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

kellyjoeds · Jul 24, 2008

Thank you for your reply!

Joan Z · Jul 24, 2008

"I think nursing has an inferiority problem" JDCitizen, I think you hit it on the head there. When I look at nurses with alphabets of initials after their names I have always been reminded of new officers, insecure about their authority, who must remind those under them that they do know what they are doing, as opposed to the older, more experienced officers, who have the confidence built on true power.

It is unfortunate that for years the nursing profession was under the jurisdiction of the medical field, and in large measure still is. While there is some overlap the expertise is not universally there. I don't want the kindly old family physician running a code in the ED, I would much rather have the ACLS RN with years of experience. I watched a new MD who insisted on evaluating a patient's ambulation once--he hurt his back and he had ignored suggestions from an RN and a couple of CNAs.

However, no one is going to be impressed simply by initials after a name. My peers in my MSN program also cited lack of pharmacology and clinical experience as the minuses in the program, and we mostly all busted our butts to make up for this. My patients are more interested in what I have to say about aliskiren than Martha Rogers.

In no way do I mean to downplay the importance of the field of nursing. In my opinion, the nursing approach to the patient is far superior to the medical. However, the value of the medical approach can't be discarded. I don't see the DNP, as it is currently proposed, adding anything to my practice.

MikeTexas82 · Jul 24, 2008

I have read many articles and experienced several aspects on the D.N.P., P.A-C, N.P., M.D./D.O. situation. It has been shown in numerous studies that the N.P. does without a doubt provide primary care that is better or equivalent to that of primary care physicians. The DNP program is in the incipient stages and is going to be very a sensitive subject to the whole health care provider system.

We must remember that being called Doctor extends from the Latin verb, docere, meaning "to teach." In remembering this we should extend the courtesy to all who reach the level of Ph.D., M.D., D.N.P, Pharm.D., etc., to be called Doctor. Patients are not stupid... when a health care provider walks into a patients room, the name badge and credentials should be visible and the hcp should introduce themself as Dr. of medicine, Dr. so and so, Nurse Practitioner, Dr. so and so , clinical pharmacist, etc. The word physician has several roots stemming from Greek, Latin, and French terms. Several groups of people are throwing fits about a nurse with a DNP being called Dr. This reaction is totally unnecessary! Patients' have a right to chose who provides their care, whether it be a physician, a np, a healer, or a group of health care providers. Physicians do not need to be afraid or vehement to the changes happening in the world, esp. in the nursing world. Change is all around us, we can either choose to embrace it or be afraid and live in the past.

On the training of nurses... Nurses may not learn advanced anatomy and physiology and how to dissect a cadaver, but the prerequisites for entering nursing school are just as competitive to other professional programs. As we all know, nursing is holistic and all encompassing of the whole person and their environment. The nursing model is followed all the way from R.N. to D.N.P. Nurse practitioners are not trying to compete or replace physicians. Nurse practitioners are providing holistic patient care at an advanced level. This gives the patients more informed choices about who provides their care and the care of their family. Hopefully, in the not so far future, the D.N.P, physician, PharmD, PA-C, etc. will all work together for the benefit of the patients they care for and for the well being of society as a whole.

In my personal opinion I believe that the BSN program should require Chem I and II for pharmacology and believe it or not, drug calculations. Stoichiometry is needed for chemistry and quite useful in solving drug calculations. Secondly, I believe that all Masters programs should require Organic Chem I and II for the advanced pharmacology used in the masters program. Yes, I agree this will make it tougher, but will better our understanding of pharmacology for the patient. I also believe that the masters program if not already incorporated should include a human genetics course. We can't let the future of the N.P. and D.N.P. fall behind in technology.

The D.N.P. program is so new... I don't quite know how to critique it yet. My thoughs so far are prereq's of at least 1 year as a N.P., Human Genetics (if not incorporated in the masters program), and Biochemistry I and II. I like how several programs have the Advanced Differential Diagnosis courses with Clinical Management. I believe that learning advanced skills, teaching techniques, and varied clinical experiences will enhance the care and futrue of the D.N.P. and nursing in general.

