Nurses, physicians weigh in on new doctoral nurse degree

znov11 · Feb 28, 2009

We are talking about clinical doctorates. A DNP is a clinical doctorate, and therefore NPs with this title WILL be working in the clinical setting...this is what has the physician's panties in a bunch. I went to return a call to a speech pathologist the other day, and the HUC reminded me that he (the speech pathologist) was a Dr. The nurse next to me was all, "he's not a DR!! He just has his doctorate! Give me a break!!". I told her that he earned it, and I was going to respect that. I guess the level of education didn't mean much to her...it does to me... I have also had surgeons talk about CRNAs getting their DNP, and saying, "what now you will have the same level of education as me? Am I supposed to call you "Dr"?" they are threatened by this even when it has nothing to do with confusing patients! I had one physician (that I respect very much) tell me to call him, "Tom" not Dr so and so, unless I wanted him to refer to me as "Nurse so and so". He pointed out that we were collegues, with the same goal in mind! If more of them had this attitude, then this wouldn't be an issue...

I agree. Instead of just thinking of our patient's welfare, more MDs are more concerned with the threat to their degree of education. What good is a title if we don't live up to that title? I respect Dr. Tom, I have a friend like him.

znov11 · Feb 28, 2009

Oh my goodness no, I'm not kidding you. It is hard to distinguish between people in white coats when they don't introduce themselves properly. But if you introduce yourself, explain who you are and your role then they are quite capable of making the distinction, trust me. They may forget names, but they know very well, who their heart doctor is and who the pharmacist is and who the nurse practitioner is. Give the patients some credit.
As for being embarassed, they are often embarassed to admit to the physician that they may not have understood something clearly, and they are certainly sometimes intimidated when a group of doctors with medical students, residents, fellows and attendings gang up on them but they are not embarassed to admit their confusion to the nurse. You're still a student so you don't know this and I'm not sure your attendings get it either, but trust me when you guys leave the room they call the nurse and ask us to interpret what was just said to them. I tramslate everything from lab results to prognosis. That's something for you to think about as you learn to communicate with your patients.

I so like this reply. Very True.

cardiacRN2006, ADN, RN · Feb 28, 2009

You're still a student so you don't know this and I'm not sure your attendings get it either, but trust me when you guys leave the room they call the nurse and ask us to interpret what was just said to them. I translate everything from lab results to prognosis. That's something for you to think about as you learn to communicate with your patients.

This is worth repeating. (bold emphasis my own)

You guys really have no idea how much we do this.

You leave the room feeling confident and good, walk off the unit, and I go in the room and fix the mess. They have no problems telling us how they feel, what they know/don't know, what's really going to happen, etc.

You'd really be suprised.

cruisin_woodward · Feb 28, 2009

Are you kidding me? I get confused as to the roles of who is the physician and who isn't in the hospital, and I'm a med student. It'ts fricking hard, and I can only imagine that if you're in bed, sick, and half-drugged the last thing you're going to remember is the distinction b/w "Dr. so and so the nurse in the long white coat with a stethoscope hanging around her neck and Dr. so and so the physician with the stethoscope hanging around her neck." Face it, you all look the same to patients and patient families, especially when you're all dressed in white coats and/or scrubs, and no one can read those badges, especially elderly patients who tend to have visual impairments. If I can't see your qualifications on your badge, chances are your patients can't read 'em either. Plus you have so many letters after your name, they're probably busy trying to figure out what they all mean anyway OR they're just figuring that you MUST be qualified to have that many abbreviations on your badge.
Your patients probably don't ask you because they're embarassed. I'm guessing that you're not horrible and mean to your patients, and who wants to ask their provider what the heck her position is again once they've already said it? Who wants to go, "So what is it that you do again, dear?"

