[markdanurse]

Originally Posted by FNP/DNP

I have to disagree with you. I have my DNP and have been a practicing FNP for 6 years. The full time NP's where I work make 100,000 per year. I am quite certain that my doctorate has advanced me professionally in terms of salary and aquiring NP positions. The DNP is not intended for NP's to have independent practice. That is a state legislated issue. The DNP is to recognize that Master's level programs are inadequate to prepare one to practice at a novice level once graduating from the NP program. I felt very confident when I graduated that I was competent and ready for a busy practice. The clinical doctorate brings credibility to our profession, and don't kid yourself into thinking it isn't necessary. It isn't easy being a nurse practitioner, it is a constant fight and the more credentials we have and the more competent we are, the more we will be respected by our physician colleagues.

Finally, someone who thinks a doctorate degree in nursing is a necessity. Masters' level programs are inadequate? Really? Then why are there so many NP's with masters degrees that are doing just fine in the clinical arena? You need a doctorate degree to properly prepare an NP? I have a better idea...take out all of the advanced nursing theory fluff from the NP programs, and put in its place more clinical hours at the master's degree level. Yes, you and I both know nursing leadership is trying to create another breed of healthcare provider that is INDEPENDENT...first MD, then DO, now NP. And the best way to do that is to make the NP a doctoral degree. Then comes the almighty one-liner: "...the more credentials we have and the more competent we are, the more we will be respected by our physician colleagues." Here is another misnomer...if we have a doctorate degree being a nurse, maybe the physicians will finally respect us." Nope. Not as long as you have the word "nurse" in your title. I have spoken to many ER physicians I currently work with, and many of them laugh at the thought "Doctor Nurse". Many have asked, "Why bother?" Most have asked, "Why not just go to medical school?" Seriously, you got your BSN, then a 4 year doctoral degree to be an NP...why not just go to medical school? It's like saying having a PharmD is necessary to be a Pharmacist, or a DPT to be a Physical Therapist, or an Aud.D. to be an audiologist. Does it really take a doctoral degree to dispense medications all day? Or to exercise a patient and formulate a care plan? Or to test a person's hearing and fit him or her for hearing aids? Answer: No. Please...all of these professions have managed to get caught up in the degree-hype game. Apparently, so have you. Doctors do not look at DrNP's, DPT's, and PharmD's as their peers and you know that. More education IS better...more money for universities, more money for college professors, more money for student loan companies. On the academic level, we have confused MORE with BETTER. Just look at the 100 richest people in America...over a third of them are college dropouts. HMMM...how could this happen? They don't have MBA's? Thus, they can't possibly be good in business, can they? NP's were created to assist physicians, not compete with them. Let's keep it that way. If you want to be so independent, try being a physician, NOT an NP.

[platon20]

I agree with markdanurse.

Look guys the bottom line is there is a whole helluva lot of degree inflation going on here.

It started with doctors. They decided that they wanted to elevate their degree to doctoral level so they could look good to the public.

Next up? Pharmacists. Just like doctors, pharmacists decided that they would look more "important" in the eyes of the public if they ramped up to a doctoral degree program. It wasnt always that way, and there's very little evidence to show that doctoral educated pharmacists are better than bachelors.

Then we have the physical therapists. Just like doctors, just like pharmacists, PTs also decieed that they too wanted the doctoral degree so they could call themselves "doctor" and look good to the public.

As if on cue, the optometrists decided that they too wanted a doctoral degree.

Now, nurses all of a sudden want to do the same thing. Get real. There is very little substance and a lot of hype to this plan. This is nothing more than a superficial "feelgood" measure thats totally unnecessary.

Everybody and their brother now wants the "doctoral" degree program. It has NOTHING to do with clinical outcomes and EVERYTHING to do with wanting to elevate your status in society.

Stop the insanity already. Next thing you know, doctors will add a new degree program called the "super duper doctoral degree" thats 20 years long. Next thing you know, pharmacists, physical therapists, optometrists will want to do the same thing. This is all a bunch of crap based on insecurity and nothing more.

[sirI]

It has NOTHING to do with clinical outcomes

Illogical statement and grossly inaccurate as well.

[platon20]

Originally Posted by siri

Illogical statement and grossly inaccurate as well.

Sorry you are wrong. There is no evidence that longer training leads to better clinical outcomes.

Take for example CRNAs vs MDAs and NPs vs MDs

IN both cases, the nurses have substantially less training than the doctors, yet studies have proven over and over again that clinical outcomes are IDENTICAL.

