[NPInfo] Call me "Dr. Nurse"

Mon Apr 28 08:10:37 PDT 2008

Dear Lisa:

Sometimes I think about working as a barista at Starbucks. I would have autonomy there and could brew up an espresso all on my own, without a protocol and a supervising physician. But being an NP pays better! 

There are some DNP online programs that have minimal residency requirements, and they wouldn't involve much travel. But I agree with you that we don't need more leadership, theory, and health policy courses. The title of "doctor" won't mean much for us as a profession unless our scope of practice expands with the title. I don't think the DNP will help us much politically.

I work in a psychiatric unit with a mental health counselor who has a doctoral degree in Divinity. She insists on being called "Dr.", even though the degree that qualifies her to practice mental health counseling is her   master's in Psychology. The added doctoral degree, although in a somewhat related field, doesn't increase her scope of practice. Spiritual counseling doesn't do much in the treatment of bipolar disorder or schizophrenia. Some of our co-workers roll their eyes when she introduces herself as "Dr." 

I fear that it might be the same for us in some settings. An NP with a DNP degree will not have better suturing skills than you. Where I work, an NP can suture superficial wounds (not several layers) that are not on the face, hands, or genital areas. I suspect that in the future, the DNP prepared nurse practitioners who will come along after us will not be permitted to have the same suturing privileges as our physicians, who can suture facial wounds, lacerations of the hands, and (occasionally) genitals.   

I do believe that the MSN degree will become a thing of the past, because so many people are pushing for the DNP as the entry level for NP practice. Those of us who are masters prepared may be seen as "lowly" among nurse practitioners someday, but to the public and others it won't much matter. Just think of bedside RN skills. Do you care if your nurse has a diploma, a two-year degree, or a BSN when you are in the hospital? I just want a nurse who can provide good care. 

Best Regards,

Shelby Havens, ARNP, MSN     

-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf Of Lisa Meyer
Sent: Monday, April 28, 2008 10:34 AM
To: NP Info
Subject: Re: [NPInfo] Call me "Dr. Nurse"

Bethany and list--

You are not alone!  I totally agree that we are already being made to look 
like idiots over this.  I have no desire in my role to devise elaborate 
programs/projects, or to get involved just too much with the "health care 
system".  I WANT, and my rural community needs, me to suture wounds and 
treat the sick.  More theory, leadership, and health care systems won't help 
me to do this, and the public (who was just starting to catch on) will have 
no bloody idea that I am capable of doing that.  Even if us lowly master's 
prepared people are "grandfathered in", is the public, after reading 
articles like the one below, going to be suspicious of a clinician who is 
not a physician, who is not a doctor-nurse suturing their wounds?  Talk 
about making the whole damn thing complicated.  And I know I will get flames 
on this list from those who have already forked over the $25,000 for their 
DNP, but I will work down at the local greenhouse watering the plants before 
I will travel the 6 hours by car to the nearest DNP program.

Lisa

----- Original Message ----- 
From: "Bethany Hartrum" <hartrumb at charter.net>
To: "'NP Info'" <npinfo at nurse.net>
Sent: Sunday, April 27, 2008 9:08 PM
Subject: RE: [NPInfo] Call me "Dr. Nurse"

