[NPInfo] AMA News/ HOW A FEW SCREWED SO MANY!!!!!!

Tue Jun 10 18:48:47 PDT 2008

Agree with you Dave.  What has occurred was never the intention of the DNP degree.  A doctor was talking with me about this today as a friend of his in PA is furious and out for bear.  I explained what the degree meant, how it was not developed to tick off the AMA, that the NP does in fact have 7-8 years to get this degree (BSN, MSN, then DNP) and it is to make the NP stronger in certain areas.  He stated he couldn't think the NP would want to be in an adverse relationship with the doctors we have worked with.  He suggested we band together and make Columbia and Muninger hush.  Which isn't such a bad idea.  (He in fact has a PA and NP in his office and treats them with respect and appreciates their knowledge).
Melissa 

-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf Of mfnp at cox.net
Sent: Tuesday, June 10, 2008 9:15 AM
To: NP Info
Subject: Re: [NPInfo] AMA News/ HOW A FEW SCREWED SO MANY!!!!!!

Sounds fantastic! Those who have been behind the "movement" should be very proud of themselves, especially the "Ivory Tower" crowd. 

They have now undone almost 50 years of progress in Nursing by allowing the physicians to gain further control over the practice of nursing. What it appears like is that DNP grads will be able to be tested to the standards of physicians, but still be at a level that offers no further income, no other benefits, with a great deal of negatives. 

Way to go, because you have just begun the down fall of NPs, and possibly  most of nursing, and we soon can wear white caps, come under physician control, and watch the rest of the hard worked for benefits just get sucked down the drain. Those that pushed for this should be very proud because this is an explanatory new beginning. So, for those that pushed this, stand up, ID yourselves, and we should all remember what was done by a small few to change a great deal of progress. 

Bedpans anyone???

---- 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
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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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