discussion regarding education of NP (DNP) and PA compared to MD/DO

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You are reading page 3 of discussion regarding education of NP (DNP) and PA compared to MD/DO

To answer an earlier Question IM residency:

The IM residency that includes other specialties it is 4 years then

SO CORE0 was right on this in the sense that IM itself is 3 years but an extra year for focus can be added. This is considered a 4 year IM residency not a IM residency and a fellowship to make that clear

Prior to the advent of the DNP, NP's have already been training at the master's degree level and were already providing safe, cost-effective, and quality care to all types of patients. Primary care NP's have been able to practice with little physician involvement in rural and underserved areas of the country. There is approximately 1% of NP's who are independent but this number is likely inaccurate.

Not all master's prepared Nurses are NP's, this is part of the problem, if the admission critea was for NP's only then the DNP would be accepted a little better by Physicians

Part of the Problem I have is this:

The courses I have looked at are nursing oriented when if you expect to be primary care givers it should look like medical school

to be 100% autonomous then DNP should look like Medical school

2 years Basic Science and then at least 2 years residency to equal 4 years for this.

You are asking for autonomous practice for the DNP so you should accept that more time and study will be involved, time in the field cannot replace study and class time, if it could then there would be no reason for CME's or journals.

Nursing experience can help in a lot of ways but it does not replace medical experience, I now see that myself.

Autonomous means no Physician oversight what so ever, 1% is correct.

The fact there is currently NP's working in real life in areas of the country where Physicians are not doing a proper over sight does mean this is right and safe, there have been 100's of proactices, procedures and treatments over the last 100 years that were found to be unsafe with time.

Tylenol is one of the most dangerous drugs on the market, why is it still out there? What is practiced does not make it the right thing to do. ;)

Advanced Practice Columnist / Guide

Corey Narry, MSN, RN, NP

8 Articles; 4,362 Posts

Specializes in ACNP-BC, Adult Critical Care, Cardiology.
I feel there are two points, sure there have been states where NP's have a lot of autonomy, but where are the studies that show Care for patients has exceeded care by a Doctor? Patients satisfaction surveys are not even close to the right kind of study, we are talking about life and death here.

I want to see that the NP's are catching Diseases and properly treating and referring people, by themselves.

The Model I think is best is the Collaboration model, this is where a MD or DO is consulted on the cases, not all the routine but all the unusual and complicated. Why are so many Nurses and NP's against simple collaboration? Are not to work together? NP's are not licensed to practice Medicine.

I think that you should probably research the studies on nurse practitioner care outcomes before you post your opinions. Many regular members here have posted links to them and I know that they are not perfect studies. In fact, there will never be a perfect study because no study involving human subjects can allow a strict manipulation of variables for ethical reasons. Like you said "we are talking about life and death here".

But one thing nurses in general are aware of is the fact that health care can be a matter of life and death. Nurse practitioners no matter how independent they are in their practice, will know when things are beyond their knowledge and expertise. We did not earn the reputation of being the most trusted profession in the US for years on end for nothing. I am not a primary care NP and I am not independent in my practice either. My NP specialization deals with clinically complex critically-ill adult patients. Nothing less than an interdisciplinary team of collaborating professionals will suffice in my setting.

I invite you to take the time to talk to primary care NP's who have successfully practiced with little physician involvement and then let me know if there is anything they do that is unsafe and beyond what is expected in a primary care environment.

yes, no one here is arguing the equivalency of the dnp to a physician. the op seems to have a huge chip on his/her shoulder -- bordering on being a big ole' troll. any more passive agressiveness should lead to banning the hairy thing under the bridge.:cool:

this has been brought up in a "passive aggressive way" by people here on the site, when openly comparing md and do training to dnp and statements like md = doctorate and dnp= doctorate

as for the time it takes to do the programs... a dnp and md *are* the same amount of time (a doctoral degree is a doctoral degree is a doctoral degree)

i have read these articles, you tell me what is the real intent? i feel it is to replace md and do's in primary care and so do many other people.

