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]

yeah but being a pa has its own limitations... nps typically have a lot more independence. this depends on the state, of course.

*** maybe, but more often they are interchangeable.

also, if you're interested in a specialty it's pretty much all on the job training for pa, whereas an np can dedicate all their clinical hours and training to that specialty (whnps, psych nps, cnms, etc.)

*** actually you just listed one of the primary advantages pas have over np.

of course, that limits their scope of practice. there are pluses and minuses to both professions.

*** yes of course but certain people want to start adding huge minuses to the np column. starting with an extra year or two of of doctorate level education at doctorate level cost for no return in increased scope of practice or compensation.

[PMFB-RN, RN]

I agree that PAs can have it better, depending on the circumstances. NPs can also have it better. It really depends on your specialty, what state you plan on practicing in, etc. Since I'm interested in psych, NP was a no-brainer choice.

*** But the circumstance are changing. The PA is going to have a huge advantage of dramaticaly less cost, particularly when a whole year or more of lost wages are calulated in and one to two years less time spent in school.

[PMFB-RN, RN]

PA never has independent practice so I'm not sure what you mean by issues with scope of practice. We have it much, much better than PAs.

*** Of course there are PAs who have independent practices. The issues with scope of practice I referred to: Like Rn's PA is a general lisence. There nothing to stop an RN who is an NICU nurse from being hired into L&D, or any other nursing job the next day. The same is true for PAs but not true for NPs. A neonatal NP can not be hired as an adult ACNP tomorrow.

To me the independence of solo practice is a straw man argument. The vast, vast majority of NP and PAs work in team care environments with physicians or other providers.

My argument is not that PA is superior to NP. My argument is that if we (nursing) continues to insist on forcing wannabe NP attend a whole extra year, or maybe two years of doctorate level cost, plus addistion an extra year or two of lost wages, PA will become more attractive to those who wish to pursue midlevel careers.

[apocatastasis]

unplannedRN, I appreciate your comment and pretty much agree with you. An NP (or RN!) who holds a doctoral degree can and should refer to himself as Dr. so-and-so, the nurse (+practitioner).

I, like you, have serious reservations about the value of the DNP as it stands now... I'm becoming an NP because I want to TAKE CARE OF PATIENTS! If I end up going into policy or systems or administration--so be it, but I just don't feel it's necessary (or even appropriate!) to mandate extra years of education for this purpose! I question the motives of any organization or university that seeks to mandate the DNP. Degree creep does nothing but discourage and frustrate most current NPs and encourage fewer RNs from pursuing graduate education. Fewer NPs will lead to less availability of care for everyone. Where will we be then as a profession?

I live in Texas, which is truly a backwards state as far as Nursing (and healthcare in general) are concerned. And from everything that I've seen in our struggles, we do NOT need a mandatory doctoral degree to achieve greater parity with physicians. We need more nurses and nurse practitioners who have strong clinical backgrounds and day-to-day experience; nurses who can think critically; nurses who will speak up and who will share their experiences with legislators, think tanks, and the public at large.

I''m 27 and I've spent 5 years getting a liberal arts BA, a year and a half becoming an RN, and now three years in NP school. If they want to mandate an extra two years for a useless DNP for us, my next stop (if there is one) will likely be to throw in the towel and just head to med school.

[nomadcrna, DNP, CRNA, NP]

No, PAs can NEVER have an independent practice. They must have a physician. Unless I"m mistaken, it is this way in all 50 states.

I think they should have independent practice, just as I think NPs should have it in all 50 states.

[zoidberg, BSN, RN]

not quite sure what the quote was for, and i never meant to say that fnp's must do family practice. if i did i was incorrect. i also should have specified that the PA/NP privileges i was referring to are from a specific hospital system i am familiar with, which has nothing to do with state regulations. sorry for upsetting you nomadcrna...

[nomadcrna, DNP, CRNA, NP]

benm93,

The below is what I was referring to. :)

FNPs can and do do other things besides family practice. They practice in all areas to include ortho, neurology, neurosurgery, hematology, cardiology and yes, ER, hospitalist and intensivist roles.

The same way a PA goes to work in women's health (not L&D, PAs cannot work there and deliver babies) or ER, a FNP and PA either gets OJT and is taught or tailors their program.

An FNP can see any age and any population, just as a PA can. Obviously state practice laws dictate your practice.

Hospital credentialing is another matter. Hospitals do not have to credential you for certain privileges even though you are allowed to perform them according to state law. I've gone through the credentialing process at more than 30 or more hospital in 22 years, both locums and permanent. Sometimes you have to fight, most times you don't.

Many rural hospitals in montana, alaska, washington, new mexico, arizona have solo FNP ER coverage.

