[NPInfo] AMA News

Tue Jun 10 18:08:24 PDT 2008

OK- Anyone on list with a DNP planning on taking the exam? 

Dr. Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP 
President, Fitzgerald Health Education Associates, Inc. 
85 Flagship Drive 
North Andover, MA 01845-6154 
978.794.8366 
 FHEA website www.fhea.com 
FHEA on line store www.fhea.biz 

peg at fhea.com

FNP, Adjunct Faculty, Family Practice Residency 
Greater Lawrence (MA) Family Health Center, Inc.

> From: galdena at sbcglobal.net
> To: npinfo at nurse.net
> Subject: RE: [NPInfo] AMA News
> Date: Tue, 10 Jun 2008 17:24:51 -0700
> 
> 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
> ???
> 
> 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
> ???
> 
> 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.
> 
> 
> ???
> Discuss on Sermo
> Back to top.
> 
> 
> 
> 
> 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
> 
> Back to top.
> 
> 
> Copyright 2008 American Medical Association. All rights reserved.
> 
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