Doctoral degree to become an NP???

Coffeegirly · Jul 10, 2006

yes, nursing has been complacent. i ask you why. no, we don't need men to have a voice..... but why haven't we had one? with all the numbers of nurses we have.. i ask you again, why haven't we used our numbers to become more powerful?

i don't recall ever giving residents or interns the "stink eye." i don't think

fuegorama vbmenu_register("postmenu_1725510", true); has read any of my posts regarding my respect towards mds. i didn't become a np to practice medicine or write a long list of differentials. so what? i know my limits. i hope my own md (and the np i see) does too and knows when to refer me to a specialist too. it sounds like the ama is lobbying long and hard.

fuegorama · Jul 10, 2006

Yes, nursing has been complacent. I ask you why. No, we don't need men to have a voice..... but why haven't we had one? With all the numbers of nurses we have.. I ask you again, why haven't we used our numbers to become more powerful?

What do you mean by "more powerful". What else do you require?

Nurses essentially run healthcare in this country. They are by far the most powerful lobbying group with members heavily invested in the AHA, JCAHO etc.

What will all of this power do for ya? The physician lobbying groups are actually pretty weak. We depend on individual donors and have a law that keeps us from working collectively. We cannot unionize, nor do we have any kind of unified voice.

The power docs have is from individual contributions from formerly lucrative business oriented practices. These are a thing of the past. Nursing is about to get its wish. As the reimbursement apocalypse nears, healthcare will be federalized. That's great for folks that need a midlevel of care. God help they rest of us that will need a thrombotic eluting stent or any other miracle that the money years of medicine have given us. It's about to be a thing of the past and the coin that formerly brought us lifesaving/quality-of-life giving tx. modalities will be saved and spent on the weak and worried.

Wow. I gotta get out more.

[i believe in so many ways nursing power is why we see these crazy rises in healthcare costs. Nurses are fantastic technicians and occasionally good managers. They are lousy executives. But this is for a whole other thread.]

ERNP · Jul 11, 2006

Nurses are fantastic technicians and occasionally good managers. They are lousy executives. But this is for a whole other thread.]

My, my. Well not just the comment I pulled out of the previous post, but the whole conversation. What a nasty feeling turn it has taken!

In all my years as a nurse and NP, I have never ever met a single doctor that I thought was a decent businessman. They often appear so because they have more to work with, but in so far as the management of it.... not really executive office material.

But I digress.....

I also chose to be an NP. Medical school was certainly an option for me. I suppose if I wanted to go to med school, I still could. As recently as last year I did consider it, but in the end it wasn't worth it. I am a FNP working ER. I don't make the ER doc salary, but I am right up there with family physicians working in private practice (and half the work days). I recently found out I am not too far off the hospitalist mark where I am either.

I have all the hospital privileges I want. I have the respect of my physician and nursing colleagues. All that considered, the rigors of medical school aren't that attractive.

I have looked at a couple of dnp programs. I don't think it is necessarily a bad idea. This argument about confusion with "real doctors" is ludicrous. I always introduce myself as NP, and no matter how many times I correct patients, I always end up being called "doctor" or get some comment like, "same thing" or "you are MY doctor". So the argument is that a DNP will cause this kind of confusion is just unfounded. The confusion already exists.

rhenmag9 · Jul 11, 2006

;)thats goodnews!!!

fuegorama · Jul 11, 2006

In all my years as a nurse and NP, I have never ever met a single doctor that I thought was a decent businessman. They often appear so because they have more to work with, but in so far as the management of it.... not really executive office material.

Agreed. However, the days of the money stupid doc are dying. We frankly are not paid that much anymore. Money management has become a part of some schools' curriculum and the MBA is now a common addition to the educational vitae of many physicians. We have to manage better just to pay our loans and try to retire before 70. Especially us old ones.

My point was that the explosion in beauracracy and zany cost vs. reimbursement paradigms has paralleled the rise of nurses into hospital administrative roles. I don't think it's a reach to draw a cause/effect conclusion.

Without some serious business education neither docs or nurses are prepared to make sound health economic decisions. Frankly this mess will not end until patients realize the true cost of a hospitalization. Unfortunately this is not a realistic desire. Not gonna happen. We are now a nation of entitlees that want the moon but have no intention of paying for it. (see it really does need its own thread)

I also chose to be an NP. Medical school was certainly an option for me. I suppose if I wanted to go to med school, I still could. As recently as last year I did consider it, but in the end it wasn't worth it. I am a FNP working ER. I don't make the ER doc salary, but I am right up there with family physicians working in private practice (and half the work days). I recently found out I am not too far off the hospitalist mark where I am either.
I have all the hospital privileges I want. I have the respect of my physician and nursing colleagues.

Given your success, my decision to go my own route with the accompanying debt, loss of time, emotional and relationship stress looks like a pretty dumb decision.

