A proposal for the future of advance nursing practice

[hoosier guy]

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?

[NPinWCH]

I only want to add that even if/when DNP becomes the standard, MSN prepared NPs won't have to worry about "salvaging" their careers as long as they keep their certification up to date. Believe it or not, but there are currently APNs with ONLY BSN degrees practicing. Why? Because, before the MSN became the standard you could do the job with only a bachelor degree. One of my good friends is a CRNA with ONLY a BSN after his name and he is one of the best anesthesia providers, MD or RN, I have ever worked with.

So far, the DNP doesn't add to an APNs clinical skill; I haven't seen a large increase in clinical hours or classes. That may change, but so far it seems to be more focused on setting up business and understanding regulations, insurance and other such requirements. Not that that is bad, but it's not going to make a new NP a better clinician, though it may give them more tools to set up independent practice.

[BCgradnurse, MSN, RN, NP]

BCgradnurse,

We WILL get that recognition. Well... That's my future vision anyway. :) BTW, I get uncomfortable now when new (not even done with residency yet) physicians at work described us as midlevels and "subordinates to physicians". So I said: "alright dude, lets have a nice talk shall we". hehe

Here's my take, and it may not be a popular view. I am not a physician. I don't want to be a physician. I chose the NP role for a reason-I wanted to do advanced practice nursing. I want to work within my scope of practice, be respected and recognized for the valuable role I play and compensated appropriately. I really don't care what someone calls me. I'm proud of what I do. That being said, I don't ever plan to get my DNP. For those that do, I think it's great, and I hope you are respected and recognized for it, cause you certainly deserve it. I really hope that the DNP programs can be developed further so NPs come out with increased clinical skills and knowledge, and are valued as another level of advanced practice nurses. We don't need to be called physicians to know how valuable a role we play in health care.

[NPinWCH]

I am not a physician. I don't want to be a physician. I chose the NP role for a reason-I wanted to do advanced practice nursing. I want to work within my scope of practice, be respected and recognized for the valuable role I play and compensated appropriately. I really don't care what someone calls me. I'm proud of what I do.

Well said and I couldn't agree more.

[Tinabeanrn]

Ditto to BCgradnurse. I also don't want to be a physician. I like nursing..no I love nursing and I am proud to be an advanced practice nurse. (Well soon anyway).

[llg, PhD, RN]

Preface: I am not an NP -- just a curious well-wisher who has been involved in roles for nurses with graduate education for years.

This proposal sounds like it might be a "divide and conquer" strategy -- one that might actually be very appealing to some of the more devious physicians.

Step 1: Divide the NP's into 2 camps, MSN & DNP

Step 2: Pit them against each other MSN vs. DNP

Step 3: Support the MSN group as their practice will require supervision from a physician. Fight against the DNP group as they will be competition for physicians.

Step 4: Enjoy the show and the financial rewards that will come after reigning in MSN practice to fall under physician control and the competitive, independent DNP practice is defeated. The nurses will beat each other up in the fight and the physicians will end up controlling it all.

[hoosier guy]

first off i would like to thank everyone for their replies. i really wasn't trying to mandate a change to nursing as much as i was trying to flush-out my ideas and get some opinions.

the comments so far have me wondering; is there anything that can be done to prevent the dnp from becoming the norm? (i know it's not set in stone or it hadn't been the last i checked) i believe i have already said that i hate seeing degree inflation, and all the evidence seems to suggest that more education isn't necessary for what np's do. on the other hand i am sure colleges and universities will love having another doctorate degree to profit from offer.

on another note; is it possible for the nursing community to fight for their practice rights, or rather, is it a winnable fight? the more research i do on nurse ran clinics the more i like it and the more i want to see it expanded. i also see a whole lot of doctors pushing hard against it.

[hoosier guy]

preface: i am not an np -- just a curious well-wisher who has been involved in roles for nurses with graduate education for years.

this proposal sounds like it might be a "divide and conquer" strategy -- one that might actually be very appealing to some of the more devious physicians.

step 1: divide the np's into 2 camps, msn & dnp

step 2: pit them against each other msn vs. dnp

step 3: support the msn group as their practice will require supervision from a physician. fight against the dnp group as they will be competition for physicians.

step 4: enjoy the show and the financial rewards that will come after reigning in msn practice to fall under physician control and the competitive, independent dnp practice is defeated. the nurses will beat each other up in the fight and the physicians will end up controlling it all.

interesting theory, i just don't see msn nps and dnps taking up arms against each other. assuming dnps were given the same practice rights as physicians (with or without the amas blessing) i would imagine msn nps would prefer to work under dnps.

