discussion regarding education of NP (DNP) and PA compared to MD/DO

RockyCreek · Mar 15, 2009

What exactly do your patients call you?

Let's say you are working with Nancy MakeMeBetter, NP: In private, I assume you just call her Nancy; in front of your patients do you still just call her Nancy? Mrs. MakeMeBetter? Hopefully not 'Nurse' Nancy! Nurse Practioner Nancy or Nurse Practioner MakeMeBetter is a lot of name to say very often. And, calling someone an "Nancy NP" is just never something I have ever heard.

The reason I ask is because the unwritten hospital rule has always been to call the physician "Dr. So-and-so" in front of the patients even if you call them by their first names in a social setting -- it is considered a professional courtesy. I want to show the proper respect for the NP's I meet, too -- how should I be handling introductions?

enoRN · Mar 15, 2009

I think wowza does not understand nurses are not competing with physicians who call themselves doctors. Nurses are only trying to be heard more and more as the years pass by. :nurse:

Are you for real? I cant remember in the last 20 years or so anyone who was not familar with what an NP is or what they do.

wowza · Mar 15, 2009

Very interesting clarification. So, if I understand your theory here, medical students are much brighter than other college students, which is why they are in medical school? So its not just nursing students and nurses who arn't so bright, its all college students who are not medical students. Is that right?
It kind of reminds me of when John Kerry said if you are smart enough to get good grades, you go to college and if you don't, you go to Iraq.
I suppose with this misinformed characterization and uninformed generalization your path must have been nursing or general college studies. Too bad. Better luck in the next lifetime.

You can twist my words all you want but it is clear you are manipulating the meaning.

If we take any population and then select the best students based on GPA and scores, those selected are, on average, going to be brighter than the original population. If we were to select a proportion of nursing students who had higher grades and scores than the average nursing students, that new population of nursing students would be brighter on average than the larger population of nursing students. Duh.

1) Uh, because they have a clinical doctorate degree. Thanks for keeping the questions simple for us nurses otherwise, we would have trouble following along.
2) Equivalence to what? To physician? Cite your authority.
3) Cite your authority of why medical school should be 4 years and not the former 2 year apprentice program.

1) My question was aimed at why you think it should be a clinical doctorate when it is essentially the same thing as the masters degree was? Why not a clinical masters? To me it seems it was for political jockeying.

2) Are you saying you actually feel that 3 years, with 1 year of that being fluff, is equivalent training to 4 years of medical school, plus 2 years of residency; that 1000 clinical hours prepares you in a similar manner that over 12,000 clinical hours do? Because if that is what you are saying it is clear you no longer have patient care, but rather ambition on your mind.

3) Please see the flexner report. Do you feel medical education can be summed up in 2 years or are you just being hyperbolic? 2 years is inadequate. It was adequate at a time... the early 1900s. As medical knowledge has been accumulated, we have needed significantly more time to teach it. I know you are not saying you want medicine to be practiced like it was in the early 1900s?

Are you for real? I cant remember in the last 20 years or so anyone who was not familar with what an NP is or what they do.

Sure, when you are surrounded by nursing, it seems obvious. The average person is not very familiar with the different iterations in health care. Most patients see a white coat and think, "that's a doctor." I have personally run into many patients just in the last month who do not understand what an NP is. Perhaps my patient population is just dumb...

greygooseuria · Mar 15, 2009

Wowza, NPs with doctorates do not want to be called physicians. They want to be called "Dr. JBeau, DNP" just like an MD would be "Dr. Wowza, MD". Get it? Got it? Good.

So are you saying I should have gone to med school? I got all As in pre-med classes and had a 3.8 GPA. So because I want to be an NP I am somehow lesser than MDs?

And not to be crass, but many of my college friends are in med school now. They may be book smart, but I foresee them having MANY problems with their bedside manner moving forward in their career, and that is something that patients DO NOT like.

hypocaffeinemia, BSN, RN · Mar 15, 2009

So are you saying I should have gone to med school? I got all As in pre-med classes and had a 3.8 GPA. So because I want to be an NP I am somehow lesser than MDs?

I don't see where he is saying that at all.