the american association of colleges of nursing (aacn) is calling for the requirement of doctorate in nursing for advanced practice nurses, such as nurse practitioners, nurse midwives, clinical nurse specialists, and nurse anesthetists. this new degree will be called a doctor of nursing practice and, if the aacn has its way, will become the entry level for advanced nursing practice.

http://www.aacn.nche.edu/media/news.../dnprelease.htm

you think i have a "chip" because i question the dnp degree and the intentions of the nurse educators to make this a replacement to family practicioners, i have read the articles, i have a right as a nurse to be here and comment my take on this and question it. this is a real issue not made up by me. and at the moment i do not think dnp's should replace md and do's as primary care givers, so i want to disscuss this.

i believe calling me a troll is unprofessional. what are you afraid of?

I think that you should probably research the studies on nurse practitioner care outcomes before you post your opinions. Many regular members here have posted links to them and I know that they are not perfect studies. In fact, there will never be a perfect study because no study involving human subjects can allow a strict manipulation of variables for ethical reasons. Like you said "we are talking about life and death here".

But one thing nurses in general are aware of is the fact that health care can be a matter of life and death. Nurse practitioners no matter how independent they are in their practice, will know when things are beyond their knowledge and expertise. We did not earn the reputation of being the most trusted profession in the US for years on end for nothing. I am not a primary care NP and I am not independent in my practice either. My NP specialization deals with clinically complex critically-ill adult patients. Nothing less than an interdisciplinary team of collaborating professionals will suffice in my setting.

I invite you to take the time to talk to primary care NP's who have successfully practiced with little physician involvement and then let me know if there is anything they do that is unsafe and beyond what is expected in a primary care environment.

I have seen the research and it was based on satisfaction surveys. Wheres the Outcomes? that is what I'm talking about. It needs to be done in rural areas not in ares where the NP is backed up by MD and DO's

You earned the reputation because many MD and DO's have bad bedside manners, I have been there and seen it this past year, the loved doctors are the ones who take the extra time ( a few minutes most times) like I have learned as a Nurse to do. So I understand this,

You are talking about two different things though, the difference between perception and real life statistics in the treatment, cure and management of diseases, At the moment NP's cannot practice outside the NP cert, meaning if it is Peds then they cannot practice on Adults ( true in my state but I think this is true other states) A IM in Peds can see adults and Kids if they want there are no limitations, an Licensed MD is a Licensed MD (DO)

Public perception can be skewed

facts about outcomes should not be.

As far as unsafe, if the states laws say collaboration or oversight and this is not happing then its breaking the law and deemed out of the practice limitations and seen as unsafe.

Some of you are the NP's show me the studies or links so I can see what you are claiming.

in time I'll dig up the stuff I have read too.

We should work together not call me names and act unprofessional because I went to medical school. What happened to team work?

AN yet a new thread pops up, for those of you who say NP's are not being equated to MD/DO's

To sum it up, when APN's state that MD's and NP's are "not equivalent" I am hopeful this is only in the context of training and licensure and not practice, outcome or product-based.

In this context for anyone to claim that APN's and MD's are not equivalent, they would have to subscribe to the following system of beliefs:

1) APN's do not demonstrate the same excellence in care and practice as the physician,

2) APN's are insignificant; of lesser value and ultimately mean less to themselves, their clients, their profession and the institutions in which they are employed.

3) Clients have less than a positive outcome when treated by APN's as compared to those who are treated by physicians.

4) APN's provide primary health care services to clients in an inferior manner as compared to the physician.

5) APN's have lesser of a value than physicians.

I hope, in this context, that I will not be the only one on this board who believes APN's are equivalent to physicians.

https://allnurses.com/forums/f34/np-md-equivalency-316413.html#post2957696

Please stop posting I have a chip on my shoulder for addressing this.

Advanced Practice Columnist / Guide

Corey Narry, MSN, RN, NP

8 Articles; 4,362 Posts

Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Not all master's prepared Nurses are NP's, this is part of the problem, if the admission critea was for NP's only then the DNP would be accepted a little better by Physicians

Right on!

