the american medical association (ama) house of delegates plans to consider resolutions at its june 14-18 meeting, to place limits on nursing education and practice. resolution 214, "doctor of nursing practice," would require physician supervision for dnps. resolution 303, "protection of the titles 'doctor,' 'resident' and 'residency,'" would limit the use of these terms to physicians, dentists and podiatrists. while these resolutions are policy statements, they set the agenda for state medical associations as well as the ama itself, to advocate for state and federal action. please click on the links below to view the ama resolutions and psna/ana’s responses to them:
...february 2007 report entitled "changes in healthcare professions’ scope of practice: legislative considerations." this report was drafted collaboratively by representatives of six healthcare organizations, including the national council of state boards of nursing (ncsbn) – and the federation of state medical boards (fsmb). this report notes that "it is no longer reasonable to expect each profession to have a completely unique scope of practice, exclusive of all others. overlap among professions is necessary. no one profession actually owns a skill or activity in and of itself."
Furthermore, the ANA response to resolution 303 hits the nail on the head. It is all about money and this is a step towards restriction and regulation of advanced nursing practice.
Over 100 years ago, the AMA claimed every single thing that in anyone's wildest dreams, could be considered the "practice of medine". There was a time, not that long ago, that taking Blood Pressures, was condered the "practice of medicine", and restricted to physicians only.
That being said, I completely agree that the AMA is panicking, and using their substantial political influence to once again, restrict any one from intruding on their turf. Perhaps nurses should protest the use of "make believe nurses", also known as Medical Assistants, in doctors offices. That is an encroachment on OUR TURF. The doctors know it, but want a cheap way to provide nursing care and professional nursing practice, "on the cheap".
I hope that the ANA will continue to protest this "practice battle", in the courts if necessary. If the AMA gets away with this we will all be in trouble. JMHO and my NY $0.02.
Over 100 years ago, the AMA claimed every single thing that in anyone's wildest dreams, could be considered the "practice of medine". There was a time, not that long ago, that taking Blood Pressures, was condered the "practice of medicine", and restricted to physicians only.
That being said, I completely agree that the AMA is panicking, and using their substantial political influence to once again, restrict any one from intruding on their turf. Perhaps nurses should protest the use of "make believe nurses", also known as Medical Assistants, in doctors offices. That is an encroachment on OUR TURF. The doctors know it, but want a cheap way to provide nursing care and professional nursing practice, "on the cheap".
I hope that the ANA will continue to protest this "practice battle", in the courts if necessary. If the AMA gets away with this we will all be in trouble. JMHO and my NY $0.02.
Lindarn, RN, BSN, CCRN
Spokane, Washington
I also wanted to add, that if the AMA thought that the could get away with it, they would claim haircutting as the "Practice of Medicine". After all, don't barbers and beuticians use sharp instruments to practice their trade? We wouldn't want anyone to get hurt, now would we?
They're scuuuuuured. They should be welcoming this with open arms. They point out nurses with doctorates will be able to be called doctors. Ummm....anyone with a doctorate in any field can be called doctor. Surely they know that and the tag won't say MD.
And I wonder if this doctors who let their office staff who aren't licensed be called nurses see the hypocrisy here. Doubt it.
Get out the flamethrowers because I suspect there will be a roast of GilaRN shortly.
First, I am suprised that anybody is suprised over these AMA considerations. This should have been anticipated long before the first DNP program ever hit the scene.
Second, we really need to have some empathy if we are going to deal with the resistance. We complain all day long about UAP's taking over our jobs, performing advanced procedures, and providing nursing care that "should be a nurses duty." Just look at some of the paramedic in the ER and hospital threads? Very serious debate.
So, in a way it is the pot calling the kettle black. We are resistant to having other providers (With less formal education in some cases.) play in our back yard, but cry foul when physicians look at the DNP the same way? In many ways they most likely see it the same way as as nurses see the whole UAP debat. (However, more and more paramedics are actually licensed with 2 year degrees.) But still, it is a similar way of thinking.
So, to really debate this situation, we need to see where physicians and the AMA are coming from and make compelling arguments that are evidenced based rather than simply complain.
I want to be very clear. I am not siding with the AMA; however, we will need some serious ammunition to bring to the fight on this one.
Get out the flamethrowers because I suspect there will be a roast of GilaRN shortly.
First, I am suprised that anybody is suprised over these AMA considerations. This should have been anticipated long before the first DNP program ever hit the scene.
Second, we really need to have some empathy if we are going to deal with the resistance. We complain all day long about UAP's taking over our jobs, performing advanced procedures, and providing nursing care that "should be a nurses duty." Just look at some of the paramedic in the ER and hospital threads? Very serious debate.
