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.
Specializes in Anesthesia, Pain, Emergency Medicine.
Once again, don't compare apples to oranges. You are comparing a doctoral level emergency focused program for people who are already PAs to an entry level NP ER/primary care focus program.
You switch around so fast it is hard to keep up. If you want to compare the basic PA program that according to you, gets way more ER training to a comparable program like vanderbilt's or others, that would be accurate.
I'm glad you are proud of your husband.
Washington state laws concerning PAs and Nps are below. In Washington, NP are TOTALLY independent per state law. If a facility wants to limit the NP practice, they can. But any requirement that the NP has to call a physician for a patient is only for that facility. Many rural ERs have solo NP coverage without that requirement.
PAs MUST have a supervising physician, period. So they are never can have primary responsibility for a patient and must always have their charts signed.
I don't agree with this. I think PAs should have the same independence as NPs but that is the state law.
(1) A licensed advanced registered nurse practitioner (ARNP) is a registered nurse prepared in a formal educational program to assume primary responsibility for continuous and comprehensive management of a broad range of patient care, concerns and problems.
(2) The ARNP is prepared and qualified to assume primary responsibility and accountability for the care of patients.
(3) ARNP practice is grounded in nursing and incorporates the use of independent judgment as well as collaborative interaction with other health care professionals when indicated in the assessment and management of wellness and health conditions as appropriate to the ARNP's area of practice and certification.
(4) The ARNP functions within his or her scope of practice according to the commission approved certification program and standards of care developed by professional organizations.
(5) The ARNP shall obtain instruction, supervision, and consultation as necessary before implementing new or unfamiliar techniques or practices.
(6) Performing within the scope of the ARNP's knowledge, experience and practice, the licensed ARNP may perform the following:
(a) Examine patients and establish diagnoses by patient history, physical examination and other methods of assessment;
(b) Admit, manage and discharge patients to and from health care facilities;
(d) Manage health care by identifying, developing, implementing and evaluating a plan of care and treatment for patients;
(e) Prescribe therapies and medical equipment;
(f) Prescribe medications when granted authority under this chapter;
(g) Refer patients to other health care practitioners, services or facilities; and
(h) Perform procedures or provide care services that are within the scope of practice according to the commission approved certification program.
(4) A physician assistant and supervising physician shall ensure that, with respect to each patient, all activities, functions, services and treatment measures are immediately and properly documented in written form by the physician assistant. Every written entry shall be reviewed and countersigned by the supervising physician within two working days unless a different time period is authorized by the commission.
(5) It shall be the responsibility of the physician assistant and the supervising physician to ensure that adequate supervision and review of the work of the physician assistant are provided.
(6) In the temporary absence of the supervising physician, the supervisory and review mechanisms shall be provided by a designated alternate supervisor(s).
[TABLE]
[TR]
[TD][h=2]RCW 18.71A.020[/h][h=1]Rules fixing qualifications and restricting practice — Applications — Discipline — Payment of funds.[/h] [/TD]
[TD]
[/TD]
[/TR]
[/TABLE]
(1) The commission shall adopt rules fixing the qualifications and the educational and training requirements for licensure as a physician assistant or for those enrolled in any physician assistant training program. The requirements shall include completion of an accredited physician assistant training program approved by the commission and within one year successfully take and pass an examination approved by the commission, if the examination tests subjects substantially equivalent to the curriculum of an accredited physician assistant training program. An interim permit may be granted by the department of health for one year provided the applicant meets all other requirements. Physician assistants licensed by the board of medical examiners, or the medical quality assurance commission as of July 1, 1999, shall continue to be licensed.
(2)(a) The commission shall adopt rules governing the extent to which:
(i) Physician assistant students may practice medicine during training; and
(ii) Physician assistants may practice after successful completion of a physician assistant training course.
(b) Such rules shall provide:
(i) That the practice of a physician assistant shall be limited to the performance of those services for which he or she is trained; and
(ii) That each physician assistant shall practice medicine only under the supervision and control of a physician licensed in this state, but such supervision and control shall not be construed to necessarily require the personal presence of the supervising physician or physicians at the place where services are rendered.
