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SDN Reports: The DNP Degree

Created 04.13.11 by Helena Bachmann
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This spring, the University of Rhode Island in Providence is starting the registration process for the state’s first Doctor of Nursing Practice (DNP) degree. Scheduled to commence in the fall, it will join the ranks of 153 other DNP programs presently operating in the United States; some 106 new ones are currently under development.

(Information courtesy of American Association of Colleges of Nursing, http://www.aacn.nche.edu/Media/pdf/Docprograms.pdf)

As this degree is gaining ground, it continues to stir intense debate and conflict within the health care community.

On one hand are the proponents, who argue that the doctoral-level degree focused on the clinical practice (as opposed to a PhD, which prepares nurse researchers/scientists), gives nurses enhanced knowledge and skills to treat patients, especially in places where there are no other primary care providers. On the other side are the critics, claiming that the “doctor” prefix confuses and misleads patients into believing they are being treated by a Doctor of Medicine (MD) or a Doctor of Osteopathy (DO), the two professional doctoral degrees for physicians in the US. Just as importantly, many medical organizations say, is the quality of patient care provided, since DNPs receive far less training than MDs and DOs do.

DNP’s Evolution

The Commission on Collegiate Nursing Education (CCNE), the leading accrediting agency for Bachelor’s and graduate degree nursing programs in the United States, began the process of accrediting DNP programs in 2008.

While leaving the specifics of the DNP curriculum up to individual academic institutions, the American Association of Colleges of Nursing (AACN) explains on its website that the degree’s focus is on “providing leadership for evidence-based practice.” Furthermore, AACN states, “It is believed that enhanced educational preparation will lead to degree parity with other health care professions and assist graduates to assume leadership roles in clinical practice, clinical teaching, and policy development.”

AACN, the voice for the country’s nursing education programs, notes in its position statement that more doctoral-level nurses are needed to meet the changing demands of the nation’s health care system. An estimated 32 million additional Americans will gain coverage as of 2014 under the recent health care law, so a larger number of health providers will be needed to care for these patients. For this reason, AACN has suggested moving the level of preparation necessary for advanced nursing practice from the master’s to the doctorate degree by 2015.

Butting Heads Over DNP’s Role

The idea is that DNPs would fill some of the gap left by the on-going shortage of primary care physicians needed to treat not only the newly insured, but also the growing aging population. If predictions are accurate, the demand for health services will outstrip the supply: The Association of American Medical Colleges says that, at current graduation and training rates, the U.S. could face a shortage of up to 150,000 physicians in the next 15 years.

These present and future trends and challenges have prompted the Institute of Medicine (IOM), the nonprofit arm of the National Academy of Sciences, to issue a report at the end of 2010 urging increased training and autonomy for nurses. The most contentious part of this report is a call for the so-called “scope of practice” – the authority nurses would have to order tests, prescribe drugs, as well as perform other medical services.

According to Kaiser Health News (KHN), an independent news organization providing coverage of health care policies and trends, the report “calls for states and the federal government to remove barriers that restrict what care advanced practice nurses provide and includes many examples of nurses taking on bigger responsibilities.”

Some states have already started this process, while others are on the way. KHN notes that Colorado “recently became the 16th state to allow nurse anesthetists to work without a doctor’s oversight. In Michigan, nurses are pushing for legislators there to allow advanced practice nurses to prescribe drugs. Other fights over scope of practice for registered nurses loom in Kentucky, North Carolina, Iowa and Minnesota.”

But as increasing numbers of DNPs are being trained and getting ready to assume more responsibility for patient care, many physician groups are concerned about the implications of these measures.

The Level of Training

One of the main arguments advanced by organizations such as the American Academy of Family Physicians (AAFP) and American Medical Association (AMA) against giving DNPs autonomy to care for patients is the lower level of education and clinical experience as compared to training MDs and DOs receive.

AAFP’s president Roland Goertz, MD, MBA, tells SDN that the educational requirements for DNPs “focus more on topics such as concepts in nursing, health policy, illness management, drug therapy, epidemiology, and health assessment. In general, the DNP does not have residency training, and the only clinical requirement is that candidates for this degree receive at least 1,000 hours of supervised clinical experience.”

By comparison, Goertz points out that family physicians spend nearly 6,000 hours in lectures, clinical study, lab and direct patient care as medical students. They then go on to three years of residency training, in which they complete an additional 9,000 to 10,000 hours of clinical training.

(Information courtesy of American Academy of Family Physicians, http://www.aafp.org/online/etc/medialib/aafp_org/documents/press/nurse-practicioners/educational-training.Par.0001.File.tmp/NP-Kit-FP-DNP-UPDATED.pdf)

The table clearly demonstrates that not all “doctors” are created equal, at least as far as the level of their training is concerned.

By the time MDs and DOs start family practice, they have completed about 11 years of rigorous training – both academic and residency, clocking in between 20,000 and just over 21,000 hours dedicated to the study and practice of medicine. By comparison, DNPs education lasts, on average, between 7.5 and 9 years over 3,500 to 6,000 hours.  In other words, physicians routinely receive 15,000 to 17,000 more training hours than DNPs.

The curricula for both degrees also vary. Just as an example, medical students learn anatomy, biochemistry, physiology, pharmacology, psychology, microbiology, and pathology, among numerous other courses focusing on treatment and prevention of a wide array of diseases.

Some of the courses offered by various DNP programs (determined by each educational institution) include Evidence-Based Practice and Nursing Systems, Health Policy Development & Implementation, Ethics and Public Policy in Healthcare Delivery, and Global Health & Social Justice.

An important consideration when assessing the DNP curricula, AMA Board Member Rebecca Patchin, MD tells SDN, is that “there appears to be little consistency among educational programs across states awarding the DNP degree.”

She notes that some programs offer DNP degrees that focus on administration, some offer the degree online, and others “have little or no clinical content.”

“The first issue is ensuring that patients understand that a new term for their advanced practice nurse doesn’t necessarily mean additional education and clinical training,” Goertz says. “DNP advocates want the degree to become the minimum educational requirement for advance practice nurses. It is, in essence, the ‘new’ master’s degree and thus doesn’t necessarily reflect clinical expertise beyond today’s master’s degree-trained advanced practice nurses.”

However, AACN’s spokesman Robert Rosseter points out to SDN that doctoral-level nurses play an important part in the evolving health care environment.

“Preparing a more highly educated nursing workforce is in the best interest of patients and serves the public good,” he says. “Nurses and physicians both have essential roles to play in the provision of primary care.”

 

He notes that while some doctors’ groups have voiced concerns about the DNPs’ role, “many physicians realize the obvious benefits to enhancing health care access and meeting the needs of the patient population.”

As an example, he cites Jeff Susman, MD, Editor-in-Chief of Journal of Family Practice, who wrote in the publication’s December 2010 issue that “joining forces with APRNs to develop innovative models of team care will lead to the best health outcomes.”

Is There a Doctor in the House?

 

Another bone of contention between physicians and nurses is the confusion surrounding the use of the “Dr” title.  Organizations like AMA and AAFP claim that the proliferation of doctoral medical degrees is confusing to the lay public and therefore only board-certified physicians should identify themselves as “doctors” to their patients.

AACN spokesman Rosseter responds that the title is “common to many disciplines and is not the domain of any one group of health professionals.”

“Many Advanced Practice Registered Nurses (APRNs) currently hold doctoral degrees and are addressed as ‘doctors,’” he says, adding that other expert practitioners such as clinical psychologists, dentists, and podiatrists, also use this title.

However, AMA’s Patchin points out that her organization’s data “consistently shows that patients are confused about the qualifications of the different types of health care professionals.”

For example, a survey conducted by AMA in 2010 found that 35 percent of Americans thought a DNP was a physician, and another 19 percent were not sure whether a DNP was a physician.

“For DNPs to introduce themselves to a patient as ‘doctor,’ can set up false expectations and possibly hinder the patient’s ability to receive the most appropriate care,” Patchin notes.

AAFP’s Goertz agrees that if the “doctor” title is used without clarification, it can be misunderstood by the patients.  “A significant number of Americans assume a doctor of nursing has the same clinical training and expertise as a medical doctor or doctor of osteopathy,” he says. “This can be detrimental to patient care”

The same AMA survey also demonstrates that 83 percent of respondents prefer a physician to have primary responsibility of the diagnosis and management of their health care.

“All patients have a right to know who is providing them care and what training they have,” Goertz adds. “Transparency in who is delivering care should be a priority.”

AACN’s Rosseter explains that, to avoid misrepresentation and confusion,  “DNP graduates will be expected to clearly display and explain their credentials to insure that patients understand their preparation as a provider, just as current APRNs do.”

Proposed Law

 

The resolution to this controversial issue may very well lie in the proposed federal legislation called the Healthcare Truth and Transparency Act, a bipartisan bill introduced in May 2010. Supported by AMA, AAFP, and several other physician organizations, including the American Osteopathic Association and the American Society of Anesthesiologists, it would require that health care professionals be truthful about their credentials and qualifications when advertising services.

Additionally, the state chapters of the physician organizations are pushing for state laws requiring accurate advertising and information about the licenses of health care professionals. Illinois, Oklahoma and Pennsylvania have recently passed such legislation.

As patients navigate the increasingly complex health care system, “consumer education is the most important way to ensure that they understand the clinical expertise of the person who is providing their health care,” Goertz concludes.

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Comments

  1. p-rog says:

    Article seems pretty biased, but it was interesting. Not sure I understand some of the numbers for the hours in that second table.

  2. Me says:

    What a disgrace! Coming to a Walgreen’s near you though…more and more prevalent. Thanks Obama!

  3. cookiefairy says:

    DNP sounds pretty useless. And no, I’m not a DO nor MD.

  4. selftaughtdoc says:

    Extending the responsibilities of nurses well-beyond the scope of their training is not the solution to the physician shortage. First everyone wants to wear a white coat and now they are fighting to have the same responsibilities. I hope the American people wise up to what is happening.

