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?
edit: just finished reading the article. it basically says what i tried to propose but in much more eloquent terms; expand nurse initiated interventions by creating innovative procedures and not simply acquiring or barrowing from medicine. excellent reading.
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
... 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.
I find it insulting that you describe the clinical research produced by your physician peers as "groundbreaking" enough to influence patient care standards yet completely ignore the large body of clinical research nurses are involved in. Nursing and medical research are two separate bodies of knowledge. If nursing research is not a legitimate science, then how come the National Institutes of Health created the National Institute of Nursing Research as a source of federal funding for the advancement of extramural nursing investigations?
Just to give you an example of the distinctions between biological science, medical, and nursing research, let's take for example the common problem of delirium among hospitalized patients. It is a significant problem not only because it is common, but because it is associated with a high mortality rate. Biological scientists who study the pathophysiology of delirium are interested in the chemical triggers of delirium (imbalances in acetylcholine, dopamine) or maybe the cellular mechanisms and inflammatory reactions that cause it. After all their hard work, we all know that these are just theories that continue to evolve in shedding light in our understanding of this syndrome.
Your physician peers on the other hand, may be involved in investigative treatments to suppress its onset (such as the use of atypical antipsychotics, for example) which as you alluded to, shape current standard of care. But do physician peers have all the answers in this case? Nursing offers a bio-behavoral approach to manifestations of illnesses, ailments, syndromes, maladies, etc. The reality is nursing holds a big part in unlocking the key to managing this problem. The most effective measures in delirium have been nurse-driven, a result of nursing research which does not involve pharmacologics or simulating human responses in a lab.
Nursing research on this very topic have focused on the provision of care focusing on making sure the patient's circadian rhythm is preserved during a stressful hospital stay in a strange setting where monitor alarms go off at an instant or where patients are greeted by the unfamilar faces of various healthcare providers everyday. The mere promotion of restlful night's sleep by dimming the lights at night and keeping noise to a minimum, opening the curtains during the day, interventions nurses use and have studied have produced "ground breaking" positive outocmes on patients.
Just because nursing research to you does not equate to multi-million dollar funding on new medications or a sterile lab with mice simulating humans does not mean our research is of a lesser value in the overall outcome of patient care. Our nursing peers who have PhD's have been involved in numerous patient-centered research that have improved patient care - what I gave you is just one example.
I agree with you, nurse practitioners like myself are not working on groundbreaking studies that aim to identify a genetic mutation that causes autism nor have we published a novel surgical procedure that involves minimally invasive techniques in repairing abdominal aneurysms. Yes, we read well-respected, physician led journals like NEJM and JAMA and use Harrison's Internal Medicine in our NP program. And yes, as NP's we do base our treatments on national standards borne out of the work of physician colleagues.
For a profession that has only been around since the 1960's, I think it's just a matter of time until we also become active participants in medical research endeavors. We are not incapable of conducting research in fact, there is already a small number of nurse practitioners who are currently involved in medical research along with physician peers. Physicians have a long held dominance in this field and rightfully deserve the glory that comes with it but healthcare is a team effort, one that provides room for everyone who has the drive to make a difference.
Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care.
Sailornurse:I think you have either misread or misinterpreted my posts. Obviously those who currently practice with MSN degrees will be allowed to continue to do so. My proposal is to keep the MSN prepared NP even if that means that new graduates of MSN NP programs have to work with a limited scope of practice. I have researched the nursing programs in my area, they all offer the DNP as a post masters degree. There are no BSN-DNP programs in my area. Finally, I understand that individual states regulate the scope of practice / rules for all licensed professionals. Not just healthcare workers. That still doesn't preclude anything I have posted.
I have not misunderstood your original post or LLG's future version. Neither of you needed to say that you were not nurses/nurse practitioners. Gee Hoosier, the first person to post a response noted this right away.
What do you mean by the above "have to work with a limited scope of practice?
and by "same practice rights as Physicians"? This is is what you don't seem to understand. So because Indiana requires physician collaboration, requires physician supervision to prescribe, and requires protocols before a NP can prescribe, you seem to think this applies to most NPs in the USA. In about eleven states we have completely independent practice. No physician involvment. Prescribe independently. Don;t have to collaborate/consult/can prescribe class 2-5 narcotics, have own DEA number, own NPI number.
There are 2 FNP's in my city That I know, that hold the DNP degree. Per the State Board of Nursing, it recognizes them and all MSNs the same, we have the SAME scope of practice. The Doctoral degree does not grant them a "broader scope of practice" which would be tough to do since in this state we have completely independent practice, no physician involvement. I also know a FNP who was a "diploma" (are you familiar with this term/type of nurse?), does not have a Bachelor's or Master's Degree. She was the third NP in the state. Went straight through a "certificate" course "Back in the Day"
,So the only solution is to "grandfather all current NP's in while the DNP is phased in and becomes the degree for NP's.
