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

Specialties Doctoral

Published

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?

Specializes in Nursing Professional Development.

And finally, once again, the burden of proof is in the claimant, meaning it is the responsibility of nurse practitioners to show they are as good of practitioners as physicians, not the other way around. Aside from research that showed that nurse practitioners that were supervised by physicians were possibly as good as residents, there is none.

Actually, if the burden of proof is on the claimant, then that burden falls to the physicians who claim that harm is being done. Doctorally prepared nurses have earned a doctoral degree and are therefore entitled to be called "Doctor" as is customary in our society for people with doctoral degrees.

If the physicians want to make a claim that an exception to that customary titling practice should be made, then it is up to the physicians to prove that such an exception is needed.

By your own espoused basic principle, Josh, you have it backwards.

llg, PhD, RN

Specializes in Pain Management.
Actually, if the burden of proof is on the claimant, then that burden falls to the physicians who claim that harm is being done. Doctorally prepared nurses have earned a doctoral degree and are therefore entitled to be called "Doctor" as is customary in our society for people with doctoral degrees.

If the physicians want to make a claim that an exception to that customary titling practice should be made, then it is up to the physicians to prove that such an exception is needed.

By your own espoused basic principle, Josh, you have it backwards.

llg, PhD, RN

Wrong. It is not up to the physicians to prove that nurse practitioners cause harm, it is up to the nurse practitioners to prove that they don't. Similarly, it is not up to the consumer to prove that a medication causes harm, it is up to the pharmaceutical company to prove that it doesn't. That is how the system works.

To suggest the reverse is to commit a logical fallacy.

It is not up to the consumer to prove that a medication causes harm, it is up to the pharmaceutical company to prove that it doesn't. That is how the system works.

Do you really trust the pharmaceutical companies to monitor themselves? That's why we have the FDA!

Specializes in Nursing Professional Development.
Wrong. It is not up to the physicians to prove that nurse practitioners cause harm, it is up to the nurse practitioners to prove that they don't. Similarly, it is not up to the consumer to prove that a medication causes harm, it is up to the pharmaceutical company to prove that it doesn't. That is how the system works.

To suggest the reverse is to commit a logical fallacy.

You've changed the topic of the basic argument of the thread. The point of the thread is not "Should NP's be allowed to practice or not? Are NP's safe?" The point of the thread is whether or not DNP's can/should use the title "Doctor"? On that question, the burden of proof is on physicians as the customary practice is to refer to people with doctoral degrees as "Doctor."

As to whether or not NP's provide safe care or not ... whether they are doctorally prepared (and called "Doctor") would not be a relevant issue.

I just received this from ANA....

ANA Voices Opposition to AMA's Attempts to Limit Nursing Education and Practice

06/17/08

The American Nurses Association (ANA) will be attending the American Medical Association's (AMA) House of Delegates as official observers. ANA representatives will be monitoring the progress of the proceedings and will present verbal comments.

ANA is already challenging several proposed Resolutions under consideration by the AMA; 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 those terms to physicians, dentists and podiatrists.

ANA believes these resolutions are an attempt to limit nursing education and practice, and that any matter concerning nurses' scope of practice is a matter for the state legislatures, state boards of nursing, and the nursing profession itself.

ANA President Rebecca M. Patton, MSN, RN, CNOR and CEO Linda J. Stierle, MSN, RN, CNAA,BC have submitted letters to the AMA recommending rejection of Resolutions 214 and 303 Resolution 214.

I suggest we all contact our representatives both federal and state and let them know how we feel about this.:down:

Where is the evidence that medicine is male-dominated and therefore physicians make more than women nurses? Sounds like the biased, unscientific claims made in my Graduate Nursing Theory book...or assumption, if you will.

And finally, once again, the burden of proof is in the claimant, meaning it is the responsibility of nurse practitioners to show they are as good of practitioners as physicians, not the other way around. Aside from research that showed that nurse practitioners that were supervised by physicians were possibly as good as residents, there is none.

A real patient advocate would demand good research to show that solo nurse practitioners are not causing harm to the patients and function as well as physicians.

Keep in mind that Nurse practitioners are educated to provide primary care.

