NPs practicing as DRs

[SkiBumNP]

This has been a heated discussion between some of my friends and I, so I thought I would bring it to the forum.

Should people who are going through a DNP programs and taking the SAME test we all took for our MSN - NP for national certification think their education 'doctorate" is a clinical doctorate?

Until there is a national standard and an elevation of the test (think along the USMLE) then I think anyone who thinks their DNP is a clinical doctorate is a joke.

your thoughts. . . . .?

[PMFB-RN, RN]

maybe because you have not worked at many places?

*** i have worked in a variety of hospitals in 4 states. i have done a fair amount of travel nursing over the last 15 years.

i've seen many pharmd intoduce themselves as doctor in the hospital.

*** "intoduce"? i guess you were right, spelling must not be taught in doctorate programs. i deliberately didn't say it never happens, i said i have never heard of it.

when you get a doctorate, come back. until then it just sounds like more of the same jealousy.

*** "jealousy"? (chuckle, chuckle) uh sure, ok, think that if you need to. if you have a good argument to add to the discussion for why nurses with dnp should be called doctor in a clinical environment, or why dnp should be required for entry to advanced practice please bring it.

[msn10]

msn10

[color=#333333]i think we need to be very careful about how we assign the 'doctor' title, however. the title is loosing its meaning when every specialty decides that it too is a doctor.

crf250xpert

we've been using the term "doctor" for people that never went to medical school for hundreds of years and somehow if i ask folks to call me doctor i am cheapening "the meaning" of the title? that just doesn’t make sense. please explain how i could be "very careful"?

i am saying that about 50 years ago the term 'doctor' only used to mean physician and phd. in both of these educational tracks participants had to do at least 10 - 12 years - full time - school and/or residency. now we are calling chiropractors doctor and in many cases they have less schooling than a masters prepared np.

what i am saying is that we need some uniform basis for obtaining and being referred to as a doctor. otherwise, basket-weaving specialists can self determine that 3 years is enough time to be an expert in the basket-weaving field and now they now should be referred to as dr. basket-weaver. if every specialty gets to be called doctor without obtaining a phd, then i believe we are cheapening the word.

[msn10]

.nomadcrna

When you get a doctorate, come back. Until then it just sounds like more of the same jealousy.

Funny, that is the same thing anesthesiologists have been saying to CRNA's for years.

[nomadcrna, DNP, CRNA, NP]

Huh? Not sure how you came to that conclusion?

MDAs want to control CRNA for pure economic reasons, period. Even with a DNP/DNAP the MDA still wants to make money off the CRNA.

[nomadcrna, DNP, CRNA, NP]

I have 13 years of education.

BTW, PhD is a research degree. DNP/DNAP is a practice degree.

[nomadcrna, DNP, CRNA, NP]

it is difficult to discuss the pros and cons of a dnp with someone who does not have a dnp and is not an np.

how can you intelligently discuss it when you have no idea what it entails?

all you have is what you perceive about np and the dnp program. how can you intelligently give any information about dnp being entry level for a np?

you are not either.

i welcome a discussion with nps and/or dnp nps who have walked the walk and actually know what it entails.

maybe because you have not worked at many places?

*** i have worked in a variety of hospitals in 4 states. i have done a fair amount of travel nursing over the last 15 years.

i've seen many pharmd intoduce themselves as doctor in the hospital.

*** "intoduce"? i guess you were right, spelling must not be taught in doctorate programs. i deliberately didn't say it never happens, i said i have never heard of it.

when you get a doctorate, come back. until then it just sounds like more of the same jealousy.

*** "jealousy"? (chuckle, chuckle) uh sure, ok, think that if you need to. if you have a good argument to add to the discussion for why nurses with dnp should be called doctor in a clinical environment, or why dnp should be required for entry to advanced practice please bring it.

