[NPInfo] Re: DNP Autonomy

[Eric Doerfler]

Carla, you are right, in the sense that competence does matter. But I think
most of you are underestimating the power of the first name "doctor." Like
it or not, this strategem has worked wonders for all professions seeking
advancement and autonomy. I do agree with respondents that think more of the
advanced, doctoral-level work needs to be clinical. But I disagree with
anoyone who argues that nursing theory and research study doesn't matter.
Indeed, in an age of "evidence-based practice" they matter more than ever.
e.d.
 

-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
Of Carla Anderson
Sent: Saturday, December 01, 2007 9:17 PM
To: NP Info
Subject: Re: [NPInfo] Re: DNP Autonomy

Tracy, Your words are very succinct, and clearly point out what I believe
most of us feel, that NP autonomy is based on clinical competence, scope of
practice, and nursing board regulations and not on getting an advanced
degree. And that we should continue to pursue constantly additional clinical
training, so our practice may remain diverse and skilled. 
   
  One thing I might comment on regarding Pharmacists, however, and I do not
know much about what they go through is this:  One pharmacist recently told
me, that in the past, they had "language in their scope that allowed them to
"initiate or modify" medications along with a collaborating provider..but
apparently the AMA threatened to sue the Pharmacy board if they did not
remove the language. The Pharmacy board, became afraid, backed down and
erased the key words "initiate" and "modify", which of course nullified the
entire premise, and hence that part of the scope. I asked why the Board of
Pharmacy did not get more involved to change things at the legislative level
if they felt they were practicing below their level of training and
competence,  and the pharmacist just said they have always been afraid to
buck the AMA, but that they remain very frustrated with the level of
regulation. 
  Carla /Portland, OR

Tracy Klein <whcnp at comcast.net> wrote:
  
I was on a national committee in 2001 when Mary Mundinger clearly presented
the incipient DrNP model as a "third level of licensure" 
which would permit independent status and third party billing for NPs. While
this is not being overtly articulated now, it certainly is being covertly
implied. That is a problematic way of promoting the degree which negates,
among other things, the status and level of practice we've had for 30 years
in many states. NPs do not need, and regulation is ill prepared to support,
a third level of licensure so that other states can do what they perceive
they have failed to do legislatively. The same arguments will be brought
forth once you get that third level. Quit equating autonomy with more
educational preparation and start equating it with competency based clinical
evaluation.

The autonomy argument continues to vex me since it seems to be so frequently
focused on Nurses and not on other health care professions. The masters
degree at this point is the clinical preparation for practice. What it has
had to drop in the process of expanding clinical competencies and practice
needs is the rest that used to go along with it: policy, research, and
teaching preparation. 
I know this because I review many transcripts and curriculums for my job and
have seen this change over time.

The DNP simply adds those elements back to the role. Its a good move, but it
has little to nothing to do with autonomy to practice clinically and it is
not useful to make that the focus of why the degree should be sought. All
NPs should be able to practice what they are competent to do autonomously,
and should seek preparation above their clinical preparation in order to
expand into other or different roles. No one has this discussion about MDs
supervising Physical therapists or pharmacists. These professions do what
they are prepared and safe clinically to do. As should we.

Tracy Klein, WHCNP, FNP
Portland, Oregon
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Carla R. Anderson, FNP-C
  Healing Presence Family Practice, PC
  carla_rayne at yahoo.com
  503 819 9726
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