This is a publicity move, pure and simple. NPs are ALREADY JUST AS GOOD AS DOCTORS. Adding more training time wont result in any changes to outcomes.

[sirI]

platon20, you are definitely allowed your opinion.

[SharonH, RN]

Originally Posted by platon20

I agree with markdanurse.

Look guys the bottom line is there is a whole helluva lot of degree inflation going on here.

It started with doctors. They decided that they wanted to elevate their degree to doctoral level so they could look good to the public.

Next up? Pharmacists. Just like doctors, pharmacists decided that they would look more "important" in the eyes of the public if they ramped up to a doctoral degree program. It wasnt always that way, and there's very little evidence to show that doctoral educated pharmacists are better than bachelors.

Then we have the physical therapists. Just like doctors, just like pharmacists, PTs also decieed that they too wanted the doctoral degree so they could call themselves "doctor" and look good to the public.

As if on cue, the optometrists decided that they too wanted a doctoral degree.

Now, nurses all of a sudden want to do the same thing. Get real. There is very little substance and a lot of hype to this plan. This is nothing more than a superficial "feelgood" measure thats totally unnecessary.

Everybody and their brother now wants the "doctoral" degree program. It has NOTHING to do with clinical outcomes and EVERYTHING to do with wanting to elevate your status in society.

Stop the insanity already. Next thing you know, doctors will add a new degree program called the "super duper doctoral degree" thats 20 years long. Next thing you know, pharmacists, physical therapists, optometrists will want to do the same thing. This is all a bunch of crap based on insecurity and nothing more.

Is it possible that over the years, as healthcare has advanced both technologically and in body of knowledge that more education is needed to be proficient in this field? I certainly think so and that is a valid reason to offer advanced degrees.

[markdanurse]

Originally Posted by SharonH, RN

Is it possible that over the years, as healthcare has advanced both technologically and in body of knowledge that more education is needed to be proficient in this field? I certainly think so and that is a valid reason to offer advanced degrees.

Okay Sharon, I'll bite here. Yes, IF NP's were able to do absolutely EVERYTHING that their MD counterparts can do, and this includes major surgeries, admitting patients to hospitals and overseeing the ENTIRE care process, and FULL prescriptive abilities in EVERY state in the U.S. without physician collaboration, then YES, the doctoral degree in nursing practice might prove useful. But as it is, the NP role was not created to replace physicians, right? NP's do handle complex cases...on occasion. But you and I both know that the truly complex cases go to the physician. Is the DrNP going to change that role? Will the DrNP give NP's the right to do everything that MD's do? My bet is that YES, one day this may happen, because that is what the nursing leaders who have proposed the DrNP want. These leaders deny this, but we both know this is the case. But as is the case right now, NP's do not have unlimited scope of practice. The AMA will also make sure of this fact too, regardless of the NP being doctorally prepared.

Do you truly believe healthcare has developed so technologically and its body of knowledge has become so advanced that to simply put an exercise regimen together for a post-op patient, and to show the patient how to perform the exercises requires a doctorally prepared P.T.? Do you really believe it takes a doctorally prepared audiologist to test a person's hearing and fit him or her for an appropriate hearing aid? Do you believe it takes a doctoral degree to dispense medications or even perform a drug review on a patient? Does it really take a doctoral degree to test a patient's vision and prescribe contact lenses and eyeglasses? Look at education versus scope of practice. These professions have a VERY limited scope of practice, unlike the physician. The physician requires a doctoral degree because he or she encounters an onslaught of medical problems. Physicians really MUST know pharmacology, advanced pathophysiology, minor and major surgical interventions, advanced anatomy and physiology, and so much more. THEY order the medications, the hearing exams, the physical therapy, etc...Not the practitioners that are supposed to be carrying out the physician's orders. So you may then argue that NP's do all that too. The answer is yes, they do, but to a limit. When things get too complicated, the NP appropriately sends the patient to the physician to seek higher level care. If the NP is NOT going to replace the MD, or at least compete with the MD/DO phenomenon, then the scope of practice remains limited, and a doctoral degree remains overkill. Thus, I cannot support the NP moving to a doctoral degree...UNLESS that doctoral degree meant NP's obtaining the SAME privileges as their MD counterparts.

