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Doctor shortage? 28 States may expand Nurses' role!

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doctor shortage? 28 states may expand nurses' role

by carla k. johnson, ap medical writer carla k. johnson, ap medical writer

april 13th,2010 – 1 hr 18 mins ago

chicago – a nurse may soon be your doctor. with a looming shortage of [color=#000]primary care doctors, 28 states are considering expanding the authority of nurse practitioners. these nurses with advanced degrees want the right to practice without a doctor's watchful eye and to prescribe narcotics. and if they hold a doctorate, they want to be called "doctor."

for years, nurse practitioners have been playing a bigger role in the nation's health care, especially in regions with few doctors. with 32 million more americans gaining health insurance within a few years, the health care overhaul is putting more money into nurse-managed clinics.

those newly insured patients will be looking for doctors and may find nurses instead....

...states regulate nurse practitioners and laws vary on what they are permitted to do:

• in florida and alabama, for instance, nurse practitioners are barred from prescribing controlled substances.

• in washington, nurse practitioners can recommend medical marijuana to their patients when a new law takes effect in june.

• in montana, nurse practitioners don't need a doctor involved with their practice in any way.

• many other states put doctors in charge of nurse practitioners or require collaborative agreements signed by a doctor.

• in some states, nurse practitioners with a doctorate in nursing practice can't use the title "dr." most states allow it....

the new u.s. health care law expands the role of nurses with:

• $50 million to nurse-managed health clinics that offer primary care to low-income patients.

• $50 million annually from 2012-15 for hospitals to train nurses with advanced degrees to care for medicare patients.

• 10 percent bonuses from medicare from 2011-16 to primary care providers, including nurse practitioners, who work in areas where doctors are scarce.

• a boost in the medicare reimbursement rate for certified nurse midwives to bring their pay to the same level as a doctor's.

the american nurses association hopes the 100 percent medicare parity for nurse midwives will be extended to other nurses with advanced degrees. "we know we need to get to 100 percent for everybody. this is a crack in the door," said michelle artz of ana. "we're hopeful this sets the tone." ...

here's the link:

http://news.yahoo.com/s/ap/20100413/ap_on_he_me/us_med_dr_nurse

Edited by NRSKarenRN

DuluthMike

Specializes in ICU, ED, PACU. Has 6 years experience.

If we lack primary care providers create incentives to draw new physicians into that role, expand schooling opportunities, and increase reimbursement for primary care. The answer is not to dilute the primary care role by equating a physician to a nurse practitioner. A nurse practitioner is its own role, they are not a physician. Equating the two is ludicrous.

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience.

Having NPs going around saying that they're "just like doctors" is not in anyway helpful to the profession.

sjt9721, BSN, RN

Specializes in Emergency/Trauma/Education.

If we lack primary care providers create incentives to draw new physicians into that role, expand schooling opportunities, and increase reimbursement for primary care. The answer is not to dilute the primary care role by equating a physician to a nurse practitioner. A nurse practitioner is its own role, they are not a physician. Equating the two is ludicrous.

I agree...just like I believe the answer to the 'nursing shortage' is not to expand the roles of medical assistants and medication aides.

From the article: "A shortage of one type of professional is not a reason to change the standards of medical care," said AMA president-elect Dr. Cecil Wilson. "We need to train more physicians."

RN_stucky621

Specializes in non-animals.

This line from the articles is what gets me the most....

"And if they hold a doctorate, they want to be called "Doctor.""

DuluthMike

Specializes in ICU, ED, PACU. Has 6 years experience.

Just another point, NP's and PA's are awesome. They fulfill a need in our health care system. They are not physicians though. We do have a physician shortage. Those gaps need to be filled by physicians. We set a dangerous precedent if we start replacing physicians with NP's or PA's.

Diluting skilled labor is not an answer. Doctors are trained to be doctors, Nurse Practitioners are trained to be Nurse Practitioners. Their roles are not synonymous. If a floor is short of nurses, the answer is not to hire/train more techs, it is to bring in more nurses.