Drs of nursing practice follow the nursing model with advanced training. Drs of medicine follow the medical model with specialty training in their area. They are different and are going to have to coexist to benefit our Nation's health care system. Let's not fall behind in patient care and technology because of our differences.

Dreamer-RN · Jul 25, 2008

In my personal opinion I believe that the BSN program should require Chem I and II for pharmacology and believe it or not, drug calculations. Stoichiometry is needed for chemistry and quite useful in solving drug calculations.

I'm a little confused with the above statement. I thought Chem I and Chem II are required for BSN programs (at the least, the majority requires these courses). The Nursing schools I have applied to required these two courses as pre-reqs. I took the drug calculation course during the first semester for my BSN program. I do agree understanding Stoichiometry helps with solving drug calcuations.

MikeTexas82 · Jul 25, 2008

From my understanding, ADN programs do not require Chemistry, and the BSN programs I have looked at only require Gen Chem I. All nursing schools can set their prereqs. I do believe there should be a gold standard through out the Nation for Gen Chem I and II for the BSN program.

dhigbee · Jul 25, 2008

From my understanding, ADN programs do not require Chemistry...

Incorrect in my state. Chemistry is required, along with anatomy, physiology, biology and micro (among other courses) for ADN programs.

Dana

JDCitizen · Jul 25, 2008

Incorrect in my state. Chemistry is required, along with anatomy, physiology, biology and micro (among other courses) for ADN programs.
Dana

Could be another example of where rules vary from state to state????

I don't even know the requirements for my when I entered my program since I was focusing on multiple majors: Chemistry, Biology, Nursing and had enough credits to minor in Psychology, Math and English. If you all knew how much I hated college Math and English having those as minors is more than just hilarious..... Truth be known I was a part time student for a large chunk of my life. Yep the younger years few bills, many dreams.....

silas2642 · Jul 25, 2008

I have read many articles and experienced several aspects on the D.N.P., P.A-C, N.P., M.D./D.O. situation. It has been shown in numerous studies that the N.P. does without a doubt provide primary care that is better or equivalent to that of primary care physicians. The DNP program is in the incipient stages and is going to be very a sensitive subject to the whole health care provider system.
We must remember that being called Doctor extends from the Latin verb, docere, meaning "to teach." In remembering this we should extend the courtesy to all who reach the level of Ph.D., M.D., D.N.P, Pharm.D., etc., to be called Doctor. Patients are not stupid... when a health care provider walks into a patients room, the name badge and credentials should be visible and the hcp should introduce themself as Dr. of medicine, Dr. so and so, Nurse Practitioner, Dr. so and so , clinical pharmacist, etc. The word physician has several roots stemming from Greek, Latin, and French terms. Several groups of people are throwing fits about a nurse with a DNP being called Dr. This reaction is totally unnecessary! Patients' have a right to chose who provides their care, whether it be a physician, a np, a healer, or a group of health care providers. Physicians do not need to be afraid or vehement to the changes happening in the world, esp. in the nursing world. Change is all around us, we can either choose to embrace it or be afraid and live in the past.
On the training of nurses... Nurses may not learn advanced anatomy and physiology and how to dissect a cadaver, but the prerequisites for entering nursing school are just as competitive to other professional programs. As we all know, nursing is holistic and all encompassing of the whole person and their environment. The nursing model is followed all the way from R.N. to D.N.P. Nurse practitioners are not trying to compete or replace physicians. Nurse practitioners are providing holistic patient care at an advanced level. This gives the patients more informed choices about who provides their care and the care of their family. Hopefully, in the not so far future, the D.N.P, physician, PharmD, PA-C, etc. will all work together for the benefit of the patients they care for and for the well being of society as a whole.
In my personal opinion I believe that the BSN program should require Chem I and II for pharmacology and believe it or not, drug calculations. Stoichiometry is needed for chemistry and quite useful in solving drug calculations. Secondly, I believe that all Masters programs should require Organic Chem I and II for the advanced pharmacology used in the masters program. Yes, I agree this will make it tougher, but will better our understanding of pharmacology for the patient. I also believe that the masters program if not already incorporated should include a human genetics course. We can't let the future of the N.P. and D.N.P. fall behind in technology.
The D.N.P. program is so new... I don't quite know how to critique it yet. My thoughs so far are prereq's of at least 1 year as a N.P., Human Genetics (if not incorporated in the masters program), and Biochemistry I and II. I like how several programs have the Advanced Differential Diagnosis courses with Clinical Management. I believe that learning advanced skills, teaching techniques, and varied clinical experiences will enhance the care and futrue of the D.N.P. and nursing in general.
Drs of nursing practice follow the nursing model with advanced training. Drs of medicine follow the medical model with specialty training in their area. They are different and are going to have to coexist to benefit our Nation's health care system. Let's not fall behind in patient care and technology because of our differences.

