Nurses, physicians weigh in on new doctoral nurse degree

Specialties Doctoral

Published

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.

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http://www.npr.org/templates/story/story.php?storyId=100921215

If you look at European countries that don't have a physician/nursing shortage, you'll find that their salaries are considerably lower, Physicians make $60,000 to $120,000 according to a UK 2004 based study.

The education of UK doctors is also allot lower!

DC's can function as a PCP in all 50 states. I do not have to "function" or "practice" exclusively as a manipulator of the spine to use the title "Doctor". We can diagnose, but not treat most of the conditions/diseases that an Internal Medicine doctor can. We don't, simply because most normal DC's understand that we simply do not have enough patient exposure to be proficient at these diagnoses. But if talking "scope of practice", then we can function as a PCP. So then would you care to explain why I shouldn't be able to refer to myself as a doctor in my primary care practice once I have an NP?

A chiropractor can not practice medicine in any state. If you want to continue working in your current capacity and practice medicine, then go to DO school - you have a jump start. Then you can do it all...and even PRESCRIBE MEDICATION!

Specializes in OB, HH, ADMIN, IC, ED, QI.
Agreed. If you earn the degree then you earn the title. Wear a name badge with your title and introduce yourself appropriately to the patient.

When I consider going to a new doctor or nurse practitioner, :confused: it is not their education that indicates who I favor. It is rather their experience doing what I need them to do. I would rank a nurse practitioner with 10 years experience in practise much higher than a newly licensed family practitioner whose main experience is with hospitalized patients, for maintaining my wellness.

I was making a point that the reason why Uk doctors get paid less is because they go to med school right after high school. There is no four years of pre med. Hence they should not get paid the same as Us doctors.

I was making a point that the reason why Uk doctors get paid less is because they go to med school right after high school. There is no four years of pre med. Hence they should not get paid the same as Us doctors.

That doesn't really make sense to me. Im in a second degree nursing program and A LOT of the people in my class have pre-med degrees because they had origionally planned on going to med school. should they get paid more than a nurse with a bsn because they did 4 more years of school?

There are lots of other reasons European doctors get paid less compared to those in the US. Not only do they go to school for fewer years and have no student loans (higher education essentially free) but they also work fewer hours and have fewer overhead expenses. Most European doctors work the equivalent of a US physician's part-time schedule (35-45 hours per week) and take far more vacation (up to 12 weeks per year). They also have no personal administrative overhead since they work in an NHS and have no premiums.

If you take an average PCP's income in the US, subtract out monthly student loan payments and some kind of opportunity cost calculation for training for more years, and then subtract out the overhead and malpractice premiums, and finally cut the remaining amount by at least 1/3 (to adjust for the hours worked)... it would come darn close to being less than or equal to their European counterparts' incomes.

There are lots of other reasons European doctors get paid less compared to those in the US. Not only do they go to school for fewer years and have no student loans (higher education essentially free) but they also work fewer hours and have fewer overhead expenses. Most European doctors work the equivalent of a US physician's part-time schedule (35-45 hours per week) and take far more vacation (up to 12 weeks per year). They also have no personal administrative overhead since they work in an NHS and have no malpractice insurance premiums.

If you take an average PCP's income in the US, subtract out monthly student loan payments and some kind of opportunity cost calculation for training for more years, and then subtract out the overhead and malpractice premiums, and finally cut the remaining amount by at least 1/3 (to adjust for the hours worked)... it would come darn close to being less than or equal to their European counterparts' incomes.

:loveya:

I see a lot of people saying that DNPs have "earned" the right to be called doctors. The question really comes down to whether or not the DNP curricula offers enough to warrant being a doctorate degree. To be honest, the DNP curricula has a significant amount of courses that are pretty useless clinically and it seems relatively easier to obtain than any other doctoral degrees (ie. it takes years to get a PhD, an intense several years for an MD/DO, etc.).

No one's telling you that you cannot have a doctoral degree. If you really do want to be called a doctor in a clinical setting, however, the least you could do is develop a decent curriculum that's at least somewhat standardized (which it is currently not at all), etc. So really, instead of assuming I'm just attacking DNPs because I'm a nurse-hater or something, take a look at the curricula and honestly ask yourselves, is that worth a doctorate degree or is it really just a glorified MPH?

Specializes in CT ICU, OR, Orthopedic.

