A proposal for the future of advance nursing practice

Specialties NP

Published

  1. Should the scope of practice for NP's be expanded?

    • 15
      Yes, Full practice rights for all NP's
    • 17
      Yes, but education and curriculum need to be revised
    • 7
      No, we are Nurses not Doctors
    • 1
      other, please explain in a comment

40 members have participated

There seems to be a lot of opinions about what role NP's should fill in health care. I offer my personal view for the future of advanced practice nursing. Please critique my proposal, as I am not a Nurse Practitioner I suspect some of my views might miss an obvious limitation or reality of nursing practice.

Near term: eliminate the proposed requirement for all NP programs to transition to DNP by 2015. emphasize NP collaboration with physicians as a mid-level practitioner. Revise and expand the curriculum for DNP and / or begin to model the curriculum after medical and osteopathic schools. Push for an expanded scope of practice for DNP's as primary care providers

Far term: Give DNP's full practice rights (they will probably have to take a route like DO's, begin with family practices and gradually expand into all specialties) Maintain masters degree prepared NP's as mid level providers with supervision or collaboration with DNP's and MD's/DO's

Are there any glaring errors or problems with this proposal?

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Specializes in Anesthesia, Pain, Emergency Medicine.

Are you even an RN? Needless to say it makes me nervous when someone join March 13,2012 and posts a poll like this.

What is your reason behind this? You are NOT a NP. I don't think you are even a nurse from reading a couple other posts.

BTW, we are not mid-level providers.

FYI, like it or not, our care is judged by the same standards as our physician colleagues.

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easy there, why the hostility?

you guessed correctly, i am not a nurse. i work for a firm that analyzes public health policy. i am sorry if i have somehow offended you.

the title of my post may have been a little presumptuous; perhaps i should have been more detailed. my proposal is really just a pragmatic synthesis of what i have heard and read from both nurses and doctors on the issue. i am interested in the role of the advanced practice nurse. i am also interested in comparing nursing and medical professional’s roles in the health care system.

you may not see yourself as a “mid-level” provider (and in some instances you may not be) but many doctors and state legislatures do. i didn’t mean to insult you or your profession by suggesting that your care is less than that of a doctor; that is not my opinion. please explain your position.

this is not a judgment about the excellent care i am sure you provide. i have a deep respect for nurse practitioners and all nurses in general. is it your judgment that np’s should be entitled to the same practice rights as doctors within their respective specialties? how do you feel about the proposal for all np programs to transition to dnp programs?

once again, my deepest apologies if i have caused any offense. please share your opinion.

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Specializes in School Nursing.

Grabbing some popcorn because this could get interesting. Honestly, though, IMO it's not half bad for a start. It makes senseto take a lot of the fluff out of the DNP programs and sub with more hard science. It makes sense to me that a doctorally prepared NP would have a greater scope of practice than a master's prepared. I dunno, looking forward to hearing the responses on this one.

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Specializes in allergy and asthma, urgent care.

Hoosier Guy,

FWIW, it would have been helpful if you disclosed your affiliation/background and your reasons for posting this survey. Unfortunately, we have many people posting here pretending to be nurses, and all they really want to do is stir up trouble.

It's made us all cautious and maybe a little standoffish. I hope you understand.

That being said, I believe NP education should be more clinically focused. I'm not a fan of the doctorate trend for health care professions, as I can't really see what value that adds to patient care, at least as these programs exist now. If the DNP becomes a requirement, I certainly hope the compensation increases accordingly.

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Specializes in Anesthesia, Pain, Emergency Medicine.

Sorry to be abrupt. sorry in advance for. Any typos as I'm on my iPad.Bcgradnurse is correct. I am sensitive. It comes from to many years of fighting for my profession. To many people come here just to stir up the pot.The major NP organizations have come out against the term mid level provider. They, and I feel it it derogatory.I do the exact same job as my physician colleagues. In both my certifications in anesthesia and family practice. Absolutely no difference at all.We have numerous peer reviewed studies showing our care and outcomes (np/CRNA) is the same or superior to our physician counterparts.

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Thanks for all the replies thus far and sorry again if I caused any confusion or offense by my post.Personally I agree that a Doctorate shouldn't be necessary for what NPs currently do. However, I am almost certain that will be what happens. Even if individual state BON don't require the DNP, Colleges will almost certainly adopt it in order to make more money, assuming it's not required to sit for the boards.*So if the DNP is going to be the default degree might as well take a path similar to osteopaths and work towards full recognition as Physicians. *The path of DO's to full recognition is an interesting case study btw. At the same time masters level practitioners might be salvaged if they take on the physician's assistant role in this new nursing model. *I don't say that to disparage MSN NP's but if DNP becomes the default it will be the only way I see to salvage the master's level practitioner in nursing. I would like to see MSN NPs keep their autonomy (heck, I think PAs should have more autonomy but this is a nursing forum) I am just not sure how that would work with the DNP mandate.*I also think that creating a "Physician-Nurse" would give nursing a huge leap forward; undisputable grounds to argue for full professional equality. The nursing community could argue that its way / philosophy of treatment is unique enough to justify (it's actually less justifying and more just doing it) a third type of physician. Students and patients would have three types of physician to choose: MD, DO, and DNP. Obviously DNP programs aren't quite there yet but they easily could be in 5 - 10 years. All of this would give DNPs a strong ground to insist on equal pay.All of this is unfortunate because it will ultimately hurt the patient financially even if it makes for a better prepared health provider. I hate to see degree inflation but it seem to be the wave of the future, you can either go kicking and screaming or find the best way forward.

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Specializes in allergy and asthma, urgent care.

The idea of catagorizing DNPs as physicians will be vehemently rejected by physicians. What are your thoughts on overcoming this obstacle?

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I think that is to be expected, again look at the DO model. It took quite a few year and establishing their own hospitals and clinics before they were accepted, even then some MDs see them as second rate doctors. Ultimately DNPs are going to have to just do it, have their own clinics and maybe even hospitals at some point. There is already a good start in some states that allow nurse ran clinics but the nursing community will need the academics to back it up if they ever want DNPs to be counted as Physicians.

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Specializes in allergy and asthma, urgent care.

Yes, the DOs did fight an uphill battle and got recognition. I don't think NPs, even DNPs, will get the same recognition in my lifetime. But, maybe I'm wrong. The academics have to change before we can even address that issue.

In my previous job, I worked as a primary care provider right alongside MDs. I had the same patient panel size, the same responsibilities, etc. My colleagues (MDs) were accepting of the NPs in this role (maybe because we were all miserable!). However, administration treated NPs like second class citizens and we made less than 50% of what the MDs made. So, not only do we face obstacles from MDs, we also face them from administrators, 3rd party payers, etc. There's a lot of work to be done on many fronts.

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I think politics will have the biggest effect on how long it takes. I'm not as familiar with Canada ( I am assuming the BC is for British columbia) I am in the US, so depending on how our health care battle and economy goes I could see the change happening in 10 - 15 years. That is largely a guess though. A large part will also depend upon how hard nurses fight for it as well.

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Specializes in allergy and asthma, urgent care.

No, I am in the United States. The BC stands for the school I attended.:)

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