Curious...using the title "Doctor" for a DNP...

[justme1972]

For a friendly debate topic.....

I remembered reading an old post awhile ago where an NP (who got her DNP) was told by Human Resources that she couldn't use the title "Doctor" at the hospital, because it would mislead the patients.

I am wondering if anyone has seen or heard anything similar where they work (you personally or someone else).

If hospitals are "all about introductions", I see nothing wrong with telling a patient, "Hi, I'm Dr. Smith, I'm a Nurse Practioner"...I see no difference between that and saying, "Hi, I'm Dr. Jones and I'm your Cardiologist".

To me, that would be a HUGE slap in the fact to someone who has worked hard for that degree, because they are entitled to use that title.

What ya'll think?

[amzyRN]

My father was such a physician. He was a family practitioner (among the first group of 1500 "general practitioners" to be certified as "family practice specilists") who welcomed the development of all the advanced nursing roles -- including the Nurse Practitioner roles.

When a lot of people were encouraging me to become a physician back in the 1970's, he encouraged me to be a nurse -- often telling me that there were all sorts of new advanced roles being developed for nurses and that they would offer me lots of opportunities to do whatever type of work I wanted without some of the "down sides" of becoming a physician. My career didn't go the NP route as I took a CNS track instead, but I often heard him express support for the NP role over the years. He valued it as a way to get good health care to people who needed it.

I've known a few physicians who were probably like your dad. In my current nursing program, I've met physicians who told some of us in my clinical group that if they had to do it again, they might go advanced practice nursing instead, mainly due the time commitment. I think that people who go into medicine to help people and because they are interested in the science aspect are less vicious than people that do it for the money and prestige. It's true for nursing as well. Thanks much.

[dhigbee]

Ideas and the energy they produce, like "competition," "getting what they deserved," "vicious," etc. are not conducive to healing, health care, or compassion and unbecoming of a physician or nurse. I am a person who believes in negotiation. I am not attached to a particular outcome and have options regarding my future practice as a NP or physician. I think it will be interesting to see what happens. Hopefully our attitudes change and maybe the health care system in general, but that's a different thread. I think if NP practice was being limited nationally, there'd be a broader action by nurses, which may not have the effect some physicians would want. Thanks for the interesting link.

From that link: The Louisiana Nurse Practice Act provides that the "practice of nursing... shall not be deemed to include acts of medical diagnoses or medical prescriptions of therapeutic or corrective nature.

I wouldn't be surprised if APNs from Louisiana start looking for "friendlier" states to relocate their practices.

Dana

[amzyRN]

From that link: The Louisiana Nurse Practice Act provides that the "practice of nursing... shall not be deemed to include acts of medical diagnoses or medical prescriptions of therapeutic or corrective nature.

I wouldn't be surprised if APNs from Louisiana start looking for "friendlier" states to relocate their practices.

Dana

What do you think will happen? Do you think that the DNP will create a national practice act, that includes medical Dx/Tx in nursing practice? I didn't read what the nursing associations in Louisiana is going to do about this set back. What are your views and ideas. Do you think NPs or DNPs will expand their scope of practice, considering the need for greater access to cost effective health care?

[justme1972]

From that link: The Louisiana Nurse Practice Act provides that the "practice of nursing... shall not be deemed to include acts of medical diagnoses or medical prescriptions of therapeutic or corrective nature.

I wouldn't be surprised if APNs from Louisiana start looking for "friendlier" states to relocate their practices.

Dana

That applies to LPN's/RN's.

That statement also says that nurses cannot prescribe medications.

We all know that NP's have prescription authority and DO make medical diagnoses, the same as CRNA's that don't need to consult with a Anesthesiologist before administering meds to a patient undergoing surgery.

Not even close to the same thing.

[dhigbee]

What do you think will happen? Do you think that the DNP will create a national practice act, that includes medical Dx/Tx in nursing practice? I didn't read what the nursing associations in Louisiana is going to do about this set back. What are your views and ideas. Do you think NPs or DNPs will expand their scope of practice, considering the need for greater access to cost effective health care?

The general trend nationally has been towards more independent practice, although this is very threatening to certain politically-minded physicians (or future physicians). Even though this group outwardly focuses on "patient safety", I believe that loss of income is their underlying fear and motivation.

I think a national practice act could be a good thing, but I'm not convinced that the recent DNP movement (as it is now) is the way to go. It will be interesting to see how things develop.