Considering MSN and presumably DNP degrees require both undergraduate and graduate level statistics courses, there seems to be a poor understanding of wowza's point regarding populations, here.

cruisin_woodward · Mar 15, 2009

orignally posted by wowza

"sure, when you are surrounded by nursing, it seems obvious. the average person is not very familiar with the different iterations in health care. most patients see a white coat and think, "that's a doctor." i have personally run into many patients just in the last month who do not understand what an np is. perhaps my patient population is just dumb..."

well i think this is true (not the dumb part, but the part that a lot of people see white lab coat and they think dr), particularly the elderly, but they also think, "female= nurse, male=dr." perhaps there should be a division? no female physicians, no male nurses? where i work, which is a very busy inner city hospital in detroit, managers, educators, nps, pas, cns, physicians, pts, ot, pta, ota, etc etc all wear white labe coats. is that intimidating to physicians too? the whole point is that we all need to be introducing ourselves to our pts! they are not stupid...but i wouldn't know a housekeeper from a nurse if they didn't introduce themselves...that is just common courtesy. you will find that nurses, np or otherwise, come into the room and introduce themselves. many physician's don't even talk to the patient. they walk into their room, with a group of physicians and med students, and talk about the patient right in front of them as if the pt isn't even there. so maybe that is where we need to start!

wowza · Mar 15, 2009

Wowza, NPs with doctorates do not want to be called physicians. They want to be called "Dr. JBeau, DNP" just like an MD would be "Dr. Wowza, MD". Get it? Got it? Good.
So are you saying I should have gone to med school? I got all As in pre-med classes and had a 3.8 GPA. So because I want to be an NP I am somehow lesser than MDs?
And not to be crass, but many of my college friends are in med school now. They may be book smart, but I foresee them having MANY problems with their bedside manner moving forward in their career, and that is something that patients DO NOT like.

You may say one thing but your lobbying organizations are behaving completely differently and you guys do not object. They are trying to expand practice rights such that while not called physicians, DNPs would have all rights and responsibilities of a family physician despite a much abridged training regimen. That they would not be called physicians would be semantics. The scope of nursing has now been expanded to include much of medicine. DNP/NP lobbying groups are working hard to expand that even further without regard to how this may adversely affect pt care. I think this is wrong.

Again, as I have said previously in this thread, there are many very bright nurses. You seem like one of them. I suspect since you were chosen to continue your education over other candidates, you are brighter than the average nurse. You as a person are not lesser than an MD. Your training however is not the same as a medical student receives.

Bedside manner is one of those things that just cannot be taught to everyone. Some have it some do not ( cue Tammy79RN saying something about me having a poor bedside manner).

Dr. Tammy, FNP/GNP-C · Mar 15, 2009

You can twist my words all you want but it is clear you are manipulating the meaning.

OK, I'm an educator. Let me educate you on what you said.

I have a bunch of friends that completed nursing school and are current nurses. There definitely are some very bright ones but on the whole, they are not the same caliber as an average medical student. Academically, can you really say you think the average nurse is on par with the average medical school matriculant?

Perhaps I should clarify my point:
My comments would also fit for the average college student- non-medically related. Since medical students have been selected out of that pool of college students, it fits that they on average would be brighter than the average college student.

.

Now you are saying, (and by the way this is my favorite jargon of the day:

If we take any population and then select the best students based on GPA and scores, those selected are, on average, going to be brighter than the original population. If we were to select a proportion of nursing students who had higher grades and scores than the average nursing students, that new population of nursing students would be brighter on average than the larger population of nursing students. Duh.

If I were to receive a paper with this written as a passage, even from what you would consider a dense nursing student, which is all that I am privledged to teach, I would write, "Please read this aloud to 10 different classmates and ask them if this makes any sense whatsovever. Pay attention to detail and articulate your points and reference your authorities." Not bad from a not-so-bright nursing faculty, heh?

1) My question was aimed at why you think it should be a clinical doctorate when it is essentially the same thing as the masters degree was? Why not a clinical masters? To me it seems it was for political jockeying.

.

Because the title is "Doctor of Nursing Practice." Pay attention to the "practice" part and say it slowly--p r a c t i c e. Then take this multiple choice quiz:

(1) What does the term practice mean?

a) research

b) clinical

No cheating now, and you only get 5 minutes to answer.

2) Are you saying you actually feel that 3 years, with 1 year of that being fluff, is equivalent training to 4 years of medical school, plus 2 years of residency; that 1000 clinical hours prepares you in a similar manner that over 12,000 clinical hours do? Because if that is what you are saying it is clear you no longer have patient care, but rather ambition on your mind.

