[NPInfo] AMA News

Tue Jun 10 17:24:51 PDT 2008

I also find it amusing that MDs are apparently just nervous about the DNP
degree... have they expressed the same sentiments about NPs in the clinical
setting with PhDs or DNSc? Plus do THOSE doctorally prepared NPs have to
take another credentialing exam? Also the latest on the movement by the AMA
to limit the title "Dr" in a healthcare setting to only MD/DOs, dentists,
and podiatrists, leaves out doctorally prepared PT/OTs, chiropractors
(understandable given the long history of turf wars between MD/DOs and
chiropractors), and to psychologists as well! Now THAT'S not going to sit
well with everyone, is it <G>?
Dena Galler

-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
Of AnnMarie Roetzer
Sent: Tuesday, June 10, 2008 5:09 PM
To: NP Info
Subject: Re: [NPInfo] AMA News

I even find the tone of the initial article condescending. When are they
going to get it... I don't want to provide the same care of a physician, I
want to provide my own type of care which is a fusion of medicine and
nursing as well. I provide caring compassionate well-informed care which is
much appreciated by my patients. I take the time to make sure that their
needs are met. 

  Futhermore, it is obvious that this NP in the article must not practice
independently as they "allow her" full prescriptive authority and when she
is in the office they "feel free" to do hospital rounds or take a day off.
How condescending! 

  I got into a big argument after interviewing a new nurse the other day
with the nursing supervisor. The nurse works in a jail and see patients
according to protocols -- the nursing supervisor said "well its similar to
what you do as an nurse practitioner and that takes critical thinking" I was
furious I replied that it is not similar -- and where are my standard
protocols. I also heard one of the front desk staff telling a patient that I
"work under" Dr. So and So, well needless to say there was some education
provided that in fact work "in collaboration with" the physicians -- his
reply, well same difference you know what I meant.

  My last question, why are nurse anesthestists having the turf battles and
drama -- they seem to be well-accepted and I never hear someone say "well
thats just the nurse anesthestist NOT the doctor." Maybe we should study
their model... seems to working better. 

  Its a shame to see everything that we have worked for --- just be trashed.

  Ok my rant is over -- I rarely pipe in on these issues, but I am steamed
now...

  Take care,
  AnnMarie 

David Mittman <dmittman at comcast.net> wrote:
  This is all such BS but the people at Columbia may by their mistakes 
still positively push on the envelope. This remains to be seen. Where 
doesw this place :PAs and NPs who don't want to play in this?
Dave
ï¿¼

PROFESSIONAL ISSUES

Medical testing board to introduce doctor of nursing certification

Physicians are concerned that the move will lead to scope-of-practice 
expansions.

By Myrle Croasdale, AMNews staff. June 16, 2008.

Starting this fall, doctor of nursing practice graduates will be able 
to take a certification test that proponents say will set a national 
standard for DNPs and add to the profession's credibility.

The voluntary test, being created by the National Board of Medical 
Examiners, is based on the medical licensing exam. It will be offered 
at a time of growing momentum in the DNP movement: About 200 nursing 
schools are expected to offer the two-year DNP degree by 2015 -- more 
than double the programs available today.

Discuss on Sermo
ï¿¼

The making of "Dr. Nurse"
See related content
Test proponents said the DNPs, called "doctor nurses" by some in the 
nursing profession, are comparable with primary care physicians in 
their diagnostic and disease-management skills.

But physicians expressed concerns that DNPs will use the test as 
leverage to seek scope-of-practice expansions that cross into medical 
practice.

"Why would they get a DNP unless they want to do things that are 
currently not in the nursing scope of practice in most states?" asked 
AMA Board of Trustees Secretary William A. Hazel Jr., MD. "It makes 
sense they will want to change their scope."

The AMA and the American Academy of Family Physicians said they 
support advances in nursing education but emphasized that nurses 
should operate as part of a health care team under physician 
supervision. Dr. Hazel said there are important distinctions between 
DNPs and physicians that the public should understand.

"I do not want to be construed as attacking nurses, but there are 
concerns," Dr. Hazel said. "There's a difference in training that 
should not be overlooked."

In April, the nonprofit Council for the Advancement of Comprehensive 
Care contracted with the NBME to create the exam, which is expected 
to be offered in November.

