Medicine decries nurse doctorate exam being touted as equal to physician testing - page 2
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Jun 10, '09Seems that there are nurses out there with some sort of inferiority complex regarding MD's... I've seen this before in the move among some in nursing to abolish the 2-year RN programs. One proponent put forth the notion that MD's "will respect us more if we all have higher degrees." What a crock of nonsense. It's apples and oranges. MD's do what they do and we do what we do, and any MD worth his/her title knows that nurses save their butts over and over again by pointing out errors and oversights that they can then correct before anybody gets hurt. I enjoy working with most MD's and have only rarely felt any disdain due to my status as an RN, and that only from docs that were well-known a-holes.
I worked as a TV reporter and university instructor, among other things, before I got into nursing and the nursing mania for collecting little titles to put after the RN exists nowhere else in the professional world that I have ever seen. I still don't get it after a decade.
I think we need nurses to be nurses and take direct care of patients. I think most docs would agree that the hospital would collapse in ruin far faster if the nurses stayed away than if the docs did, but we need both equally. Neither can do the work of the other and if someone wants to try they should switch professions.
Jun 10, '09I'm all for more education, and how cool would it be to have "equal" knowledge to a physician, but until I graduate from medical school and pass medical boards I will NOT be a physician (oops, didn't mean to dis any osteopaths, just using 'medical' as an example).
If people want a DNP, that's fine, but that doesn't make them doctors, and I don't think it should be mandated that to be an advanced practice nurse you must have a DNP. I will be starting CRNA school soon, and there is talk of requiring a DNP-type degree for that. However, from talking with other CRNA (who are more in the political/educational loop than I am), the move to make it a DNP required is not coming from within the CRNA communittee, it's coming from other nursing regulatory groups. Also, unless the CRNA-DNP curriculum has some way more in depth science/anesthesia/pharm/longer clinical training/residency in it, it seems like a waste. If it's just to write more papers or something, what's the point? CRNAs, CNSs, NPs have been delivering high quality, safe, care for a long time. What is expected to change with a requirement of DNP???
Okay, I'm done complaining But to sum up, medical/osteopathic doctors study/train/work hard to earn those degrees and board certifications. Until a nursing program matches or exceeds that you cannot say the two professions are equal. And might I point out that if a nursing program had education and experiences equal to medical school well, um, I think we'd call that a medical school. . . :uhoh21:
Jun 10, '09Quote from Rick2323Ever spend time working EMS? Hey, I have no problem with people putting initials after their name. Smoke em if you got em IMHO. However, I do not feel this is the crux of the discussion at hand.I worked as a TV reporter and university instructor, among other things, before I got into nursing and the nursing mania for collecting little titles to put after the RN exists nowhere else in the professional world that I have ever seen. I still don't get it after a decade.
Jun 10, '09I totally agree that nursing is different than medicine and brings its own set of wonderful emphases and values to healthcare. No, nurses don't have the same amount of education as doctors, but it's not so much that we're "less than" doctors as we are just "different than" doctor. However, I'm probably exactly the kind of person for whom a DNP option might be great.
People have said, "If you want to be a doctor, go to medical school!" I understand that sentiment, but I'm a life-long learner. Two year after I graduated from undergrad, I started taking courses again because I missed intense learning. I'm in right now and will probably take several years off to work and start a family, but I expect I will eventually get my Master's. Someday -- after my imaginary children are older? -- I may will go back for my DNP. This isn't because I was to be an MD, but because I love to learn and expand my skills. I also wouldn't have gone to medical school to begin with because I didn't want to spend 8 straight years in school (and I wasn't one of those people who knew at 17 exactly what I wanted to be doing in 10 years!), but I'll definitely spend more than 8 years in post-secondary education when it's all over. I also think the nursing approach is also much more in line with my character and values.
I don't think a DNP is just like a doctor, but a DNP should has at least as many years of graduate education as an MD does and should be as qualified as an MD to provide primary care. Think of NPs and PAs, who came up through the nursing and medicine tracks, respectively function almost interchangibly, though their approaches are no doubt colored by the nursing and medical emphases of their respective programs. It would seem to me that DNPs could be to doctors as NPs are to PAs.