But then I did contemplate your path. The thing that bugged me about being a nurse and even an advanced practice nurse, is that I didn't want to pretend to know. I wanted to treat my patients with the best education/experience/training that I could muster. This is not just punching the clock and hoping I could correctly guess. I will still be guessing. That's the beast. But my guesses will be very educated guesses and logically the better for them.

This is people's health. As nurses and docs we supposedly do this because we want the very best for that person in the stretcher. It's this nurse's opinion that a solid medical education is the best for that person. It's what I want for me and mine and that in the end is what we all ask when we make decisions around care. Playing doctor without adequate training is dangerous and unethical.

Mid levels have a valuable role. They see people quickly. Their lower patient volume allows more of the get-to-know ya time that is a cornerstone of great nursing practice. They bring into focus the social context physicians sometimes lack. They are an integral part of the healthcare milieu.

They are not equipped to be stand alone clinicians.

All that considered, the rigors of medical school aren't that attractive.

True. So terribly true.

I have looked at a couple of DNP programs. I don't think it is necessarily a bad idea. This argument about confusion with "real doctors" is ludicrous. I always introduce myself as NP, and no matter how many times I correct patients, I always end up being called "doctor" or get some comment like, "same thing" or "you are MY doctor". So the argument is that a DNP will cause this kind of confusion is just unfounded. The confusion already exists.

As an NP in an ED I assume (and for-the-love-of Gawd hope) you have physician expertise to back you up. This is an efficient evidence-based model.

People call you doc. Yippee. When that diagnostic toolbox that got filled in graduate school comes up empty, it is reassuring that a real physician can step in and do what needs to be done.

I will reiterate that the DNP is an attempt by the ANA to supplant physicians under the guise of equivalent training. It is dishonest, confusing and ethically circumspect.

Please prove me wrong.

brownrice · Jul 11, 2006

Fuegorama:

Oh how you generalize...IF I were to do the same, I would say this:

I have witnessed the practice of God awful physicians, many with an underaverage social IQ, combined with the inability to communicate or maintain direct eye contact with their patients. The entire profession is built on the reductionistic model, which rarely includes preventive nor holistic medicine. Most of the nurse practitioners with whom I have practiced have been perceptive and intuitive, and possess above-average communicative skills. Their education and years of experience have armed them with the tools they need. They always treat the whole person, and teach the patient.

Of course, one cannot generalize like this. There are both bad and good physicians, NP's/PA's. Things are not just black and white.

PS. Funny that the word "doctor" comes from the Latin word 'docere" or teacher. A "docere" was to empower the patient. I've yet to see a doctor that has attempted to teach me anything about how to maintain or improve my health. Yes, this takes time. The time that you mentioned "midlevels" are spending on their patients!

fuegorama · Jul 12, 2006

Fuegorama:
Oh how you generalize...IF I were to do the same, I would say this:
I have witnessed the practice of God awful physicians, many with an underaverage social IQ, combined with the inability to communicate or maintain direct eye contact with their patients. The entire profession is built on the reductionistic model, which rarely includes preventive nor holistic medicine. Most of the nurse practitioners with whom I have practiced have been perceptive and intuitive, and possess above-average communicative skills. Their education and years of experience have armed them with the tools they need. They always treat the whole person, and teach the patient.
Of course, one cannot generalize like this. There are both bad and good physicians, NP's/PA's. Things are not just black and white.
PS. Funny that the word "doctor" comes from the Latin word 'docere" or teacher. A "docere" was to empower the patient. I've yet to see a doctor that has attempted to teach me anything about how to maintain or improve my health. Yes, this takes time. The time that you mentioned "midlevels" are spending on their patients!

Actually, I didn't generalize. the NP model was built on nurses that had years of clinical experience prior to seeking a a higher degree of training leading to advanced practice. Today, this generation is fading away. The majority of NPs being churned out today from nursing programs typically graduate in less than 3 years and the vast majority of those do not have 3+ years of clinical experience.

Agree? yes/no

If your beloved spouse/son/daughter/mom/previously-unnamed-someone-important is presenting to an ED with a complaint. Do you want them seen and treated by someone that has 5 semesters of dissertation based "clinical training" that pats a good hand, oooooorrrr do you want them seen by someone who has 4+ years of hardcore pathphys based diagnostic skills + 3-7 years of apprenticeship tutelage training under a master in this art?

I'm betting on the latter.

Look. We all have known the socially dysfunctional physician. I happen to got to class with about thirty of them. These people are frequently emotionally stunted by the direct to doctor path they took. Many of them don't know why they are there. But, at the end of the H&P, the vast vast majority of them make the right call and compile an accurate plan of care.

I don't want a friend when I'm sick. I want a physician.

Oh. We are not reductionist. We can't be. No matter how expansive our differential for a specific complaint might be, we know there are at 5-10 things either we haven't thought of, or that haven't been yet elucidated.