  5. Chem Major says:

    Can somebody explain the difference between RNs,NPs, and now DNPs???? Because, whenever I ask someone to explain the difference between nursing degrees, nobody can give me a straight answer.

  6. av says:

    An RN is a registered nurse; they have gone through nursing school in one of two ways: either they got a bachelor’s degree in nursing (aka, BSN, 4 years) and then became registered (by taking the nursing licensing exam), or they got a bachelor’s degree in any field (4 years) and then chose to go to nursing school and become an RN (2 years). An NP (nurse practitioner) gets a master’s after going through nursing school, and are more focused on primary care. A DNP is a “doctor of nursing practice.” You go through nursing school first and then decide that you want to get a PhD in nursing. I agree, it’s pretty much a bogus degree. It takes almost as long to go to med school and actually become a doctor. If nurses really want to practice on their own and be independent, then they should just go to medical school and earn the title of Medical Doctor.

    1. georgia says:

      the reason that nurses don’t go to medical school instead of furthering their nursing education is the Thought Process. Nurses, if you are one, treats the Whole patient and that includes their environment and family. Where Doctors are trained to look at diseases and treatments, kinda like tunnel vision. they don’t concern themselves with where the patient lives or if they can afford their medication, that is the nurses issues to deal with. It comes down to the Nursing Model vs the Medical Model.

      1. texas says:

        FALSE parts in GEORGIAs statements. Family practice/internal medicine physicians and usually any physician that works for or around a low income based population such as university hospitals DO concern and care for patients beyond the scope of the actual disease and treatment. Its the whole basis of patient-doctor communication and relationship. Empathy. We can look at it this way.., the physician will lead and guide you to all of the information you need and if you get lost along the way, they are more than happy to redirect and help whereas the nurse will hold the patients hand through the entire way and basically do everything with/for them. Patients, most people are capable of handling such things on their own as long as they have some sort of guidance and a point in the right direction.I have worked with such physicians so I know this to be a fact and I, as a patient, have met many more nurses that are in it for the job security and pay. Overtime hours are not regulated for Nurses like they are for every other healthcare profession i.e RTs, PTs, CLS, MTs etc

        RNs: you absolutely DO NOT have to have ANY sort of 4 year degree. Apparently we are SOOOOO short of nurses that the criteria and requirements have been lowered to just put out more RNs. Basically the ones that were LVNs are now RNs because they have taken their registry board. There are RNs out there with just as Associate’s Degree. FACT

      2. Lotsa Luck says:

        You don’t even need a degree to be an RN. You can attend a diploma school.

        Nurses are simply tools, not professionals, despite what they will try to tell you. If you punch a clock, are sent home because of “over-staffing” (which truthfully NEVER happens as we are always UNDERSTAFFED), and are subjected to the whims of female nurse managers who want you under thumb, it’s laughable to consider yourself professionals in any sense of the word.

        Nurses trying to obtain a “higher” degree are wasting their time. You won’t get any additional pay for your efforts except maybe a thousand dollars more PER YEAR over your diploma nurse co-worker. When the budget is pushed, they’re going to phase out the long-term nurse with the higher salary. Experience won’t count for much as outcomes in patients doesn’t matter much. It’s about the money.

        We just hired an advanced practice nurse to sit in an office 8 hours a day, 5 days a week, to oversee some type of “neuro program” on our ICU. What the hell? She’s going to give classes to the nurses on how to do neuro checks. That’s about all I can figure she’s worth. She’s certainly not worth $80,000 unless she’s wiping ass like the rest of us.

        And that statement that nurses treat the “whole body” bullshit. What a crock. As if doctors don’t.

        I’m a 20 year ICU nurse. You can’t get much past me. I’ve seen new nurses come in all gung-ho, enrolled in further education programs, etc. Nothing comes of it except another title…a useless title…to put after their name.

        When it comes to staffing, we need an RN, not and RN APN, NP, Critical Care certified, etc. Get your extra education if it makes you happy and makes you more sure of yourself, but you’re not getting anymore job security or money from it.

        And you nurses who don’t believe me? Don’t tell me that you’ve never worked side-by-side to a registry nurse who is simply a tragedy of errors…and they keep using her. We just need bodies to take a patient assignment.

        Advanced Practice. That’s a laugh. Answer the call lights, and watch MY patients when I go to lunch…if I get one.

      3. Heather says:

        Thank you “av” that is exactly what I was going to say. I know many people do not understand the differences in title or education, but many people recognize the difference in the approach between a NP and MD. The MD treats the disease (that is their focus) and the Nurse treats the person (which includes the disease) that is our focus. I do not wish to be an MD. I love the different approach nursing has to patient care. I wouldn’t trade it if it was offered for free.

      4. >. says:

        Georgia, these statements prove that you don’t know anything about a physician’s education. I’m a medical student and the first thing we are taught in our clinical essentials class is to look at the whole picture. You will get eaten alive by your attending if you miss an important part of the H&P, so every applicable aspect of the patient’s experience must be taken into consideration. In fact, histories and physicals (which we do hundreds and hundreds of) are set up so that you get the whole story, because disease is not one-dimensional. To think that there is something about a nurse’s training that is any more holistic than a physician’s training, especially a PCP’s training, is ridiculous.

  7. Miguel says:

    153 DNP schools in what 7-10 years??? and how many schools of medicine in over 50 years 120’s. This degree will be so freaking easy to get with the creation of over 120 new shcool like the article states!!!!

    I feel bad for the patients, they will get cheated on this one!!!

  8. Ashley says:

    This article is SO biased it’s unreal. I don’t see the merit in comparing the two degrees because they are NOT the same and no one ever said they were. Of course MDs have more training and clinical hours…because they’re MDs. No DNP ever claimed to be a physician or ever purposely lead a patient to believe so. Advanced practice nurses play a vital role in providing primary care in this country. This is REALLY about status and the only MDs that are upset are the ones that don’t want to hear anyone else called doctor and want to be the only ones allowed to sport white coats. It’s not about the patients. No nurse would ever mislead a patient to believe that he or she has physician level training. Plus, it’s not like I see medical students running in droves to fullfil the MAJOR need for primary care clinicians in this country. Why can’t we work together to advance healthcare as a whole (including every profession that makes up the healthcare team) and to work together to collectively meet the needs of our patients?

    1. RACHAEL says:

      I agree with Ashley this hostility that physician associations have against nursing profession has to stop somewhere. They don’t want, us in medical school because we are nurses, now they don’t us to answer doctors, what next is on their mind? And these are people that depend heavily on nurses to carry out their functions. Anyone who have worked in the hospital or have stayed in the hospital would know that nurses are doctors brain.

      1. Rachael says:

        Physicians choose to go to medical school, we nurses choose to go to nursing school. The world doesn’t have to change nursing school curricular because physicians want them to. Nurses have endured enough intimidation from physicians. If physicians want to change their titles to suit their ego, they are free to do so. We nurses are not trying to be physicians, we just studied and earned a doctorate.degree in nursing thats all. I wanted to go to medical school after i became a nurse, but after i read how impossible it is for RN to get into medical school, i changed my mind. Now am considering going in for my, DNP, here i am reading all these articles about physicians trying hard to protect their egos.

      2. Brent says:

        Rachael, it isn’t impossible for an RN to get into medical school. My class has RNs, LPNs, RTs, and EMTs. You just need to apply if you are interested. Don’t let other people tell you that you can’t go to medical school because you are a nurse. Show them why you want to be a physician and let the school decide.

    2. georgia says:

      Thank you, Well put!

      1. texas says:

        RACHEL, just because you are a nurse doesnt mean medical schools will not accept you. I have friends that got their nursing degrees and went into medical schools. Many nurses choose not to go to medical school because of the intensity and years it takes to become a physician. Financially, nursing careers are very stable and a good money making job ( i’ve seen too many nurses that should not be in patient care) They shouldnt change nursing credentials/education or any healthcare profession education/credentials just to put out more bodies in the fields. This is why we are having so many incompetent professionals practicing in their line of work. Unfairly, MCAT itself becomes harder every year so in theory, more difficult for students to get in, yet in other healthcare professions, they are making it easier to graduate and move on? It is absolutely ridiculous that RNs can just have an associates degree in some places.

    3. texas says:

      I disagree with you. This article is merely stating facts with statistics because as a DNP, these nurses are allowed to set up and open their own clinics without the supervision of a physician. Before this, Nurse practitioners were to be competitive with PAs but as a DNP they are becoming competitive with MDs/DOs because many are allowed to practice without a physician supervision. I personally have dealt with the problem of these DNPs not identifying themselves as nurse practitioners when I had clearly asked to be seen by a doctor, the nurse claimed herself to be a doctor and I had to sneak a look for myself at her ID badge where it stated DNP. Like this article says, when patients ask to be seen by a doctor, we usually mean a physician, not a nurse which was exactly my case. In a different case, I have also had DNPs treat me incorrectly and abusing antibiotics. I have a pretty strong medical science background and I knew enough that if you dont have an idea of what you are dealing with as far an a disease or ‘bug’ goes then you do not prescribe potent antibiotics <–over prescribing antibiotics are the reasons why there are so many resistant strains of bacteria. Case in point, finally I went to a doctors office, was seen by a PA who actually had an idea of the what kind of bacteria it could be and was treated efficiently. This took 4 months to fix. As a patient, I've dealt with very competent PAs over any DNP.

      1. Eve says:

        I totally disagree with you, you are basing your OPINION and comparing the competencies of a PA and a DNP off of your one little experience. Please come back with more concrete evidence. I can not believe you took the time out to write this. Do a 5 yr. comparison of your experience with treatment from these to professionals. Then you can speak on competencies. Your just bias and ignorant. There are great, MD’s, DO’s, PA’s, DNP’s, and there are bad ones, just so happen you had a bad experience. Get over it.

    4. Trevor says:

      very well spoken, you have great a heart

  9. Jason says:

    What the hell kind of a comparison chart is that? “Post graduate schooling: 4 years vs no entrance exam”??? “Residency and duration: REQUIRED vs …”???

