Medicine decries nurse doctorate exam being touted as equal to physician testing

  1. June 8, 2009 - Physician leaders say a new doctor of nursing practice certification exam is being wrongly compared with testing that physicians take. And they fear that patients may be misled into believing nurses who pass the exam share the same qualifications as physicians.

    In its announcement, the CACC (a non-profit nursing group) said the exam "was comparable in content, similar in format and measured the same set of competencies and applied similar performance standards as Step 3 of the USMLE, which is administered to physicians as one component of qualifying for licensure."

    Physician leaders are chastising nursing organizations for what they say is a failure to portray the certification exam accurately. They also want the NBME to step in and further clarify that the DNP exam and physician tests are not equivalent.

    "Our concern prior to the first round of testing was that the meaning of this test would be deliberately misconstrued to imply there was equivalence between nurses and physicians. And indeed some of the first statements seem to go in the direction of making those comparisons, which we believe are totally invalid and misleading to the public," said American Medical Association Board of Trustees member William A. Hazel Jr., MD.

    The AMA and dozens of state and specialty medical organizations are asking the NBME to mandate that nursing groups clearly spell out the differences between the DNP and physician exams.
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  3. by   nerdtonurse?
    Here's what the AMA wants to do about DNPs -- basically make them NP II, with no additional abilities. And to do that, they're going to prevent the creation/usage of the tests which are the equivalent of USMLE step 3....If you're a NP or DNP, (or even a lowly LPN like me), take your blood pressure medicine before you read their document...

    Seems like if they weren't scared of DNPs passing the test, they wouldn't care, would they?
  4. by   elkpark
    Mundinger is not doing advanced practice nursing any favors, IMHO. I wish she and her minions would shut up.
  5. by   GilaRRT
    I cannot support this DNP movement. In fact, I am strongly against this movement.

    First, it seems that nursing has been derailed and steered off course. This emphasis on primary care medicine, and watered down USMLE like exam, and DNP credentials is so far from the concept of nursing, it is like we are advocating for some hybrid provider who barely represents our core foundations and values.

    NP's have been providing good care for years. The first NP courses started in the 1960's and since, NP's have made great advancements and are finally being looked at as competent and cost effective mid level providers. It seems like we have destroyed all the hard work of our predecessors. Now, we are pushing the DNP and this USMLE like exam to make us more "doctor" like? To what end? We are not doctors, we are nurses. Why the focus on the "doctor" and USMLE like board exams?

    It seems we are not emphasizing core components of nursing such as; community outreach, patient education, and enhancing the effective delivery of nursing care at the bedside. Are these not the backbone components of nursing? All three of these concepts are a mess and we cannot even retain and adequately educate our entry level nurses, yet we want to push into the primary care arena with board exams that do not represent nursing?

    I am not opposed to doctoral education; however, the execution of this is not going well. We need people to support us and assist us. It seems like we continue to disregard everybody else's concerns by arguing "it's all about money" and "the doctors are afraid of us invading their turf." Perhaps the arguments are valid; however, we need the medical community as a whole to support us, and we are not helping ourselves by rushing into this without considering other peoples points. Empathy = FAIL IMHO, Foresight= FAIL IMHO, and emphasis on nursing = FAIL IMHO.

    Good luck to you guys in DNP programs, and nothing personal against anybody. However, this whole concept stinks. Something is rotten in the state of nursing IHMO.
    Last edit by GilaRRT on Jun 9, '09 : Reason: Perhaps a DNP would help my grammar.
  6. by   Ginger's Mom
    PA who have a similar scope of practice only have a Masters Degree. I have always preferred NP since NPs have background with nursing which is more holistic. NP when nursing is having trouble getting MSNs, does not make sense to me.+++++++++++
  7. by   12hours
    GilaRN has stated my sentiments so accurately. We are here to nurse individuals and the population to health. Leave the practice of medicine to physicians.
  8. by   cardiacmadeline
    GilaRn-My thoughts exactly!
  9. by   sonnyluv
    this is a long post- but i'll end the argument right here. this one is important. i think the dnp is waaaay ahead of itself. certified nurse specialists are hardly recognized. i work on the floor with n.p.'s who are kicking themselves because the payoff for 20k to 40k in loans and two more years of time and effort has been nothing. having a bsn's doesn't guarantee diddley squat professionally, either. i don't think r.n.'s need a doctorate to prove their worth. it's like an industry wide lack of self esteem. the ability and potential of a minority of educated and motivated nurses is like medicine's dirty little secret.