Can't we all pursue excellence without turning it into a competition?
Jun 10, '09Quote from nerdtonurse?What they're saying is a perfectly fair statement. It's like saying that an intern who passes step III isn't equivalent to an attending physician and that for that intern to be practicing autonomously without any supervision could be potentially hazardous to the public and patients should realize that passing a "USMLE-like exam" does not even come close to ensuring competence in a medical setting.Here's what the AMA wants to do about DNPs -- basically make them NP II, with no additional abilities. And to do that, they're going to prevent the creation/usage of the tests which are the equivalent of USMLE step 3....If you're a NP or DNP, (or even a lowly LPN like me), take your blood pressure medicine before you read their document...
Seems like if they weren't scared of DNPs passing the test, they wouldn't care, would they?
Step III was designed to be to taken after a person's internship, during the very beginning of one's residency training when they are still very green and can't function autonomously. Yet, most US grads, >95% pass this exam without problem. The vast majority will go on to take their specialty boards once they finish their residency, which are even more brutal-- I believe most consist of a written portion and an oral exam in which their examiners can ask them anything they want.
The trial run of DNP's took a watered down version of this exam and half of them failed. Not a good sign of competency and an ability for them to function autonomously if their fund of knowledge is less of that of a resident about to enter their second year.
Jun 10, '09Very few things in life make me angry, and stupidity is one of them; if I do something stupid, I'm harder on myself than anyone else. I also prize knowledge and intelligence.
Unless something catastrophic happens, I will be in school in some fashion from now on. Give me the opportunity to keep growing, keep learning, and keep refining my ability to keep my patients alive. I don't care if that means I spit out with a MSN, a DNP, or a grand high poohbahness award. Just don't keep me from learning what I need to learn.
Jun 10, '09Quote from 83studentnurseProblem being, those NP's and PA's have been providing primary care among other things. Why is there a push to redefine the NP? I do not think you understand, there is a push to in essence phase out NP's for this new DNP.I don't think a DNP is just like a doctor, but a DNP should has at least as many years of graduate education as an MD does and should be as qualified as an MD to provide primary care. Think of NPs and PAs, who came up through the nursing and medicine tracks, respectively function almost interchangibly, though their approaches are no doubt colored by the nursing and medical emphases of their respective programs. It would seem to me that DNPs could be to doctors as NPs are to PAs.
Can't we all pursue excellence without turning it into a competition?
Another major problem with your analogy is the comparison. PA's and NP's are considered midlevel providers. However, you seem to indicate that the DNP is something else? In essence you are saying the DNP is ~ to physician? Again, this goes against the whole concept of nursing, and I cannot support this movement.
If you want this new provider to be comparable to a MD/DO, then perhaps it should be disassociated from nursing? If this is the case, make them take all three steps of the "actual" USMLE and have a board of medicine regulate their practice, as this goes against and beyond a nurse utilizing advanced nursing practice. IMHO as always.
Jun 10, '09Sorry if I offended anyone. I didn't mean nurses are "less than" doctors, but we are trained differently and have different certification/boards criteria.
As I said, if a nursing program opens up that trains nurses in depth in the same areas that doctors are trained, have residencies for comparable training, then maybe nurses can argue the DNP puts them on par with medical doctors. But I mean then why not go to medical school if you want to treat pts with the scope and authority that a doctor does? Not saying one shouldn't continue to learn and push themselves acedemicly and professionaly, the more you know the better ! I just think nurses must make it clear to pts that they are nurses with a Ph.d or a DNP or what have you. Make it clear you are not the medical doctor, because you aren't.
That's just me.