  10. turkaglew says:

    The DNP is not a PHD. If you can read you would know this was pointed out in the acticle. DNP = Doctor of Nursing Practice. PHD are nurse scientists in academia and research, DNPs are more clinical.

    @Ashley it is about the patients. There are many less educated people in this country who will go to a walk in/PCP and see a lab coat and here the word doctor and won’t even think to ask. MD/DOs are trained to see these patients, that is why they take Anatomy (cadaver, not on paper), Physio, Pharm, Histo, Endo, Path, etc etc etc… not “ethics in healthcare” as the article states.

    1. Heather says:

      @turkaglew Nurse practitioners ALSO take cadaver anatomy, physiology, pharmacology as a nurse, and advanced pharmacology for prescribers, pathophysiology, etc etc etc in ADDITION to “ethics in healthcare”. Every nurse practitioner provider I know states they are a NURSE PRACTITIONER as they should, regardless of having a DNP or a masters. This is a turf war and it is ridiculous. Unfortunately, it has nothing to do with the patients in the communities we serve.

  11. Michael says:

    @ AV Nurses (RN’s) can also get an associate degree which is 2 years and practice as an RN then take online courses to obtain their BSN, online course obtain an MSN, NP, or DNP. Check out Gonzaga and Western University of Health Sciences. They both have online courses and they don’t require much.

    My wife has her BSN. It would not take much for her to go further if she chose to do so.

  12. blah says:

    watch out, here come the Noctors. Let’s please use this term as much as possible until it becomes known by the mainstream.

    1. Karen says:

      You can call it any ‘title’ you want, but as a DNP I am called ‘doctor’ because I earned it. In case you don’t know this, the title ‘doctor’ is, and always has been, an academic title – it was awarded to PhD grads FIRST – then medicine claimed it. The important part I want you to remember here is that NO profession can claim an academic degree for itself. I call MDs physicians, which is what you are. I have an academic degree which designates me as a Doctor of Nursing Practice, and that’s what I am.

  13. school says:

    @Michael… Exactly. Almost the entire “Doctor of Nurse Practice” track can be completed online. And how would you like to have your “doctor” who has received online training to write you a prescription for drugs? Make a life-threatening diagnosis? Send you to the wrong specialist? I respect what nurses do, but this is crossing the line.

  14. blah says:

    “Is there a Noctor is the house?”

  15. Miguel says:

    when i was in residency in a bad socio-economical city my patients referred to the PA as ” I saw the doctor last week”. As someone said above, alot of patients dont know the difference between one and the other, they see white coats and they think doctors, unfortunately.

  16. Barry says:

    @school. Are you currently in med school? If so, what’s the attendance percentage? How is a working RN taking online classes AFTER working his/her shift (clinical experience) any different than a med student listening to podcast lectures?

    Two points:
    1. Of course RN’s moving up to NP don’t have residency training. They’ve had thousands of hours of clinical experience already (1 year @ 40/wk=2080 hours), both in their RN training and in practice. Do you think they’re stupid? They see what’s going on. I’m sure they’ve got the patient diagnosed before the physician even walks into the room. To say RN’s have no medical experience is to completely marginalize their profession and their intelligence.

    2. Ask any med student what they think about Family Medicine or primary care in general. Would “boring management of chronic hypertension, hyperlipidemia, and diabetes” sound accurate? Endless OB visits? Med checks? How are these activities reimbursed with regards to time spent? Pretty crappy? Do you think the addition of tens of millions of people to the system will make these activities more profitable? Of course not! NPs are poised to get down in the trenches and deal with these issues. There is no way the MD/DO medical education system can produce enough providers to see the huge influx of primary care “bread-and-butter”.

    As an aspiring family medicine doc, I say, “Bring on the NPs.” They’ll be seeing more of the ‘boring’ complaints so I can focus on cases my medical school and residency training prepare me for.

    1. Yeaa says:

      A med student busting their butt to learn the actual science in the preclinical years and then going onto clinical rotations 3rd and 4th year is completely different from a noctor handing out medication for 8 hours and then writing a paper on ethics and feel good noctoring.

      If these people want to have the responsibility of diagnosing and prescribing then they should have the proper level of education to make sure it is safe for the patient.

      Why not have the transportation department start prescribing….they work in a clinical setting and can take online classes just the same as everyone else. See how the argument of clinical exposure doesn’t hold up?

      1. NP Brenda says:

        It’s sad that you think that all I need as an NP is to write a paper on ethics. My training was much more than that. if you are going to comment on this topic, then you should actually know what you are talking about

    2. Karen says:

      Barry,

      Thank you for clarifying the real issue between nurse practioners/DNPs and family medicine physicians. Most family docs don’t want to do exactly what you listed… but the NP/DNPs ARE willing to see those patients – and research has proven that the care of NPs is just as safe and efficient as that of the PCP. NPs are not trying to ‘take over medicine’ – they are trying to fill the ‘hole’ in patient care that medical docs don’t want to do anyway.

      The REAL issues for most physicians are (1) reduction in profit and (2) turf. Physicians don’t want nurses to be called ‘Doctor’ – even though pharmacists, physical therapists, psychologists, and many others in healthcare are called ‘Doctor.’ Physicians don’t ‘own’ the term ‘Doctor’ – it was in use long before physicians were called doctors – so they need to ‘get over’ that ownership thing.

      I think much of this issue could be resolved by interdisciplinary education, where each healthcare role could actually see and understand what the other roles learn and experience.

  17. bairn says:

    And what’s the proof that DNP’s will fill the primary care need? there is none.

    Once they gain rights to other specialties……see YA!

  18. Jim says:

    @Barry, a nurse’s hours mean very little compared to a doctor’s hours. I worked in the ER and some of the nurses there knew quite a bit (although none could make diagnoses they hadn’t seen before, aka other than CHF, flu, etc., using the skills they learned in med school), others knew near crap. Some nurses get degrees in buisness, go to a ONE year post-bac deal and are RN’s. Some, not all, nurses couldn’t make the simplest diagnoses, and that’s the problem. You give some people the ability to become a DNP that absolutely should not be practing because they don’t know their stuff and didn’t learn it in their DNP graduate online program where they took ethics, and all that non sense that isn’t “doctor material’

    A nurse may work 2000 hours a year, but those hours are spent as a nurse, not a doctor. Basically following directions given on a chart.

    1. Heather says:

      To “Jim” oh I respect your opinion and agree with some of your assessment of incompetent nurses. I would like to say though, that incompetence exists in every profession. I worked in a cardiac unit once and there was an MD who would “pretend” to listen to the patient’s heart. Once when he was pretending and I was in the room, I had to tell him “you don’t have the stethescope in your ears”. Also, as much I respect your opinion as you own, it is an uneducated opinion. Nurses do not just follow directions. I have had to FIGHT with MDs before to treat my patient when they didn’t think it was necessary and it turned out to be a life saving treatment. Most nurses can account many stories where they did not follow orders because it was not the best option for their patient. We are patient advocates, not MD puppets. This is what makes nursing a special practice, we see the big picture-not just the focused disease process.

      1. Wynettern says:

        Very True… I know a few incompetent doctors that couldn’t treat my dog……a surgeon that didn’t know what the Hell he was doing, which another surgeon actually suggested my mom sue him for his incompetence…So there are incompetence in every profession so lets not go there..There have been tons of times I had to actually call an attending at home because of the stupid ass resident/fellow damn near killed the patient or they ask me what I think needs to do of which I tell them to put that nice education to use…..I respect all people in everything profession because the truth is everyone makes a difference and no one is better than the rest….

  19. BananaManWill says:

    Noctor, Noctor, gimme the news…

  20. BananaManWill says:

    Seriously though…. I agree there is definitely a need for an advanced practice nurse. And I fully support a PhD in nursing research and the current NPs scope of practice. But if a nurse wants to be advanced enough to practice autonomously and be called “Doctor”, they should have gone to medical school. My wife is a nurse, and she made this point.

    One major difference I see is a “specialty”. What qualifies the DNP to work in FP or EM when they had two years of nursing experience in peds or surgery? I know several nurses that can indeed diagnose, call the correct tests, and pretty much function without a doctor in the unit they work in…. but I don’t think they would be prepared to work in any field of medicine. That is the importance of a residency DNP programs lack. Agreed (with someone above) that when I get sick or really hurt…. I want the person that has gone through 15,000 more hours of specific training to treat me than the person that has been prepared for administration, research, and/or “Global Health & Social Justice”.

    Finally, (my wife asked me to make this point) why are the nurses so bent on being called “Doctor”? She said she is extremely proud to be a nurse and has spent years dedicated as a nurse and wouldn’t want to be called anything different even if she did decide to get her master’s. If they have spent years trying to attain the highest level of NURSING education, why wouldn’t they want to be called a nurse? Why is that title not sufficient? Nurses are respected; it is a honorable title in my opinion.

  21. lmesina says:

    I understand that the DNPs’ warcry consists of filling the primary care gap, but I just learned recently that there are “DNP residency” programs. I guess USF, Florida, has a dermatology residency.

    http://health.usf.edu/nocms/nursing/AdmissionsPrograms/DNA_Dermatology_Residency_Presentation.pdf

    I’m not quite sure about the scope of practice of graduates of this program, but I wonder if it is the same as a board certified MD/DO? I wonder if they will be “Dermatologists”?

    Don’t get me wrong, I’m all for higher education for nurses, and I believe there is some kind of potential (although limited due to lack of basic clinical sciences) for DNP’s to help out with the Primary provider disparity, as evidenced by current NP’s.

    I’m not sure about the purpose of these residencies, but if its purpose is not regarding the primary care gap, then..

    My sister is currently an RN, and is considering pursuing a DNP. I’m going to encourage her to go for a PA degree instead, since they learn some essential basic sciences important for diagnosis, rather than ethics/research courses that seem to be geared more towards medical administration rather than clinical practice.

