Doctoral degree to become an NP???

core0 · Nov 25, 2006

bczito wrote: "nps/cns have been shown in various studies accross multiple specialties to provide comparable care to other health care providers (including md's). this actually suggests that perhaps md's go to school for longer than is needed to provide excellent patient care. so why make np's go to school longer if their care is already at excellent standards? (unless of course someone wants to line their pockets)
david carpenter, pa-c wrote (i apologize if i am attributing this to the wrong poster):i would challenge this. there are studies that show that patient satifisfaction is better. there is one study that shows that between np's and physicians the only measureable difference was that the np group had a lower bp. however, i am not aware of a study that follows outcomes measures for independent np's vs. physicians. until you can show that you cannot say that you provide compareable care.
i wish i could come up with where i read the following (perhaps u of rochester's nursing website) but there is a study from 1994 at the university of rocherster where researchers reported that intensive-care babies cared for by neonatal nurse practioners averaged 2.4 fewer hospital days and more than $3,400 less in charges than those cared for by medical residents, despite the fact that the nps' infants were younger and had significantly lower birthweight. unlike residents, nurse practioners, don't rotate, are 'more consistent caregivers' who can follow infants through their entire stay, and need to rely less on support services to stay appraised of a patient's progress."
this was in a nicu compared to residents. both parties were supervised by attending physicians. can an experienced np do better than a resident, certainly. the consistency is the thing here. they have different agendas. for the nnp's this is a job. for the resident it is a learning experience.
in another post it was noted that nurses do not have residencies which i beg to differ. many hospitals have introduced residencies for their nurses to complete in their first year of working in the hospital. during the residency, the nurse carries a reduced patient load and is overseen by a more experienced nurse who acts as a mentor. i believe this may become the wave of the future especially as technology becomes more complex and the patients that are being cared for are far sicker than they used to be.
these are residencies for nurses. we are talking about np's here. are the same opportunities available for np's?
also, i just read an article about an office of all nurse practioners in nyc that appears to run without any oversight from a doctor and many of the patients believe they get better care from seeing an np than a doctor. nps as has been stated before are more interested in the entire patient. while doctors will try and explain to patients the physiological reasons they have high blood pressure, nps will focus on the patient's life style. it is very easy to treat high blood pressure with pills but if you don't look at a person's life style you are missing a large part of the picture. i believe doctors and nps have a lot to offer and each is better equipped for certain things.
np's in ny must have a collaborating physician. the np profession does not regard this as independent practice (there are very few states that actually allow true independent practice). it's nice that the patients believe that they get better care from np's, but where are the outcomes results. if i treat you lipid disease with twinkies and ho ho's, the patient will be happier with your care, while they die of cardiovascular disease. i also think that you are making an oversimplification comparing focus of physicians and np's. most physicians will try lifestyle modification first, but if you look at any of the data this rarely works. also, of the guidelines recommend medication early in the clinical ladder. if you are not following these guidelines, what evidence based medicine are you using?

david carpenter, pa-c

BCzito · Nov 25, 2006

David Carpenter, PA-C

CONCLUSION: As hypothesized, management of patients who required prolonged mechanical ventilation with tracheostomy had equivalent outcomes with the ACNP team or the fellows team ( Hoffman LA, Miller TH,Zullo TG,Donahoe MP.

2006 ). respir care

___________________________

* Hoffman LA,

* Tasota FJ,

* Zullo TG,

* Scharfenberg C,

* Donahoe MP.

Schools of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.

BACKGROUND: Many academic medical centers employ nurse practitioners as substitutes to provide care normally supplied by house staff. OBJECTIVE: To compare outcomes in a subacute medical intensive care unit of patients managed by a team consisting of either an acute care nurse practitioner and an attending physician or an attending physician and critical care/pulmonary fellows. METHODS: During a 31-month period, in 7-month blocks of time, 526 consecutive patients admitted to the unit for more than 24 hours were managed by one or the other of the teams. Patients managed by the 2 teams were compared for a variety of outcomes. RESULTS: Patients managed by the 2 teams did not differ significantly for any workload, demographic, or medical condition variable. The patients also did not differ in readmission to the high acuity unit (P = .25) or subacute unit (P = .44) within 72 hours of discharge or in mortality with (P = .25) or without (P = .89) treatment limitations. Among patients who had multiple weaning trials, patients managed by the 2 teams did not differ in length of stay in the subacute unit (P = .42), duration of mechanical ventilation (P = .18), weaning status at time of discharge from the unit (P = .80), or disposition (P = .28). Acute Physiology Scores were significantly different over time (P = .046). Patients managed by the fellows had more reintubations (P=.02). CONCLUSIONS: In a subacute intensive care unit, management by the 2 teams produced equivalent outcomes.