Part of the Problem I have is this:

The courses I have looked at are nursing oriented when if you expect to be primary care givers it should look like medical school

That's your opinion. If it looks like medical school, then shouldn't we be calling it medical school then and not a NP program? Nurse practitioner training has evolved from the nursing standpoint even though the discipline uses knowledge and concepts from other sciences including the science of medicine. It has been argued that NP programs offer very little in terms of basic medical sciences and clinical rotations compared to MD/DO programs. Very true and this battle is definietly won by physicians hands down. The question that is not answered is that how long is long enough for learning the field of primary care medicine? Again, primary care NP's with the current educational model have been able to provide safe and quality care to their patients. Because you decided to go to medical school, you have to convince yourself that all the years that you will spend training is what it takes. The FNP's who successfully provide primary care to their patients do not think so.

to be 100% autonomous then DNP should look like Medical school.

You are asking for autonomous practice for the DNP so you should accept that more time and study will be involved, time in the field cannot replace study and class time, if it could then there would be no reason for CME's or journals.

Again, you are confusing the DNP degree with other issues such as NP's in primary care. Autonomous practice in primary care already began before the DNP was even made public. And what makes you think NP's do not need CME's or read journals because we do? The next time you attend a medical conference, look around you because you may be sitting next to a NP.

Nursing experience can help in a lot of ways but it does not replace medical experience, I now see that myself.

I already know that. But I didn't go to medical school.

The fact there is currently NP's working in real life in areas of the country where Physicians are not doing a proper over sight does mean this is right and safe, there have been 100's of proactices, procedures and treatments over the last 100 years that were found to be unsafe with time.

Show me the studies and the figures to support this claim and how NP's contributed to these unsafe procedures and treatments.

ibnathan

39 Posts

I would like to see advanced nursing education changed. The first year would be devoted to clinical sciences such as bio, genetics, gross anatomy, and pharm. During the later part of first year start going through the ten systems and clinical application. Then the last 2 years full time clinical residency. Or instead of requiring a BSN make the requirement a BS in biology or biochemistry. I agree nursing does need to have more science in it's curriculum.

That's your opinion. If it looks like medical school, then shouldn't we be calling it medical school then and not a NP program?

I do not think so, PA programs are more like medical school why cannot DNP be such if they expect this autonomy? I think its a fair question.

Autonomous practice in primary care already began before the DNP was even made public. And what makes you think NP's do not need CME's or read journals because we do? The next time you attend a medical conference, look around you because you may be sitting next to a NP.
Not true/pure Autonomy in most states ( like a Physician has) I want to clarify this

Show me the studies and the figures to support this claim and how NP's contributed to these unsafe procedures and treatments.

I do not know of any good ones, at least I have not seen them, I'm asking you the NP's for them. I will try to dig up the one I did see, it was based on Patient satisfaction surveys so only annecdotal
I would like to see advanced nursing education changed. The first year would be devoted to clinical sciences such as bio, genetics, gross anatomy, and pharm. During the later part of first year start going through the ten systems and clinical application. Then the last 2 years full time clinical residency. Or instead of requiring a BSN make the requirement a BS in biology or biochemistry. I agree nursing does need to have more science in it's curriculum.

I 100% agree with this, I think when in Nursing school the nursing theory and even (Gulp) nursing care plans were needed since I was studying nursing. But some more disease oriented study would have been a good thing.

I also think Nurses should be allowed to do more disease process teaching in the Hospital, not diagnosing but teaching abut progression and possible options of care. This is done to some extent in the Teaching Hospitals but not in the small community hospitals as much. It needs to be universal.

Off topic but one thing I want to say, I ask the floor nurses for opinion and collaboration, and read the nurses notes.

One attending I was with read the nurses notes and told me most doctors do not, I agreed and said they are not doing what they should.

I have to go for while, please keep posting, I have no problem with you disagreeing with me, in fact I expect some to, I wish I had all the info in front of me, I have to study for clinicals tomorrow (IM) some review.

Maybe in time I will understand this better and in time you will understand what I and others fear.

Thanks to those of you willing to discuss this.

Specializes in ER; CCT.
We did not earn the reputation of being the most trusted profession in the US for years on end for nothing.

:yeah::yeah::yeah::yeah:

My favorite quote so far on allnurses.

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