Jun 10, '09Quote from sonnyluvActually, the DNP's from Columbia (which I understand is one of the top DNP ) took a very watered-down version of the USMLE Step III exam and had around a 50% pass rate. This is, according to most medical students/residents that I've talked to, the easiest USMLE step and most don't spend much time studying for it at all. So, the DNPs did not take a test that is equivalent to the USMLE. That's one thing that the AMA is saying in the article. Mary Mundinger and others are saying it's equivalent to the USMLE and passing it means that DNP = physician. I have nothing against people wanting to learn more, etc., but you have to admit, this tactic is a bit low.The truth is that the A.M.A. is concerned with the bad publicity they will receive when advanced nurses start taking the equivalent of the USMLE. THEY WILL DO OUTSTANDING. Nothing like the motivation of those with something to prove.
Also, if you look at the courses taken in medical school and compare it to the courses taken in DNP school, you'll see that they are very different. There's very little physiology/pathophysiology and lot of "fluff" courses. The medical school curriculum has full two years of basic sciences. Also, medical students seem to get more hours out of their clinical years than a DNP does. I guess you can say the the DNP has had prior clinical experience being a nurse, but that's not the same as in medicine though; what you would be doing as a nurse wouldn't really help you if you want to practice medicine (like the DNP). So how can you say the education is similar? The AMA is not scared because of competition; it's not purely about money as some posts seem to suggest. Patients will be put to risk if this trend continues (the studies done so far that suggest NPs have similar patient outcomes to physicans have been very flawed). How can DNP's manage patients with multiple comorbidities when they're basic science and clinical education in medicine are nowhere near the level of physicians?
Like I said, I'm not against people wanting to learn more. That's great that you do! Just don't go touting that you're equivalent to a physician when you're not. Mundinger and her minions disgust me.
Edit: To the poster who mentioned that DNPs have similar amount of years of training, that's not true. MDs have 4 years of medical shool + a minimum of 3 years of residency, during which time they are practicing medicine (not nursing); they come out with more than 12000 hours of clinical training practicing medicine. DNPs have around 1000 and there are several programs around that let you get the degree online.
Jun 10, '09Quote from Rick2323Your comment is absurd! Doctoral level education is available to most people in a huge variety of fields...literature, child development, education, engineering, law, etc. The list goes on and on, so why in the h*ll would you say that is absurd to have doctorate level of education available to nurses?????? Your comment is offensive to all who value the importance of education.Sorry folks, but I think the very concept of a Doctor of Nursing is absurd. Like others have said, if you want to be a doctor go to med school. The NP program is quite enough.
Jun 10, '09Quote from yelnikmcwawaA PhD is not the same as a clinical doctorate. You're comparing PhD's to DNP (a clinical doctorate). I don't think Rick2323 said anything offensive. Plus, from the curricula of various DNP programs, it looks like a doctrate in nurse practice (DNP) is easier to get than a doctorate in other fields. For example, a doctorate in the sciences or humanities takes years of research to get. Compared to that, what you currently need to do to become a DNP seems much easier, especially when you know there are several programs that offer this "doctrate" degree online. If anything, this is offensive to every other doctrate degree out there other than nursing. I haven't heard of anyone getting a biochemistry PhD online, have you?Your comment is absurd! Doctoral level education is available to most people in a huge variety of fields...literature, child development, education, engineering, law, etc. The list goes on and on, so why in the h*ll would you say that is absurd to have doctorate level of education available to nurses?????? Your comment is offensive to all who value the importance of education.
If you value education so highly, how can you say that the DNP provides a proper doctoral level education when there are many flaws with its current setup?
Jun 11, '09As a practicing NP, I think the DNP sounds awesome. It may not be for me at this time and it may not be for all Advanced Practice Nurses but for those who choose it, I am happy it is a choice they can make. Anyone that wants to further their education and level of expertise should be allowed to and not recieve so much negativity, especially from fellow nurses. One beauty of our Nursing Profession is that there are so many options and so many roles that we can choose. None of these roles have to compete with eachother or be "better" than the next. I chose Advance Practice because I wanted to do more as a nurse. I did not chose it to be a mini MD or instead of Med School. I love Nursing and all that it entails. I do love all of the knowledge my advance degree has given to me, to furhter undertand pathophysiology behind the disease, why a certain treatment will or will not work and even how to go about making the correct diagnoses is awesome for me. These are the things as a RN I wasn't able to do. But as an APRN, I can, but I can also do my "nursing" as well. Yet if the DNP can bring even more to my ability to provide total care for my patients then it may be something that I will choose one day. If I don't choose this option, I am still happy that it is available and would enjoy working with and respect the nurses that do choose this option, just like I respect all other nurses!