So, in a way it is the pot calling the kettle black. We are resistant to having other providers (With less formal education in some cases.) play in our back yard, but cry foul when physicians look at the DNP the same way? In many ways they most likely see it the same way as as nurses see the whole UAP debat. (However, more and more paramedics are actually licensed with 2 year degrees.) But still, it is a similar way of thinking.
So, to really debate this situation, we need to see where physicians and the AMA are coming from and make compelling arguments that are evidenced based rather than simply complain.
I want to be very clear. I am not siding with the AMA; however, we will need some serious ammunition to bring to the fight on this one.
Ok, I know this is off topic, but are all NP programs going to become dnp programs or is this just in the works? I'm curious cuz if this is the case, I'll just finish my BSN and thats it.
Get out the flamethrowers because I suspect there will be a roast of GilaRN shortly.
First, I am suprised that anybody is suprised over these AMA considerations. This should have been anticipated long before the first DNP program ever hit the scene.
Second, we really need to have some empathy if we are going to deal with the resistance. We complain all day long about UAP's taking over our jobs, performing advanced procedures, and providing nursing care that "should be a nurses duty." Just look at some of the paramedic in the ER and hospital threads? Very serious debate.
So, in a way it is the pot calling the kettle black. We are resistant to having other providers (With less formal education in some cases.) play in our back yard, but cry foul when physicians look at the DNP the same way? In many ways they most likely see it the same way as as nurses see the whole UAP debat. (However, more and more paramedics are actually licensed with 2 year degrees.) But still, it is a similar way of thinking.
So, to really debate this situation, we need to see where physicians and the AMA are coming from and make compelling arguments that are evidenced based rather than simply complain.
I want to be very clear. I am not siding with the AMA; however, we will need some serious ammunition to bring to the fight on this one.
Wellllllll yes and no. I agree that we need to bring some serious ammunition to the fight and in order to debate we need to be able to anticipate their arguments.
And yes, like our battle with the use of UAPs it is somewhat a turf war. But the difference is that UAPs are under our control and supervision. As a separate entity with our own licensure and scope of practice, I have a real problem with a different profession deciding what our education and scope of practice should be. It is not their right to "limit" us. Now they can lobby state legislatures to define what should strictly the domain of medicine but to try to limit nursing implies that they have the right to have an input on what our education and scope of practice should be and that is alarming to me.
Whether or not, you agree with the DNP movement and I have voiced some concern about recent developments within that area, it should be up to nurses to decide whether or not it is an appropriate direction for our field, not another profession.
Wellllllll yes and no. I agree that we need to bring some serious ammunition to the fight and in order to debate we need to be able to anticipate their arguments.
And yes, like our battle with the use of UAPs it is somewhat a turf war. But the difference is that UAPs are under our control and supervision. As a separate entity with our own licensure and scope of practice, I have a real problem with a different profession deciding what our education and scope of practice should be. It is not their right to "limit" us. Now they can lobby state legislatures to define what should strictly the domain of medicine but to try to limit nursing implies that they have the right to have an input on what our education and scope of practice should be and that is alarming to me.
Whether or not, you agree with the DNP movement and I have voiced some concern about recent developments within that area, it should be up to nurses to decide whether or not it is an appropriate direction for our field, not another profession.
What right do nurses have to control and supervise UAPs? Do many UAPs not have their own education pathways to certification separate from nursing pathways? Are you not regulating another separate profession with its own scope of practice?
And I was really hoping that someone could explain to this ignoramus how the practice of medicine by a primary care physician differs from the practice of nursing by an APN/DNP.
Wellllllll yes and no. I agree that we need to bring some serious ammunition to the fight and in order to debate we need to be able to anticipate their arguments.
And yes, like our battle with the use of UAPs it is somewhat a turf war. But the difference is that UAPs are under our control and supervision. As a separate entity with our own licensure and scope of practice, I have a real problem with a different profession deciding what our education and scope of practice should be. It is not their right to "limit" us. Now they can lobby state legislatures to define what should strictly the domain of medicine but to try to limit nursing implies that they have the right to have an input on what our education and scope of practice should be and that is alarming to me.
Whether or not, you agree with the DNP movement and I have voiced some concern about recent developments within that area, it should be up to nurses to decide whether or not it is an appropriate direction for our field, not another profession.