Mary Mundinger, DrPH, speaking for the council, said the goal is for 
a national standard that distinguishes DNPs who have an advanced 
clinical knowledge from those who have an emphasis in research, 
administration or systems management.

"While a primary care physician went to medical school and did 
residency, a nurse practitioner with a DNP has achieved many of the 
same competencies but through nursing education," said Mundinger, who 
also is dean of Columbia University School of Nursing in New York 
City. "They have the same skills in identifying a disease state and 
treating it, but it's a different hybrid of care."

Using a similar test

Richard Hawkins, MD, NBME vice president for assessment programs, 
said the test will be based on Step 3 of the U.S. Medical Licensing 
Exam, the last level in the test series.

"We're a testing organization, and this fit our mission," said Dr. 
Hawkins. The NMBE develops assessments for health care professionals 
in general, not just for physicians.

Mundinger said about 75 graduates qualify to take the DNP 
certification test. Once nursing schools finish their program 
expansions, she expects there will be at least 2,000 DNPs graduating 
each year. Candidates must first complete a master's-level nurse 
practitioner degree before they begin a DNP program.

Though DNPs have a year of residency as part of their two-year 
program, Dr. Hazel said, it is important to recognize the difference 
between physicians' and nurses' residencies.

Residency, DNP style

DNPs' residency year entails 1,000 hours, Dr. Hazel said. Medical 
residents work 80 hours a week, racking up about 4,000 hours their 
first year and approximately 12,000 hours over three years, he added. 
In addition, patients could easily confuse these nurses with a 
licensed physician.

"Let's make sure they make the distinction between a doctor of 
nursing and medical doctor," Dr. Hazel said.

At press time in early June, the AMA House of Delegates was expected 
to consider a resolution to endorse policy that the title "doctor" be 
used only by licensed physicians, dentists and podiatrists in a 
medical setting. The resolution also sought to have the title 
"resident" apply only to individuals enrolled in a medical, dental or 
podiatry training program.

Another resolution sought to oppose the NBME's development of the 
certification test and to urge the Association to adopt policy that 
DNPs practice under physician supervision.

AAFP President James King, MD, said that although these nurses pass a 
test similar to the one for medical school graduates, that does not 
make them physicians.

"I don't think they can replace family physicians," Dr. King said.

"If they are sincere in saying they are going to contribute to easing 
the physician work force shortage, they'll work as part of a team, 
not leading that team," he said.

Mundinger said the nursing degree and test do not alter existing 
scope-of-practice rules, but as DNPs demonstrate their expertise, she 
expects that scope to change.

"The more nurses prove they can do certain things, the more likely it 
is legislation will follow, but there is no direct link between 
certification and what nurses [legally] can do," Mundinger said.

Working with physicians

Richard Mulder, MD, is a family physician in Ivanhoe, Minn., who has 
worked with Dawn Bucher, DNP, since she was a registered nurse and 
then a nurse practitioner. He said her level of expertise as a DNP 
has eased his workload.

On days she works, he feels free to do hospital rounds or take a 
coveted day off.

He is confident that patients will be well taken care of by Bucher. 
He and his partner set her prescribing formulary and have given her 
unrestricted prescribing authority.

Bucher said the biggest impact her DNP degree has had is how she 
thinks about patient care. She looks for ways to better meet 
patients' needs and coordinate their care.

"We're all about patient care," she said.

Bucher does not introduce herself as doctor. When the voluntary DNP 
certification test is available, she plans to take it.

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ADDITIONAL INFORMATION:

The making of "Dr. Nurse"

The doctor of nursing practice degree is a two-year program open only 
to those who hold a master's degree in advanced-practice nursing. New 
York's Columbia University School of Nursing, one of the schools 
offering this degree, has a 40-credit-hour curriculum that includes a 
year-long residency.

1. Support core courses (19 credit hours):

Translation and synthesis of evidence for optimal outcomes
Quantitative research methods
Legal and ethical issues
Clinical genomics advanced seminar
Practice management
Informatics
2. Clinical core courses (11 credit hours):

Doctor of nursing practice I and IIv
Didacting and clinical
Chronic illness management.
Doctor of nursing practice I and II
Didactic and clinical
Chronic illness management
3. Residency/seminar (10 credit hours)

Source: Columbia University School of Nursing

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