And re: the teacher remark...maybe they gave you credit for being a nurse. Teaching patients is an integral part of what I am taught in my rotations. This has been over-the-top emphasized on OB and Peds.

Maybe you oughta see a DO. (smiley thingy and all that)

brownrice · Jul 12, 2006

Now, do you really believe an ED is going to hire "someone that has 5 semesters of dissertation based "clinical training" that pats a good hand." ?!!!! I don't think so! Every hospital has had many lawsuits, many well publicized. What type of an administrator would deliberately place themselves in such a precarious position? NONE.

IF however, the PA, NP or MD is experienced in emergency medicine, then yes, all of the above can treat myself, my mom, dad or other. And, should anyone needs anesthesia, I would choose a CRNA. (topic for another thread).

Does one need a doctorate in nursing to do the job~~they have done a beautiful job so far without it.

SharonH, RN · Jul 12, 2006

My point was that the explosion in beauracracy and zany cost vs. reimbursement paradigms has paralleled the rise of nurses into hospital administrative roles. I don't think it's a reach to draw a cause/effect conclusion.

*snicker* It's more than a reach, it's completely absurd. Your dislike/resentment of nursing/nurses has seriously affected your ability to view things objectively. Factors affecting the explosion in bureacracy and zany costs vs reimbursement as you call it include the influence of JCAHO, Medicare regulations, the increase in healthcare technology and consumer demand and influence. Those are only some of the factors. It has nothing to do with the rise of nurses into hospital administration. I'm not a philosopher but that looks like flawed reasoning if I've ever seen it. Give me one example of how having a nurse in a managerial role has led to decreased reimbursement to a physician. If that's what they are teaching in those business classes you are taking in med school, then you are getting cheated.

fuegorama · Jul 12, 2006

Now, do you really believe an ED is going to hire "someone that has 5 semesters of dissertation based "clinical training" that pats a good hand." ?!!!! I don't think so! Every hospital has had many lawsuits, many well publicized. What type of an administrator would deliberately place themselves in such a precarious position? NONE..

And you would be wrong. There are fresh-faced master's holders right now that are being employed in ED fast tracks across the country one month after graduation. There are NPs being put into clinics with no clinical experience outside of their shadowing time. I know this because I know them!

You have beautifully illustrated one of the points I am trying to make. Your faith that hospital administration would not hire an inexperienced NP is 1. incorrect 2.based on an ideal where the administration actually recognizes a difference between clinical accumen and legal allowance. NPs are allowed to dx/write scripts/do procedures/refer etc. Therefore, they must have the requisite training/experience to do these things. We now have a situation where admin is counting on NPs ability to do what they claim, and in-the-know nurses believe administrators will vet NPs before they get hired.

It's a terrifying blind leading the blind situation.

IF however, the PA, NP or MD is experienced in emergency medicine, then yes, all of the above can treat myself, my mom, dad or other. And, should anyone needs anesthesia, I would choose a CRNA. .

Hey. Did you see that guy that BASE jumped off a bridge 200 times in Twin Falls Idaho? He lived too.

Does one need a doctorate in nursing to do the job~~they have done a beautiful job so far without it.

Um......Um.....I do not know how to respond to this since I totally agree.

fuegorama · Jul 12, 2006

Your dislike/resentment of nursing/nurses has seriously affected your ability to view things objectively. .

This is not true. I respect and enjoy working with nurses/nursing. I AM A NURSE!! A good bit of my angst here is stemming from my belief that nursing is stretching far from its primary role that is direct, bedside, patient-based care. This most recent absurd proposition by the AACN is simply the culmination of the self-loathing rampant in the profession. "Just being a nurse" is not good enough for the self-promoters. It seems from this insiders perspective that the only thing the NP lobby and AACN borg machine do these days is self promote regardless of consequence.

The second prong of this issue is the blatant end run around paying required dues to gain a title and its accompanying benefits. This is a back door, a short cut, a cheat, a scam...you get it.

Factors affecting the explosion in bureacracy and zany costs vs reimbursement as you call it include the influence of JCAHO, Medicare regulations, the increase in healthcare technology and consumer demand and influence. Those are only some of the factors. It has nothing to do with the rise of nurses into hospital administration. I'm not a philosopher but that looks like flawed reasoning if I've ever seen it. Give me one example of how having a nurse in a managerial role has led to decreased reimbursement to a physician. If that's what they are teaching in those business classes you are taking in med school, then you are getting cheated.

Oh I'm getting cheated on a lot of things in med school! but this point about nurses+administration=high cost is something I would like to read a bit about.

I will get back on this later.

Right now I need to start my 12 hour day on inpatient Peds. This is week four of 6. How much time do NPs get again?

Editorial Team / Admin · Jul 12, 2006

All opinions are equally welcome.

However, to come to the boards and simply make comments that only serve to be divisive is not necessary.

We ALL, the physician and the NP/CNS/PA, serve the public. Please, let's work together. After all, we are all professionals in the name of healthcare.