[NPInfo] Re: [ACC-Circle] Fwd: Wall Street Journal DNP article

[David Mittman]

Connie et al: How do we best show that NPs are comparable to docs?  
This is one way... Although this is a strange way to do it- but  
taking a test equivalent to the clinical section of the Med Boards is  
an interesting concept. IF and it is a BIG IF ( as the DNP students  
would be different disciplines-would not just ANPs and FNPs) they do  
well on a test made up by the NBME, it would go a long way to show  
that we learn the same CLINICAL information physicians do. Would  
elevate the NP profession BUT EVERYONE PLEASE NOTE-THIS WOULD  
PROBABLY CREATE A DIFFERENT PROFESSION FROM AN NP-no doubt in my mind  
unless a Master's prepared NP could also sit for this test. Still, as  
DNPs will be from many disciplines and they all are eligible sit for  
the test, the new profession would almost have to have different  
rules and regulations than a profession that has not taken the test.  
Or else why take it?
ALSO VERY IMPORTANT....Just because the NBME tests you does not mean  
you are under any control from medicine. They do not want to control  
anyone and they are not political. They see this as a future  
undertaking that could take off and make them money. Why not? I think  
they originally tested the peeds NPs for years? Might still do. They  
come with instant credibility and the regulators know them.
The NBME is not a threat, adding another level of NP might be.
Dave

On Apr 4, 2008, at 12:36 PM, Dr.Constance A. Morrison, Esq. wrote:

> WELCOME TO THE ACC-CIRCLE DISCUSSION LIST!
> Strength in Unity: Join the ACC today: http://www.amcollege.org
>
> *********************************************************
> Gentleman and Ladies,
>
> I  have no intention as an NP/DNP to  come under the wing of  
> Medicine. No way , no how. We  as NPs have struggled for  
> independent practice and indeed have this in many states, including  
> one of mine NH. . Its my understanding that there is a " move on "   
> for  DNPs  not to " partake of this foolishness ". I know there are  
> other DNPs  out there who are privy to much more information than  
> I. So please folks weigh in on this and speak more eloquently than  
> I on this hot topic of the day. E-mails are flying back and forth  
> on this subject.
>
> More to come later. Greetings from Palm Springs CA , temp 80  
> degrees and sunny all the time. Back to NH and MA in May : )
>
> As Always I appreciate this wonderful forum to voice my  most  
> humble of opinions. Thank the highest order that  we decided not to  
> kill all the lawyers - now is it the DNPs  ? Guess you will have to  
> listen to me on this now !
>
> Connie
>
>
>
>
>
>
>
>
>
>
> ----- Original Message ----- From: <Surgblumm at aol.com>
> To: <ACC-Circle at listserve.com>
> Sent: Friday, April 04, 2008 5:04 AM
> Subject: [ACC-Circle] Fwd: Wall Street Journal DNP article
>
>
>> WELCOME TO THE ACC-CIRCLE DISCUSSION LIST!
>> Strength in Unity: Join the ACC today: http://www.amcollege.org
>>
>> *********************************************************
>
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> ---------------------------------------------------------------------- 
> ----------
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>
>>
>>
>> Advance for PAs has set up a blog on this  issue and it would be  
>> to the
>> benefit of our group to look and add to that blog.  This was my  
>> reply.
>>
>> I wrote a nice response but  must have copied a code number  
>> erroneously so my
>> nice comment died. Second  try--First-don't see this as a NP/PA  
>> turf war as
>> it clearly is not. This will  become a MD/DO/NP Turf war as this  
>> is already
>> being discussed in Administrative  board rooms with physicians and
>> administrators.
>> Do expect some thoughtful  comment by the AMA who will either back  
>> off and
>> realize they cannot change the  power of this river of thought or  
>> they will set
>> up dams to slow it down and  divert its streams.
>> The real question may also be " How would you , as a PA  feel, if  
>> it were
>> mandated that you receive a doctorate?" This is going on in the   
>> minds of many
>> senior NPs who don't have the time or finances to return to   
>> school. Will this
>> education really make some of the more seasoned practitioners   
>> more proficient?
>> I can only say that I believe that another didactic focused  year  
>> coupled
>> with a clinical residency program can only improve the craft of  
>> any clinician.
>> This is not an issue for us to become smug and flip the bird at.   
>> This is a
>> serious issue that demands our concentrated thinking and hundreds  
>> of comments
>> on this blog and in other forums such as at state and national   
>> meetings. The
>> tone cannot be argumentive but thought  provoking and  dedicated  
>> to finding
>> real answers not just being defensive. Let's let the  fertile soil  
>> of an open
>> mind permit us to reap a harvest of thoughts that will  direct a  
>> path for PA
>> involvement and progressive action.
>> Bob  Blumm
>>
>>
>>
>>
>> ____________________________________
>> From: dmittman at comcast.net
>> To: ACC-Circle at listserve.com, NPinfo at nurse.net,  paforum at mc.duke.edu
>> Sent: 4/2/2008 11:28:35 A.M. Eastern Daylight  Time
>> Subj: Wall Street Journal DNP article
>>
>>
>>
>>
>> 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_ (mailto:informedpatient at wsj.com) .
>>
>> =
>>
>>
>>
>>
>> **************Planning your summer road trip? Check out AOL Travel  
>> Guides.
>> (http://travel.aol.com/travel-guide/united-states? 
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>>
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