[NPInfo] DNP Credentials

Wed Jun 11 19:47:47 PDT 2008

As many of you know, I lurk on the list serve.? I have read this dialogue with interest and I understand and appreciate both sides of this discussion.? I just don't understand the purpose of the examination for the DNP.? If it is intended to become a certification tool, the examiners will need to conduct a role delineation study, develop competencies, develop test questions based upon those competencies to prove that the exam is psychometrically sound and legally defensible for certification purposes.? If the purpose of taking the test is show that DNP practice is comparable to medical practice, I have concerns.? I believe that nurses can and will master the content and the test, but there is something lacking when one profession has to "prove" its validity to another profession.? Have we looked introspectively and thought hard about why some nurses need to prove comparability.? I think docs and nurses are like apples and oranges-- both have comparable values, provide services but do so from a different perspective (which I personally like).? Some have used the term mini-docs to describe nurse practitioners.? Of all of the terms that have been used to label NP practice, I find this the most offensive.? Why?? Because nurses only need self-validation.? We should not look externally to prove the value of the profession.? If I need a nurse practitioner, I don't go to a doc.

What are the benefits of taking a medical exam to prove DNP competencies?? I am not sure, but I can tell you that it reinforces the notion that NP/DNP need to be regulated jointly or by boards of medicine.? It gives validity to arguments made by the AMA and MDs across the country that NPs practice medicine, not nursing.

I have been working on nurse practitioner scope and regulatory issues for over twenty years and I am saddened that we still have to have these discussions.? Why can't we relish in the fact that NPs and DNPs are and will be nurses with expansive, extensive clinical expertise who can provide excellent primary care, case management, etc.? How does comparing the NP or DNP with MD's improve access and quality of care?? The reality is that NP and DNP?have and continue to fill primary care needs; and we don't have enough doctors to address all of the health needs of the American public.

Either we want comprehensive care or we don't.? The present system has not worked well, even with?NPs?filling the gaps.? Can?we afford to retain?MD?hierarchy within the health care system?? No.? We need to think about and support the nurse components of advanced nursing practice.? When doctors ask us about whether we intend to?become primary care providers and use MDs for specialized complex care, ask them?whether they can articulate more and better alternatives for?providing the public with access.? Docs can't have it both ways if they really want health reform.? There just are not enough docs to provide primary care and the fractured method of patient management by insurance companies (and not health care professionals) doesn't work well.? Evidence-based practices clearly reflect the benefits of utilization of NPs as well as other ANPs as hospitalists and clinicians.? Why should nurses apologize for being good at what you do?? When we?are approached about not being doctors, we need to?stand up and clearly and articulately pronounce the wonders of NP/DNP practice.? And, we need to?stop docs and others from making the comparisons.? The services and care provided by NPs?is wonderful.? You save lives,? You care for your patients excellently and you don't have to be doctors or prove your competence to continue this practice.? The?health care system is responding to?economic and other variables and they need you considerably more than they profess.

Until we change OUR mindset, we cannot change the health care system. We need to quit trying to change the regulatory and education system just to prove NP competence to docs.? If NPs are considered competent by nursing standards, then NPs are competent and don't need additional validation.

For those who don't know me, I am not a nurse, just an ANP?lover, supporter and advocate. (Also some say I am a ANP wannabe)

Winifred Carson-Smith, Esq.
CarsonCompany, LLC
www.CarsonCo.net 
nursinglaw at aol.com
202-232-5193
202-232-5194(fax)

-----Original Message-----
From: David Carpenter <coloradopa at gmail.com>
To: NP Info <npinfo at nurse.net>
Sent: Tue, 10 Jun 2008 11:44 pm
Subject: Re: [NPInfo] DNP Credentials

Actually the real question should be, is a test designed to measure
primarily inpatient management after a physicians first year the best test
to measure NP practice which is primarily outpatient (according to the press
release)? The other part is that they are only administering half of the
test. There is a practical escalating question portion of the test that they
chose not to do. Its really a lose lose proposition. If the NPs do well then
its because they only took what is considered the easiest of the step tests
by the med students and residents. If they do poorly its because they don't
have the knowledge of the physician (even though the test is not targeted at
the areas that Mundinger claims are the domain of DNPs).

As far as MDs administering the test, that isn't really true. The National
board of medical examiners along with the State boards of medical examiners
sponsor the step tests.The NBME is also in the business of developing and
administering tests related to medical practice. They are considered one of
the pre-eminent research groups regarding test taking and consult with a
number of non physician groups including veterinarians, medical assistants
and Public health. For a fee they are happy to work with any group that
wished to develop certification standards. Their board is largely physician
oriented as is their mission but as with any independent agency you will
find a number of non physicians and lay members.

David Carpenter, PA-C

On Tue, Jun 10, 2008 at 11:19 PM, Rose Moran-Kelly <rosemorankelly at gmail.com>
wrote:

> But Meg...  Do you think we should take a test that the MDs administer??
> Rose
>
> On Tue, Jun 10, 2008 at 10:07 PM, Meg <enigma462003 at yahoo.com> wrote:
>
> > This is only my opinion but I believe we are witnessing history in the
> > making (literally) with the launching of the DNP programs...this is one
> of
> > the biggest events to encompass nursing and its move forward in a
> century.
> > This is a step our profession must take, with or without backing of
> everyone
> > involved, including Advanced Practice...many will be able to be
> > "grandfathered" under present law...many will go on to become prepared at
> > the doctorate level...this is how a profession evolves. With primary care
> in
> > dire need of professionals to care for the aging population and increased
> > need for primary care in this country this is the perfect opportunity for
> > nurses to actually move into this role since more and more physicians
> will
> > be in the "specialist" role in the future. We need to take this
> > opportunity. Meg Helgert FNP
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> > NPInfo at nurse.net
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