Edited by DuluthMike

IMO its appalling to pay nurse midwives the same as an OBGYN and NPs the same as an MD because they "do the same thing". Why on God's green earth would anyone attend medical school, take out 200k in loans and spend 11+ years working their ass off if you could just be an NP in 6-7 years with the end result being equal reimbursement :rolleyes:.

RN_stucky621

Specializes in non-animals.

IMO its appalling to pay nurse midwives the same as an OBGYN and NPs the same as an MD because they "do the same thing". Why on God's green earth would anyone attend medical school, take out 200k in loans and spend 11+ years working their ass off if you could just be an NP in 6-7 years with the end result being equal reimbursement :rolleyes:.

because more midwives are willing to practice in rural areas of the country than MDs are? If that's the case then they should be reimbursed the full amount unlike a midwife practicing in a big city which I agree they shouldn't be reimbursed 100%

because more midwives are willing to practice in rural areas of the country than MDs are? If that's the case then they should be reimbursed the full amount unlike a midwife practicing in a big city which I agree they shouldn't be reimbursed 100%

even if they practice in a rural area, they shouldn't be reimbursed the same as a physician...i feel very bad for physicians, i would never wish to undergo that kind of training and be replaced by nurses...i would love to be a physician, but that would take too long and be too hard just to be replaced by NP/DNPs

PsychNurseWannaBe, BSN, RN

Specializes in LTC, Nursing Management, WCC. Has 13 years experience.

With the addition of NPs having DNP I don't think it is wrong for them to be called doctors... there just has to be public education done so the public knows. Many professions have doctors, why shouldn't nurses? Dr/Dentist Dr/Physician Dr/Professor, Dr/PhD, Dr/Psy, etc... they still wish to be called Doctor.

Now I don't think a NP is "just like a doctor", but really the phrase should be I don't think a NP is "just like a physician". They both can be doctors; just different disciplines.

DuluthMike

Specializes in ICU, ED, PACU. Has 6 years experience.

With the addition of NPs having DNP I don't think it is wrong for them to be called doctors... there just has to be public education done so the public knows. Many professions have doctors, why shouldn't nurses? Dr/Dentist Dr/Physician Dr/Professor, Dr/PhD, Dr/Psy, etc... they still wish to be called Doctor.

Now I don't think a NP is "just like a doctor", but really the phrase should be I don't think a NP is "just like a physician". They both can be doctors; just different disciplines.

The difference is the environment that the term is used. The use of the term Dr by a PsyD/DDS ect in their own setting is fine. This is similar to a Biochem professor introducing themselves as "Dr. Soandso" in the classroom. The problem lies when these same individuals use this term in a clinical setting. They are then misidentifying themselves as a physician. This is unethical and illegal in some states. In a clinical setting the term "Doctor" refers to a M.D., D.O., or D.P.M. To be more clear, what if I obtained my Phd in Molecular Biology in addition to my BSN. Given this situation can I enter a patients room and identify myself as "Dr. Duluth"? Of course not. This is a misrepresentation of my scope of practice in a clinical setting.

In a non clinical setting the argument against the labeling of a DNP as Dr is a silly one and a mater of egos and semantics. Of course they should be called Dr, as it is a term of respect for an accede mic degree obtained. In a clinical situation it is an unethical misrepresentation of who you are.

PostOpPrincess, BSN, RN

Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU. Has 19 years experience.

IMO its appalling to pay nurse midwives the same as an OBGYN and NPs the same as an MD because they "do the same thing". Why on God's green earth would anyone attend medical school, take out 200k in loans and spend 11+ years working their ass off if you could just be an NP in 6-7 years with the end result being equal reimbursement :rolleyes:.

Don't forget....the same liability.

PostOpPrincess, BSN, RN

Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU. Has 19 years experience.

I have no problem with very, very, very experienced Nurse Practitioners.

I have one myself that I prefer as my primary moreso than the doc. She is THAT good.

However,

I wouldn't let a direct entry MS-prepped NP with absolutely NO experience touch my dog. They should not be allowed to practice on the same level as the super-experienced RN to NP.

NO WAY and I think the public ought to know this too.

SharonH, RN

Specializes in Med/Surg, Geriatrics. Has 20 years experience.

