[NPInfo] DNP Credentials

[Calif NP]

This is an insightful, well-reasoned opinion, and very clearly stated
perspective on this on-going 'fight' !

----- Original Message ----- 
From: <nursinglaw at aol.com>
To: <npinfo at nurse.net>
Sent: Wednesday, June 11, 2008 7:47 PM
Subject: Re: [NPInfo] DNP Credentials


>> 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 servic!
>  es 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