Once again, don't compare apples to oranges. You are comparing a doctoral level emergency focused program for people who are already PAs to an entry level NP ER/primary care focus program.
You switch around so fast it is hard to keep up. If you want to compare the basic PA program that according to you, gets way more ER training to a comparable program like vanderbilt's or others, that would be accurate.
I'm glad you are proud of your husband.
Washington state laws concerning PAs and Nps are below. In Washington, NP are TOTALLY independent per state law. If a facility wants to limit the NP practice, they can. But any requirement that the NP has to call a physician for a patient is only for that facility. Many rural ERs have solo NP coverage without that requirement.
PAs MUST have a supervising physician, period. So they are never can have primary responsibility for a patient and must always have their charts signed.
I don't agree with this. I think PAs should have the same independence as NPs but that is the state law.
[TD=colspan: 2] [h=1]Advanced registered nurse practitioner (ARNP) scope of practice.[/h][/TD]
[/TR]
[/TABLE]
(1) A licensed advanced registered nurse practitioner (ARNP) is a registered nurse prepared in a formal educational program to assume primary responsibility for continuous and comprehensive management of a broad range of patient care, concerns and problems.
(2) The ARNP is prepared and qualified to assume primary responsibility and accountability for the care of patients.
(3) ARNP practice is grounded in nursing and incorporates the use of independent judgment as well as collaborative interaction with other health care professionals when indicated in the assessment and management of wellness and health conditions as appropriate to the ARNP's area of practice and certification.
(4) The ARNP functions within his or her scope of practice according to the commission approved certification program and standards of care developed by professional organizations.
(5) The ARNP shall obtain instruction, supervision, and consultation as necessary before implementing new or unfamiliar techniques or practices.
(6) Performing within the scope of the ARNP's knowledge, experience and practice, the licensed ARNP may perform the following:
(a) Examine patients and establish diagnoses by patient history, physical examination and other methods of assessment;
(b) Admit, manage and discharge patients to and from health care facilities;
(d) Manage health care by identifying, developing, implementing and evaluating a plan of care and treatment for patients;
(e) Prescribe therapies and medical equipment;
(f) Prescribe medications when granted authority under this chapter;
(g) Refer patients to other health care practitioners, services or facilities; and
(h) Perform procedures or provide care services that are within the scope of practice according to the commission approved certification program.
(4) A physician assistant and supervising physician shall ensure that, with respect to each patient, all activities, functions, services and treatment measures are immediately and properly documented in written form by the physician assistant. Every written entry shall be reviewed and countersigned by the supervising physician within two working days unless a different time period is authorized by the commission.
(5) It shall be the responsibility of the physician assistant and the supervising physician to ensure that adequate supervision and review of the work of the physician assistant are provided.
(6) In the temporary absence of the supervising physician, the supervisory and review mechanisms shall be provided by a designated alternate supervisor(s).
[TABLE]
[TR]
[TD][h=2]RCW 18.71A.020[/h][h=1]Rules fixing qualifications and restricting practice — Applications — Discipline — Payment of funds.[/h][/TD]
[TD][/TD]
[/TR]
[/TABLE]
(1) The commission shall adopt rules fixing the qualifications and the educational and training requirements for licensure as a physician assistant or for those enrolled in any physician assistant training program. The requirements shall include completion of an accredited physician assistant training program approved by the commission and within one year successfully take and pass an examination approved by the commission, if the examination tests subjects substantially equivalent to the curriculum of an accredited physician assistant training program. An interim permit may be granted by the department of health for one year provided the applicant meets all other requirements. Physician assistants licensed by the board of medical examiners, or the medical quality assurance commission as of July 1, 1999, shall continue to be licensed.
(2)(a) The commission shall adopt rules governing the extent to which:
(i) Physician assistant students may practice medicine during training; and
(ii) Physician assistants may practice after successful completion of a physician assistant training course.
(b) Such rules shall provide:
(i) That the practice of a physician assistant shall be limited to the performance of those services for which he or she is trained; and
(ii) That each physician assistant shall practice medicine only under the supervision and control of a physician licensed in this state, but such supervision and control shall not be construed to necessarily require the personal presence of the supervising physician or physicians at the place where services are rendered.
Sorry, to confuse you. I was just meaning to compare the entry level IPAP to Vanderbilt.