Contrary to popular belief, the purpose of the DNP is NOT to make "mini Docs". We are NURSES. We are trained from a nursing model, NOT a MEDICAL model. We focus on caring for the pt, family, and community. We look at pt's spiritual, and mental well being, not just their disease.

The Doctor of Nursing Practice (DNP) was recommended by the American Colleges of Nursing (AACN) in 2004 in an attempt to further the profession of nursing, address the need for advanced practice, form a link between research and clinical practice, and to educate future clinical leaders (Loomis, Willard & Cohen, 2007). The DNP encompasses nursing theory and research and brings evidence based practice to the bedside. The advanced degree offers more education in order to improve patient outcomes.

Nelson, (2002) indicates that nursing has been historically perceived as a technical trade rather than a respected profession. She suggests that this view is owed to the lack of educational qualifications. Many other health related fields require a doctorate for entry level; these include audiology, chiropractic, psychology, pharmacy, optometry, podiatry, as well as medicine and osteopathic medicine, and many more. It is logical then, that in order to command the same level of respect, APRNs should have the same level of academia, advanced training and knowledge.

Critics of the DNP argue that there is too much research and theory, and not enough of a clinical focus. The DNP encompasses specific clinical specialty areas, and prepares students for certification in that specialty. It also offers more clinical hours in the form of the clinical inquiry project, where the focus is on a particular area of interest for the doctoral candidate. According to the American Association of Colleges of Nursing, (2004) higher levels of nursing education have been shown to improve patient outcomes. Another criticism is that there are already several nursing doctorates, so there is no need for another. the DNP will focus on implementing research into every day practice, whereas the PhD and DNS are research intensive. In other words, the DNP will be educated to evaluate research, and put it into practice. With higher education, comes better critical thinking skills, and clinical judgment, thus leading to improved patient outcomes.

The DNP program IS being regulated. The AACN has implemented criteria that must be met by the schools, and in order for a BSN to DNP graduate to sit for certification, that program MUST be accredited. The program is 4 years...plus 4 years of undergrad...so, it's 8 years all together, I'm really not certain why people feel that this is not enough time? I understand the need for more clinical time, and I agree that it should be offered. HOWEVER, shouldn't we also consider the clinical hours put in as a nursing student and an RN? Obviously, it is NOT the same, but PA's and physician's keep claiming that we do not get enough clinical hours, I think those hours do count for something. If I've been a critical care nurse for 6 years, and I go on to be an ACNP in the ICU, then I think those hours count quite a bit!!

As far as the right to be called "Doctor", I think that argument has been so well covered, that I think it is a waste of time to continuously say the same thing. Personally, I don't care what I'm called. I just want respect for what I have earned. So far school has been very tough, and after I finish, I know that I will have earned the right to be called, "Doctor". Whether or not I am is not my concern at this point. I think patients are pretty smart, and if they are properly introduced to the nurse practitioner, then they will understand their roles. I also think that if there was a pathologist and a DNP standing next to each other, and the patient coded, they'd be much happier to have the DNP run the code than the pathologist....

contrary to popular belief, the purpose of the dnp is not to make "mini docs". we are nurses. we are trained from a nursing model, not a medical model. we focus on caring for the pt, family, and community. we look at pt's spiritual, and mental well being, not just their disease.

the doctor of nursing practice (dnp) was recommended by the american colleges of nursing (aacn) in 2004 in an attempt to further the profession of nursing, address the need for advanced practice, form a link between research and clinical practice, and to educate future clinical leaders (loomis, willard & cohen, 2007). the dnp encompasses nursing theory and research and brings evidence based practice to the bedside. the advanced degree offers more education in order to improve patient outcomes.

nelson, (2002) indicates that nursing has been historically perceived as a technical trade rather than a respected profession. she suggests that this view is owed to the lack of educational qualifications. many other health related fields require a doctorate for entry level; these include audiology, chiropractic, psychology, pharmacy, optometry, podiatry, as well as medicine and osteopathic medicine, and many more. it is logical then, that in order to command the same level of respect, aprns should have the same level of academia, advanced training and knowledge.