Thus, I respectfully disagree with your quoted statement listed above. I think the degree creep these professions have been exhibiting is ABSURD based on the very limitations of their scope of practice. It seems like EVERY healthcare profession is going to the doctoral degree, and doing so unecessarily. The next thing you know, the requirement for radiology techs to obtain licensure will be at the master's level, and the minimal requirement for a janitor will be a bachelor of science in environmental services. Don't laugh...with the way things are going, this may one day be a reality. To me, it's the equivalent of requiring a bachelor's degree in computer science to do the job of a cashier at the local grocery store!

[SharonH, RN]

Originally Posted by markdanurse

Do you truly believe healthcare has developed so technologically and its body of knowledge has become so advanced that to simply put an exercise regimen together for a post-op patient, and to show the patient how to perform the exercises requires a doctorally prepared P.T.? Do you really believe it takes a doctorally prepared audiologist to test a person's hearing and fit him or her for an appropriate hearing aid? Do you believe it takes a doctoral degree to dispense medications or even perform a drug review on a patient? Does it really take a doctoral degree to test a patient's vision and prescribe contact lenses and eyeglasses? Look at education versus scope of practice. These professions have a VERY limited scope of practice, unlike the physician. The physician requires a doctoral degree because he or she encounters an onslaught of medical problems. Physicians really MUST know pharmacology, advanced pathophysiology, minor and major surgical interventions, advanced anatomy and physiology, and so much more. THEY order the medications, the hearing exams, the physical therapy, etc...Not the practitioners that are supposed to be carrying out the physician's orders.

I don't know a lot about audiologists and optometrists so I will not comment on their preparation but I am flabbergasted that you think that all PTs do is put an exercise regimen together and train the patient to do them. Likewise, do you really believe that pharmacists only dispense meds and perform a drug review? You do realize both jobs require not only skills which apparently you do not see in your experience, but they also require a knowledge base to perform those tasks that you may not understand. You say that the physicians are the ones who order the PT, meds, etc and that they are the practitioners carrying out the orders. In my experience, pharmacists and PTs are often consulted as to the appropriate therapy for XYZ situation, etc. I equate your oversimplification of the scope of practice of PTs and pharmacists to someone saying that nurses don't need a degree because all they do is pass meds and put people on bedpans.

Originally Posted by markdanurse

So you may then argue that NP's do all that too. The answer is yes, they do, but to a limit. When things get too complicated, the NP appropriately sends the patient to the physician to seek higher level care. If the NP is NOT going to replace the MD, or at least compete with the MD/DO phenomenon, then the scope of practice remains limited, and a doctoral degree remains overkill. Thus, I cannot support the NP moving to a doctoral degree...UNLESS that doctoral degree meant NP's obtaining the SAME privileges as their MD counterparts.

There are other reasons for the doctoral degree. It has been pointed out that the amount of time spent for a master's degree is almost equivalent to the time one would spend for a doctorate in other programs. There has been derision from some quarters(mostly medicine) about the inadequate amount of time spent preparing NPs. And who said that the NP is not to compete with the MD? In some markets they are and rightly so. Why shouldn't the healthcare consumer have a choice?

[platon20]

Originally Posted by SharonH, RN

And who said that the NP is not to compete with the MD? In some markets they are and rightly so.

Yes NPs can compete with MDs, but not on all levels. NPs cant do surgeries yet, for example. Mark is talking about competition at ALL LEVELS, not just primary care. Mark is talking about NPs being replacement surgeons, neurologists, endocrinologists, neonatologists, the whole gamut. And you are delusional if you think NPs compete against doc at all levels. Sure, we compete for primary care, but you wont find any NPs running their own surgeries yet.

How many NPs run the medicine department at hospitals? How many NPs serve on boards at hospitals? How many NPs serve as department chair of radiology? Until NPs infliltate those levels, you cant argue that we are in full competition with MDs.

Why shouldn't the healthcare consumer have a choice?

If thats your logic, we should just allow anybody off the street to advertise their services as doctors. EVen if they only had some paramedic training. Let the public decide if that person is good enough to be a doc.

BTW, you dont really believe your own logic there. You use the title RN in your handle. What if I proposed a new training model for RNs, where we took highschool students off the street and have them skip college and go thru a special advanced track where they got nursing training for 2 years and get the RN title. Do you think thats OK? And if not, why not? Dont you think the public should have a choice of which RN provider they want?

[HeartsOpenWide]

This is only going to apply to those that do not become FNP, CNM ect byt 2015 right? Every one else will be "Granfathered" in? For Gods sake. I work for two of the best FNP's in my area and neither of them even have their BSNs!