I would agree; however, we still have to sort out the little problem of the double standard. For example; when a paramedic wishes to work in the ER, he/she in many cases is turned into a UAP when they come through the doors of the ER. They are placed under the RN and the duties they perform are deligated to them from the RN. When, in fact they have a different body that licenses them and defines their scope of practice. This is a great example of one profession deciding the SOP of another. In fact, the same profession that is now calling foul on physicians and the AMA for taking similar steps.
Again, I am not saying I agree with the AMA; however, there are some serious points of discussion that must be resolved if nurses are to have a case.
Forpath: see my post. I think we can make a distinction in many cases. For example, CNA's are considered UAP's. Since CNA education and SOP is decided by the state BON, you cannot argue that CNA is a stand alone profession.
As far as your second question: This is where I think this entire mess will eventually lead for better of worse. We are going to have to define our practice in a different way, and I think it could get very complicated and messy. Nusing follows a more holistic model while physicians typically follow an allopathic model of delivery; however, the lines between the two concepts and definitions have become blurry and perhaps antiquated.
I would agree; however, we still have to sort out the little problem of the double standard. For example; when a paramedic wishes to work in the ER, he/she in many cases is turned into a UAP when they come through the doors of the ER. They are placed under the RN and the duties they perform are deligated to them from the RN. When, in fact they have a different body that licenses them and defines their scope of practice. This is a great example of one profession deciding the SOP of another. In fact, the same profession that is now calling foul on physicians and the AMA for taking similar steps.
Again, I am not saying I agree with the AMA; however, there are some serious points of discussion that must be resolved if nurses are to have a case.
Forpath: see my post. I think we can make a distinction in many cases. For example, CNA's are considered UAP's. Since CNA education and SOP is decided by the state BON, you cannot argue that CNA is a stand alone profession.
As far as your second question: This is where I think this entire mess will eventually lead for better of worse. We are going to have to define our practice in a different way, and I think it could get very complicated and messy. Nusing follows a more holistic model while physicians typically follow an allopathic model of delivery; however, the lines between the two concepts and definitions have become blurry and perhaps antiquated.
G
But, if the UAPs are not nurses, then nurses are indeed regulating a profession outside of their own. Just because the BON has historically regulated it does not make it right. What if the UAPs were to secede from BON control and expand their scope of practice to include even more tasks that are considered to be the sole domain of nurses yet state that the nurses are powerless to do anything about it, as they are not under their control anymore? And at a much cheaper rate of compensation, say 85% of what nurses make? What then? Will there be ANA proposals out there?
The holistic argument was the way many people used to state that osteopaths differed from allopaths. As you say, the lines have blurred and almost all osteopaths will, albeit begrudgingly, state that there is no longer much difference. My guess is that you are right, after a while, there will be no difference b/w APNs and physicians, for reasons I state below.
Before I begin, what do you mean by the holistic model, exactly? Do you mean taking care of spirit and mind? Like holistic healers? The ones who operate often unsupported by basic or clinical evidence?
While the holistic concept may be appealing, it is not sustaining. It takes a lot of time to counsel a patient about their mind/spirit/how to remain healthy/exhaustively explaining lifestyle choices, plans, etc, etc. As more and more APNs/DNPs get out into the real world, they will soon feel the same time crunch as primary care physicians do.
My guess is those APNs already out there will tell you the same thing. As practices expand, more revenue is needed. And in a "cerebral" field of medicine, such as FP (APNs included), general internal medicine, pediatrics (ones that are office-based as opposed to procedural-based, which reimburse much better for the same amount of time spent with a patient), the only way to make more revenue is to see more patients. To see more patients, you either have to work more hours and expect your patients to come into the office at 8-9 pm and have NO life away from work, or you have to cram more into your regular office hours. Compound that with ever-decreasing Medicare reimbursement and you've got a problem on your hands. Also take into account that APNs can only get reimbursed at 85% of what a physician does, and that means they have to work even harder just to start at what a physician gets.
lindarn
1,982 Posts
Over 100 years ago, the AMA claimed every single thing that in anyone's wildest dreams, could be considered the "practice of medine". There was a time, not that long ago, that taking Blood Pressures, was condered the "practice of medicine", and restricted to physicians only.
That being said, I completely agree that the AMA is panicking, and using their substantial political influence to once again, restrict any one from intruding on their turf. Perhaps nurses should protest the use of "make believe nurses", also known as Medical Assistants, in doctors offices. That is an encroachment on OUR TURF. The doctors know it, but want a cheap way to provide nursing care and professional nursing practice, "on the cheap".
I hope that the ANA will continue to protest this "practice battle", in the courts if necessary. If the AMA gets away with this we will all be in trouble. JMHO and my NY $0.02.
Lindarn, RN, BSN, CCRN
Spokane, Washington