[Tinabeanrn]

The issue is that it is already an "open wound" in the nursing community. Some ppl (nurses) are completely for a DNP becoming the standard of care as they see it as advancing our practice and others are really against it as they see no value added to the clinical arena....

Personally I hope it doesn't become the standard to enter the NP role. When I got my ADN they kept saying that they were going to phase out the ADN programs and make all undergrad nursing at the BSN level. I really could not tell a difference in the BSN prepared nurses vs ADN. Now in Michigan, you pretty much have to have your BSN to be hired at a hospital. And the nurses with their ADN cannot advance in their roles i.e become an assistant manager. I think that is unfair myself. It is a lil heartbreaking to see. I wonder why everything has to be a cast system....and now that I am getting my MSN in a few weeks it looks like the same thing is going to happen. Why?? I have been in school since 2001 so for 11 years and I cannot see myself doing one additional day of school. Especially if it will cost me another 60 k and bring zero increase to my clinical knowledge and income. I think it should be optional for those who want it. Unsure of a way to keep it from becoming a standard. Just hoping to be grandfathered in as I will not be returning to school unless it is completely paid for.

[benzos]

It's really sad and scary how much laymen and nonphysicians don't understand the value of a physician education. I agree that there are many similarities between what NPs, MDs, PAs, ... do on a day to day basis. but let me ask you, how many groundbreaking clinical studies/research have NPs, PAs, CRNAs have published that have changed the have influenced the standard of care compared those done by MDs? How much basic science or clinical research do NPs, PAs, CRNAs do compared to those done by MDs? How many high impact basic or clinical journals are there that are published by NPs, PAs, CRNAs? How many important basic science, clinical textbooks are written by non-MDs? How about surgical techniques, inventions?

It's easy to look at the surface and make these big assumptions but even life long NPs/PAs dont even understand how much work/academics MDs do outside of our day to day bedside duties. I kind of see why DNP is structured as it is to try and make nurses more academic and have as much impact to the medical/scientific world as MDs, PhDs but a lot of these knowledge is really taught more in depth in medical school, residency by people that have earned MDs, PhDs.

Anyways, I'm tired. I still think that MD curriculum is gold standard anything less is not ideal. There is a reason why we are called "doctors" - teachers of medicine and why our pay, social responsibilities/expectations are different.

[myelin]

I think it's humorous that you keep lumping MDs and PhDs together, as if the research training that an MD gets is anything close to comparable to that of a PhD. And I guess there's no such thing as a nurse who has a PhD and is an academic. Off to laugh, now.

[hoosier guy]

benzos:

and the vast majority of pediatricians, internists, podiatrist, psychiatrist all do clinical research and contribute to the knowledge base… right (sarcasm)

you don’t need a masters degree in engineering to fix a car, you don’t need a medical degree to treat the vast majority of issues that present in a general practice. i am not trying to devalue the research the doctors do, but that level of education isn't nessisary for what nps do.

[BCgradnurse, MSN, RN, NP]

It's really sad and scary how much laymen and nonphysicians don't understand the value of a physician education. I agree that there are many similarities between what NPs, MDs, PAs, ... do on a day to day basis. but let me ask you, how many groundbreaking clinical studies/research have NPs, PAs, CRNAs have published that have changed the have influenced the standard of care compared those done by MDs? How much basic science or clinical research do NPs, PAs, CRNAs do compared to those done by MDs? How many high impact basic or clinical journals are there that are published by NPs, PAs, CRNAs? How many important basic science, clinical textbooks are written by non-MDs? How about surgical techniques, inventions?

It's easy to look at the surface and make these big assumptions but even life long NPs/PAs dont even understand how much work/academics MDs do outside of our day to day bedside duties. I kind of see why DNP is structured as it is to try and make nurses more academic and have as much impact to the medical/scientific world as MDs, PhDs but a lot of these knowledge is really taught more in depth in medical school, residency by people that have earned MDs, PhDs.

Anyways, I'm tired. I still think that MD curriculum is gold standard anything less is not ideal. There is a reason why we are called "doctors" - teachers of medicine and why our pay, social responsibilities/expectations are different.

Benzos,

I think it's to come out of the ivory tower you seem to be living in. There are many professionals in the health care world that do publish groundbreaking research, contribute to journals, write textbooks, etc. Many of them are not MDs. NPs and PAs also do work outside of the clinical setting. We continue to study and participate in research, as many MDs (but not all) do. Please don't be so patronizing. Having an MD doesn't necessarily make someone a better healthcare provider. A MD may have a more in depth education, but that level of education is not always necessary in certain settings.