[NPInfo] COMMENTS IN THE WALL STREET JOURNAL

[David Mittman]

What Boundaries for Nurse Practitioners' Role in Health Care?
April 11, 2008; Page A15
The doctor of nursing practice degree is a powerful innovation in  
nurse-practitioner education ("The Informed Patient: Making Room for  
'Dr. Nurse,'" April 2). With a looming primary-care physician  
shortage, qualified primary-care providers are in great demand. Who  
better than nurse practitioners to provide leadership to help meet  
that demand? Like other health professions, including pharmacy,  
psychology and physical therapy, the breadth and depth of knowledge  
and responsibility in advanced-practice nursing warrants clinical- 
doctorate preparation.

Nurse practitioners aren't the same as doctors, nor do we purport  
that DNPs will be. Patients who see nurse practitioners will tell you  
the difference and express their satisfaction with nurse  
practitioners, who have a different approach to managing patients  
while using the same evidence-based standards of care used by  
physicians. Nurse practitioners will continue to provide person- 
centered, high-quality care to the patients we serve. Doctoral  
education will enhance our already important clinical contributions.

Joanne Pohl, Ph.D. APRN, BC, FAAN
President
National Organization of Nurse Practitioner Faculties
Ann Arbor, Mich.

We have the deepest respect for nurses, and the American Medical  
Association wholeheartedly believes that each member of the health- 
care team plays a critical role in ensuring patients get the best  
possible care. However, it's an undeniable fact that a nurse with a  
graduate degree doesn't have the same education and training as a  
physician who has completed medical school and residency training,  
and it's misleading to patients for nurses to introduce themselves as  
a doctor.

While standards for the DNP are presently being devised, nursing  
organizations currently recommend that DNP students complete just  
1,000 hours of "practical experience" after obtaining a bachelor's  
degree. Physicians complete more than 12 times that amount during  
their graduate education. In addition to the two years of clinical  
rotations physicians fulfill during their four years of medical  
school, they also complete three or more years of full-time medical  
residency training.

Edward L. Langston, M.D.
Chair
American Medical Association
Board of Trustees
Chicago

If nurse practitioners want to pursue a doctorate, I feel it should  
be a Ph.D. to prepare for teaching or research. If we are well  
trained and educated as nurse practitioners and pass the  
certification exam, then a "clinical doctorate" is overkill. To use  
the title "doctor" is knowingly misleading. Why antagonize the  
physicians who are just now beginning to accept the nurse  
practitioner as a vital part of the medical team?

Marylu Manning, CRNP, MPA
Cancer Program Manager
Union Memorial Hospital
Baltimore

Nurse practitioners need physician support and mentorship, which work  
both ways. Each profession has a lot to learn from the other, and the  
problem of access to health care needs to be addressed by physicians  
and the nursing profession working together as a team.

Sherri W. Osborne, RN, BSN GNP/APNP
Kernersville, N.C.

Mary Mundinger, dean of New York's Columbia University School of  
Nursing, has used her enviable media attention to push her own  
personal agenda for DNP credentialing. Unhappily, her efforts have  
discredited the more than 100,000 master's-educated nurse  
practitioners who practice safely and effectively and do so with our  
patients' unqualified support and trust. As for a DNP, I personally  
have no intention of seeking it. I have been fulfilling that exact  
role for more than 10 years now. You see, regardless of Dr.  
Mundinger's agenda, you can't learn clinical expertise in school. You  
learn it from experience, expert clinicians and your patients.

I didn't become a nurse because I was too stupid to get into medical  
school. I became a nurse because I was more interested in getting  
patients well than I was in studying what makes them sick. I fully  
respect the skills doctors possess, as well as their education and  
training. However, as a nurse practitioner, I, too, have skills,  
experience and expertise that doctors don't possess. Within my scope  
of practice, studies have proven that my care is equal to or superior  
to physician care.

Carla Mills
Nurse Practitioner
President
MaverickHealth
Naples, Fla.