Specializes in Anesthesia, Pain, Emergency Medicine.
Yes, I am quite aware of them. I spent lots of time at Ft. Sam playing.My point on that is it sounds cool, kinda fun but for anyone of any advanced level, not a real learning experience.
The tissue labs on civilian side do not have the financial means to support a live tissue lab for trauma. Sure they might do one every now and then, but you are not doing annual training. That would cost way too much. You need a barn with animals or procure them. Vets are suppose to be on site. I am not talking about an animal under anesthetics. Like porcine labs, which still cost a lot of money. I am talking about animals that are fully awake. You induce mass trauma and then manage it. I doubt there are many schools that do that.
I received an outstanding NP education, and I am a completely independent provider. I don't have any feelings of inferiority compared to PAs, or MDs for that matter, lol.
Yes, I am quite aware of them. I spent lots of time at Ft. Sam playing.My point on that is it sounds cool, kinda fun but for anyone of any advanced level, not a real learning experience.
Hey, I was at Fort Sam for a little over a year in 71-72 in 91C school. They had stopped the goat labs at our class. Guess they started them back. Had a great time at that base...or rather off base!
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Washington state laws concerning PAs and Nps are below. In Washington, NP are TOTALLY independent per state law. QUOTE]
*** I know that is true is some states but to me it is sort of a straw man argument. The vast majority of NPs work in a team enviroment with other providers. Very, very few NPs will want to practice totaly independantly. In most jobs PAs & NPs are interchangable.
Specializes in Anesthesia, Pain, Emergency Medicine.
Many states are independent. Many NP in Montana, Washington, Arizona and Alaska(states I've practiced in extensively) are in independent practice. Mainly rural areas, of course.
I agree that PAs and NPs are pretty much interchangable.
I feel like I'm watching a tennis match. As much as everyone seems to be debating and disagreeing with each other, this thread is an amazing resource of experience and opinions. Thank you to everyone for sharing!
IMO, up to this point, I've felt strongly that DNP is a doctorally prepared nurse and should be addressed as so ("doctor"), but hadn't considered the quality and necessity of the education itself as a point in the debate. I've been looking closely at my own school's DNP program and honestly, I'm disappointed. Sounds to me like many are like mine.
Anyway, I'm still a student, so I know that I can't lend any experience. But from an outsider perspective, I think I still mostly lean toward the feeling that a person who has obtained a doctoral degree has earned the title "doctor".
Specializes in Anesthesia, Pain, Emergency Medicine.
The DNP is in its infancy. Many more programs are becoming much more clinically based. The consumers (us) need to speak out with our voices and our money.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
anyway, i'm still a student, so i know that i can't lend any experience. but from an outsider perspective, i think i still mostly lean toward the feeling that a person who has obtained a doctoral degree has earned the title "doctor".
*** i wonder if any of these doctor / nurses will call themselves "doctor" at work?
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
The DNP is in its infancy. Many more programs are becoming much more clinically based. The consumers (us) need to speak out with our voices and our money.
*** We have two DNPs who are not advanced practice nurses. One works in the employee education department and another is an ICU nurse. They both got their DNP through U of P and nobody calls them doctor.
good question. a thought that i have regarding this is the appropriateness of the context in which the title is being used. if they are not in a clinical setting in which they are functioning as an md, then the usage of the title "doctor" would be inappropriate. then again, they did legitimately earn the title and i think this would be a discussion that would be best handled between that md/rn and their supervisors. honestly, i'd the title is do important that they have to use it/keep it while performing as a nurse, it would make me wonder why they need to feel above their peers. i do believe the md to rn scenario is comparing apples to oranges. your talking about dnps working as dnps, vs. mds working as rns. i see a difference there.
As much as everyone seems to be debating and disagreeing with each other, this thread is an amazing resource of experience and opinions. Thank you to everyone for sharing!
nomadcrna, DNP, CRNA, NP
730 Posts
Once again, don't compare apples to oranges. You are comparing a doctoral level emergency focused program for people who are already PAs to an entry level NP ER/primary care focus program.
You switch around so fast it is hard to keep up. If you want to compare the basic PA program that according to you, gets way more ER training to a comparable program like vanderbilt's or others, that would be accurate.