_________

1: Am J Crit Care. 2005 Mar;14(2):121-30; quiz 131-2.Click here to read Links

Outcomes of care managed by an acute care nurse practitioner/attending physician team in a subacute medical intensive care unit.

* Hoffman LA,

* Tasota FJ,

* Zullo TG,

* Scharfenberg C,

* Donahoe MP.

Schools of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.

BACKGROUND: Many academic medical centers employ nurse practitioners as substitutes to provide care normally supplied by house staff. OBJECTIVE: To compare outcomes in a subacute medical intensive care unit of patients managed by a team consisting of either an acute care nurse practitioner and an attending physician or an attending physician and critical care/pulmonary fellows. METHODS: During a 31-month period, in 7-month blocks of time, 526 consecutive patients admitted to the unit for more than 24 hours were managed by one or the other of the teams. Patients managed by the 2 teams were compared for a variety of outcomes. RESULTS: Patients managed by the 2 teams did not differ significantly for any workload, demographic, or medical condition variable. The patients also did not differ in readmission to the high acuity unit (P = .25) or subacute unit (P = .44) within 72 hours of discharge or in mortality with (P = .25) or without (P = .89) treatment limitations. Among patients who had multiple weaning trials, patients managed by the 2 teams did not differ in length of stay in the subacute unit (P = .42), duration of mechanical ventilation (P = .18), weaning status at time of discharge from the unit (P = .80), or disposition (P = .28). Acute Physiology Scores were significantly different over time (P = .046). Patients managed by the fellows had more reintubations (P=.02). CONCLUSIONS: In a subacute intensive care unit, management by the 2 teams produced equivalent outcomes.

________

1: Br J Gen Pract. 2005 Dec;55(521):938-43.Click here to read Links

Comment in:

Br J Gen Pract. 2006 Feb;56(523):137-8.

Comparison of GP and nurse practitioner consultations: an observational study.

* Seale C,

* Anderson E,

* Kinnersley P.

School of Social Sciences and Law, Brunel University, Uxbridge. [email protected]

BACKGROUND: Studies show that satisfaction with nurse practitioner care is high when compared with GPs. Clinical outcomes are similar. Nurse practitioners spend significantly longer on consultations. AIM: We aimed to discover what nurse practitioners do with the extra time, and how their consultations differ from those of GPs. DESIGN OF STUDY: Comparative content analysis of audiotape transcriptions of 18 matched pairs of nurse practitioner and GP consultations. SETTING: Nine general practices in south Wales and south west England. METHOD: Consultations were taped and clinicians' utterances coded into categories developed inductively from the data, and deductively from the literature review. RESULTS: Nurse practitioners spent twice as long with their patients and both patients and clinicians spoke more in nurse consultations. Nurses talked significantly more than GPs about treatments and, within this, talked significantly more about how to apply or carry out treatments. Weaker evidence was found for differences in the direction of nurses being more likely to: discuss social and emotional aspects of patients' lives; discuss the likely course of the patient's condition and side effects of treatments; and to use humour. Some of the extra time was also spent in getting doctors to approve treatment plans and sign prescriptions. CONCLUSIONS: The provision of more information in the longer nurse consultations may explain differences in patient satisfaction found in other studies. Clinicians need to consider how much information it is appropriate to provide to particular patients.

______

sorry so long .. there are many many many studies that show this...

I suppose you are correct about them adding the more health assessment stuff, but if health care is comparable what is the purpose of this...? Still it appears that the majority of classes are not centered around pt care.. don't you think?

also I agree about the need for new aprn's to have more confidence comming out of school, and therefore I am in favor of a required residency program that would require NP's and Psych CNS's to have either an experienced NP/CNS or Physican supervisor in their specialty field for a set amount of years before becoming fully autonomous. However, feelings of confidence does not necessarily indicate that these practitioners are not able to preform the appropriate care, it could be for many reasons. They are new, they have to face resistance from certain groups that want to criticize them before they even begin. I think its normal to feel vulnerable when you are new at something. Also nurses may be more socialized to vocalize their concerns while young doctors are often ridiculed by their superiors if they admit to not knowing the answer to something or feel unsure of themselves.. just a thought...