    1. NP Brenda says:

      Why would you insist that NPs don’t actually learn science??? THAT’S NOT TRUE

  22. Former EMT/ER PA now EM MD says:

    Aspiring Doctors go to medical school. Aspiring Nurses go to nursing school.

    I spent 10+ years in EMT/ER PA prior to medical school, but wanted to be an ER doctor. I knew I learned a huge deal while on the job about medicine, but knew scope of my training was still limited. Therefore I applied, got accepted, and completed medical school- now in EM residency. This NP crap is like me saying I could have be an ER doc without going to medical school because of my long experience in this field, directly side by side with nurses.

    As one commenter said, you can have 10000+ hours in an area- however, as a RN/PA, you are taught to follow orders of a doc, not write the orders. THIS THINKING IS VERY DIFFERENT! I used to boast that I can be a doc while i was still a PA, but now i look back- it makes me chuckle with embarrassment.

    Why can’t nurses do the same and go to medical school if they want to be a doc?

  23. Former EMT/ER PA now EM MD says:

    i meant ‘side by side with DOCTORS’ at end of first paragraph

  24. Susanne says:

    You can’t compare a working nurse’s hours to residency. So as a nurse I changed 5000 bedpans. As a resident I rotated through 12 different specialties and saw the worst cases possible with the best trained physicians. There is no comparison. As someone else alluded to, when you work within a scope, you don’t care about what is outside that scope.

  25. Mr. Bean says:

    If the DNP is designed to address the shortage of primary care providers, then the training should focus on enhancing their clinical experience. However, it seems to me that the training is primarily administrative and policy driven. On the other hand, I am surprised to see the number of online clinical degrees currently offered. You can practically become a nurse without stepping into a lab or a clinic. Community colleges are now offering online anatomy classes. Students purchase an anatomy kit to fulfill the necessary lab components at home.:)

    In terms of patient confusion. I agree with the above comments that patients already have a very difficult time determining who their provider is. I know of several people who refer to their PA’s as doctors. Where do we draw the line? Do we start a Doctor of surgical technology program? A doctor of phlebotomy? Bottom line, as the article stated, DNP programs do not mean advanced clinical training, therefore, it is nothing but another glorified degree that does not serve the purpose it was arguably created for.

  26. DO Student says:

    I want to know more about what is going to happen with the DNP’s gain rights into the other specialties b/c this will happen! we are opening a back door for them to get into the Specialty realm as opposed to what we as medical students and Physicians have been through. they can have the Doctor title, but they will NEVER be a PHYSICIAN ! :)

    oh.. and if the Noctors want the responsibility that bad, let’s let them pay into the hefty mal-practice insurance premiums as well. I bet they’ll find a way to escape that one too!

  27. Incredulous says:

    “Ashley says:

    …I don’t see the merit in comparing the two degrees because they are NOT the same and no one ever said they were….No DNP ever claimed to be a physician or ever purposely lead a patient to believe so….No nurse would ever mislead a patient to believe that he or she has physician level training…. ”

    Really? I can only assume you haven’t practiced in the medical community, then, because I see this happen EVERY day. I routinely see PAs, NPs, and nurses addressed as “Doctor” by a patient and the patient is never corrected. This is absolutely misleading. A million other examples could be used here. My favorite (::sarcasm::) is the quote from a girl I went to high school with who, when telling me (an MD) that she was doing the DNP program said that she “was just SOOO excited to finish because then her patients would HAVE to call her Doctor.” Why? Because she doesn’t feel that the title “nurse” is good enough for her. So, until the world is devoid of egocentric people (found in ALL professions), there will ALWAYS be a nurse/NP/PA out there who takes joy in misleading their patients into thinking they are doctors in the original sense of the word (MD or DO). It is quite naive to believe otherwise.

    The ultimate point is that a patient who has not been clearly told who they are seeing, and what training that person has received, is a patient who has lost the ability to make an informed choice about their medical care.

  28. RealMD says:

    If a nurse wants a doctorate degree, s/he should either go to medical school or a REAL graduate school and get a PhD. Everyone knows nurses are stoopid or else they would have gone to medical school. Who wants to clean sh!t for a living? The only reason DNP is being created is because nurses WOULD NEVER GET ACCEPTED TO MEDICAL SCHOOL OR A PHD PROGRAM.

  29. Former EMT/ER PA now EM MD says:

    I wouldn’t be as offensive as RealMD- I think nurses are valuable to the profession and yes, cleaning sh!t is pretty darn important part of health care. Important in terms of patient safety and quality of care. As a doc, I apologize for my colleague who made those comments above.

    However, I will re-state that a NP wanting to have full practicing privileges as a doctor and/or same salary (as IOM report unfortunately stated regarding NP scope of practice), he/she should go to medical school, go thru residency, and come out with an MD/DO the right way. Not only makes sense for the medical community, but also to patients needing the best care that a doctor with intense medical and residency training provides.

  30. MS says:

    The chart comparing hours, although a step in the right direction to give consumers of medical care a side-by-side view to the VAST differences in education, underestimates the number of hours for medical students. 3000 hours of study during M1 and M2 year combined? C’mon, it’s more like 3000 hours each pre-clinical year… and 6000 for M3/M4 year… yeah, right.

  31. DNP lol says:

    DNP’s want to fill the PCP gap, eh? I guess that explains the DNP “residency” programs in dermatology (1000 hours, wow! *rolls eyes*), cardiology, endocrinology, pain management, orthopedics, etc.

  32. Mike says:

    The amount of clinical training hours a DNP gets compared to a MD/DO student is not even comparable, yet DNP’s want the title doctor, can take online classes and want equal pay? What a joke. A quote from Kaushik on SDN regarding training:

    BSN to DNP: 2.5 – 3 years of training; longer if courses taken part-time; 600-1000 clinical hours!
    BS/BA to MD/DO: 4 years med school + 3-5 years residency: 7-11 years of training; not possible part-time; clinical hours > 17000″

  33. bob says:

    DPTs are not trying to increase their scope of practice or be called doctor in a clinical setting. Use a better example.

  34. Confused says:

    Interesting, DNPs can prescribe, refer, etc????? I wonder what the AMA will say about this. What did the AMA say about NPs when that degree was first started.

  35. Kris says:

    I graduated with a B.S. in Chemistry with honors. Phi Beta Kappa. I worked 3 years doing clinical research. I sacrificed a whole summer for studying the MCAT. I made it through the gauntlet of medical school admissions. I survived two years of basic science training- I dissected a cadaver, remastered biochemistry, obsessed over pathology, memorized microbiology. I learned each speciality one at a time: cardiology, hematology, neurology, rheumatology, dermatology, pulmonary, nephrology. I sacrificed a whole summer on Step 1. I worked 80 hour weeks as a medical student and squeezed in time for studying. I passed each shelf: internal medicine, family medicine, general surgery, psychiatry, neurology, ob/gyn. I delivered babies, I used a giggle saw to do a BKA, I saw bypass surgery, I coded patients, I learned to share bad news, I’ve sat in a darkroom and learned to read films, I saw an autopsy for a murder, I sat in the back of an EMS truck, I performed countless of prostate exams/hemoccult tests until I could feel a prostate nodule. I mastered scut work. I wore a short white coat. I enjoyed 4th year. I traveled the country for interviews. I anxiously awaited for match day. I matched. I finished AOA. I survived intern year. I survived 30 hour work shifts without sleep every fourth night for a whole year. I’ve ran numerous codes, placed central lines, gained access, performed lumbar punctures. I learned to be an upper level. I learned to teach medical students. I learned to lead. I survived residency. I matched into fellowship.

    Anyone can call themselves a doctor. But not anyone can be a doctor.

    1. MBBS to MD says:

      Well said.

    2. NewMD says:

      PERFECTLY STATED! I have a similar history to yours (including Phi Beta Kappa and B.S. in Biochemistry [SCL]) so I will not rehash what you have already stated. I will add that my entire senior year of the advanced biochemistry curriculum in undergrad was condensed into a 3 month course in med school (with the addition of more material related to medicine). Do the math and one “year” in medical school becomes the equivalent to a 3.25 year course of study in any other field’s curricular tract) Not to mention, this was one of 11 courses that we had to juggle at the same time (this was only first year). I will not even comment on the exams. One thing that gets lost in all of this is the fact that the MCAT is designed to prevent the lower 99% of IQ levels into a US allopathic school (medical students are purported to be in the top 1% of IQ, so they are told). We endured the hell of it all because we knew that some day the sacrifices would all pay off. Any ‘D’NP who asks me to recognize them as “Dr.” can shove that request straight up their a.s.s. They have NO CLUE just how pretentious that is (ask any NP/RN–>MD/DO). And that “just because I have a doctorate I should be called Dr.” line is BS. Just ask any Juris Doctor how he or she is addressed in court. “Your Honor, how DARE you not call me ‘Dr.’ … I worked hard for that doctorate.” Case dismissed.

  36. Confused says:

    @Kris

    And yet, now even nurses can be doctors.

  37. Eric says:

    From the first few sentences, I can see where this is going…

    “On one hand are the proponents, who argue that the doctoral-level degree focused on the clinical practice (as opposed to a PhD, which prepares nurse researchers/scientists)”

    LOL

  38. Karlee says:

    Kris-your arrogance is what makes “doctors” so approachable to patients?

    How many patients will tell the truth to their nurse but not doctor. Yes, thats right you get the whole clinical picture and nurses do not.

    As a PGY-1, I am eagar to work with NP’s. There are several staff RN’s that I work with now that are going to be wonderful NP’s. Honestly, they can tell when someone is going bad before MDs/DOs can. They hours that they spend with patients can’t be compared.

    Like it was mentioned above, most NPs are NOT trying to perform surgery or diagnose cancer – they wish to provide solid primary care. Are the extra “thousands and thousands” of extra clinical hours really necessary to diagnose strep and ear infections, prescribe birth control, or manage diabetes?

    Why aren’t you yelling about physical therapists? Their degree is DPT which is DOCTOR of Physical Therapy. Are you offended by that? Are you threatened by that? What about Podiatrists or psychs?

    The emotional and arrogant responses here only show your own feelings about your clinical incompetence. If you are as good as you claim, you will not feel the need to attack others or proclaim your greatness all the while restricting primary care to thousands of people you will never even meet.

    SDN – get real and write non-biased articles insted of this dramatic crap.

  39. jaja says:

    How many 30s do RN/NP/DNP pull throughout their training? How many pager calls are they getting to manage the “simple” stuff or being woken up for insignificant lab values. How many hours away from family do they spend? What’s the cost of their tuition?

    You get the point…

  40. DNP lol says:

    Karlee,

    As a PGY-1, I suggest you take some time to understand exactly what is going on with DNP’s.

    Why are we not talking about physical therapists? As Bob said, DPT’s are not trying to increase their scope of practice. They’re not saying they are as capable as a physician (MD/DO) while receiving significantly less training. They don’t expect to be called “doctor” in a clinical setting the same way MD’s/DO’s are.

    DNP’s wish to provide solid primary care? That is complete B.S. What DNP’s want is the recognition and pay of a physician without putting in the hard work. If DNP’s want to fill the PCP gap, why do they have “residency” programs in bread-and-butter specialties (derm, pain management, ortho, etc.)?

    If they want to be a doctor so badly they should either pursue an MD/DO, or lobby for DNP schools to change their curriculum to mimic medical schools, institute board exams, and require legitimate residencies.

    I have a question for you Karlee. Would you trust somebody that just finished their third year of medical school to be your primary care provider? If your answer is “no”, then why would you trust a DNP? As Kaushik pointed out, by the time a medical student enters their fourth year of medical school they already have a more thorough basic-science background and more clinical hours than a DNP.

  41. MM says:

    Karlee,
    There are NPs who have no interest in diagnosing cancer, however, there are several who DO want to diagnose cancer. In fact, they want to assume all the same rights and privileges that physicians do without putting in the necessary training. That is what this discussion is really all about. It isn’t about doctors hating on nurses, it’s about quality of care. Being a PCP is more than managing diabetes and hypertension. It’s being able to recognize whatever comes through the door. That type of expertise comes only from years of exposure and training, not from a few hours behind a computer screen combined with about 6 months of clinical hours.

    I enjoy working with NPs also and I think they are an essential part of our health care system but they have their place and we have ours. Our jobs are not equivalent.

  42. john says:

    Give ‘em full practice rights, damnit. As soon as their patients start getting effed up, people will be able to differentiate between DNP’s and physicians.

  43. Mike says:

    Haha Karlee, I didn’t know telling the truth = being arrogant. What is arrogant about all the training Kris mentioned he/she and ALL MD/DO students go through?

    Also you mention that for nurses “the hours that they spend with patients can’t be compared.” Uhh, YES they can, and nurses fail miserably. That has to be the funniest quote I’ve ever heard. Who do you think the MD/DO students are spending their clinical hours with? Now for another one of your quotes:

    “Are the extra “thousands and thousands” of extra clinical hours really necessary to diagnose strep and ear infections, prescribe birth control, or manage diabetes?”

    First off I want to say that I LOVE how you put quotes around the “thousands and thousands” of clinical hours, as if it isn’t important or as if you don’t believe it. In order to practice medicine competently you need to put in the hours, no shortcuts. Nurses want the title “doctor” and want to wear white coats but don’t want to put in the extra work involved, so what do they do? Make a half-assed degree that does nothing but confuse the public and make nurses feel better about themselves. Go look at the curriculum for a DNP degree: online classes, fluff classes mostly and basic if any hard science.

    Are there aspects of medical care (treating diabetes, ear infections, strep) that REQUIRE the medical training of an MD/DO? No but for the 95% of cases that are routine and simple, there will be that 5% of complications and unexpected problems that require the expertise of a doctor.

    Let me end this by mentioning that DNP’s from Columbia’s program, supposedly the cream of the crop, had a nearly 50% fail rate pof a WATERED-DOWN version of Step 3, the EASIEST exam a medical student is required to take. Let that speak about the quality of DNP’s.

  44. 4winns says:

    The few people I know pursuing the DNP are doing so because it is becoming a requirement for teaching at University programs.
    They also may be doing so because it (DNP) may become a requirement to become a “nurse practitioner”.
    I would not use the title “doctor” on the floor as it could confuse patients.
    I do not agree with above posters that nurses are looking to be doctors. It is simply a PHD-like degree, and if a nurse on your floor wishes to further their education, you should support it. It benefits patient care.

  45. DNP lol says:

    4winns,

    They want fully autonomous practice rights, want to be called “doctor” in a clinical setting, and want to prance around in a white coat. Yet you believe they are not looking to be doctors?

  46. Kris says:

    I am not diagnosing “strep throat” I am making sure it is not croup or H1N1. I am not diagnosing left arm numbness, I am making sure it is not a stroke, or myocardial infarction, or a peripheral neuropathy. I am not diagnosing lower extremity swelling, I am making sure it is not a CHF exacerbation or a DVT.

    Until you have trained like a doctor you will not know how to think like a doctor. Anyone who thinks they can autonomously make complex-medical decisions without the training a physician endures is arrogant.

    1. NewMD says:

      well said

  47. IAMMD says:

    Karlee, are you sure you are a PGY1 and not a noctor, because if you are really a resident than you would realize how difficult “diagnosing strep throat, managing diabetes, and prescribing birth control” are. BOOKS have been written on those
    individual subjects.

    When I was in med school, I saw no less than 5 cases of scarlet fever, in kids who were misdiagnosed with a viral illness but actually had strep throat. If you are not really a doctor, let me tell you, in this day and age of antibiotics, 5 cases of scarlet fever is very unusual. And strep is actually not that hard to diagnose, even if the patient doesn’t have classic sx, as soon as it crosses your mind, especially in a child, get a rapid strep test and culture. That wasn’t done. Managing diabetes is much more complicated. and OCPs while seemingly pretty easy to manage, are not that benign of a drug and have many contraindications and complications.

    I am not a primary care doc, but a “super” specialist, and one of the reasons I decided to pursue sub-specialization is because I can’t possibly imagine having to know and manage the wide variety of thing a primary care doc has to. So if doctors with tens of thousands of hours more of training than NPs have difficulty keeping track of everything and have a much more analytical education, why would NPs with their “history of nursing theory” classes be better at it.

    Again, then answer to fill the primary care gap is not to fill it with underqualified people (sort of like plugging a hole in the hoover dam with dry wall) but to create more incentives to go into primary care or to equalize the pay scale among physicians, (being a specialits, I suggest increasing PCP salaries, rather than decreasing specialist salary :-D)

    Furthermore, if NPs/CRNAs etc. so desperately want autonomy, let them have it with all that that entails, malpractice insurance, absolutely zero physician oversight etc. If they and the government want to continue down this path, let them burn themselves once and they won’t do it again.

  48. RealMD says:

    I am not trying to be inflammatory, but giving a “doctor” title to anyone who wants one diminishes the title to those who truly earn it. The “doctor” of DNP is not the same as the “doctor” of MD or PhD. Why not call it what it really is… a masters-equivalent?

  49. RN-DO says:

    As a RN, BSN, EMT-I attending a DO school I have been exposed to the DNP. I am supporter of more education but calling everyone a doctor confuses the patient. Having defined roles in the healthcare system is required. The term nurse describes the type of care provided.

  50. Duh! says:

    Anyone with an MD or DO:

    If you want a title that distinguishes physicians from DNPs, just start introducing yourself as a physician. It’s that easy! If you have an MD/DO then you ALREADY have a protected title.

    Nurses can be doctors.
    Psychologists can be doctors.
    Dentists can be doctors.
    French literature professors can be doctors.
    … but only an MD/DO can be a physician!

    1. NewMD says:

      It is the context in which the title is used that matters, not the degree itself. Yes, a nurse can also have a doctorate; however, when used within a hospital/clinic setting, the title is assumed to mean MD/DO. It is the public which has bestowed this honor to MDs/DOs, not the physician him/herself.

  51. Mr. Bean says:

    Is there a doctor on the plane? I can see a DNP raising her/his hand very slowly. LOL

  52. Uh....duh says:

    “If you want a title that distinguishes physicians from DNPs, just start introducing yourself as a physician. It’s that easy! If you have an MD/DO then you ALREADY have a protected title.”

    That’s the entire basis of the controversy….”Doctor” in a clinical/hospital setting is synonymous with “physician”. Opting to choose “physician” will do nothing however having nurses calling themselves “doctor” will mean that patients assume they are a physician because the term physician is associated with the term doctor.

  53. Just Don't Know says:

    This is ridiculous. I think that the DNP is ridiculous any nurse who has one better not be going by the title of “Doctor”. I am a nursing student who was considering furthering my education by getting a graduate degree in nursing but if I have to get a DNP I may change my mind. Some of my fellow nursing students hate me for this, but I know that DNP does NOT equal Doctor. Maybe I should consider becoming a PA…

  54. bob says:

    “Sorry to disappoint you but PA schools are also looking at creating a Doctorate degree. I think a few schools already have. I have said this many times. It’s ok for Podiatrists, dentists, chiropractors, psychologists, Pharm-D’s ect. to get doctorate degrees but the world ends if a nurse does it? Those are all clinical doctorates. We spend just as much time in school as other clinically prepared doctor’s, maybe even more. We’ll call them Dr. with no problem though. Mind boggling :-/”

    I think you fail to understand that just because you spent as much “time” in school as other doctoral degrees does not even remotely mean the rigor and amount of material covered was even close to being the same. How many dentists are able to hold down a part-time or full-time job while going through school? Are the degrees online for a dentist or DPT? Are there online courses and degrees for DNPs? Absolutely! So, no the whole “I spent 4 years post-undergrad” just doesn’t fly when you can complete that “degree” online while working and your courses consist of “nursing theory” and other fluff classes that have nothing to do with increasing your clinical abilities. I’m sorry the DNP degree just pales in comparison to every other doctoral degree out there.

  55. BananaManWill says:

    with Duh!….

    Yup, and when I go to a dentist, I’m pretty sure my doctor has a DMD or DDS. And when I go to history class, I’m pretty sure my doctor is a history major with a PhD. Or when I go to rehab, I’m pretty sure my doctor specializes in physical therapy. When I go to a KISS concert, I know that Gene Simmons really is Doctor Love.

    Yet… in the hospital, everyone is going to be a doctor!!! Please watch what will happen to us in the near future…

    Really guys, this whole thing CAN be resolved if we only use the term NOCTOR! And limit the scope of practice of DNPs to what current NPs can do right now.

  56. Lovanurse says:

    Sorry to disappoint you but PA schools are also looking at creating a Doctorate degree. I think a few schools already have. I have said this many times. It’s ok for Podiatrists, dentists, chiropractors, psychologists, Pharm-D’s ect. to get doctorate degrees but the world ends if a nurse does it? Those are all clinical doctorates. We spend just as much time in school as other clinically prepared doctor’s, maybe even more. We’ll call them Dr. with no problem though. Mind boggling :-/

  57. pre-med says:

    On a personal level, it doesn’t seem fair to have nurses called doctors. On the other hand, there are millions of uninsured people and a huge foreseeable demand for primary care that towers the supply. I think organized medicine is a culprit for the huge debts in health care. Why the prestige or income for doctors? Is that more important than having enough good health care for the country? Looking it from a health economy point of view, DNP seems like a sound alternative to break the pattern of more debt and less care. Why not be like France where doctors don’t have a large income benefit over other professions, yet everyone has coverage + access. just some thoughts…

  58. BananaManWill says:

    @ Lovanurse…

    Sorry, I guess I wasn’t direct enough in my last point. You become a “doctor” of any specialty when you are an expert in that area, such as a Doctor of Dental Medicine, Doctor of Podiatry, Doctor of Physical Therapy, etc. When you become a “Doctor of Nursing Practice” and you compare it with the training and scope of practice of a Doctor of Medicine or Doctor of Osteopathy, can you really say you are an expert in the field of medicine? That is what is misleading. When I go to have a medical problem treated, I want to have someone with the most training and expertise in medicine…. not nursing. The curriculum will tell you that MDs and DOs are experts in the clinical setting (although far from perfect, they do have the most training according to the set standards). I don’t think anyone reading these posts would disagree. That is why I am opposed to calling them a doctor in the clinical setting.

    Also Lovanurse, when you go to see one of these other clinical doctorates, are you not aware of where you are going? I go to the podiatrist to have my ingrown toenails removed. I go to the physical therapist for physical therapy. I go to the dentist for cleanings. People are aware of their surroundings when they go to these clinical specialties, and therefore associate them with being experts in that field. If you went to an emergency room and had a “Doctor” treat you… are you truly getting an expert if that person is a nurse?

    Now, my previous posts will tell you that I fully support an advanced practice nurse, and if the nursing community wants to raise their standard and make it a doctorate level degree… FANTASTIC! Good for them for raising the standard. Same goes for PAs. But please don’t tell me they are experts in medicine and just as qualified as a Doctor of Medicine or Doctor of Osteopathy.

  59. . says:

    “It’s ok for Podiatrists, dentists, chiropractors, psychologists, Pharm-D’s ect. to get doctorate degrees but the world ends if a nurse does it? ”

    Physicians, dentists, pods, pharmacists, etc earned their title by taking rigorous classes in sciences. DNPs take laughable curriculum because they have no knowledge or basis for understanding actual science.
    Do nurses take gross anatomy, biochemistry, physiology, pharmacology? Do they have anything that compares to the rigor and workload involved in clinical rotations?
    Actually educating a physician requires more than: ailment A gets treatment B or symptom X gets labs Y and Z.

    “Those are all clinical doctorates. We spend just as much time in school as other clinically prepared doctor’s, maybe even more. We’ll call them Dr. with no problem though. Mind boggling :-/””

    The problem is that the function of a nurse and the function of a physician is significantly different. Nurses practice nursing and doctors practice medicine.
    If DNPs want to practice medicine, they should have attained the degree which enabled them to.

  60. Lovanurse says:

    Whoa!!!! I fell asleep while I was getting smashed at my comment last night! LOL. (1). The scope of practice IS the same as a MSN-NP. The additional education is focused on research and practicing using evidence-based practice. (2) @ pre-med you make a good point. (3) @ Mr. BananaMan I’m sorry if you have ever seen a nurse practitioner and no one let you know that it WAS in deed, a NP. And I don’t know where people are getting there information from regarding the type of class’s DNP’s take. Our degrees, all 4 of them, are science based. And Clinically matches or even supercedes that of our peers. However, it is no where near a physicians education. A podiatrist knows when something is out of there scope of practice, and refers to a MD. So do I. I don’t pretend to know something I don’t. So, the next time your in a ER or dr.’s office, please, by all means wait for a physician to treat your sore throat or minor stitch. I’m sure he’ll be busy handling strokes, acute MI’s, gunshot wounds ect. He’ll be glad to service you in about 9 hours when he’s finished. Won’t take anything outta my pay. And with millions of newly insured patients, one day you’ll be grateful for the MSN-NP and DNP because primary care isn’t paying off physicians loans. Please see link below for my DNP education.

    http://sentry.rmu.edu/web/cms/academics/snhs/nursing/Pages/dnp-family-nurse-prac.aspxhttp://sentry.rmu.edu/web/cms/academics/snhs/nursing/Pages/dnp-family-nurse-prac.aspx

  61. Lovanurse says:

    @ Bob. By no means, am I going to start a DNP vs. MD education war. And anybody who thinks the education is the same is silly. It’s no where near the same. Im on your side. However, I am gonna demand the same respect as other clinically prepared doctors. I worked my a** off to obtain the degrees that I have and like it or not, nobody can take them away. I am professionally trained to assess, diagnose, treat, and prescribe for conditions in MY SCOPE OF PRACTICE!!!!!! As I said above, if you don’t like nurses having terminal degrees, don’t deal with them. I understand that their are some bone head DNP’s who want to portray themselves as MD’s. And they should have their license revoked, as far as I’m concerned. But as for me…. Hi I’m Dr. Lovanurse and I am a nurse practitioner, how can I help you?

  62. Sam says:

    Can you supersize the DNP degree?!

    I think the world is going crazy and this is just another symptom.

    We should make things really interesting. How about “Become an astronaut in 6 months…online”

    I think that the DNP degree is great just as long as it’s called the “Doctor Non-Physician” degree.

  63. bob says:

    “However, I am gonna demand the same respect as other clinically prepared doctors.”

    I’m sorry, you’re not going to get it when your degree is a watered down version of everything else out there and can be completed largely online. Respect is something that is earned through hard work and dedication. Not taking open book exams on a saturday afternoon from your computer.

  64. CommonPatient says:

    Hi Dr. Lovanurse. You can help me by getting my physician. After that, you can continue to help me by knowing your role as a nurse and completing all the things my physician ordered for my health care. Thanks! =)

    If you want to “assess, diagnose, treat, and prescribe for conditions”, go to medical school. If you want to “assess, diagnose, treat, and prescribe for conditions” under the SUPERVISION of a physician, go to physician assistant school. If you want to deliver basic everyday health care prescribed by physicians, go to nursing school. If you want compete with physician assistants but with less education in the sciences to properly assess, diagnose, treat and prescribe for conditions, become a nurse practitioner. If you want to put your “advanced practice nurse” degree to good use, go manage your fellow nurses and make sure your units are running efficiently to SUPPORT the physicians who are doing the assessing, diagnosing, treating, and prescribing for conditions.

    Every health care professional has their role. Everyone seems to know their roles except APRN’s. If you’re not happy with the role that YOU went to school for, then go to a different school and get the PROPER education and credentials to do something else.

  65. vanbamm says:

    This makes no sense. Redundancy exists between the DNP, NP, PA…they all do the same thing. And, the DNP will be treating cases for perhaps the very first time that an MD and DO have seen numerous times in residency- scary. What this is going to do in the long run I would suppose is oust one of those three professions as they become underutilized and people start to figure out which one is the easiest route to the higher income. Then the other programs enrollment will fall and the program will be dropped as it stops bringing in revenue to the school. Funding will then go to support and nurture whatever program comes out on top.
    But really- no residency. Nonsense.

  66. bob says:

    Do you want us to golf-clap for your N=1 example?

  67. Derek says:

    To those who recommend the use of the word physician, that makes sense in an educated world. Most people don’t know what that means though. Besides, podiatry has already started to use Podiatric Physician.

    The doctor=MD distinction is over.

  68. bob says:

    Also your “I treated more patients on vents in the ICU than residents” example is bogus. You worked as a RN NOT as a physician or NP. Your responsibilites differed during this experience. That’d be like me saying my 7 years working as an EMT/ED tech is equivalent to working as an ED physician. Ive “treated” many MIs, but I am not foolish enough to say this experience is even remotely equivalent. Sorry, working as an RN even an ICU RN is NOT equivalent experience. You were NOT overall responsible for the patient’s treatment plan, no matter how much you think you were the person calling the shots. Do you also think that flight attendants should be allowed to fly planes because they have spent countless hours on a plane and watching? Seriously, this logic is so jacked up, that arguing with you people is pointless. It is like arguing with a 3rd grader.

  69. 789456 says:

    “I am professionally trained to assess, diagnose, treat, and prescribe for conditions in MY SCOPE OF PRACTICE!!!!!!”

    No you are not. Watching Kobe and the Lakers play every game of the season doesn’t mean someone can play basketball. Watching the physician diagnose and treat patients doesn’t mean that you can either.

    “Hi I’m Dr. Lovanurse and I am a nurse practitioner, how can I help you?”

    You really can’t.

  70. shelleyTheNPfutureDNP says:

    I am an NP and soon to be DNP. I am going to school to complete my DNP. The type of training and amount of hours in school and amount of time you read books doesn’t translate into being a competent physician.

    I have met many, many physicians whose skills and knowledge base is actually less than the NP’s and DNP’s that they work with. As an NP I am able to treat COPD, CHF, an MI, asthma, pneumonia, DM, HTN and countless other diagnoses just as well (if not even better) than my physician colleagues. I can also do certain procedures like paracentesis and arterial lines just as well as any physician.

    Just because you complete a certain degree (MD) and training (residency) by no means says you are more competent than a DNP in real world experience.

    Physicians some how get the arragont idea that the only way to treat lets say a CHF exacerbation is if you go through 3 years of residency. There are more than one way to learn how to treat something. I have been an ICU nurse for 7 years before I will get my DNP. I have treated more septic patients and patients on vents than any doctor who went through residency and does a one month rotation in the ICU every year. To be honest, I wouldn’t trust a lot of those residents with my life.

    In my own experience and the experience of other DNP’s, there have not been any more adverse outcomes from treatment from a DNP than a physician. If you ask patients, many of them prefer a DNP as we have a lot better bedside manner and communication skills than a lot of physicians. Making the diagnosis is important, but communicating to your patients also is.

    My goal once getting out of school is to be a hospitalist. I don’t intend on being a hospitalist any differently than my physician colleagues who have also chosen to be a hospitalist. I will get the same pay, see the same number of patients, and have the same clinical responsibilities as the physicians. In the end, my care of hospital patients will be just as good as a DNP as a physician.

    We are all here with a common goal, to treat sick patients and get them better. If an NP or DNP is able to do it just as well as a doctor, that is all that matters. Why the fuss?

  71. bob says:

    “The DNP with time, in the very near future will get compensated the same as physicians for providing an equal service. This is a fact. Once the DNP is allowed to practice independently, insurance companies and Medicare will pay them the same as a physician for an equal service.”

    Annnnnd the truth comes out. It was never about saving money and serving the underserved. Shocker? I wouln’t count on this btw, many NPs are making 1/2 the wages of a physician in the same specialty. Why in the world would a patient or anyone for that matter want to pay the same and go to someone with inferior training?

  72. CommonPatient says:

    “I have met many, many physicians whose skills and knowledge base is actually less than the NP’s and DNP’s that they work with. As an NP I am able to treat COPD, CHF, an MI, asthma, pneumonia, DM, HTN and countless other diagnoses just as well (if not even better) than my physician colleagues. I can also do certain procedures like paracentesis and arterial lines just as well as any physician.”
    Classic noctor who’s trying to equate their degree in NURSING with a degree in MEDICINE.

    “I have been an ICU nurse for 7 years before I will get my DNP. I have treated more septic patients and patients on vents than any doctor who went through residency and does a one month rotation in the ICU every year. To be honest, I wouldn’t trust a lot of those residents with my life.”
    I certainly hope you have seen more patients on ventilators working in the ICU for 7 years than a resident doing a one month rotation in the ICU because if you didn’t, then there is something wrong with that hospital. Of course you’re comparing yourself to a resident. I find it hard to believe that you can treat an ICU patient on a ventilator just as well or better than a critical care attending physician who has done a residency in internal medicine and a fellowship in critical care/pulmonary medicine. Also, if you don’t trust a resident physician (who is still in training), how would you expect anyone to trust a nurse who took online courses in nursing theory and health policy?

    shelleyTheNPfutureDNP, your logic is laughable. You and your APRN colleagues who are pushing to practice medicine and not nursing are not on the same team as any of the other health care professionals. Do you want to go beyond the scope of nursing? Go to medical school. Quit trying to take shortcuts. Have some pride in your CHOSEN profession which is nursing.

  73. Mr. Bean says:

    To me DNP programs look more like course work required for a degree in sociology or public policy but NOT medicine. Bottom line, if you prefer to practice medicine, go to medical school and get your MD or DO. I hope legislators will see right through this program but they seem to always surprise me. :)

  74. john says:

    @Shelley – what an arrogant piece of work. how would you feel if a phlebotomist one day walked into the ICU and proclaimed that, since he had been there for 25 years, and had seen the treatment of many patients, that he was qualified to be an RN in the ICU?! That is essentially what you are saying about DNP’s and physicians, and it is frankly frightening.

  75. DNP=LicenceToKill says:

    What’s scary in all of this is that I actually do think the noctors believe they are equivalent to physicians. If a np tries to say that nursing experience is actually somehow equivalent to a residency then how can anyone take what they say seriously? Somehow they’ll make up for their clinical deficiencies by taking online courses in business management? None of this makes any sense. Let’s call a spade a spade…these NPs are people who wanted to be real doctors but didn’t have what it takes to get into medical school. I pray for our future patients, and will do my best to inform the public of the dangers that NPs are posing upon them.

  76. john says:

    What drives me crazy is that the noctors keep saying overtly that they in no way want to be physicians, and that they are not equal, and therefore should not be compared, etc. Then they ask for more and more physician practice rights, physician pay, the physician title (Dr.), etc. What the hell is it? Either admit that you just want physician jobs without the work of becoming a physician or STOP trying to reach beyond your scope. This is getting me really worked up.

    It would be painful, but maybe better in the end if noctors got full practice rights, effed up a few hospitals/patients, and got sued out of existence.

  77. haha DNP! says:

    Shelley if you think you should get the same pay and have the same scope as any other MD/DO Hospitalist, your nuts. The bottom line is you should not ever be close in salary as you will work under his license vicariously and he will assume the risk inherent in your ‘lack’ of training. Though these advanced practice nurses have place in the healthcare system (i.e. diagnosing sore throats at walgreens). They do not belong in hospitals until they can sit down and pass the equivalent licensing exams as a physician. IF you think you learned A to Z of how to be a top not Hopsitalist by working in an ICU for a decade, then take all of the steps of the USMLE or Comlex and take a Board Certification Exam. The day DNPs can do this, the day will have my respect as proficient autonomous clinicians.

  78. CommonPatient says:

    @shelleyTheNPfutureDNP
    I’m a tech in the ICU and was a phlebotomist. I’m going to go start a bachelors in patient care technology and will fight to have all the privileges of a registered nurse. Since I have all that experience working in the clinical setting assisting nurses, I must have the skills and thought process to do everything a nurse can do. I can push medications, start intravenous lines, transfuse blood, etc, all on my own. These new R.P.C.T (Registered Patient Care Technicians) are going to be needed badly in the future because most R.N.’s are going to go off to nurse practitioner school.
    Does that sound absurd to you? I certainly hope so for the sake of all patients.

  79. shelleyTheNPfutureDNP says:

    Some comments:

    1. We DNP’s are not going anywhere. As a matter of fact, the DNP revolution has just started. We are a brand new type of provider that has just started up in the past decade but is sure to grow and grow as health care changes.

    2. If you think that we are going to get our DNP and just sit in a Walgreens and hand out Z-packs for a cold, you are crazy. Not one of us is going to get our doctorate for that. As an NP, I can actually work independently in some states doing that.

    3. We can and will be called DOCTOR. For those of you who don’t know, the D in DNP does stand for DOCTOR. In no way, shape, or form is it incorrect to introduce ourselves as doctor, nor is it wrong for patients to address us as doctor. As a matter of fact, it is the correct thing to do. If we introduced ourselves as “nurses”, that would be misrepresentation.

    4. Of course there ARE limitations to what a DNP can and can’t do. All of the DNP’s know this. We will never do cardiac caths. We will never do brain surgery. We will never do a hip replacement. We will never do a colostomy. We know that and know our limitations.

    5. At the same time, there are many things we are capable of doing. We can function independently as primary care physicians. We can function independently as hospitalists. There is nothing in our training our licensing that precludes us from doing this.

    6. Most states (if not all) within the next 10 years will grant DNP’s the right to work independently without direct physician supervision. We are NOT the equal of a PA. A PA will always require direct physician supervision. We have obtained a higher degree.

    7. Hospitals within the next 10 years will grant DNP’s full privileges just like any MD or DO. That means they can admit and follow patients without any physician supervision.

    8. There is an overall arrogant belief because we have a different training, it must not be equal. I would like anyone to please show any verifiable studies that have shown more adverse outcomes of patients treated by DNP’s as opposed to MD’s / DO’s.

    9. The DNP with time, in the very near future will get compensated the same as physicians for providing an equal service. This is a fact. Once the DNP is allowed to practice independently, insurance companies and Medicare will pay them the same as a physician for an equal service.

    10. All of you physicians who are so bitter just need to get over it. There are still some MD’s who resent DO’s. There are physicians who went to Harvard who look down on the physician who went to the State U for med school and the State U grad who looks down on the foreign medical grad. Of course it is no different and as a DNP, we know there will be physicians who resent us. All of this bickering and resentment is not doing anyone any favors, certainly not patients. We should all learn to work together and achieve the best patient care we can. No reason to harbour all of this anger.

    1. MBBS to MD says:

      May the God bless your patients.. lol

  80. DNP=LicenceToKill says:

    Shelley sounds like she suffers from a huge napoleon complex. Facts are facts…your online public health courses do not provide you with the knowledge to treat patients effectively. You are not primary care physicians because you are not a physician at all, you went to nursing school. You want to confuse the patient for your own benefit so you can call yourself a doctor and you want to expose them to sub-par clinical treatment…this is an incredibly malicious and selfish way to approach life.

    I do think that the np movement will balance itself out. Their malpractice and overhead costs will skyrocket and most np programs are degree mills…the market will be saturated with these pseudodoctors and market forces will drive their pay down. I’ve already seen a huge upswing in the lawsuits brought towards NPs, lawyers are salivating because it’s easy to prove how undertrained NPs are.

  81. IAMMD says:

    @shelley, if the DNPs will get the same pay as physicians and work in the same locales, than in no way does the AANAs platform of increasing access and decreasing costs is truthful, in fact what they are doing is creating an undertrained workforce that will lead to worsening healthcare costs, because in their infinite ignorance, autonomous mid-levels will get a chest CT for every person coming in with shortness of breath and an MRI for every patient with a headache.