critics of the dnp argue that there is too much research and theory, and not enough of a clinical focus. the dnp encompasses specific clinical specialty areas, and prepares students for certification in that specialty. it also offers more clinical hours in the form of the clinical inquiry project, where the focus is on a particular area of interest for the doctoral candidate. according to the american association of colleges of nursing, (2004) higher levels of nursing education have been shown to improve patient outcomes. another criticism is that there are already several nursing doctorates, so there is no need for another. the dnp will focus on implementing research into every day practice, whereas the phd and dns are research intensive. in other words, the dnp will be educated to evaluate research, and put it into practice. with higher education, comes better critical thinking skills, and clinical judgment, thus leading to improved patient outcomes.

the dnp program is being regulated. the aacn has implemented criteria that must be met by the schools, and in order for a bsn to dnp graduate to sit for certification, that program must be accredited. the program is 4 years...plus 4 years of undergrad...so, it's 8 years all together, i'm really not certain why people feel that this is not enough time? i understand the need for more clinical time, and i agree that it should be offered. however, shouldn't we also consider the clinical hours put in as a nursing student and an rn? obviously, it is not the same, but pa's and physician's keep claiming that we do not get enough clinical hours, i think those hours do count for something. if i've been a critical care nurse for 6 years, and i go on to be an acnp in the icu, then i think those hours count quite a bit!!

as far as the right to be called "doctor", i think that argument has been so well covered, that i think it is a waste of time to continuously say the same thing. personally, i don't care what i'm called. i just want respect for what i have earned. so far school has been very tough, and after i finish, i know that i will have earned the right to be called, "doctor". whether or not i am is not my concern at this point. i think patients are pretty smart, and if they are properly introduced to the nurse practitioner, then they will understand their roles. i also think that if there was a pathologist and a dnp standing next to each other, and the patient coded, they'd be much happier to have the dnp run the code than the pathologist....

thanks for the response.

i really don't understand how nps/dnps can get away with practicing medicine under the guile of nursing. it seems like every np/dnp on this board fighting for independent rights says that they do the same things as a doctor and then, go on to say that they practice advanced nursing, not medicine. maybe someone can clear up exactly why nps/dnps are under the bon rather than the bom when they're practicing medicine? is it because you take a bunch of nursing theory and nurse activism courses?

also, it doesn't take 4 years to get a dnp, especially as a stand-alone. maybe some programs that are part-time or something might be that long. however, there are many programs that are much shorter than that including several direct-entry programs that require no prior healthcare experience at all. here's an example from duke: http://nursing.duke.edu/wysiwyg/down...t_mat_plan.pdf. it's a bsn-dnp program. also, i understand that dnps want to implement research into everyday practice, but do you really need 5 or 6 courses (which make up a significant portion of the dnp curricula) in order to simply understand how to evaluate studies and apply them? a basic understanding of statistics, epi, etc. is all that's needed. so the argument that the dnp is too research focused does seem relevant here: what's the point of so many research-related courses if you're not going to do research?

regarding prior nursing experience, sure it helps. but it's not a replacement for medical clinical hours. there's a difference in thinking between practicing nursing and practicing medicine and as far as i know, you are not taught to think like a doctor in nursing school. so, yea, while i agree that prior nursing experience will help, i stand by my statement (and a lot of people, both in the nursing and medical communities, seem to agree with it) that it's not a replacement for clinical hours practicing medicine.

and about your example regarding a dnp being better at coding a patient than a pathologist, i hope you realize that coding is just following an algorithm; there's not much thinking needed there. if both the pathologist and the dnp follow the algorithm, the outcome will very likely be the same.

Specializes in Addictions, Acute Psychiatry.

This is AWESOME! In real countries nursing was one step closer to being a doc. Now it's a reality! We're that much closer should we choose it! No more going off to separate schooling; we just continue on!

Yesssssssssssssssss!

This is AWESOME! In real countries nursing was one step closer to being a doc. Now it's a reality! We're that much closer should we choose it! No more going off to separate schooling; we just continue on!

Yesssssssssssssssss!

I'm not sure what you mean -- nursing and medicine are separate, distinct disciplines. If an NP chooses to go to medical school, there are no shortcuts or exceptions made for them, even those with DNP degrees. They start from scratch, just like everyone else. People with DNPs are still NPs, not physicians.

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.

Really???? I'm not sure I would go around saying that so proudly. Are you really saying that you don't know what the folks that work around you do?

I'm a second year nursing student, and I can't think of a clinical experience where I didn't know who was in the room with me. I might not have remembered their name, but I knew their role.

Maybe it's just my school, but it's really stressed to us that we are part of a health care team. How do you work on a team if you don't know who's in what role?

Just my .02

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