    "medicine decries nurse doctorate exam being touted as equal to physician". uhhhh-so what if it is? there are many different kind of nurses. many different kind of doctors. lawyers. sales people. pool cleaners. judges. some people in their chosen profession choose to take it as far as they can. you want to encourage these people. some nurses i wouldn't even let take care of my pet turtle. same goes for everything.

    so what if the exam is equal to the usmle? whenever i talk about my job people ask me if i'm a doctor. i proudly tell them "no, i'm a r.n."- i usually get a quizzical look implying the person asking the question thinks that if i'm not a m.d. i must hang around slinging bed pans all day, their look clearly says: "why is this guy talking about his patient like he makes decisions about their care?" so i politely explain that m.d.'s make disease diagnosis and are in charge of plotting a course of treatment for the patient. i explain that is is my job to not only understand the course chosen for treatment- but i am the one who institutes the treatment and i manage it's physical run. yes, doctor's prescribe medications and order diagnostics. but in my i.c.u. they sure as heck don't give medication. i start the i.v. i give the medications, i assess the patient and if anything goes wrong i need to catch it before it happens and give the doc a heads up so they can re-plot the course of treatment. if this is not true then why do i need to have a license? why am i held accountable for an adverse reaction to treatment or a change in patient status?

    last night- i admitted a patient from the e.r. with a primary diagnosis of pneumonia, c/o chest pain-with an extensive cardiac history. the cardiologist who ordered the admit had full privileges at my hospital as he was standing in for an intensivist who had a family emergency. the cardiologist was responsible for the admit and all other standing orders. other than the insurance the patient had, the cardiac history, and the fact that the patient had received nitro and morphine in the e.r. the cardiologist didn't know anything abut the patient or what to do with him. he had no clue how to address the possible pneumonia and or sepsis. (apparently he hadn't heard of joint commission)

    so i walked the cardiologist though activity, diet, fluid type and rate, antibiotic regimen and all other diagnostic procedures to rule out sepsis. i wrote the "orders" as i gave them with his consent. apparently the patient had thrown up in the e.r.- i asked for an anti-emetic-all i heard on the phone was,"uhhhhh" so i suggested a medication with rate and frequency. i asked him for cardiac parameters. the cardiologist asked me how the patient looked. i gave him my the results of my cardiac and pulmonary assessment. he thanked me profusely, gave parameters, and kept apologizing that he was just moonlighting, he hadn't done this in a while. he asked me for my interpretation of the chest xray. i told him "sorry, out of my scope." but i had seen bilateral infiltrates in lower lobes when i read it. so i again encouraged that we follow the sepsis protocol. no problem. it was nice that he was pleasant. but when push comes to shove-yeah, m.d.'s don't find the r.n.s so incapable after all. and then i began the paperwork.

    later that night, the attending came by and said, "wow! dr.--- can still write icu orders like he works here everyday." i'm not a doctor. i sure as heck don't know as much as one. but how much education combined with clinical experience do i need to know as much as one? no doubt, a lot. as a brand new nurse i got chewed out by the attending physician right along with the interns and residents for flubs that we all should have caught.

    you see, it's role reversal, plain and simple-without the exchange of authority. i want to learn more about the disease and cures while many of those interns, now residents, want to develop their bedside manner. seems the smart ones have figured out that it increases the odds of a better outcome to be able to communicate with one's patient. nurses learn this immediately. some doc's never get it, or care to. in my opinion, they are the ones who are doing the most damage to physician's. not a dnp. it appears that the few nurses who choose to pursue advance training, pushing the envelope of our assigned role is clearly terrifying to m.d.s. perhaps a bit of "man behind the curtain", huh?

    they can call us dumb nurses, wanna-be doctors, whatever. md's know very well that as treatment becomes more rapid, more complex, more demanding, nursing education is becoming a dynamic new modality in itself. if i don't understand or anticipate treatment then i am useless.

    and as frightening as it is to the a.m.a., i am rather inclined to learn as much as i can about the science behind my work so i 1) don't hurt my patient 2) continue to bring enthusiasm to my career. that may include advanced degrees. and i'm gonna say it: in my area of specialty, it certainly appears that experienced and well educated r.n.s know absolutely as much as physicians do, in that specialty area, and physicians know it. much in the same way a cardiologist doesn't know what to do with an admit. you want evidence to back that statement up? ever watch a new intern ask an experienced nurse a question? tell me who is giving "orders" to who. what doctor hasn't been shown the ropes by a r.n. at some point? from the basics "he needs a fluid challenge" to "write an order to start a levo drip at 20mcg/min and start a central!"
    according the the a.m.a.-this is simply impossible.
    the a.m.a.'s argument is essentially,"if you didn't start your career with a m.d. then you can't ever be as capable as one." look how they treat d.o.'s? childish.
    the truth is that the a.m.a. is concerned with the bad publicity they will receive when advanced nurses start taking the equivalent of the usmle. they will do outstanding. nothing like the motivation of those with something to prove.
    example: my hospital is a teaching hospital affiliated with a major university. it has a c.r.n.a. program. the s.r.n.a.'s have to retake anatomy and physiology along with the med students. scores were posted in doctor's break rooms. most of the med students pulled c's and d's. the nurses all scored above 80%. the hospital promptly stopped posting scores in the break rooms.

