Medicine decries nurse doctorate exam being touted as equal to physician testing

I do not have a problem with a NP that has a doctoral degree and additional clinical based education. My problem stems from this push to make the DNP more "physician" like without medical school. This simply goes against the core concepts of nursing and nursing care. While I understand advanced nursing practice and NP's utilizing this concept, I cannot support this whole DNP/USMLE like push where truly it feels like we are transitioning into some doctor wannabe hybrid.

Again, I know many nurses do not want to be doctors and many nurses will probably go through DNP programs because it almost seems like the writing is on the wall. Be a DNP by this date, or you cannot go into advanced practice. Not much of a choice or decision if you ask me. So, nothing personal guys.

Why use the example of an intern and an experienced nurse to demonstrate that nurses know "as much" as physicians? Interns (and residents) aren't supposed to know everything. Of course a seasoned nurse can assist physicians in any stage of training, but this isn't evidence that they "know" more. Would you accept comparisons between the knowledge level of a student nurse practitioner to a veteran attending physician in an attempt to demonstrate who "knows" more?

As for how "they" treat DOs... you do realize that the AMA represents both the allopathic and osteopathic community, right? DOs also have the AOA to represent them, but the AMA is open for membership to both MDs and DOs. Historically allopathy discriminated against DOs, and rightly so, because their educational and training standards were not what they are today. But today's MDs and DOs consider each other equals. DOs are welcomed into ACGME residencies and can sit for either the COMLEX or the USMLE. So what is this "childish" treatment that you talk about?

Finally, to your last point, DNP candidates have already started taking the watered-down USMLE-lite exam, and only 49% of them passed last fall. I doubt they would have fared better on an actual USMLE-equivalent examination. And considering that a "passing" score was determined by the CACC and is not necessarily as high as the passing score for the USMLE, we don't even know what that data means anyway.

I'm not a physician but I get why they're a little annoyed by Dr. Mundinger and company. I think she's been way out of line in stating in the past that DNPs have "all the medical knowledge of a physician" and can work independently in any healthcare setting (which would include surgery apparently). She calls the 10-credit, 800-hour clinical portion of Columbia's DNP program a "residency" when in reality they are just clinical rotations like any other MSN NP student or MS-III/IV would complete. The shortest of medical residencies, in contrast, are at least three years and around 12,000 hours in length. She's tried to co-opt a lot of the terminology that physicians have always used (and this goes way beyond the "doctor" title, and includes things like comparing the CACC exam to the USMLE and calling clinical rotations a "residency"). Why wouldn't they defend their profession and their turf? Nurses do it all the time on the other end, fighting to keep medications assistants from passing meds, CNAs from doing nursing tasks, paramedics/EMTs from working in hospitals, etc all in the name of "patient safety." All professions, if they are smart, would do the same.

I logged in just to give you a big "thank you" for your post Sonnyluv!

Seems 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.

There!

I'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. . .

Ever 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 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 nursing school 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?

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.

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.

Very 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.

Problem 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.

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.