Dana

[elkpark]

That applies to LPN's/RN's.

That statement also says that nurses cannot prescribe medications.

We all know that NP's have prescription authority and DO make medical diagnoses, the same as CRNA's that don't need to consult with a Anesthesiologist before administering meds to a patient undergoing surgery.

Not even close to the same thing.

Well, the statement doesn't not apply to APNs unless it specifically says so somewhere else in the state NPA. Rx authority for NPs and other APNs is not a "given" or a right; it varies on a state-by-state basis, the same as everything else in nursing. There's one state, I think it was GA but I can't swear to it, in which NPs only recently (within the last few years) finally got Rx authority for the first time (does someone else here know the specifics of that?) Rx authority is a privilege granted by each individual state -- there's absolutely no reason that a state couldn't decide that NPs can't prescribe, if the state legislature chose, regardless of the nurses' educational preparation. You still are governed by your legal scope of practice within the state, and if the SOP in your state says that you can't practice to the full extent of your educational preparation, your choices are to live with it (you can work on getting the SOP changed, of course, but until that happens, you have to live with it), or move somewhere else.

That's the point that some of us here are trying to make -- if physicians decided they wanted to, they could make things extremely unpleasant and difficult for advanced practice nurses by lobbying to restrict their scope of practice and arguing that they are practicing medicine, not nursing. And physicians' groups have a lot more money and clout than nurses' groups do -- they generally get what they want.

I was active in my state nurses' association advanced practice group (I am a CNS, not an NP) when the SNA tried, quite a few years ago, to expand the scope of practice for advanced practice nurses in my state, and the docs in the state didn't think much of that idea. It was an extremely educational, enlightening experience. Until you see for yourself how the system works, you don't realize (certainly I hadn't, prior to that) how much control other, non-nursing, people in your state exercise over the practice of nursing.

I don't think we're ever going to see a "national" NPA, particularly not one for only one group or level of nurses. The states will not give up their right to control the practice of nursing, medicine, law, or any other licensed profession/occupation within their own boundaries, and I don't blame them for that. Also, when it comes to the question of affecting/changing the practice of nursing in the US, I'd rather be dealing with 50 smaller organizations than one huge, monolithic, "all or nothing" entity.

[sirI, MSN, APRN, NP]

There's one state, I think it was GA but I can't swear to it, in which NPs only recently (within the last few years) finally got Rx authority for the first time (does someone else here know the specifics of that?)

Yes, Georgia. Last state to leap the hurdle and receive prescription privileges in '06, but think some issues....??:

Prescribing in Georgia: Still Unresolved

Last year, Georgia nurse practitioners celebrated a hard-fought victory for prescriptive privileges. Unfortunately, that triumph has been overshadowed - first by restrictive regulations from the Composite Board of Medical Examiners and more recently by legislation (SB 253, HB676) attempting to amend the prescribing law to include the unfavorable regulations...

http://nurse-practitioners.advanceweb.com/editorial/content/editorial.aspx?cc=88191

In Reading the Pearson report:

...six states (Arizona, Illinois, New York, Pennsylvania, Texas, and Virginia) that have legislatively allowed qualified NPs to be addressed as "doctor" as

long as they clarify that they are NPs.

...seven states (Georgia, Iowa, Maine, Mississippi, Ohio, Oklahoma, and Oregon) have statutory restrictions against doctorally educated NPs being addressed appropriately.

[dhigbee]

Physician groups certainly have most of the money and the history. It's illuminating to consider how much money affects healthcare legislation (or national elections, for that matter).

[n_g]

Well, the statement doesn't not apply to APNs unless it specifically says so somewhere else in the state NPA. Rx authority for NPs and other APNs is not a "given" or a right; it varies on a state-by-state basis, the same as everything else in nursing. There's one state, I think it was GA but I can't swear to it, in which NPs only recently (within the last few years) finally got Rx authority for the first time (does someone else here know the specifics of that?) Rx authority is a privilege granted by each individual state -- there's absolutely no reason that a state couldn't decide that NPs can't prescribe, if the state legislature chose, regardless of the nurses' educational preparation. You still are governed by your legal scope of practice within the state, and if the SOP in your state says that you can't practice to the full extent of your educational preparation, your choices are to live with it (you can work on getting the SOP changed, of course, but until that happens, you have to live with it), or move somewhere else.