[nomadcrna, DNP, CRNA, NP]

Lapses in anesthesiologist supervision of CRNAs are common even when an anesthesiologist is medically directing as few as two CRNAs, according to an important new study published in the March issue of the journal Anesthesiology. The study, titled "Influence of Supervision Ratios by Anesthesiologists on First-case Starts and Critical Portions of Anesthetics," looks at over 15,000 anesthesia records in one leading U.S. hospital and raises critical issues about propriety and compliance in the most common and costly model of anesthesia delivery at a time when quality and cost-effectiveness are white-hot healthcare issues at every level.

As you know, Medicare medical direction payment rules reimburse anesthesiologists 50 percent of a fee for performing all seven medical direction tasks in each of up to four CRNA cases concurrently. Anesthesiologist medical direction of CRNAs is not required by Medicare. Rather, medical direction is a billing modality in which physicians billing for medical direction personally attest to having performed specific tasks warranting reimbursement.

Yet, this new study states that "(e)ven at a ratio of 1:2, there would have been at least one such lapse in supervision for 35% of days. At a ratio of 1:3, there would be supervision lapses on 99% of days." The researchers define a "supervision lapse" as an instance when there is an "inability to supervise all critical portions" of a case. Without personally performing such supervision, the seven medical direction tasks that an anesthesiologist must complete for billing Medicare for medical direction are not fulfilled, and a medical direction claim is not permitted.

The findings now reported in Anesthesiology, published by the American Society of Anesthesiologists, are confirmed by AANA member survey data. According to our member data, where CRNA services are supervised by anesthesiologists, 74 percent are supervised at a rate of 1:2 or greater. Half of CRNAs report that 100 percent of their cases are considered medically directed by anesthesiologists. And of the seven medical direction tasks, CRNAs report anesthesiologists are involved in those activities only between 5% and 42% of the time. Anesthesiologists are simply not completing the requirements of medical direction, and may be billing Medicare for them.

Yet, is patient safety at issue here? No. The AANA has long held that medical direction ratios have nothing to do with quality of care, and everything to do with reimbursement systems-inefficient, unsustainable systems that make healthcare cost too much and divert millions upon millions of scarce healthcare dollars from real patient needs. Recent landmark studies on anesthesia safety and cost-effectiveness published in the journals Health Affairs and Nursing Economic$ have confirmed the safety and cost-effectiveness of CRNAs, and the Institute of Medicine in The Future of Nursing emphasizes APRN safety in arguing for nurses to practice to their full scope. Now, this study in Anesthesiology confirms anesthesiologist supervision of CRNAs is more honored in the breach than in the observance.

Empowered by this additional peer-reviewed evidence in Anesthesiology on top of the evidence recently published in Health Affairs and Nursing Economic$, your AANA is continuing to work to make this message heard in the places it needs to be heard. Stay tuned.

What does this new study mean for CRNAs? Click here to access additional information on the AANA website to help you prepare for the potential impact of the study. Scroll down to the bullet points on that page.

Additionally, know that your voice matters. I encourage you to share your thoughts with your colleagues via the AANA members' discussion group at http://www.aana.com/my/community/groups/hottopicsinanesthesiaclinicaldiscussiongroupfornurseanesthetists.

After all these years, anesthesiologists themselves have now stated in their own journal what we CRNAs have long known: Medical direction responsibilities are not fulfilled in every case where that service is billed. Such a striking conclusion confirms the evidence and our view that supervision ratios do not benefit patient outcomes, and that medical direction costs tremendous sums of money needlessly. Perhaps now the focus can be placed where it belongs and as we have long advocated: on the needs of patients.

For all you do for the profession, thank you, and stay vigilant always.

Sincerely,

Debra P. Malina, CRNA, DNSc, MBA

AANA President

[BlueDevil,DNP, DNP, RN]

*** My observation is that most physicians, expecialy with more experience, have no idea what a DNP is. Find one who does and have mostly likely found one who doesn't like it.

This has most assuredly not been my experience. I have had nothing but positive reinforcement and congratulations. I say this not to discount your experience, but to offer a different perspective and perhaps a bit of sanguinity to current DNP students or those considering the DNP path that may be lurking.

FTR, when speaking to patients about me, my physician colleagues call me "Doctor Devil," just as I refer to them by their title and surname when I speak of them to patients. When speaking to one another we use first names. We are colleagues and friends. There is none of this nonsense in the real world as it exists among students and message board denizens!

