[NPInfo] Wall Street Journal DNP article

[David Mittman]

Keeping the argument aside on whether one needs this or not- I know  
that not just NPs are able to get the DNP and that in many programs  
there is little advanced CLINICAL training (ie. clinical residency).  
This article seems to suggest something very different. It is one  
institutions view of the DNP not what is fully happening.
Dave


Making Room
For 'Dr. Nurse'
April 2, 2008; Page D1
As the shortage of primary-care physicians mounts, the nursing  
profession is offering a possible solution: the "doctor nurse."

More than 200 nursing schools have established or plan to launch  
doctorate of nursing practice programs to equip graduates with skills  
the schools say are equivalent to primary-care physicians. The two- 
year programs, including a one-year residency, create a "hybrid  
practitioner" with more skills, knowledge and training than a nurse  
practitioner with a master's degree, says Mary Mundinger, dean of New  
York's Columbia University School of Nursing. She says DNPs are being  
trained to have more focus than doctors on coordinating care among  
many specialists and health-care settings.




Dawn Bucher, DNP, and child patient at Ivanhoe Clinic in Ivanhoe, Minn.
To establish a national standard for doctors of nursing practice, the  
non-profit Council for the Advancement of Comprehensive Care plans to  
announce Wednesday that the National Board of Medical Examiners has  
agreed to develop a voluntary DNP certification exam based on the  
same test physicians take to qualify for a medical license. The board  
will begin administering the exam this fall. By 2015, the American  
Association of Colleges of Nursing aims to make the doctoral degree  
the standard for all new advanced practice nurses, including nurse  
practitioners.

But some physician groups warn that blurring the line between doctors  
and nurses will confuse patients and jeopardize care. Nurses with  
doctorates use DrNP after their name, and can also use the  
designation Dr. as a title. Physician groups want DNPs to be required  
to clearly state to patients and prospective students that they are  
not medical doctors. "Nurses with an advanced degree are not the same  
as doctors who have been to medical school," says Roger Moore,  
incoming president of the American Society of Anesthesiologists.

"With four years of medical school and three years of residency  
training, physicians' understanding of complex medical issues and  
clinical expertise is unequaled," adds James King, president of the  
American Academy of Family Physicians. While nurses with advanced  
degrees play an important role in delivering care, Dr. King says they  
should work as part of a physician-directed team.

Although there are no precise statistics on the number of nurses with  
doctorates because the programs are relatively new, there are about  
1,874 DNP students currently enrolled in programs nationwide, up from  
862 students in 2006, according to the American Association of  
Colleges of Nursing.

Nurses have increasingly been moving into more specialized and  
advanced roles over the past few decades. Advanced-practice nurses  
include specialists in fields such as nurse midwives and nurse  
anesthetists, and there are now more than 125,000 nurse practitioners  
in the U.S. Nurse practitioners in some states are required to work  
with or be supervised by physicians, but often have independent  
practices in family medicine, adult care, pediatrics and oncology.

A study led by Columbia's Dr. Mundinger and published in the Journal  
of the American Medical Association in 2000 showed comparable patient  
outcomes in patients randomly assigned to nurse practitioners and  
primary-care physicians.

Nurse practitioners fear the doctoral programs might be raising the  
bar too high for their profession. The American Academy of Nurse  
Practitioners says it supports access to a higher educational degree  
for nurses, but wants to ensure that members won't be marginalized or  
required to go back to school for a costly advanced degree. Nurse  
practitioners can write prescriptions, are eligible for Medicare and  
Medicaid reimbursement, and often act as the primary health-care  
provider for their patients.

"Nurse practitioners with master's degrees are already filling the  
primary-care shortages and providing quality, cost-effective care,  
many times in places that physicians are unwilling to practice," says  
Wendy Vogel, a nurse practitioner specializing in oncology at Blue  
Ridge Medical Specialists in Bristol, Tenn. There are "as yet no data  
to support the need for increasing the amount of education required  
to practice in this role," she says.

With an acute shortage of nurses, some medical professionals worry  
that the doctoral programs, with promises of higher-paying jobs and  
prestige, will lure more nurses away from the critical tasks of day- 
to-day bedside care.

But program proponents say they could help bring more nurses into the  
profession by increasing the number of faculty candidates to train a  
new generation of nurses. The U.S. Bureau of Labor Statistics says  
that more than one million new and replacement nurses will be needed  
by 2016. Still, nursing schools had to turn away 40,285 qualified  
applicants to bachelor's and graduate nursing programs in 2007 in  
part because of an insufficient number of faculty, according to the  
American Association of Colleges of Nursing.

Dr. Mundinger, of Columbia, says the primary aim of the DNP is not to  
usurp the role of the physician, but to deal with the fact that there  
simply won't be enough of them to care for patients with increasingly  
complex care needs. As doctors face shrinking insurance  
reimbursements and rising malpractice-insurance costs, more medical  
students are forsaking primary care for specialty practices with  
higher incomes and more predictable hours. As a result, there could  
be a shortfall ranging from 85,000 to 200,000 primary-care physicians  
by 2020, according to various estimates.

In addition to training in diagnostic and treatment skills, doctors  
of nursing practice can have hospital admitting privileges,  
coordinate care among specialists, help patients with preventive  
care, evaluate their social and family situations, and manage complex  
illnesses such as diabetes and heart disease, says Dr. Mundinger, who  
has been leading the effort behind the National Board of Medical  
Examiners' planned certification exam.

A spokeswoman for the medical licensing board, which provides  
examinations used by licensing authorities for several health  
professions, says the planned DNP exam will be narrower in scope than  
the three-step exam that doctors take, including tests on organ  
systems and a range of medical disciplines. A number of physicians  
have supported the efforts to advance nursing to the doctorate level  
through the Council for the Advancement of Comprehensive Care.




All nurses currently are licensed by the state in which they practice  
and are certified by specialty groups. The planned certification exam  
won't be a requirement for licensing of DNPs, and it is too early to  
say whether it will catch on broadly as a desirable credential for  
practice. Jeanette Lancaster, president of the American Association  
of Colleges of Nursing says "we are keeping an open mind as to  
whether it will add another level of validation of competency."

Columbia University's Columbia Advanced Practice Nurse Associates,  
which includes several DNPs, has for several years been taking care  
of patients with complex illnesses, working with medical doctors and  
specialists affiliated with the university. Judith Gleason, a 76-year- 
old writer and researcher, says she became a patient of the practice  
after her family physician died. Now, she counts one of Columbia's  
DNPs as her primary physician.

Ms. Gleason says she liked the practice's emphasis on preventive  
care. More significantly, when she complained of a throbbing headache  
on one side of her head, Edwidge Thomas, a doctor of nursing  
practice, noticed something in her blood test that indicated a form  
of rheumatic infection linked to her arthritis. The diagnosis was  
confirmed when Ms. Gleason was referred to a neurologist, who  
prescribed medication. "They are patient-oriented, and they always  
pick up the pieces, so to speak," says Ms. Gleason. "Edwidge is my  
primary-care provider now."

Email informedpatient at wsj.com.