There is research that shows that NPs provide a valuable service that is comparable to pysicians and is also cost effective.

http://www.rwjf.org/reports/grr/032806.htm

SUMMARY

From 1998 to 1999, researchers at the Columbia University School of Nursing conducted the second phase of a study comparing nurse practitioners and physicians as primary care providers.

During Phase I, researchers assigned patients randomly to either a nurse practitioner or a physician at Columbia Presbyterian Medical Center. Researchers had found no significant differences in the health status or health services utilization of patients in the two study groups, after one year.

To see if the findings were maintained over an additional year, in Phase II of the study researchers collected additional data through 756 patient interviews (439 with the nurse practitioner group and 318 with the physician group).

Key Findings

Patients who were assigned to nurse practitioners were similar demographically to patients assigned to physicians.

In the year before this data collection:

Thirty-three percent of patients received care only at the assigned clinic.

Six percent received care at the assigned clinic and another provider.

Twenty-seven percent only sought care elsewhere.

Thirty-two percent did not seek primary health care at all.

Researchers concurred with the preliminary results: in an ambulatory care situation where nurse practitioners have the same authority, responsibility, productivity and administrative requirements as physicians, patient outcomes are comparable.

Funding

The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $162,075.

See Grant Detail & Contact Information

Back to the Table of Contents

--------------------------------------------------------------------------------

THE PROBLEM

Assuring adequate access to health care for all segments of society continues to be a major challenge for policymakers and the health care industry. NPs serving as primary care providers have the potential to improve access to care, but there was a lack of definitive data on the impact of NPs in this role.

Columbia University School of Nursing assumed a leadership role in advanced nursing practice in 1994 with the opening of the Center for Advanced Practice, a nurse practitioner primary care clinic, one of six community-based primary care practices maintained by Columbia Presbyterian Medical Center.

It serves a primarily Hispanic Medicaid population of more than 3,200 adult and pediatric patients in the Washington Heights-Inwood section of Manhattan. It is staffed by faculty nurse practitioners who have been granted hospital-admitting privileges by the Medical Board of the medical center.

During Phase I of this project, the Columbia University School of Nursing conducted a randomized study to compare NPs and MDs as primary care providers. This study, conducted from August 1995 to October 1997, was entitled "The Evaluation of Primary Care in Washington Heights." It was funded by the New York State Department of Health, the Division of Nursing of the US Department of Health and Human Services, and the Leslie Samuels and Fan Fox Foundation.

The study enrolled 1,316 patients who were referred from two emergency departments and one urgent care center at Columbia Presbyterian Medical Center. These patients were assigned randomly to either a nurse practitioner (806) or a physician (510) at Columbia Presbyterian Medical Center.

Baseline data included the patients' functional health status and whether they had one of three chronic conditions targeted for study: asthma, diabetes, or hypertension. Patients were interviewed six months after their initial appointment and health services utilization data were recorded at six months and one year after the initial appointment.

As reported in The Journal of the American Medical Association (JAMA), no significant differences were found in the health status of patients who saw nurse practitioners and those who saw physicians. No significant differences were found in health services utilization after six months or one year. Following the initial appointment, there were no differences in patient satisfaction with primary care. At six months, satisfaction ratings differed only for provider attributes, with physicians rated slightly higher (4.2 vs. 4.1 for NPs on a scale where 5 equals excellent).

The researchers concluded that patient outcomes were comparable in an ambulatory care situation in which patients were randomly assigned to either NPs or MDs, and where NPs had the same authority, responsibilities, productivity, administrative requirements, and patient population as MDs.

:yeah:

Specializes in ED, Cardiac-step down, tele, med surg.
Where is the evidence that medicine is male-dominated and therefore physicians make more than women nurses? Sounds like the biased, unscientific claims made in my Graduate Nursing Theory book...or assumption, if you will.

And finally, once again, the burden of proof is in the claimant, meaning it is the responsibility of nurse practitioners to show they are as good of practitioners as physicians, not the other way around. Aside from research that showed that nurse practitioners that were supervised by physicians were possibly as good as residents, there is none.

A common critique of physicians is that they are reacting from ego when they try to limit the scope of nurse practitioners, but if you take a step back and look at the situation, it seems like the notion that nurse practitioners are at least equal to physicians in ability while only having a fraction of the training (because of some inherent benefit of the nursing model confers to the nurses over the physicians) is a function of ego.