[BlueDevil,DNP, DNP, RN]

It is difficult to discuss the pros and cons of a DNP with someone who does not HAVE a DNP and is not an NP.

How can you intelligently discuss it when you have no idea what it entails?

All you have is what you perceive about NP and the DNP program. How can you intelligently give any information about DNP being entry level for a NP?

You are NOT EITHER.

I welcome a discussion with NPs and/or DNP NPs who have walked the walk and actually know what it entails.

Veridical. Or "word," or "true dat." Whichever taxonomy you prefer.

In all seriousness, this is quite true. I have found that only other DNPs really understand the inherent value of the education, which is neither surprising nor bothersome to my way of thinking. You have to know the secret handshake before we make you privy to the details.

[msn10]

nomancrna

I have read the article, but be careful before you start quoting Dexter, Franklin M.D., Ph.D.,

He is a brilliant researcher and his wife if a surgeon. He is known in anesthesia circles as such a smart man that most people in anesthesia cannot adequately speak to his research and he is so mathematically intelligent that many statisticians cannot properly quote his research either.

Franklin is a proponent of effective and efficient anesthesia care, but he is an even bigger proponent of anesthesiologists. He has done more work on efficiency in the OR than any other anesthesiology researcher out there and he is an internationally known anesthesia consultant. This article merely reveals what his plethora of work reveals, OR's are not always efficient. He gives many suggestions for improving efficiency and this article merely states that start times should be staggered. In this article he even states:

"patient safety could be affected when there are coincident critical physiologic events"

Or

"At a ratio of one anesthesiologist to three anesthesia providers, it will not be possible to start all ORs simultaneously and have sufficient anesthesiologists to supervise all critical portions of cases on most days." So he suggests staggard start times as he has in many other articles.

Of course the AANA president has a bias, but misquoting Dexter's research doesn't make the case against supervision that much stronger. The authors of the article still believe an MD supervision model is still safer and not supervising CRNA's in a trauma hospital is not an option.

[msn10]

uh? Not sure how you came to that conclusion?

MDAs want to control CRNA for pure economic reasons, period. Even with a DNP/DNAP the MDA still wants to make money off the CRNA.

You just got done saying that in order for someone to speak to you about DNP's being called doctor, then they in fact should get one themselves. For years, MD's have said that to DNP. Just making an analogy. You and I have more schooling than many other people on this site, it doesn't mean our opinions are more important than theirs. I come to this site to hear other people's points of view even if that is different than mine. It helps to expand my horizons. Only getting opinions from people with the exact same education or experience as I have doesn't help the nursing profession. It is important to understand how others in the profession view us/others - otherwise we are no better than the physicians who do not see us as health care peers.

I have 13 years of education.

Thats fine, but do you have another degree? CRNA's don't need 13 years to become a ANP or DNP. 4 years BSN and 3 years DNP. ICU is experience, not schooling.

Look, I don't think anyone here is saying they don't respect DNPs or do not see a need for them. Most people on this thread are just asking why you find a DNP education important to your work. For years we said that NPs had adequate schooling and now there is a push for DNP. Is it really necessary and because it is not much more schooling than the traditional NP programs, should they really be called doctor. I think it is a fair question. No different than the ADN vs BSN question

BTW, PhD is a research degree. DNP/DNAP is a practice degree

I think everyone here knows that.

[PMFB-RN, RN]

This has most assuredly not been my experience. I have had nothing but positive reinforcement and congratulations. I say this not to discount your experience, but to offer a different perspective and perhaps a bit of sanguinity to current DNP students or those considering the DNP path that may be lurking.

*** Oh I am sure thet your mileage may vary. I have worked in enough settings to understand that cultures are different in different work environments. I only meant to express my personal experience and wasn't attempting to paint with a broad brush.

I think my observation may be a result of working in a medical center that hosts several types of NP DNP students as well as a DNP CRNA program. Our physicians come in regular contact with many DNP students.

I appreciate your prespective.