.

Very nice attacks against then tenets of nursing education. I'm curious, though, how is it working out for you when you go on to dental, optometrist, and psychologist forums and claim that physicians are the only ones entitled to use the title, "Doctor" because none of their programs are "the same as medical school"? Do keep us up to date on your progress there.

3) Please see the flexner report. Do you feel medical education can be summed up in 2 years or are you just being hyperbolic? 2 years is inadequate. It was adequate at a time... the early 1900s. As medical knowledge has been accumulated, we have needed significantly more time to teach it. I know you are not saying you want medicine to be practiced like it was in the early 1900s?

.

First of all, I'm just a nurse, so I don't know any of those big words like hyperbolic. But thanks for bringing up the Flexner report as I almost forgot this was the document that gave birth to the term "Quackery" as it applied to the practice of medicine. And to answer your question, I agree with Abraham as he rightly stated that two years was not enough training and that medical education back then largely existed as a revenue-generating schema for physicians.

Most patients see a white coat and think, "that's a doctor

See, there is hope for you yet. I do agree with you that when people see someone in a white coat they think "doctor." A few posts ago, you would have said someone with a white coat is a "physician". Now you understand that a doctor can be a medical doctor or a doctor of nursing practice.

Good work!

One day you may be "bright" enough for a career in nursing, or at least have the ability to provide a small measure of respect for those who have chosen nursing by not insulting their intelligence, or the general "brightness" of an entire profession.

Dr. Tammy, FNP/GNP-C · Mar 15, 2009

( cue Tammy79RN saying something about me having a poor bedside manner).

Actually, that wasn't me, but with all of your thoughts and insight on the intelligence of nurses, I could not say that I would disagree.

Editorial Team / Admin · Mar 15, 2009

I think we are waaaaay off topic of comparing education among NPs, PAs and MD/DOs..........

Let's get back on topic. We can continue the DNP topic on this thread: https://allnurses.com/nurse-practitioners-np/doctoral-degree-become-160044-page68.html

wowza · Mar 16, 2009

if i were to receive a paper with this written as a passage, even from what you would consider a dense nursing student, which is all that i am privledged to teach, i would write, "please read this aloud to 10 different classmates and ask them if this makes any sense whatsovever. pay attention to detail and articulate your points and reference your authorities." not bad from a not-so-bright nursing faculty, heh?

i am not sure how many different ways i can say the same thing. here's the cliff notes for you: if you select out those with higher scores, you are going to have brighter students, on average, than the original population on average. that does not mean that every individual is brighter- just that on average you will have a brighter group. it is basic statistics at work.

by repeatedly missing the point of my argument, you are making the the case for the argument you are fighting so hard to disprove. and funny enough, that was not even the point i was trying to make. you just misinterpreted my words. but thanks, i guess...

i don't see where he is saying that at all.
considering msn and presumably dnp degrees require both undergraduate and graduate level statistics courses, there seems to be a poor understanding of wowza's point regarding populations, here.

menetopali · Mar 17, 2009

My comments on this board are also not meant to be attacks on nursing, just that those who created the DNP degree do not have patient care on their mind.
I feel that every effort needs to be made to show the public that the new degree does not offer the same education as an MD/DO.
If the education and the licensing requirements were the same i would withdraw absolutely all of my objections. My issue is not that this is going to over crowd the market with providers or that it is going to influence my job- i am going into a field that is largely free from encroachment; my issue is that the lack of education will lead to improperly trained providers.
Years ago, the family practitioners realized that medical school alone was not adequate enough training for the expanding medical knowledge for a primary care physician so they created a 2 year residency.The DNPs have not found some efficient way to train their providers, especially not with a years worth of nursing theory/epidemiology. They are just cutting corners. Someone will get hurt. People need to put down the ambitions and start being patient advocates again.
If anyone actually feels that the training and knowledge base are the same between the two, please speak up. Otherwise you have an ethical imperative to help prevent improperly trained providers from practicing unrestricted and hurting someone.

you basic assumption is false. you assume that only through medical school can a person be appropriately prepared for primary care. this assumption has been shot down several times over - including the IOM in their quality series. if you choose to see an internist, fine; take your kids to a pediatrician, no problem; claim that NPs are "improperly trained providers" and raising the claim that they will hurt someone with zero actual evidence to back it up, now that is a bald faced lie and i challenge you to provide any evidence that such a claim is true.