Hi Mike,

Congratulations on finishing your first year of nursing school-- that's awesome.

So when you say that "It has been shown in numerous studies that NP's provide care that is equivalent or superior to that of primary care physicians," you really need to look at the study. First of all, Mary Mundinger was the PI in one of the leading studies that you're referring to-- fair to say that she's a little biased? Secondly, as David, one of the well-respected PA's has pointed out more than several times, these studies are comparing well-seasoned mid-levels to residents, that is, physicians who have not yet completed their training. That's not playing fair. Thirdly, the studies are measuring outcomes in an outpatient group-- not an inpatient group in which the patient population tend to have far more complicated medical backgrounds. Fourthly, these studies are conducted over way too short a period of time and measuring subjective outcomes like patient satisfaction. Of course patient satisfaction matters, but if the patient has a stroke because the provider missed the signs, it doesn't really matter how nice she was, now does it?

It's all well and good that you think nursing should try and integrate the basic sciences more into the field-- however, once you get into medical school, all of what you learn in college is literally reviewed in about 2 weeks. Things like chemistry I and II, stoichiometry, and organic chemistry don't really help you. What does help you (in my limited experience when physicians are explaining why they are doing something for a patient) is knowledge of physiology, anatomy, knowing how to perform a physical exam, etc.

I don't understand why with the new DNP program they are adding all these "leadership" courses, business management courses, and so on. If the program wants to be taken seriously by physicians, than add more clinically oriented courses like pathology, physiology, pharmacology, anatomy, physical diagnosis, etc. Make it standardized across the board so that you know what you're getting when you hire a DNP; otherwise the entire thing is a joke.

MikeTexas82 · Jul 25, 2008

Maybe she (Mundinger) is biased... I'm not one to say if she is. Upon examining a study, all individuals will interpret the data differently. The mass will have to come to an agreement on a generalized understanding of the data interpretation.

The nursing program and the masters program both incorporate a detailed assessment course. That is what nurses do, assess (ADPIE). I agree that a more detailed understanding of anatomy and physiology, pathophysiology, etc., are needed for the masters and DNP. Management classes, exorbitant studies/papers, and the like are not necessary. The focus, of the DNP, needs to be on exceptional patient care, advanced skills and knowledge (A&P, patho, pharm, etc.), and pedagogic methods for future nurses, as a start.

Indeed, science courses are needed to form a solid foundation for the advanced courses of A&P, pharm, micro, etc. I feel that many physicians may be too scientific... and may lose some of the human aspect of patient care. ADN's to DNP's are supposed to be patient advocates and that needs to be maintained even with the incorporation of advanced knowledge and skills.

The DNP is brand new... Nurses, physicians, and science need to work together on this new program. As stated already, I believe the standards should be uniform across the Nation.

JDCitizen · Jul 25, 2008

How many here plan on obtaining their DNP?