A real patient advocate would demand good research to show that solo nurse practitioners are not causing harm to the patients and function as well as physicians.

Take a look at some stats I found, not so recent but enough to make my point. http://www.ama-assn.org/ama/pub/category/12912.html

Though there has been increasing numbers of physicians recently, medicine has been historically a male dominated profession, nursing female. And why is it that nurse practitioners must prove something versus physicians? I don't think there's any statistically significant evidence that shows NPs provide inferior care. Where's the evidence NPs harm patients? The burden of proof is on you if you make such a claim!

J

Specializes in being a Credible Source.

I would argue that many of us are partly responsible for facilitating the co-opting of the term "doctor." After all, don't many of us use the term "doctor" to mean "physician" in some contexts? I have long been guilty of this.

Awhile back I began retraining myself to use the generic terms physician or surgeon or the specialist terms. I no longer refer to physicians as doctors though I will certainly address them as "Dr. xxx" unless invited to do otherwise. I extend that same courtesy to the holder of any doctorate.

Doctor doesn't equate to physician although all physicians happen to hold doctorates. To me, any holder of a doctoral degree is entitled to use the title "doctor"; only the holder of a medical licenses is entitled to use the title "physician."

If nurses are concerned about the monopolization of the term "doctor" then we nurses (or in my case, nursing student) should not be using the term "doctor" to mean "physician" when we speak to patients... or each other.

Specializes in being a Credible Source.
Unless you happen to live in Oklahoma. Our state physicians ramrodded through a law that prevents us from doing that. The only exceptions include chiropractor, dentist, optometrist and podiatrist...

Amazing to me that physicians in OK consider chiropractors and optometrists "worthy" of the title but not doctorally prepared nurses, physical therapists, or psychologists.

Specializes in ER; CCT.
Doctor doesn't equate to physician although all physicians happen to hold doctorates. To me, any holder of a doctoral degree is entitled to use the title "doctor"; only the holder of a medical licenses is entitled to use the title "physician."

If nurses are concerned about the monopolization of the term "doctor" then we nurses (or in my case, nursing student) should not be using the term "doctor" to mean "physician" when we speak to patients... or each other.

Too true. Unfortunately most (health care provider and consumer alike) equate doctor as synonymous with physician. I think (hope) this will change over time with brutal and strong physician opposition notwithstanding.

One event that must occur first is for the profession of nursing to come together and get an undivided sense of itself in that nurses practice nursing and physicians practice medicine. More often than not, especially in the context of advance practice nursing, I get a sense that most feel that advance practice nursing functions are within the domain of the practice of medicine and not nursing such as with diagnosing and prescribing medication. Even in today's climate with graduate nursing education (inclusive of nursing theory, nursing science-based research and advance nursing models) underpinning advanced practice nursing, I sense such dissociation between advance practice nursing models and advance nursing practice including profession, role and function confusion.

If DNP's truly want to be recognized as clinical-based doctors of the health care profession then we need to come together as a whole and make it clear that DNP's are nursing doctorates practicing nursing, not nursing doctorates practicing within the domain of another health care discipline (i.e. medicine).

If nursing cannot set itself aside from medicine in the context of DNP-based advanced nursing practice, then the medical establishment will continue to have valid arguments to control DNP practice and ultimately who may use the title of "doctor."

As a fellow PharmD, I have a problem with Dr. Ho's website. Nowhere does it state that she is a licensed pharmacist nor does it state if she utilizes FDA approved products (prescription or OTC). I can see where this type of information, or lack there of, could be misleading. I hope for the public's sake that more information is provided at her place of business.

As a clinical pharmacist, I address myself using my first name followed by "one of the pharmacists here at the hospital." I, personally, don't force people to call me "doctor" for simplicity; people generally know the difference between physicians and pharmacists. I do, however, proudly display PharmD on my lab coat mostly in honor of the people who have taught me over the years (pharmacists, physicians, nurses, respiratory therapists, speech therapists, etc.) and helped me get to where I am today. Our public needs to be re-educated that there are different types of providers participating in their care. Only then will we be able to move forward in achieving the best outcomes for our patients.

We have to get away from the "only a nurse" mentality while all the other disciplines upgrade their educational requirements and assume leadership roles in the health care system.

:up: ...

+ Add a Comment