You know, I am beginning to think that residents should not be called, "DR" either...since it's so confusing. They aren't "real doctors" by the definition of some of these physicians/ med students either...It may, "confuse the patients" (since of course they are obviously really stupid in some of the physician's opinions). So, I propose, that med students should have to wear a hat that says, "STUDENT" (Since clearly, patients are blind, and unable to read their badges!), Oh, and DEFINITELY the residents should have to wear something explaining that they are not full "Drs" yet...see here is the thing, "Dr" is an academic term, having NOTHING to do with medicine. Otherwise, would it make ANY sense that a resident is referred to as "DR" before completing the residency which is required for them to practice? Or even passing their boards? A person can be referred to as "DR", even if they have completed medical school, and never pass their boards, and never do a residency...because regardless, they have obtained a DOCTORATE in the acedemic arena....Oooh, I'm starting to get heated now.... :twocents:

Mr Ian · Feb 28, 2009

This confusion of the patient for people having the title Doctor confuses me.

If I get two people in front of me with the title of Doctor - one with a simple degree in medicine, the other with a PhD in bioengineering (and assuming I'm not having a prosthesis but say, I have a tickly sore cough) and I ask them both - "I need a doctor's opinion" - the problem is only going to come about if the PhD stands there and says - "Well I'm a Doctor so I will give you my opinion of your tickly sore throat."

Patient confusion will only come about if the PhD Doctor has no scruples and wants to deceive the patient. In which case he doesn't need a title at all and he can simply lie in the first instance.

If this remains a problem then I advocate medical degree graduates go get themselves another name - like physician - or we upgrade doctoral graduates to "Professor".

karrncen · Feb 28, 2009

New Degree Creates Doctor Nurses-And Confusion
All Things Considered, February 22, 2009
No one wants to badmouth Florence Nightingale, but a new degree for nurses is causing bad blood between doctors and their longtime colleagues. The program confers the title of doctor on nurses, but some in the medical profession say only physicians should call themselves "doctor."
Dr. Steven Knope is a family practitioner in Tucson, Ariz. "If you're on an airline," he jokes, "and a poet with a Ph.D. is there and somebody has a heart attack, and they say 'Is there a doctor in the house?'-should the poet stand up?" Knope laughs. "Of course not."
Physicians such as Knope say the title of doctor implies a certain amount of training, hours in medical school that nurses just don't have. Dr. Ted Epperly, president of the American Association of Family Practitioners, says that while doctors place a high value on nurses, sharing the same title could confuse-and even harm-patients.
Full Story and listen to radio show here:
http://www.npr.org/templates/story/story.php?storyId=100921215

Doctorate is a hard earned title and those who do so have the right to use it. I applaud any nurse who spends the years to achieve that level! Physician is a more apt term for a Doctor of Medicine.

CEG · Mar 1, 2009

advanced practice nurses will no longer work "below" and need a MD in order to practice, we will be the independent health care providers just as the MD.
.

Just to clarify- in most states NPs do not work "under" a doctor. No collaborative practice agreement at all in 22 states. In my state we have a written collaberative practice agreement. It is not supervisory and does not contain practice guidelines, simply states that in the event collaboration is required, the NP can refer his/her patients to that physician.

Ranier · Mar 1, 2009

You know, I am beginning to think that residents should not be called, "DR" either...since it's so confusing. They aren't "real doctors" by the definition of some of these physicians/ med students either...It may, "confuse the patients" (since of course they are obviously really stupid in some of the physician's opinions). So, I propose, that med students should have to wear a hat that says, "STUDENT" (Since clearly, patients are blind, and unable to read their badges!), Oh, and DEFINITELY the residents should have to wear something explaining that they are not full "Drs" yet...see here is the thing, "Dr" is an academic term, having NOTHING to do with medicine. Otherwise, would it make ANY sense that a resident is referred to as "DR" before completing the residency which is required for them to practice? Or even passing their boards? A person can be referred to as "DR", even if they have completed medical school, and never pass their boards, and never do a residency...because regardless, they have obtained a DOCTORATE in the acedemic arena....Oooh, I'm starting to get heated now....