Let's try to always support each other and our profession as it evolves...
Jun 11, '09advance voice: np : the dnp exam - talking with mary mundinger
april 4, 2008 12:52 pm by jennifer ford
i spoke with mary mundinger, who is a member of the cacc and the dean of the columbia university school of nursing (which has a dnp program), about the exam. munginder stressed during our interview that the exam is not meant to make a dnp more like a physician. she said the following:
i don't think the dnp is a goal to be more like a physician; what we are doing with this exam is testing the medical knowledge that an advanced-practice nurse at the doctoral level has to achieve to give comprehensive care.mundinger pointed out that nps provide quality care, and that the dnp and this new exam are meant to offer opportunities for growth and freedom in different practice settings.
it doesn't mean that the quality is less for a master's-prepared np, but it means that someone who achieves the dnp-the clinical dnp, the certification-level competencies-has got new skills. they're more likely to be able to take on er evaluations, admit and manage their hospital patients-it doesn't mean master's-level nurses can't learn to do that, they can-but we have formalized that in a degree program. so it's really an incremental step in measuring competency.
[color=#2200cc]nurses called "doctor"?
the clinical doctorate (doctor of nursing practice [dnp]) signifies completion of a clinically focused, rather than research-focused, advanced degree program. beginning in 2015, the dnp has been targeted as the accreditation standard for advanced practice nursing in accordance with the american association of colleges of nursing (aacn) guidelines....
...in this regard, nursing follows other professions, such as medicine, physical therapy, pharmacy, clinical psychology, and naturopathy. the call for interdisciplinary practice and education, envisioned by the institute of medicine in its report health professions education: a bridge to quality, predicts that more professionals with the title "doctor" will be working together in the same settings.[color=#004276] many of these professionals will not be physicians....
...begin working with other health professionals in your employment setting to implement nurse-positive language as advised by the center for nurse advocacy. they rightly note that the way nurses refer to other professionals models language that is then adopted by patients and by the media. as the center for nurse advocacy observes, "media, like most people, often use the term doctor to mean physician. although this usage is deeply ingrained, it gives many people the impression that physicians are the only health care workers who can earn doctoral degrees
overview: the doctor of nursing practice (dnp): need for more dialogue
- difficult professional choices: deciding between the phd and the dnp in nursing jo a. loomis, ms, fnp-c; barbara willard, nd, rn; jayne cohen, dnsc, rnc (december 22, 2006)
- reflections on the dnp and an alternate practice doctorate model: the drexel drnp h. michael dreher, dnsc, rn; gloria f. donnelly, phd, rn, faan; rita c. naremore, phd (december 12, 2005)
- the need for some sense making: doctor of nursing practice janet s. fulton, phd, rn; brenda l. lyon, dns, rn (september 30, 2005)
- the practice doctorate in nursing: an idea whose time has come elizabeth r. lenz, phd, rn, faan (september 30, 2005)
- the case against the dnp: history, timing, substance, and marginalization afaf i. meleis, phd, drps (hon), faan; kathleen dracup, fnp, dnsc, faan (september 30, 2005)
- moving forward together: the practice doctorate in nursing ann l. o'sullivan; michael carter; lucy marion; joanne pohl; kathryn e. werner (september 30, 2005)
- residency programs for primary care nurse practitioners in federally qualified health centers: a service perspective margaret flinter, aprn, msn (september 30, 2005)
- policy & planning perspectives for the doctorate in nursing practice: an educational perspective carol a. cartwright, phd; charlene k. reed, phd (september 30, 2005)