I have a problem........

Advanced Practice Columnist / Guide · Apr 13, 2012

What did you mean by the statement "envisioned and structured to be similar to a DO program"?

All 26 DO programs in the US are bona fide medical schools. Their curriculum is very similar to allopathic medical school programs in content except for the addition of Osteopathic Manipulative Techniques that are incorporated to their practice. With that said, graduating from medical school as a DO does not make one eligible to practice medicine fully in this country. DO's must first go through residencies and fellowships just like MD's, albeit typically in DO-sponsored programs in DO-run medical facilities. Is that what you hoped the DNP structure would become? if we are to ask for a similar medical curriculum with the addition of nursing science, should we also ask for residencies and fellowships along the same standards as graduate medical education? See that's what the so called "trolls" are challenging us time and again in this NP forum. If we are invoking equal footing based on equal education and training, the length and breadth of training should be similar.

I am in agreement with your second point about the kind of impression that is being spread about advanced practice nursing by merely reading the inquiries on AN. It does seem like we attract candidates who prefer the fastest and easiest way to becoming a health care provider. I also wish NP programs can be more selective in accepting students and that we don't have hundreds of NP programs housed in every school or college of nursing in every state of the union. It's also about time the NP profession form a unified provider credentialing and program accreditation process that is not a mishmash of competing organizations and entities who can't agree on how best to improve our training. But then again, I always fall back with the knowledge that I do work with some of the best NP's I've met who are committed to advancing knowledge and maintaining up to date skills that I'm convinced that some of the AN posts probably do not reflect the true state of advanced practice nursing in the real world. With that reassuring thought, I end up deciding that it's sometimes best to lay off on reading AN posts and do something else worthwhile...and I'm saying that as an AN Guide.

bsnanat2 · Apr 13, 2012

Juan,

Your point about DO programs is taken. My point is that DO's were once not allowed to practice medicine, but in many cases today, no real differentiation is made between MD and DO. We know there is a difference based on the focus of their training. If universal autonomy is the goal of Advanced Practice Nursing, the powers that be had an opportunity with the DNP to create something that, in whatever form it would take, should have addressed the issues constantly thrown at us. This could be done without abandoning the roots of nursing. Advanced Practice is different than bedside nursing and the DNP is a missed chance to remove some of the objections to advanced practice. The goal should have been to come up with something that would put AP nursing in a stronger position clinically. If the current route is the one we agree to continue on, we should accept this and stop whining about the mid-level provider label and quit bucking the states that require physician collaboration. As things stand, I am not totally against either. NP's are excellent and I am an NP student. I want the progression of my profession, but am disappointed that we are so disorganized and discombobulated that the detractors don't have to do anything but sit back and let the foolishness continue. The DNP has value, but cries out as something that academics created in order to guarantee work for themselves as opposed to being something that APRN's really need. You can "theorize" and "research" things to death. Capstones are great but have limited focus and value and sometimes you need to actually 'practice' to get the 'evidence to base things on.' More pro-active people and more clinical/academic focus. That's what we need.

NPinWCH · Apr 19, 2012

Juan,
Your point about DO programs is taken. My point is that DO's were once not allowed to practice medicine, but in many cases today, no real differentiation is made between MD and DO. We know there is a difference based on the focus of their training.

The ONLY reason there is no longer a differentiation between MD and DO is that the DO programs changed to mimic the MD programs. They just included their osteopathic theory and manipulation techniques. I didn't want to go to medical school. I wanted to continue my education and training to specialize in an area of advance practice. If I wanted to be an MD or DO, I would have gone to MEDICAL school and become one.

I want to practice at the fullest scope of my practice, but not beyond it. I have been well trained to do what I do, which is provide good primary care to families, but I know my limits, use my collaborating docs as needed and refer when appropriate.

I agree, the DNP is still an academic degree, no matter what we keep getting told and I have no desire to go beyond the masters I have to get it because it will in now way help me provide better care to my patients. I might agree that it could help me run a better business, bill better, research better, meet meaningful use better...whatever, but honestly so will a book or conference on those topics.

Advanced Practice Columnist / Guide · Apr 19, 2012

I want to practice at the fullest scope of my practice, but not beyond it. I have been well trained to do what I do, which is provide good primary care to families, but I know my limits, use my collaborating docs as needed and refer when appropriate.

You're absolutely right in my opinion. Similarly, my training is in adult acute care and my practice has been in adult critical care since 2005. I would never dream of the day when I am running a 16-bed ICU on my own. To me the best care in this setting is one that involves a collaborative practice with an interdisciplinary group that includes an intensivist, primary care physicians and specialty consultants, pharmacist, bedside nurses, physical therapists, dietitian, social worker, pastoral care, and last but definitely not the least, APN's both NP's and CNS's. My MSN program adequately prepared me for this role.

bsnanat2 · Apr 19, 2012

Juan,

I am glad to hear you say this. I personally do not see mid-level provider as an insult. Yes, a better title may be warranted but I don't agree with the "equal to physician" thing. I believe that we are different, not less, not equal, not more. A necessary part of the health care team. Independence within parameters is a good thing and I think many states' collaborative agreements are too strict, but the attitude of some APN's is a little scary to me. I think if some got what they wanted they would soon find themselves in over their heads. APN salaries do need to improve to reflect the true contribution made and laws need to be enacted to allow practice to the full of the training. That being said, as things are, malpractice insurance for APN's is relatively cheap and that is something to be thankful for. Again, the powers that be missed the boat with the DNP. That being the case, we are all responsible for our own professional growth. That includes those who wish to enter the profession but seem to struggle with some concepts basic to APN's.

Advanced Practice Columnist / Guide · Apr 19, 2012

Well, I personally prefer not to be called a Mid-Level Provider. When I was in the midwest, hospitals used this title a lot. I was moonlighting as an ICU NP in a community hospital setting where I was issued a lab coat that states:

Juan de la Cruz, NP

Mid-Level Provider Service

I did not protest the title, however. The hospital had a group of PA's and NP's under this so called Mid-Level Provider Service and we covered various specialties from IM to Surgery to ICU. It wasn't a big deal at the time to the folks there but I would have to agree that a better designation than Mid-Level Provider could have been agreed upon.

I am now in Northern California (the epicenter of political correctness! ha ha). We never address NP's and PA's as Mid-Level Providers here. In fact our medical center has a collective group of NP's, CNM's, CRNA's, and PA's that meet every so often and the committee is called Allied Health Provider Committee. The title isn't perfect but it's better than MLP.

Trauma Columnist · Apr 20, 2012

lol Juan!

allnurses Guide · Apr 20, 2012

Our hospital just changed from MLP to APP for "Advanced Practice Provider".

bsnanat2 · Apr 20, 2012

Our hospital just changed from MLP to APP for "Advanced Practice Provider".

I think I like this one better than any of the others I've heard. Good deal!

BlueDevil,DNP, DNP, RN · Apr 22, 2012

My DNP education did make me a better provider than I would have been without it, and it was most definitely clinically focused. I shun all titles except "Nurse Practitioner." I agree that there should be one certifying body, and I agree that it sometimes appears that the bar or advanced practice is too low in some institutions. I didn't see that at my alma mater, but I have met other NPs that I wonder about. And yes, I see nurses and NPs here on AN that embarrass me and the profession.

NPinWCH · Apr 22, 2012

BlueDevil, how long did you practice as an NP with your MSN before getting your DNP and it what way do you feel the DNP made you a better provider?

I also agree that one certifying body is needed and that the bar is low in some institutions, but no one seems to agree on how to improve that. The embarrassment is common in the profession, not just here on AN, but also in real life.