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.
i work with radiologists and they know "zip" about medications. i've had them tell me "if we had a code i'd probably pee in my pants" or "a code is my worst fear". are they good radiologists, yes! exceptional! every has their place. the trick is to not over-step it. my dh was at the oncologist and saw a np, when she left the room he said "thank you dr", she turned and said "no i'm a nurse, a nurse practitioner, but you're quite welcome". that's practicing responsibily imho
:chuckle wish i'd read this sooner. we had a code in ct the other day. at first they called for a radiologist, then respiratory, then the code. would have been interesting to watch them pee themselves. especially the smarmy ones.
I am currently in the University of Arizona DNP program. I occasionally run into this same type of discussion. It has been established that physicians do not have a monopoly on the title of Doctor. Many professions are requiring their members to be doctorally prepared to practice, Pharmacists and Audiologists are only two. The Nurse Practitioner who is doctorally prepared should introduce his or herself in a manner that is not confusing for patients. "Good morning, I am Dr. Jones, a nurse practitioner working with the neurosurgery team here at XYZ hospital." We have a PA who routinely introduces himself as "Hi, I am James (not his real name) with neurosurgery." Every patient who meets him thinks he is a neurosurgeon. It is dreadful. I think if physicians want to be clear about titles, they should introduce themselves as medical doctors. As for those who refuse to quit beating this dead horse, I have one word for them, Podiatrist.
Please Please Please do not use the term mid-level provider or Physician Extender. These are both incredibly limiting and when you think about them. I prefer the terms "advnced Practitioner" or "Tandem Practtioner" when an NP or DNP works with a team of other professionals. Physician extender sounds, well, Mediaographic, and mid-level puts RNs down and elevates physicians when in fact nursing and medicine are separate disciplines that cannot be compared on a continuum. Thank you, my two cents.
Pharmacists are IN primary care. They are an invaluable asset to our hospitalized patients. They perform all the kinetics necessary to dose dangerous drugs such as order lab tests and adjust the doses based upon those labs. At St. Jude's Childrens' Research Hospital, they have essentially one pharmacist for every 2 beds. That is 25 pharmacists for a 58 bed hospital. They value the pharmacist at the best children's research hospital in the country. Physicians do not have the time or the skill to do this. Pharmacists and in some places, qualified Registered Dieticians dose the TPN to individualized specifications so that nutrition is optomized. They also order the laboratory work to manage it. In a perfect world, every patient would benefit from a the collective talents of a healthcare team that is fully able to integrate knowledge of disease pathogenesis, holistic nursing care, expert chemistry and microbiology processes, and pharmacotherapy, thereby optimizing the therapy for each individual. If that means EVERY person on my healthcare team is a DOCTOR then I am a happy consumer of healthcare. This does not dilute the title of doctor, but assures me that I am getting healthcare deliver from every profession at the highest level.
Na, I just find it ironic that a physician has no problem sharing the title with someone who is only allowed to practice on tissue bellow, but not including, the knee.
Actually, nowhere in my state's nurse practice act nor in my employment contract in the hospital does it say that I am to perform physician's orders. In fact, if said orders are inconsistent with quality patient care or established standards, then I am supposed to refuse to perform them and use the chain of command to protect patients. I interact with physicians, pharmacists, NPs, DNPs, and PAs on a daily basis, and carry out their orders in a collaborative practice that promotes quality healthcare delivery.
Actually, you are as WRONG as you could be. The term NURSE is a LEGAL term regulated by states and can only be used legally by a Registered Nurse (or LPN in some states). The peson earning a nursing degree CANNOT call him or hrself a nurse unless sanctioned by a state licencing agency. However, the term doctor is available to anyone who has completed a reputable, and some not so reputable, doctoral program.
The Nurse Practitioner who is doctorally prepared should introduce his or herself in a manner that is not confusing for patients. "Good morning, I am Dr. Jones, a nurse practitioner working with the neurosurgery team here at XYZ hospital." .
Keeping in mind that many patients don't understand the difference between RN, CNA, and LVN, I just think it would be much less confusing to say "Good morning, I am Jane Jones, a nurse practitioner. A nurse practitioner is someone who has a doctorate degree in nursing."
Yep, I'm a first year med student. I'm going to have to stand by my position when I say that a nurse practitioner's clinical advice does not carry the same weight as an attending physicians. I say this not only as a med student, but as the family member of loved ones who have been through some serious illnesses and as a healthcare worker who has worked with PA's and NPs. Sorry if it hurts some egos, but it's true. You can't compare a physician's training with a nurse practitioner's-- the physician has far more rigorous training. As for all these studies that show that NP's provide equal or superior care vs. physicians, those studies have also been showed to be pretty flawed. If I recall correctly, the P value was enormous, the follow-up was for a very brief time, and the physicians they compared the NP's against were residents.