At my current location, I do women's health, prenatal care, pediatrics, geriatrics, pain, ER, inpatient medicine as an FNP. Did I become competent at placing IUDs in my fnp program? Nope. I did afterwards by attending a class and having a peer "precept" me.

The same goes for the FNPs I knew in Montana who did Ortho, The surgeon trained them, both in the clinic and in the OR. Do you really think a PA can get out of school and function in the Ortho specialty? No, they need the same training.

The hospitals like to use FNP over PAs for the simply fact of no supervision (in my states). I'm not saying the FNP is better because it is not. We are just more fortunate in regards to state law.

Again, I'm not trying to be a jerk. You make some really good point and I admire your enthusiasm. If I came off as irritated, I really am sorry. I tend to get in a hurry and electronic communication and the written word is NOT my forte. :)

My wife sometimes looks at my posts and wonders why I"m such an ass and I"m like, huh? I did not mean it that way. LOL

As an NP, if you get your FNP certification, you cannot leave family practice and decide to do work in the ICU. If you are a Psych NP, you cannot decide to go work in L & D. A PA can do this. As an Example, if an NP wants to work in the ER, they must get the right NP education to do this. With all the types of patients that come in the door, not all NP's can see every patient due to each type of NP's scope of practice being limited to a certain population. A PA is trained as a generalist and is exposed to many areas before completing the degree.

[nomadcrna, DNP, CRNA, NP]

I was around as an RN in the days when DOs had to have their own hospitals to practice. Even back then the education was not less then the MDs, just different. The states allowed them to do the same procedures and such as the MDs did. The MDs were arrogant and dismissive of DOs much like many are today of NPs.

I remember helping a DO at a DO hospital in phoenix, Az place a swan in the ICU.

NPs are ramping up the education and in 5-10 years, it will be a different landscape.

The difference here is that osteopathic education changed so that it now is IDENTICAL to allopathic education. They both have 2 years of basic science education, 2 years of clinical education and the exact same residencies. The improvement in education is why they are considered identical. It is not that MDs relaxed what they expected. It is that DO's stepped up their education.

[zoidberg, BSN, RN]

haha it is much easier to be mean in online communication. lets stop arguing (though this is not much of an argument) since i agree with everything you've said!

I am just very interested in the profession that I hope to be a part of. I hope I will one day be able to play a role in shaping the change that is happening for NP's. Back to NP's with doctorates and the who is a doctor discussion... I hope that time will bring the change that is needed--both for NP education and credentialing(im not saying its broken, but cant we always improve?) and for the public and medical world accepting NP's as people with doctorates. Chiropractors and Physical Therapists are called doctor, and NP's will be as well, but only time will tell how long it takes.

[myelin]

*** But the circumstance are changing. The PA is going to have a huge advantage of dramaticaly less cost, particularly when a whole year or more of lost wages are calulated in and one to two years less time spent in school.

Not in my specialty. Do you really want a psychiatric provider who has learned everything "on the job" and hasn't taken any in depth classes on the development of psychopathology, psychpharm, providing therapy, etc.? I believe the NP pathway will lead to a far more competent provider than the PA pathway, where the student has had, what, maybe a week of classes that focus on psych and a small fraction of their clinical hours devoted to psych.

[PMFB-RN, RN]

Not in my specialty.

*** Oh really? I didn't know that the DNP recommendation did not apply to all NPs.

Do you really want a psychiatric provider who has learned everything "on the job" and hasn't taken any in depth classes on the development of psychopathology, psychpharm, providing therapy, etc.?

***I admit I know very little about psych. In my field (ICU & ER) NPs & PAs are used interchangeably.

I believe the NP pathway will lead to a far more competent provider than the PA pathway, where the student has had, what, maybe a week of classes that focus on psych and a small fraction of their clinical hours devoted to psych.

*** I will take your word for it. However I don't really see how your comments address my post you replied to? MY point being that as NP moves to the longer and dramatically more expensive DNP more people interested in mid-level careers are likely to choose the shorter and cheaper PA option. I fear nursing is sending a clear message to many of it's own of "we don't want you".

[core0]

Not in my specialty. Do you really want a psychiatric provider who has learned everything "on the job" and hasn't taken any in depth classes on the development of psychopathology, psychpharm, providing therapy, etc.? I believe the NP pathway will lead to a far more competent provider than the PA pathway, where the student has had, what, maybe a week of classes that focus on psych and a small fraction of their clinical hours devoted to psych.

Like you said not your specialty. Every PA has a required clinical rotation in psych as well as devoted didactic path and pharm. In my program it was six weeks combined with neurology. So path was around 60 hours of lecture devoted to psych ie path and integrated pharm as well as 16 hours of specific pharm taught by a PharmD. Then 5 weeks in a locked inpatient psych unit (200 hours) plus all the hours doing psych in family practice. Yes its a small percentage of overall clinical hours (less than 7% in my case) but still very comparable to "specialties".