That's the point that some of us here are trying to make -- if physicians decided they wanted to, they could make things extremely unpleasant and difficult for advanced practice nurses by lobbying to restrict their scope of practice and arguing that they are practicing medicine, not nursing. And physicians' groups have a lot more money and clout than nurses' groups do -- they generally get what they want.

I was active in my state nurses' association advanced practice group (I am a CNS, not an NP) when the SNA tried, quite a few years ago, to expand the scope of practice for advanced practice nurses in my state, and the docs in the state didn't think much of that idea. It was an extremely educational, enlightening experience. Until you see for yourself how the system works, you don't realize (certainly I hadn't, prior to that) how much control other, non-nursing, people in your state exercise over the practice of nursing.

I don't think we're ever going to see a "national" NPA, particularly not one for only one group or level of nurses. The states will not give up their right to control the practice of nursing, medicine, law, or any other licensed profession/occupation within their own boundaries, and I don't blame them for that. Also, when it comes to the question of affecting/changing the practice of nursing in the US, I'd rather be dealing with 50 smaller organizations than one huge, monolithic, "all or nothing" entity.

Exactly, except she's more diplomatic than me. I'm like the bull in the china shop. :chuckle

[n_g]

People should remember the saying, "if it walks like a duck, quacks like a duck, it's a duck". It doesn't matter what Mundinger or these nursing organizations proclaim. Most people, including judges, have a good idea of what activities constitutes medicine and nursing. If you feel like you're practicing some form of mediciine as an APN, you're probably are and most other people in the public would agree with you. That's why it's so dangerous if such a case ever went to court. APN's would have a huge uphill climb to convince anyone outside of nursing that they really belong under BON and not BOM. Furthermore, physicians would argue that they are the best group to develop training and regulations for anyone working in medicine and they would have the processes in place to monitor and discipline. I wouldn't take such a case so lightly. It would transform and revolutionize APN as you know it.

[amzyRN]

I am not convinced that physicians have that kind of sway nationally. Nurses associations are becoming better lobbyists all the time and considering the need for NPs and other mid levels (less expensive), I doubt physicians would be able to limit NP scope of practice like some people think they might. I don't think there are enough physicians to accommodate the entire American population of sick people on their own. I think NPs are needed an valued in many states. And I think that with some negotiation, NP scope could expand, possible even nationally. I think it is good to stand up for things that are fair and make sense regardless of how the chips may fall. It is not good to cower and hide. I think I can understand the feeling some physicians may feel, like maybe they won't be needed anymore, but I don't think that is accurate.

[elkpark]

People should remember the saying, "if it walks like a duck, quacks like a duck, it's a duck". It doesn't matter what Mundinger or these nursing organizations proclaim. Most people, including judges, have a good idea of what activities constitutes medicine and nursing. If you feel like you're practicing some form of mediciine as an APN, you're probably are and most other people in the public would agree with you. That's why it's so dangerous if such a case ever went to court. APN's would have a huge uphill climb to convince anyone outside of nursing that they really belong under BON and not BOM. Furthermore, physicians would argue that they are the best group to develop training and regulations for anyone working in medicine and they would have the processes in place to monitor and discipline. I wouldn't take such a case so lightly. It would transform and revolutionize APN as you know it.

(BTW, I'm usually the "bull in the china shop" in any given situation, so I'm happy to let someone else take over the job for a while! :chuckle)

Exactly -- it is not at all difficult, in fact, it's very easy, to make the case that NPs and most other APNs are practicing medicine without a license. What's hard is to make the case for why they're not practicing medicine (without a license!) and should not be under the control of the state medical boards rather than the BONs (if not required to "cease and desist" until they have a medical license!) This may all look very simple and clear to all the bright, enthusiastic, young people here who want to become very independent NPs (and I don't mean that in any negative way at all :)), but those of us who have been "in the trenches" on this issue for many years understand what a fragile, delicate tightrope we're walking. It has nothing to do with "hiding and cowering." Too little independence/autonomy, and there's no point in being an NP. Too much, and the docs get worried and slap you down.

If some people don't want to believe us, fine; but there are plenty of us here who have personally witnessed this dynamic balance, and personally participated in the ongoing struggles over advanced practice nursing scopes of practice, for many years (and have the scars to prove it! :))

But, hey! If some of y'all want to go poke the AMA with a big, ol' sharp stick and see what happens, go right ahead. :chuckle It's not going to affect my practice or career one way or the other, so be my guest. Be sure and let me know how that works out for ya ... :)