As for patients and their families being confused by the roles of the staff in the hospital-- I don't see how you guys don't get how this is a problem. God, I'm a med student and there are times where I have a hard time spotting the doctors from the nurses from the NP's from the techs. It can be hard when you have all these different people coming in, they're all wearing white coats, with stethoscopes in their pockets. Add to that nurses calling themselves doctors. But wait, "I'm a nurse too."
I have to hand it to Mary Mundinger and her crowd, though. Mid-levels have managed to break through into the world of medicine-- you are now able to practice the field of medicine independently in six years (you could probably do most of your education via the net too!), and be called "doctor" in the end, setting up your own practice with a watered down education. Bravo.
It sounds as if you had some bad personal experiences. I myself have had a loved on in the hospital and was profoundly disappointed in many disciplines, including nursing. I want to be as compassionate as I can when I say that it is essential in science to utilize quality research to shape your thinking and your practice, not anectdotal evidence.
You will see as you progress in your education that there are attending physicians who never lay a hand or a stethoscope on their patients, read the last discharge note and dictate directly from it, and then bill for rounding on that patient. If you are a good physician, this will make you as angry as poor quality nursing makes me. You will also see Nurse Practitioners who have 20 years of bedside experience walk into a room, examine a patient head to toe, and catch a case of sepsis early enough to actually save the patient's life. You will see the best and worse of every profession and what they have to offer if they do their job correctly and what damage they can do when they don't. You will see that nursing and medicine are distinct disciplines that, when they are optimized, especially in the areas where they overlap, make dramatic improvements in patient outcomes. This is evidence-based, not my opinion.
You are passionate, that is clear. It is important in healthcare to model the best behavior, always treat your patients according to the best evidence, and that starts with a complete history and physical, and expect the same from everyone around you. It also means respecting and trusting the professionals you work with because you know their work, regardless of their title. I wish you a long and happy career as a physician, welcome to the healthcare profession.
This is again where the confusion come in. Oversight implies managing the performance of a person or a group. Who are you responsible for? Do you oversee the other nurses? Do you oversee the physicians? Are you responsible for directing their care? This is the prime problem with the title.
The patient population equates doctor with physician. However, there is are bunch of studies by the drug companies that show that the patients generally equate doctor with provider. Once you add non providers into the mix it becomes very confused.
Ultimately (at least in the inpatient population) there is one person who has ultimate medical decision making capacity. That person is a physician. Given the way the state medical acts are written there is no chance in the near future that any non-physician will be able to direct how a physician makes medical decisions. For example you would not be able to tell a physician how to treat a patient. Similarly the hospital CEO (if not a physician) could not tell the physician how to treat a patient.
In the end the proliferation of "doctors" can lead the patient to become confused over who is ultimately in charge of their care.
Realistically physicians are ultimately responsible for using doctor when more properly they should have been using physician. However, its a little late to put that genie back in the bottle. There is also an element of ego here.
Ultimately the unlike the other titles, the doctor in physician is both an academic title and by common usage a professional title. While it is illegal to state that you are a nurse without an active RN license, the use of Doctor in most states is not protected leading to the current confusion.
David Carpenter, PA-C
Doctors of Nurse Practice ARE primary care PROVIDERS and in 23 of the fifty states their scope of practice allows them to practice under their own license without being overseen by a Medical Doctor...they are also given full hospital privileges and allowed to directly bill insurance. Sorry, but like it or not...Dr. does not belong to MD's...even in the clinical setting as DNP's are providing primary care autonomously in half the country and at some point they will probably be doing so within the entire country.
While it may be true that within the clinical setting at this point in time that patients equate "Dr." to mean a physician it is only through owning your title and proper education that the differentiation and distinction will be made. "Dr." is a terminal degree...it is a level of education it is not owned by anyone or any specialty. Patients being diagnosed and treated by DNP's have a right to know the level of education their provider has achieved and how that differentiates them from other providers.
It is what it is and change is inevitable...instead of trying to fight it maybe we could look at how it will benefit everyone...especially the patient. No one is trying to mascarade as something that they are not by owning and using the title they rightfully earned and are entitled to use. MD's who think that DNP's are using "Dr." because they want to be perceived as "MD's" are missing the point...everything is not about you... if a DNP wished to be perceived as an MD they would have went to medical school.
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yellow finch, BSN, RN
468 Posts
:chuckle wish i'd read this sooner. we had a code in ct the other day. at first they called for a radiologist, then respiratory, then the code. would have been interesting to watch them pee themselves. especially the smarmy ones.