You are saying to keep both current MSN-NP programs while implementing the DNP but schools are phasing out the MSN and changing to DNPs. MSN-NP programs will slowly be phased out. Most have started with the post-Masters DNP which is what the school I taught at for 9.5 years just did but they are no longer accepting MSN students into the Adult CNS, it is changing into DNP and they did just start a BSN to DNP. They accepted NP's/CNS/CNM into their firts cohort, which is another issue you may/maynot be aware of. Some schools are accepting non NPs (CNS for example into the dnp programs, SO not all people who hold DNP degree are Nurse Practitioners. But sinced Ball State in Indiana is accepting NP's/CNS?midwives, You Should Know This!!! There are other schools that are accepting non NPs into DNP programs. Why? Tuition $$$$???
The NP school I attended just started the DNP-post Masters, all students had to be NPs. The plan is to phase out the MSN program in a few years, according to the director it will continue to be a NP program.
I think NomadCRNA was right, you are just here to stir up trouble, so go back to ANALyzing health policy and leave the evolution of NP's and our education to us. We don't need your help. This is my last response to you. Not wasting anymore time trying to explain the DNP, or the ANCC retiring NP specialties (another post).
And LLG, I reply to individual posts but they do not appear as response but posts seem to be chronological, not threaded.
Sailornurse: we are obviously talking past each other (rather your talking past and over me) so perhaps it would be better if you don't respond. I would think someone who educated nurses would be able to understand a theoretical / hypothetical question a little better and not react in such an uncivil and demeaning tone. I would like to add that I have the utmost respect for NPs and Nurses in general. I Don't think I have "stirred the pot" Atleast not for a mature critically thinking mind, that wasn't my intent either.
Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care.
Sailornurse, I hope your patient assessment skills are better than your reading and comprehension skills.
Are you trying to have an intelligent discussion? Why get so childish and attack me? Just read your profile/posts. Says you are a MSN/CNS student so what are you doing on the NP forum? And to answer your question, My assessment skils are tops!
Hope you and hoosier guy & LLG who love to roam on NP forums enjoy wasting your time disussing topics you are ill informed about even if they are hypothetical, (which is incorrect as a hypothesis by definition is based on known facts.
Specializes in Education, FP, LNC, Forensics, ED, OB.
O.k., stop the attacks. No more. No wonder some non-nursing lurkers and members come on to bash nurses in general and APNs specifically. The in-fighting is extremetly glaring and unprofessional.
If you join just to be divisive, it will not be tolerated.
If you join to start an argument, it will not be tolerated.
If you as a professional nurse want to tear apart your fellow colleague(s), it will not be tolerated.
Good grief, this is not productive, unprofessional, and downright silly.
Future attacks/personalization or publicly arguing staff redirect will be deleted and points assigned against member account OR the account closed w/o notice.
I think NomadCRNA was right, you are just here to stir up trouble, so go back to ANALyzing health policy and leave the evolution of NP's and our education to us. We don't need your help. This is my last response to you. Not wasting anymore time trying to explain the DNP, or the ANCC retiring NP specialties (another post).
I'm going to breeze right on past the first 10 paragraphs just to say: OP, I think your original post was an interesting contribution that prompted a good discussion (until recently ... ahem ). For all that it can be frustrating for NPs to encounter policy proposals written by someone who doesn't understand the role, it's a good experience for what happens in the real world. As a profession, we have to learn how to react to these situations and I'm sure it's been eye-opening to you to see the whole range of responses to your post. So as far as I'm concerned you're welcome to stay.
Thanks coast2coast, it has been very enlightening. My first career was in the military so I guess I am used to outsiders determining the future of my profession. I had no idea my hypothetical proposal would cause such a controversy.
). For all that it can be frustrating for NPs to encounter policy proposals written by someone who doesn't understand the role, it's a good experience for what happens in the real world. As a profession, we have to learn how to react to these situations and I'm sure it's been eye-opening to you to see the whole range of responses to your post. So as far as I'm concerned you're welcome to stay. 
hoosier guy
47 Posts
found this interesting article which might bare some weight on this topic.
editorial: nursing interventions vs interventions delivered by a nurse: similar words, different meanings
edit: just finished reading the article. it basically says what i tried to propose but in much more eloquent terms; expand nurse initiated interventions by creating innovative procedures and not simply acquiring or barrowing from medicine. excellent reading.