    this is a turf war, plain and simple. md's can't operate without us. let them waste their time fighting nurses. nurses don't fight for turf with doctors. we fight for respect and autonomy. meanwhile- insurance companies- the real turf monster, are wiping the floor with what used to be the physician's salary and medical authority.
    it doesn't take a dnp to prove "m.d. level" competence. all nursing needs to do is insist on receiving credit for the work we already do. spread the word. we rock.
  10. by   nolabarkeep
    Why not just go to Med. school if you want to perform physician like tasks?
  11. by   Rick2323
    Sorry folks, but I think the very concept of a Doctor of Nursing is absurd. Like others have said, if you want to be a doctor go to med school. The NP program is quite enough.
  12. by   GilaRRT
    Quote from Rick2323
    Sorry folks, but I think the very concept of a Doctor of Nursing is absurd. Like others have said, if you want to be a doctor go to med school. The NP program is quite enough.
    I do not have a problem with a NP that has a doctoral degree and additional clinical based education. My problem stems from this push to make the DNP more "physician" like without medical school. This simply goes against the core concepts of nursing and nursing care. While I understand advanced nursing practice and NP's utilizing this concept, I cannot support this whole DNP/USMLE like push where truly it feels like we are transitioning into some doctor wannabe hybrid.

    Again, I know many nurses do not want to be doctors and many nurses will probably go through DNP programs because it almost seems like the writing is on the wall. Be a DNP by this date, or you cannot go into advanced practice. Not much of a choice or decision if you ask me. So, nothing personal guys.
  13. by   Ranier
    You want evidence to back that statement up? Ever watch a new intern ask an experienced nurse a question? Tell me who is giving "orders" to who. What doctor hasn't been shown the ropes by a R.N. at some point? From the basics "he needs a fluid challenge" to "write an order to start a levo drip at 20mcg/min and start a central!"
    According the the A.M.A.-this is simply impossible.
    The A.M.A.'s argument is essentially,"If you didn't start your career with a M.D. then you can't ever be as capable as one." Look how they treat D.O.'s? Childish.
    The truth is that the A.M.A. is concerned with the bad publicity they will receive when advanced nurses start taking the equivalent of the USMLE. THEY WILL DO OUTSTANDING. Nothing like the motivation of those with something to prove.

    Why use the example of an intern and an experienced nurse to demonstrate that nurses know "as much" as physicians? Interns (and residents) aren't supposed to know everything. Of course a seasoned nurse can assist physicians in any stage of training, but this isn't evidence that they "know" more. Would you accept comparisons between the knowledge level of a student nurse practitioner to a veteran attending physician in an attempt to demonstrate who "knows" more?

    As for how "they" treat DOs... you do realize that the AMA represents both the allopathic and osteopathic community, right? DOs also have the AOA to represent them, but the AMA is open for membership to both MDs and DOs. Historically allopathy discriminated against DOs, and rightly so, because their educational and training standards were not what they are today. But today's MDs and DOs consider each other equals. DOs are welcomed into ACGME residencies and can sit for either the COMLEX or the USMLE. So what is this "childish" treatment that you talk about?

    Finally, to your last point, DNP candidates have already started taking the watered-down USMLE-lite exam, and only 49% of them passed last fall. I doubt they would have fared better on an actual USMLE-equivalent examination. And considering that a "passing" score was determined by the CACC and is not necessarily as high as the passing score for the USMLE, we don't even know what that data means anyway.

    I'm not a physician but I get why they're a little annoyed by Dr. Mundinger and company. I think she's been way out of line in stating in the past that DNPs have "all the medical knowledge of a physician" and can work independently in any healthcare setting (which would include surgery apparently). She calls the 10-credit, 800-hour clinical portion of Columbia's DNP program a "residency" when in reality they are just clinical rotations like any other MSN NP student or MS-III/IV would complete. The shortest of medical residencies, in contrast, are at least three years and around 12,000 hours in length. She's tried to co-opt a lot of the terminology that physicians have always used (and this goes way beyond the "doctor" title, and includes things like comparing the CACC exam to the USMLE and calling clinical rotations a "residency"). Why wouldn't they defend their profession and their turf? Nurses do it all the time on the other end, fighting to keep medications assistants from passing meds, CNAs from doing nursing tasks, paramedics/EMTs from working in hospitals, etc all in the name of "patient safety." All professions, if they are smart, would do the same.
  14. by   netglow
    I logged in just to give you a big "thank you" for your post Sonnyluv!