Why?

silas2642 · Jul 26, 2008

Maybe she (Mundinger) is biased... I'm not one to say if she is. Upon examining a study, all individuals will interpret the data differently. The mass will have to come to an agreement on a generalized understanding of the data interpretation.
The nursing program and the masters program both incorporate a detailed assessment course. That is what nurses do, assess (ADPIE). I agree that a more detailed understanding of anatomy and physiology, pathophysiology, etc., are needed for the masters and DNP. Management classes, exorbitant studies/papers, and the like are not necessary. The focus, of the DNP, needs to be on exceptional patient care, advanced skills and knowledge (A&P, patho, pharm, etc.), and pedagogic methods for future nurses, as a start.
Indeed, science courses are needed to form a solid foundation for the advanced courses of A&P, pharm, micro, etc. I feel that many physicians may be too scientific... and may lose some of the human aspect of patient care. ADN's to DNP's are supposed to be patient advocates and that needs to be maintained even with the incorporation of advanced knowledge and skills.
The DNP is brand new... Nurses, physicians, and science need to work together on this new program. As stated already, I believe the standards should be uniform across the Nation.

You've got to be kidding me. Physicians are "too scientific?" As a patient, I would want my provider to be as scientific as possible-- I want the options for my care that he/she presents to me to be based on evidence and science, not on fluffy feelings.

I think you might be trying to point out that sometimes physicians get all caught up in the science and disease and sometimes don't always see the patient. You have a point. Med schools and training are trying to change that, and admissions committees look for more balanced, well-rounded applicants who show the ability to communicate with their patients as well as other staff than they did before. Med students are now hitting the wards from day one to see patients, get comfortable with learning their stories, and getting to know the human side of medicine.

But we are also trained to practice evidence based medicine. We don't just make decision based on what we "feel" is right-- we base it on what the science says.

As for the DNP and uniting it, I don't think physicians want any part in it because what it really seems like is an effort of Mary Mundinger to make nurse practitioners equal to physicians without the training. There is no way that physicians are going to back that.

JDCitizen · Jul 26, 2008

you've got to be kidding me. physicians are "too scientific?" as a patient, i would want my provider to be as scientific as possible-- i want the options for my care that he/she presents to me to be based on evidence and science, not on fluffy feelings.

i think this runs into the statement below...

i think you might be trying to point out that sometimes physicians get all caught up in the science and disease and sometimes don't always see the patient. you have a point.

true i have seen many, many physicians treat the disease or process and not the patient. one of the reasons permits now have the little space about explanation of alternative treatments.

med schools and training are trying to change that, and admissions committees look for more balanced, well-rounded applicants who show the ability to communicate with their patients as well as other staff than they did before. med students are now hitting the wards from day one to see patients, get comfortable with learning their stories, and getting to know the human side of medicine.

i have been hearing this one for twenty years now. also akin to having student doctors work with nurses as part of their training.

but we are also trained to practice evidence based medicine.

wow im not? hmmm wonder what i was learning during my clinicals? even though i may not have as many clinical hours as doctors had to going through school; i did still do them with doctors.. also had more than a few mds come teach in parts of my program..

we don't just make decision based on what we "feel" is right-- we base it on what the science says.

same way i make my decisions... although how many test are ordered to protect our butts?

as for the dnp and uniting it, i don't think physicians want any part in it because what it really seems like is an effort of mary mundinger to make nurse practitioners equal to physicians without the training. there is no way that physicians are going to back that.

leaving mary out of the converstaion because i don't think she is anyway the controling factor in nursing eductaion across the world...

bsn, msn, dnp i don't think a large, large chunk of the physician even back any of them. let me rephrase: not all but a large, large chunk. too much belief of its our way or the highway..

but back to the permise of the posting...

i strongly believe the kinks of the dnp program should have been worked on before the first program even opened up. if the states are not going to do it the federal government should step in to require every program to have at least a basic / common formula (textbook / laboratory / clinical). the schools could require more but they couldn't require less.

education of np, pa and dnp compared to md/do...

i think the discussion is rather mute.. i don't believe what i have experience over the years practicing with those in medicine (mds/dos) we can make the world of medicine happy. unless medicine has their fingers in it in a controlling manner they won't be happy... no matter what degree level we link our training to it.

i do like hearing md, do, pa, and fellow aprn comments on all this though...

at least of some basic level we are interacting. :yeah: