Dr. Tammy, FNP/GNP-C

If you are a California NP and would like to say that you actually did something to ensure of SB 491 passing, send me a PM. I have some thoughts.

another proponent of dr asblow's theory: "the average doctor has more raw intellect than the average nurse--period." read more: http://health.blogs.foxnews.com/2010/04/15/nurses-masquerading-as-doctors/#ixzz1xzqmzpcj i always wonder to what extent and if any boundaries actually exist on this nursing board as to the depth nurse bashing can occur on this nursing site.

I'm sorry your chosen vocation has made you so bitter against reality and those in other professions. Hopefully, this might cheer you up. It certainly did for me: http://www.medschoolhell.com/2007/07/18/why-be-an-md-when-you-can-be-an-np/

Where do you think this enlightened chap is from?

As indicated by some of the medical student trolls--it is a big deal and should be a big deal--at least to them. As they see the progression of APRN advanced to the doctorate level and as more than half the states have autonomous independent NP practice(and growing) they are starting to reevaluate as to their medical school choice. I don't know why they feel so threatened as they will probably always have a job. Even my NP friend up in Oregon is not opposed to hiring a MD, especially if she can't find a qualified NP to fill the slot. Perhaps the medical students should have watched this before making their decision.

Just illustrating a situation that happened to someone close to me. Ultimately the physicians and the physicians' doctor did get things worked out. What still remains to be seen, though, is whether or not doctors, physicians and NP's would ever be able to tell the difference between a role, a profession and that of a title--cough, even on a board full of NP's.

Can't argue with that logic.

Kind of a similar incident happened in a different office with 4 MD's, 3 DNP's, a DO and a brand new DNP without a furnishing certificate. The doctor's supervising doctor wanted the doctor to basically spend 520 hours of half compensated time so that the doctor could get a enough time in for her furnishing certificate. The doctor responded by telling the senior doctor that, although she is a trained doctor, would only do so in consideration of the support of the other doctors for that doctor to become a partner doctor when she completed the time--you know, since they're all doctors. The other doctors stated that for this to be considered, the doctor would have to spend at least three years at the doctors' offices before a decision could be made. So the doctor essentially told the doctors that for this particular doctor to work at half price, the doctor would need the other doctors to provide for a doctor profit sharing program. Alas, the doctors told the doctor that this could not happen. So now the doctor is working with another set of doctors at full pay and considering opening up her own practice where she might hire one of the other doctors from the first doctors practice, even though the doctor is not a nurse practitioner.

I introduce myself as Dr. Tammy, the nurse practitioner. There are states, however, where this would be illegal as state medical associations are very powerful and continue to hold a monopoly over who can and who cannot use their earned credentials in the workplace. As far as the term mid level provider, the AMA and state medical associations need to control nursing, maintain ownership status over nursing in the pursuit of protecting their financial and political interests. As nurses, we perpetuate the situation by allowing ourselves to be referred to as a mid level provider. I have turned down several jobs where NP's are referred as MLP's. I always wonder what would happen if NP's stood up from around the country and did the same thing.