I'm glad you are proud of your husband.
Washington state laws concerning PAs and Nps are below. In Washington, NP are TOTALLY independent per state law. If a facility wants to limit the NP practice, they can. But any requirement that the NP has to call a physician for a patient is only for that facility. Many rural ERs have solo NP coverage without that requirement.
PAs MUST have a supervising physician, period. So they are never can have primary responsibility for a patient and must always have their charts signed.
I don't agree with this. I think PAs should have the same independence as NPs but that is the state law.
[TABLE]
[TR]
[TD][h=2]WAC 246-840-300[/h] [/TD]
[TD] Agency filings affecting this section [/TD]
[/TR]
[TR]
[TD=colspan: 2] [h=1]Advanced registered nurse practitioner (ARNP) scope of practice.[/h] [/TD]
[/TR]
[/TABLE]
(1) A licensed advanced registered nurse practitioner (ARNP) is a registered nurse prepared in a formal educational program to assume primary responsibility for continuous and comprehensive management of a broad range of patient care, concerns and problems.
(2) The ARNP is prepared and qualified to assume primary responsibility and accountability for the care of patients.
(3) ARNP practice is grounded in nursing and incorporates the use of independent judgment as well as collaborative interaction with other health care professionals when indicated in the assessment and management of wellness and health conditions as appropriate to the ARNP's area of practice and certification.
(4) The ARNP functions within his or her scope of practice according to the commission approved certification program and standards of care developed by professional organizations.
(5) The ARNP shall obtain instruction, supervision, and consultation as necessary before implementing new or unfamiliar techniques or practices.
(6) Performing within the scope of the ARNP's knowledge, experience and practice, the licensed ARNP may perform the following:
(a) Examine patients and establish diagnoses by patient history, physical examination and other methods of assessment;
(b) Admit, manage and discharge patients to and from health care facilities;
© Order, collect, perform and interpret diagnostic tests;
(d) Manage health care by identifying, developing, implementing and evaluating a plan of care and treatment for patients;
(e) Prescribe therapies and medical equipment;
(f) Prescribe medications when granted authority under this chapter;
(g) Refer patients to other health care practitioners, services or facilities; and
(h) Perform procedures or provide care services that are within the scope of practice according to the commission approved certification program.
(4) A physician assistant and supervising physician shall ensure that, with respect to each patient, all activities, functions, services and treatment measures are immediately and properly documented in written form by the physician assistant. Every written entry shall be reviewed and countersigned by the supervising physician within two working days unless a different time period is authorized by the commission.
(5) It shall be the responsibility of the physician assistant and the supervising physician to ensure that adequate supervision and review of the work of the physician assistant are provided.
(6) In the temporary absence of the supervising physician, the supervisory and review mechanisms shall be provided by a designated alternate supervisor(s).
[TABLE]
[TR]
[TD][h=2]RCW 18.71A.020[/h][h=1]Rules fixing qualifications and restricting practice — Applications — Discipline — Payment of funds.[/h] [/TD]
[TD]
[/TD]
[/TR]
[/TABLE]
(1) The commission shall adopt rules fixing the qualifications and the educational and training requirements for licensure as a physician assistant or for those enrolled in any physician assistant training program. The requirements shall include completion of an accredited physician assistant training program approved by the commission and within one year successfully take and pass an examination approved by the commission, if the examination tests subjects substantially equivalent to the curriculum of an accredited physician assistant training program. An interim permit may be granted by the department of health for one year provided the applicant meets all other requirements. Physician assistants licensed by the board of medical examiners, or the medical quality assurance commission as of July 1, 1999, shall continue to be licensed.
(2)(a) The commission shall adopt rules governing the extent to which:
(i) Physician assistant students may practice medicine during training; and
(ii) Physician assistants may practice after successful completion of a physician assistant training course.
(b) Such rules shall provide:
(i) That the practice of a physician assistant shall be limited to the performance of those services for which he or she is trained; and
(ii) That each physician assistant shall practice medicine only under the supervision and control of a physician licensed in this state, but such supervision and control shall not be construed to necessarily require the personal presence of the supervising physician or physicians at the place where services are rendered.