> Who are we kidding??? This is so typical of nursing to introduce another 
> title and level of nursing that will not benefit the majority of us in 
> primary care, working in rural health care.  This degree may be 
> appropriate for large university type settings for faculty of nurse 
> practitioner programs, or large tertiary care settings for clinical 
> ladders.  But to confuse the public and collaborating health care partners 
> with the title "Doctor", defeats the movement for us to be viewed as a 
> "health care provider"  We should stick to the title "NP"  just like 
> physicians use "MD"  or "DO". Or maybe NP-D. But call ourselves NP's. I 
> predict that this degree will not put out any higher salaries that are 
> comparable to the physicians we work for and with. Will it change the 
> reimbursement?  Unless you are independent and have your own business, the 
> degree will not make one difference in the community I live in. The 
> curriculum's that I have reviewed, look like a dressed up master's 
> curricu!
> lum. And who is going to teach in these program's? If you want to be a 
> Doctor of health care, go to med school.  I strongly oppose the title 
> "Doctor Nurse".  That is ridiculous and will make us look like fools.
>
> -----Original Message-----
> From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf 
> Of David Mittman
> Sent: Sunday, April 27, 2008 8:12 PM
> To: NPinfo
> Subject: [NPInfo] Call me "Dr. Nurse"
>
> 
>
> A doctor and a nurse, all in one package
>
> By CHEN MAY YEE, Star Tribune
> April 26, 2008
>
> Anne Boisclair-Fahey is used to patients doing a double take when she
> introduces herself.
>
> She begins by carefully explaining she's a nurse practitioner, then
> adds "You can call me Dr. Anne."
>
> Get ready to meet a new kind of hybrid at your local clinic: the
> doctor nurse. They sport name tags with the letters DNP for doctorate
> of nursing practice.
>
> Seen as one answer to the looming shortage in physicians, doctor
> nurses take the nurse practitioner concept to yet another level.
> Doctor nurses are trained in finance, health policy and systems know-
> how in addition to core clinical expertise. They can do a lot of what
> many doctors no longer have time to do in an increasingly complex
> health care environment.
>
> While doctor nurses are still a rare breed nationally, that's about
> to change dramatically. The first class of 24 doctor nurses graduated
> in December from the University of Minnesota's School of Nursing, one
> of a handful of schools at the forefront of this trend. All have
> returned to their jobs or new positions, some with expanded roles and
> pay.
>
> Now more than 90 nursing schools have introduced DNP programs and 200
> more are about to start. Beginning next year, the University of
> Minnesota is converting its entire master's of nursing practice
> program into a doctoral course, meaning any nurse practitioner who
> passes board exams will be a doctor nurse.
>
> "They are designed to work in collaboration with physicians," said
> Connie Delaney, dean of the School of Nursing, "so that very
> expensive physicians and specialists can spend their time on other
> things."
>
> But some physician groups worry that the increasingly fuzzy
> demarcation between doctors and nurses may be confusing for patients
> at best, and unsafe at worst.
>
> A looming void
>
> Experts are forecasting a shortage of physicians in the country by
> 2020 because the population has grown even as enrollments in medical
> schools have remained flat.
>
> What's more, 36 percent of active physicians are older than 55 and
> most will retire by 2020, said Edward Salsberg, director of workforce
> studies for the Association of American Medical Colleges. A new
> generation of physicians is less willing to work the long hours
> usually associated with the profession.
>
> The shortage is already showing up in primary care, which includes
> family medicine, pediatrics and internal medicine. This year, U.S.
> medical graduates filled just 1,156 of 2,387 residency positions
> nationally in family medicine; the rest were filled by foreign
> medical graduates. Primary care doctors are paid far less than
> specialists.
>
> Against this backdrop, nurse practitioners are "a phenomenal
> alternative," Delaney said.
>
> There is a parallel movement in dentistry. Dentists are in short
> supply in rural areas of Minnesota, and there is a proposal moving
> through the Legislature to allow dental hygienists to drill and
> extract teeth, and prescribe medication without a dentist on site.
> The Minnesota Dental Association opposes the proposal, saying it
> jeopardizes safety.
>
> Some doctors object
>
> For years, physicians have resisted the notion of a doctor nurse.
>
> The American Academy of Family Physicians, for example, wants it made
> clear to patients that nurses with an advanced degree are not the
> same as doctors who have been to medical school.
>
> "With four years of medical school and three years of residency
> training, physicians' understanding of complex medical issues and
> clinical expertise is unequalled," said the academy's president,
> James King.
>
> Macaran Baird, head of the Department of Family Medicine and
> Community Health at the University of Minnesota, says he's not
> worried about that. He points out that turf battles are not uncommon
> in the hierarchical world of health care.
>
> However, he noted, there's no guarantee that doctor nurses will go
> into primary care unless the gap between payments in primary care and
> specialty care narrows.
>
> Otherwise, he said, "we have the same risk of them going where the
> money is."
>
> Projects show potential
>
> For some nurses, the new title is a validation of what they've been
> doing for years.
>
> Registered nurses, or RNs, are those with a bachelor's degree in
> nursing. Nurse practitioners have a master's in nursing practice and
> can see patients and prescribe drugs, just like doctors.
>
> According to Delaney, there is already an 80 percent overlap between
> what nurse practitioners do and what primary care physicians do. The
> remaining 20 percent includes minor surgeries such as appendectomies
> or vasectomies. Nurse practitioners may also specialize in fields
> such as family practice, psychiatry, pediatrics, gerontology or
> midwifery.
>
> Doctor nurses extend that nurse practitioner role even further with
> training positioning them for leadership roles in health
> organizations or teaching.
>
> The three-semester program costs $14,500 for Minnesota residents and
> $23,500 for nonresidents. Most of the work is Web-based, with
> students coming to campus for several intensive weekends of work. So
> many nurse practitioners in the first class were able to add the
> doctor nurse credential while continuing to work part time.
>
> Their student projects showed the scope and promise of combining a
> nurse practitioner's clinical skills with a doctor nurse's new
> awareness of health care systems. One student developed and
> implemented a standard screening for asthma patients during clinic
> visits, to ensure proper follow-up care. Another devised a plan to
> institute regular bathroom breaks at school for kids who wet their
> pants because of medical problems.
>
> Karalee LaBreche, a psychiatric nurse practitioner for Ramsey County
> who was in the first class of doctor nurses, looked for ways to get
> emergency medication to those who needed it, including going to their
> homes. As a result, fewer patients showed up at the emergency room, a
> very expensive option.
>
> The project won her an award from the International Society of
> Psychiatric-Mental Health Nurses.
>
> More pay, promotions
>
> For some, the new doctor of nursing practice degree has opened doors.
>
> Six graduates have since been offered new positions or promotions,
> and a few have gotten modest salary increases, said Sandra Edwardson,
> director of the U's DNP program.
>
> For Nicole Lynch, a psychiatric nurse practitioner at Abbott
> Northwestern Hospital in Minneapolis, the added training as a doctor
> nurse brought expansion of her role beyond outpatient care to
> inpatient care, too. For Boisclair-Fahey, who specializes in
> pediatric urology, it meant a 3 percent raise and an invitation to
> sit on a major board.
>
> The proliferation of titles has caused some confusion.
>
> Lynch explained her title to a child patient, who quickly twisted it
> around to "Nurse Doctor Lynch."
>
> Most of the time though, she said, they just stick to "Miss Nicole."
>
> Chen May Yee • 612-673-7434
>
> © 2008 Star Tribune. All rights reserved.
>
> 
>
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