First, I have never practiced medicine (nor have I been educated or licensed to practice medicine) any more than I have practiced optometry, dentistry, psychology, optometry or podiatry--even though there are functions within those fields that do overlap with the advanced practice of nursing such as prescribing, counseling, performing minor foot surgery, treating dental abscess and doing ophthalmic exams. Second, It's important to remember that the DNP program that I, and the vast majority of others have completed thus far, is different than what the DNP program is today and will become in the very short future. The DNP program I went through only admitted those who were already clinical experts in their fields (NP, CRNA, CNM). All had MSN's were board certified and had many years of nursing experience. This will transition very shortly to the DNP program where the MSN content is within the DNP program and students will go straight through from BSN to DNP. So it goes, there will be no part 1 and part 2, but just one part, as it should be. The MSN portion of the NP program gave me the tools, theory and practice-based skill to work with clients as a FNP. The programmatic information I received in my DNP program gave me the direction, information and guidance for developing the context with which to provide that care. Collectively, both programs made me a beginning doctorate prepared NP. Again, in the future, this will not be an issue as there will be no part 1 and part 2. As time passes, the question of whether the DNP program makes better NP's will be equivalent to asking whether or not a NP program makes better NP's. Third, the MPH and health care administrator are not nursing-based, and are not clinician-based professions. Nursing is a clinical-based profession where both client and the systems that provide for health care are central to the profession. My accomplishments, thus far, are guided by effecting positive outcomes for my clients through nursing systems and structure. To state that my goals were as you stated, really misrepresents what I am about. The "management-administrative stuff" was just a component in the larger picture of developing programs, where there was once nothing, to provide a vehicle for me to take my clients to a greater degree of health. Lastly, it is important to remember that my particular accomplishments are not unique in there application to facilitate positive outcomes in the lives of others. I was far from head of the class. There was one student who used his knowledge and training to bust through barriers in Nebraska and established independent practice for CRNA's, thereby reducing barriers to access to care. Another developed a special diabetic registry program that decreased people from slipping through the cracks which is now implemented at Kaiser. Another developed a program that greatly reduced morbidity and mortality regarding falls with Alheimer's patients by implementing a form of line dancing. Another bridged a gap between nursing and dental health practices for the underserved. Another developed a program for mobile colorectal cancer screenings. The list goes on. In the mid 1850's, many were critical and adamantly opposed to the idea that nursing could have a place in reducing mortality and morbidity for those wounded in the Crimea. Many high power physicians, leaders and others scoffed at the idea that nursing could have a greater impact on health care outcomes than the present medical-model driven system of the time. It is sure curious how nursing has transformed the health care industry since then, rising to the most trusted profession in the US--year after year after year. It will certainly be curious to see how the health care industry transforms over the next century with the advent of the DNP compared to how we view those who served as barriers to the advancement of the DNP.

Here's a pretty cheap post cert program. http://advancednursing.nku.edu/programs/postgrad/npadvancementcert/nptopsych.php $463/Hour http://bursar.nku.edu/students/tuitionfees.php

You are absolutely correct and my sincere apologies. I had three screens opened at once and ripped into an individual who, from another post, was bashing nurses on a different thread. That's the last time I try and multitask at 2 in the am.

You forgot to list the dentist, psychologist, pharmacist, chiropractor and optometrist. Don't mean to be rude, but you clearly have a problem with nurses who hold clinical-based doctorate degrees. Wouldn't your anti-nursing, anti-professional advancement and growth for nurses rhetoric be better served on a number of other forums designed for medical student wannabes that primarily focus on the advancement of these ideas? Perhaps you could even reach out and help Dr. Kieth Assblow (Sp?) construct a few more articles on this subject, focusing primarily on how nurses are intellectually inferior to physicians and are not worthy of the doctoral title: http://www.foxnews.com/health/2010/04/15/nurses-masquerading-doctors/

Two different animals. One is clinical-based and the other is not. One is within the field of nursing, uses nursing science, nursing philosophy, nursing paradigms and the nursing process (the same that many here scoff at yet without these to inform and direct practice, they would be technicians) and the other is not.

The DNP added a new dimension to my practice for sure. Duke taught me how to access, interpret and translate evidence. Simple enough concepts, but here is what I was able to do with what many describe as "DNP Fluff courses": 1. I created the first police nurse practitioner program in the United States. Through Duke, I used my capstone experience to formulate an IRB approved study to evaluate the effectiveness of one component of the outreach program, which is being published August 3 in The Journal of Community Health Nursing. Once, where there was nothing--now there is a tangible program in place that is helping thousands in the community--all through direct implementation of what I learned through the DNP program. To date, the police nurse practitioner program has now provided screening and direct health care services for over 10,000 individuals within my community--all at no cost to the agency or the taxpayer. 2. I created a special health chair position with the NAACP where I developed a free out patient clinic program for those vulnerable populations who have absolutely no access to health care services. Even though not one physician I contacted was willing to help or provide any assistance whatosever, I used my DNP training to craft, design and implement a program that has provided more than 100 patient care primary care visits over the last few months. Now, the local chapter has procured its own clinic site to expand the services provided by my project developed within my DNP training. 3. Even though the DNP is not the research arm of nursing, there is a heavy emphasis on the research process. I now feel I have the tools to conduct research in the context of evaluating and translating evidence. As with the study I did at Duke, this will translate into improving outcomes across my practice. So, to answer your question, I would say that through my DNP training, I was not trained how to diagnose cystitis any better than within my MSN program. I wasn't provided with any additional training on how to manage diabetes or lipidemia or provide better birth control counseling, but I would say that the impact I have had on the lives of those in my community was pretty good.