-bczito

core0 · Nov 26, 2006

snip
sorry so long .. there are many many many studies that show this...
there are not. you are trying to show that you are equivalent to physicians in practice. comparisons to fellows do not hold ground. what you are probably measuring here again is consistency. also comparisons to np's in britian are very difficult to interpret due to the difference in practice acts. in addition np's in britian are trained in a far different manner than np's in the us and in my opinion have significantly more didactic clinical coursework.
i suppose you are correct about them adding the more health assessment stuff, but if health care is comparable what is the purpose of this...? still it appears that the majority of classes are not centered around pt care.. don't you think?
i am not sure what you are discussing here. if you are referring to health assessment as having more didactic study in clinical presentation and pharmacology i would agree. yes the majority of classes are centered around patient care, but how much time do you need to convey the minimal amount of information? there was an interesting discussion on studentdoctor.net where an np was claiming that lymphoma was not in the scope of practice for an np. my comment was that any disease with an incidence of 1:50 should be understood by anybody in primary care.
also i agree about the need for new aprn's to have more confidence comming out of school, and therefore i am in favor of a required residency program that would require np's and psych cns's to have either an experienced np/cns or physican supervisor in their specialty field for a set amount of years before becoming fully autonomous. however, feelings of confidence does not necessarily indicate that these practitioners are not able to preform the appropriate care, it could be for many reasons. they are new, they have to face resistance from certain groups that want to criticize them before they even begin. i think its normal to feel vulnerable when you are new at something. also nurses may be more socialized to vocalize their concerns while young doctors are often ridiculed by their superiors if they admit to not knowing the answer to something or feel unsure of themselves.. just a thought...
why not just extend clinical hours? why should you need a residency? the point of the dnp is to increase the didactic training the np receives and to extend the clinical hours. there are many np's out there providing excellent care. the discussion in this case is the current np education system adequate to prepare np's for practice.
-bczito

david carpenter, pa-c

chiromed0 · Jan 9, 2007

:trout:

Doctoral degree for an NP? Heck Yes...you are no less dead if an M.D. misdiagnoses/misprescribes/mistreats a patient than if your an N.P.! Having advanced education for clinical practice is needed and a GREAT THING.

I have to say that I'm suprised by how many supporting medical professionals (that's RN's, PA's, NP's, CRNA's and many, many others) feel so inadequate compared to MD/DO's. Do you REALLY believe they remember everything they learned in school and are THAT much more intelligent than you? I certainly hope not. I think you fail to recongnize how many times YOU save their skin and how much work you take off their plate.

Earning a doctorate of ANY kind is difficult and there is a great misperception about medical doctorates. Of course they are more science oriented but then they have to learn the clinical aspects AFTER medical school. That's when the license is in their name and they make the decisions. I really don't see this as much different other than now NP's will need to go back and perhaps learn some more science and research. Are they equivalent? Yes and No. It's like comparing a President to a CEO of a company. One can fire the other but really after a while doesn't do or know more.

To summise that an NP with 10+ years FP experience isn't a capable professional, on par, with an MD/DO FP is ridiculous in most circumstances. I don't believe NP's will probably push the scope of practice boundaries too much but as FP they are excellent. In most Docinabox practices anyway, who actually sees the patient? PA's or NP's...with cursory sign offs from a supervising physician.

The arrogant assumption that a first professional degree (and that's what an MD or DO degree is...it is NOT a research/academic degree like a phd) is somehow an unobtainable summit of knowledge is ludicrous. If you actually check out the dnp programs, many require a sizeable abundance of prequalifications and are fair in terms of hours/cost/etc. It's important to note that EVERY DNP will have to have had training in healthcare with years of experience on the job with real people. Entrance into medical school is NOT limited to science degree majors...it's history, english...basket weaving...whatever plus pre-med scores and the MCAT. So a DNP is actually more clinically qualified to treat a patient than a newby right fresh outa med school. Med school you STUDY what you're supposed to know...residency you PRACTICE what you're supposed to know.

I look forward to becoming a nurse, then NP at whatever level is required. I've two degrees, a first professional degree and a BS in Anatomy. I still think being an NP is great! Yes, it's direct competition for MD's but only in family practice settings where there is a shortage anyway. IMO it HELPS physicians to migrate into specialty w/o leaving a giant gap in healthcare. They are doing it now anyway and that's why there is a problem in the first place.

As far as independant practice...I think it's a great option. That is really my main motive as well as others, I'm sure. If the public wants another doctorate by my name for assurance...great. I'd love to practice medicine and let's not get bogged down in semantics...when you prescribe medical treatment and medicine..well you're practicing medicine and that's what NP's and PA's do. Just b/c a degree says Doctor of Medicine shouldn't give them sole ownership of the practice of medicine or healthcare in general. :nono:

In the end, IMO, nurses take care of people and physicians treat people. Nurse practioners and PA's do both and I think they are both under rated.

My background...well by the handle you'll see I'm a D.C. No, not a quack. I work with M.D.'s and D.O.'s, P.T.'s etc. every day. I didn't go to med school but I'm suprised at how many ridiculous discussions/arguements I've had with medics over my education even though my professors taught at their school (same rehashed old exams), I bought text books from their book stores (actually cheaper) and in some subject areas my undergrad and graduate education exceeded theirs...I'm still subpar. Hogwash. Overall, yeah they are the top of the heap but as NP's do not for one moment think that with a DNP you are "just a nurse". You have taken the best of both professions, nursing and medicine, and combined them into the most practical healthcare practitioner model out there.