The difference is the environment that the term is used. The use of the term Dr by a PsyD/DDS ect in their own setting is fine. This is similar to a Biochem professor introducing themselves as "Dr. Soandso" in the classroom. The problem lies when these same individuals use this term in a clinical setting. They are then misidentifying themselves as a physician. This is unethical and illegal in some states. In a clinical setting the term "Doctor" refers to a M.D., D.O., or D.P.M. To be more clear, what if I obtained my Phd in Molecular Biology in addition to my BSN. Given this situation can I enter a patients room and identify myself as "Dr. Duluth"? Of course not. This is a misrepresentation of my scope of practice in a clinical setting.

In a non clinical setting the argument against the labeling of a DNP as Dr is a silly one and a mater of egos and semantics. Of course they should be called Dr, as it is a term of respect for an accede mic degree obtained. In a clinical situation it is an unethical misrepresentation of who you are.

I work in a setting in which pharmacists identify themselves as "Dr.so-and-so, the phramacist", nurses and physicians also refer to them as "Dr" to the patient. Not one person has expressed confusion about this. Not one. It is neither unethical, illegal, a misrepresentation or any other excuse you can think of. They even wear a white lab coat! *gasp* Why shouldn't other professionals with similar credentials be afforded the same respect?

babyNP., APRN

Specializes in NICU. Has 13 years experience.

Le sigh...

I agree with the posters here...I hope to be a NNP someday and I don't see myself working in a high-risk NICU...too much liability.

If I wanted to be a doctor, I'd've gone to medical school! But alas...I like having a personal life and want to see my future children on occasion.

To the poster just above me, I agree with that to a point--physical therapists also have doctorates as another example...but I would prefer to tell my patients that I'm a nurse practitioner...i.e.,

"Good morning, my name is so-and-so. I'm the nurse practitioner that will be overseeing your infant's stay here in our NICU..."

PsychNurseWannaBe, BSN, RN

Specializes in LTC, Nursing Management, WCC. Has 13 years experience.

If you have a doctorate, referring to yourself as a doctor is not misrepresenting yourself. A nurse can not append, say, MD after their name unless they are one. Using MD, DO, NP etc... when you don't hold the credential is misrepresenting yourself. Dr. is not a credential but an educational prefix.

PsychNurseWannaBe, BSN, RN

Specializes in LTC, Nursing Management, WCC. Has 13 years experience.

"Good morning, my name is so-and-so. I'm the nurse practitioner that will be overseeing your infant's stay here in our NICU..."

Right, but there should be nothing wrong saying your Dr. babyRN and I'm the nurse practitioner that will be taking care of you. You qualify your profession.

I know the bigger part of the original post is the expansion of scopes of practices for NPs and PAs. I don't know how I feel about it. I have seen some inexpierenced docs and NPs. I think I tend to go with a MD for serious things. No problem seeing a NP for sore throat, flu, etc.

The difference is the environment that the term is used. The use of the term Dr by a PsyD/DDS ect in their own setting is fine. This is similar to a Biochem professor introducing themselves as "Dr. Soandso" in the classroom. The problem lies when these same individuals use this term in a clinical setting. They are then misidentifying themselves as a physician. This is unethical and illegal in some states. In a clinical setting the term "Doctor" refers to a M.D., D.O., or D.P.M. To be more clear, what if I obtained my Phd in Molecular Biology in addition to my BSN. Given this situation can I enter a patients room and identify myself as "Dr. Duluth"? Of course not. This is a misrepresentation of my scope of practice in a clinical setting.

But that's your hangup as well as your misunderstanding.

When my father introduced himself as Doctor on the wards of psychiatric hospitals, he was within his rights to do so. And when he introduced himself as Doctor in hospitals, elementary schools, nursing homes and wherever else he was asked to evaluate patients, he was still within his rights and not misrepresenting himself in any way. He was not identifying himself as a physician just by calling himself by his degree: Doctor. In the clinical setting, anyone who has a doctorate can identify him or herself as Doctor, just not as a "physician." Can you enter a patient's room and identify yourself as "Dr. Duluth?" Of course you can, if that's who you are.