Well, just to clarify... medical school graduates who have not passed the USMLE are not allowed to call themselves doctors in the clinical setting. And, also, a residency is not "required to practice" as you claim. Only one year of post-grad training (the internship) is required under law to be licensed to practice. Your argument might make more sense if you propose that only interns not be addressed as doctor. Residents do in fact possess an unrestricted license to practice medicine. However, the residency is required for board certification, hospital priviledges and membership on insurance panels.

silas2642 · Mar 1, 2009

Ahhh, yet another lost med student or Dr who is completely and utterly clueless about what the role of a nurse is in the hospital.
Just out of curiosity, how the heck would you know what pts are thinking or feeling? Maybe in the one or two minutes that you spent with them?
BTW, most pts are NOT half drugged.
Half the stuff we do is re-explain all the things that the Dr said to the Pt and family (you know, after you've walked out on them)
Most KNOW who their Dr is and what their role is.
Just because you are clueless about roles (trust me, we know) doesn't mean that they pts are.
All in all, there is NO convincing argument as to why a person with a doctoral degree can't be called Dr *(unless, of course, they are a nurse, right?)
Get over it, because it's happening...

Not a lost med student-- I know the confusion of the role of nurses, NP's, PA's, physicians, CNA's, and cafeteria workers because I've been there. When you have a chronically ill grandfather who you spend day after day in the hospital holding his hand, a chronically ill sister who you spend night after night in the hospital watching after, and a mother with breast cancer looking after, you get familiar with hospitals. From the family's perspective, from a patient's perspective, the faces start to merge together. People start to look like bodies in scrubs and white coats. I once got my grandfather's hospitalist mixed up with the cafeteria worker who was handing out menus because he was dressed up in a white coat and had a beard. When you're tired, have been sitting around all day staring at the walls and each other you get confused.

And not everyone gets what you're talking about, even after the almighty compassionate nurse has explained it when the big, bad physician has left the room. This has happened countless times with my grandfather. I understand the roles of nurses-- when a nurse does his/her job right, there is nothing better in the world. However, there is nothing worse in the world than a bad nurse.

You want me to call a nurse with a doctorate degree, "doctor?" Fine. Then you guys need to clean up that DNP degree and actually make it worth something, as another poster mentioned. What are all these classes in nursing theory and leadership? How does that make you a more efficient and better clinician? How is that going to help you understand the pathophysiology of the diseases that you're diagnosing better?

cardiacRN2006, ADN, RN · Mar 1, 2009

You want me to call a nurse with a doctorate degree, "doctor?" Fine.

Last I checked, it wasn't up to you, but thanks.

MinnieMomRN · Mar 1, 2009

What are all these classes in nursing theory and leadership? How does that make you a more efficient and better clinician? How is that going to help you understand the pathophysiology of the diseases that you're diagnosing better?

Advanced nursing programs do take advanced level pathophysiology, epidemiology and biostatistics, as well as qualitative research for evidence-based practice. It is important to remember that we (doctors AND nurses) are treating people who are living in a diseased state. This is the importance of understanding theory.

Advanced practice nurses are not a threat to physicians. It is a perception -- not reality. Let's take primary care as an example. Physicians have been turning away from primary care/family care for quite some time. Hence the difficulty patients have when attempting to make an appointment for a primary care physician and experiencing quite a wait. NP's provide a valuable service in health care. A doctorally prepared provider deserves respect for attaining the highest level of education in their field.

Geesh. Is a little respect too difficult these days? Is it so incomprehensible that giving respect and credit for another's achievement does not mean your own achievements are lessened or belittled?

silas2642 · Mar 1, 2009

Last I checked, it wasn't up to you, but thanks.

That may be true, but it's not up to you either. It's up the each state to decide whether or not the DNP/nurse with a PhD can call herself a "dr" in a clinical setting.