That's it. Now flame away...:angryfire

aklim3 · Jan 10, 2007

Doctoral degree for an NP? Heck Yes...you are no less dead if an M.D. misdiagnoses/misprescribes/mistreats a patient than if your an N.P.! Having advanced education for clinical practice is needed and a GREAT THING.
You have taken the best of both professions, nursing and medicine, and combined them into the most practical healthcare practitioner model out there.

Needed how? Has anyone proved thru any studies that as a MSN NP you are not adequate? If so, you might be right. It is a great thing but until someone can show some concrete proof, how do you know it is needed? IOW, can you say with certainty that as an MSN NP I am not equal to the task? Take an equally experienced NP and an MD or DO and run them thru the gauntlet and then we can see whether the MSN NP is inadequate or not. I think previously, it was shown that MSN NPs were equal to the task. If this is true then having a DnP is good but not needed. If not then it is both good and needed.

You familiar with the saying that a Jack of all trades is a master of none?

Looking at the practical point of economics. If I were a student, Convince me that I should be an NP not an MD if I have to go that far. With all the years I have to spend is school, why should I be an NP instead of an MD when the pay, independence and advancement is way, way greater? As an MD I automatically get more money. As an MD, I get more independence. (no supervising or even collaborating physician and I can set up my own shop on my own steam). As an MD I can specialize and earn a whole lot more money than an NP.

rumple · Jan 26, 2007

This would be a doctorate in nursing and from what I understand it would supercede all other MS degree's the question is what would happen to those who already have a MS degree?

rumple · Jan 26, 2007

It is the AACN and there is minimal word of gradfathering people in. To me it is disarming first NP's were told they provided quality care at a low cost, now we are forced to spend more on education and essentially being told we are not good enough still. And this is not coming from the AMA it is coming from our nursing leaders.

rumple · Jan 26, 2007

The fact is you wonnt find a single NP anywhere in the country who is the department chair for ANY specialty. The only possible example wold be NPs being department chairs of emergency medicine in EXTREMELY rural hospitals, and even those examples are few and far between.

Why do we constantly have to be in competition with MD's cant we each recognize and accept what we have to offer our patient's and the health care system. In order to function we need to see our roles as colaborative rather than confrontational. Additionally, you cannot deny that MD's recieve more in depth training than NP's and they do have a greater scope and depth of knowledge (per virtue of the rigor of their programs). A DNP program does not even begin to offer the depth of education that the MD program does--so why are we so arrogant in kidding ourselves. If you want to run a medical department in a hospital then :nono: go to medical school. As for me I was happy as an NP the perfect amount of autonomy without the cost and with a better quality of life. Now, will we let our egos get in the way (through accepting the fasad of the DNP program) and destroy the good thing we have going?

gauge14iv, MSN, APRN, NP · Jan 26, 2007

The aacn can only make recomendations - not pass laws. They havn't exactly managed to convince people that the "all RN's should be BSN's" concept is a valid one so I personally have my doubts that the "all NP's should be DNP's" version will fly very far.

rumple · Jan 26, 2007

I'm with you, LilPeanut. Even thinking that a doctorate could become a requirement has me a little apprehensive about my decision.

As a recent graduate from a MSN, FNP program it makes me feel ill. Here what I worked so hard for over the last 3 and a half years is being devalued by the DNP program.

Editorial Team / Admin · Jan 26, 2007

This would be a doctorate in nursing and from what I understand it would supercede all other MS degree's the question is what would happen to those who already have a MS degree?

The DNP for all, if passes, will be the standard by which all NPs practice. Those already practicing (MSN) will be grandfathered in.

It is the AACN and there is minimal word of gradfathering people in. To me it is disarming first NP's were told they provided quality care at a low cost, now we are forced to spend more on education and essentially being told we are not good enough still. And this is not coming from the AMA it is coming from our nursing leaders.

Has nothing about being "not good enough". It is yet another elevated standard much the same way when the MSN became standard for all NPs who had Diploma, ADN, BSN.

As a recent graduate from a MSN, FNP program it makes me feel ill. Here what I worked so hard for over the last 3 and a half years is being devalued by the DNP program.

The DNP is not intended to devalue anyone. It is only another elevated standard. Those who are in practice now, me included, will be grandfathered in.

prairienp · Jan 26, 2007

it is the aacn and there is minimal word of gradfathering people in. to me it is disarming first np's were told they provided quality care at a low cost, now we are forced to spend more on education and essentially being told we are not good enough still. and this is not coming from the ama it is coming from our nursing leaders.

this is one of those "myths" often used by the naysayers who see the dnp as a threat. all the information from the leaders of the dnp movement have clearly stated those without a dnp will not have their practices change. the majority of np programs have or all ready in the process of transitioning to a dnp curriculum. although the target date in 2015, you may see over 70% of current FNP programs offering the dnp by 2010. the momentum is overwhelming.