP to respond, as compared to having a urologist or GYN stand up and say, "I'm a DOCTOR." The roles of nurses have and will continue to expand, no matter how much the American Medical Association protests. It is an immutable fact that one cannot stop the tide from rolling up on the shore, and in the healthcare arena nurses are that tide!