    I have in the past encouraged my patients to leave their NPs as PCPs, of course it was always in the context of missed diagnosis, or an inappropriate admission. To be sure there are some quite functional NPs out there, but not one would I trust with my family’s or my own health in lieu of a doctor.

    All of the things you mentioned, colostomies, caths, etc. requires specialized training, and many doctors aren’t even qualified to do that. NP’s/PAs etc can do simple procedures like thoras and paras, but the doc is always there for the part where the needle goes into the patient. However, even the most basic medical diagnoses and treatment, HTN/DM/CHF have layers upon layers of complexity.

    I bet you could not even think of the differential diagnosis for new onset HTN in an adult patient right now, which every MD/DO graduate knows regardless of specialty. Do not bother writing it here, because you could just as easily look it up, which I recommend you do so you don’t kill whatever poor sot ends up seeing you as their PCP.

  82. James says:

    @ all of you DNP’s that are posting on here, how can you expect the same amount of responsibility as an FP and the same pay, when the hours of training are in the order of ****tens of thousands of hours**** less than a family physician. If you want to have all of this responsibility, you should have to earn it. In my opinion you should all be crying out for more rigorous training so you aren’t the laughing stock of the medical profession.

    And @ shelley — how on God’s earth is it wrong to introduce yourself as a nurse? Yes the first letter stands for doctor…but what does that second letter stand for??It is more misleading to introduce yourself as a ‘doctor’ without clarifying, because most people associate that with being a physician. Which, no matter how much you would like to be one, you are not and probably never will be.

  83. Andrew says:

    In regards to Shelley’s point #2: “If you think that we are going to get our DNP and just sit in a Walgreens and hand out Z-packs for a cold, you are crazy. Not one of us is going to get our doctorate for that.”

    Since when are antibiotics (like a Z-Pack) handed out for viral infections?

  84. bob says:

    “You can’t find any study that shows this because it has never been proven that the care provided by an DNP is inferior.”

    It is not our job to prove DNPs are inferior, it is the job of the DNP to prove they are equivalent. Your group is the one making the claims of equivalence, so therefore your job to prove equivalence. And I am not talking about generic studies where DNPs take the easy patients and turf the hard ones to physicians or have physician backup.

    “2. If you factor in the practical, real world experience we get before going to DNP school, we actually have more training hours (and more medical training) than doctors.”

    HAHAHAHAAAHAHAHA the fact that you even think this is remotely close to being true proves you have absolutely no idea and it is pointless to continue this discussion. You are delusional.

  85. DNP=LicenceToKill says:

    “So noctor, can you tell me if my ct scan shows if I have cancer?”

    “Uh, well…I’ve never actually learned anatomy or how to interpret CT scans. I can tell you about how much it will cost to treat you though! And yes I do take credit card.”

  86. justaquestion says:

    Shelly,

    just a question..Why didn’t you go to medical school..

    I have just finished my first month in the ICU as a resident and our nurses were great and taught me alot. However, there were a handful of instances where it was painfully obvious that my 4 years of medical school and only 1 year of residency have prepared me to function on the same level as an ICU nurse with many more years of experience.
    Yes, you probably know how to treat various forms of shock, MI, infections, and many other issues that you have seen because you have followed a protocol that told you what to do. However, if a patient’s condition veered from the norm it is a whole different story. The art of MD/DO medicine is understanding the physiology well and knowing what has gone wrong — it does not lie with following protocols that require no real decision making or thought process. I still have 3 more years to go in a rigorous program of 80 hour work weeks for 50 weeks a year (I am an OB/GYN resident) and while I have learned alot from the nurses that work with me and our patients; they understand how the hospital works and what to do in a particular situation — but they don’t understand “the why” of what is going on — and you must admit that this is true.
    There are no short-cuts in life, no short-cuts in medicine. Just remember when you start admitting and treating patients on your own, “without physician oversight” as you put it — there is no protocol or list of tests to run.
    And here is a fact — there will be more lawsuits from DNPs identifying themselves as “doctors” and then something goes wrong. My next door neighbor is a one of those ambulance chasing type of lawyers (his words, not mine), he was licking his chops as I told him about this new degree becoming more popular.

    1. RN to MD trauma surg says:

      So are you stating that nurses do not think critically? Yes there are protocols set in place; however, must I remind you as a physician that these are also there to remind a physician to address all aspects of orders? I cannot believe the garbage and hate being posted here. I have several ivy league attorneys in my family, non-ambulance chaser types, that think your claim is ridiculous. Hospitals are the writers of policy in what a person can be referred to. If someone is attempting to say that they are practicing as a medical doctor and truly are a DNP then yes, this would be illegal. Calling yourself Dr. Xxx when you have a doctorate in nurse practitioner is no different than a pharmacist being deemed a doctor, a veterinarian being called a doctor, or a physical therapist being called a doctor… Oh, and podiatrists and psychologists.

  87. 789456 says:

    shelly, would you mind listing the curriculum for your DNP? Is any of it related to medicine/science?

  88. MD Student says:

    Better yet shelleyTheNPfutureDNP, tell us what program you are currently or will be enrolled in.

  89. Mr. Bean says:

    shelleyTheNPfutureDNP “We can function independently as primary care physicians.”

    In that case, wouldn’t you be misrepresenting your self since you are not a physician. I think that would be illegal. ;)

    Andrew says:
    April 16, 2011 at 4:48 pm

    In regards to Shelley’s point #2: “If you think that we are going to get our DNP and just sit in a Walgreens and hand out Z-packs for a cold, you are crazy. Not one of us is going to get our doctorate for that.”

    Since when are antibiotics (like a Z-Pack) handed out for viral infections?

    I think it has been established that she does have equal or if not superior medical skills then a physician. ;)

  90. shelleyTheNPfutureDNP says:

    some more comments to ponder:

    1. We do get certified to practice. At the end of our DNP training we take a certifying exam. It is particular to our training, so of course we don’t take the same exam as doctors. In addition, different kinds of doctors take different exams. Cardiologists take their own exam, orthopedists take their own, dermatologists take their own, and on and on. They are still all practitioners none the less.

    2. If you factor in the practical, real world experience we get before going to DNP school, we actually have more training hours (and more medical training) than doctors. All DNP programs require real world training at hospitals by the nurses, most of them spent either in the ICU or in the ER. While I was taking care of septic patients on ventilators, the med school students were in the biochemistry class learning the Krebs cycle. Not which is more practical to the real practice of medicine?

    3. I challenge anyone and I mean anyone on here, please provide me one study that shows that the care given by a DNP is inferior to and MD or DO. Please show me one study that says that there are more adverse outcomes from care by a DNP. You can’t do it. Oh and I don’t mean any comments like “I know an NP who ordered an MRI for a headache who didn’t need to.” Or challenges like “can you name the differential diagnosis of hypertension?” I want a real study that was done that shows this.

    You can’t find any study that shows this because it has never been proven that the care provided by an DNP is inferior.

    1. MBBS to MD says:

      You forget the fact that , all those sub-specialities you talk about, they undergo the the basic undergraduate training to become a doc, and then go to their chosen field, therefore they ARE capable of handling any situation that comes under the description of medicine and surgery to the extent that they are trained in the med school. Do the DNP provide the same training?

    2. MBBS to MD says:

      i don’t think there are any studies of the sort that you ask for are done yet.. Why don’t you do 1 and tell us the result… the honest result..

  91. haha DNP! says:

    Shelley,

    If you demand studies, I reply with this:

    The absence of proof is no not proof of absence.

  92. DNP=LicenceToKill says:

    I’ve worked with Shelley’s type in the hospital, they’re so insecure with their inferior training that they respond with insane statements (yeah, well I was a nurse! And, uh, that’s the same as being a resident!). Get real. I’ve seen a few NPs throw absolute childlike temper tantrums because no one on the team really takes them seriously. I had one np stuttering after I told him he that he misread an EKG as afib (and I was only a 3rd year med student). I really do wish there was some magical world where people with lower academic credentials and less training were somehow equivalent, but unfortunately I live in reality.

  93. Mr ok says:

    Having an advance degree does not change the scope of practice. the path is BSN—-MSN—DNP, you still a nurse. you are caring not treating. Don’t confuse yourself. The board of nursing describes the scope for nurses( ADN, BSN, MSN, DSN or DNP). if any body suffer from a virus being a “Dr.” Go to Med schools. you go to nursing schools to become a nurse not a primary care physician. I am a nurse now, but i will go to med school to change my scope of practice. i am not crazy enough to go nursing school and claim being a “Dr”. My brother is an mechanical engineer and just got his doctorate “PhD”. Even he becomes crazy as those NPs he will never change his practice to claim himself be something else such architect or astronaut.

  94. 789456 says:

    Guys, I doubt Shelly is reading these long posts.

    So simply put:
    Shelly, if you were a doctor, you’d be a doctor.

  95. BananaManWill says:

    Noctor Shelly needs a hug :-)
    Let us all join in and give a big group hug to Noctor Shelly.
    Wow… I just realized, the auto-correct function on my web browser now recognizes the word “Noctor”! Success.

    I think the lack of studies comparing physicians to DNP graduates does not exist because it would be like comparing apples and oranges.

    Oh, and Noctor Shelly, I really am interested in your curriculum. Can you please post a link to the school you attended? If you are worried about identity, post two or three DNP programs. And throw yours in with the best ones!

    I like this one, from Capella Online….
    http://learning.capella.edu/default.aspx?v=nursing&eng=Google&WT.srch=1&DFAID=1&gclid=COPn8sHKoqgCFdI42godCylyHw
    I hope you are not from North Dakota, because their residents are not eligible to enroll :-(

    Oooh! Or what about this one from the “University of Phoenix Online”? You can see all types of online DNP programs here!!!!
    http://www.bestnursingdegree.com/programs/online-doctorate-in-nursing/

    Unfortunately, the community college I went to wouldn’t even accept credits from most of these schools.

    Finally, Noctor Shelly, this might come as a bit of a shock, but the Kreb cycle, which if understood, could help explain several causes of respiratory failure that put your ICU patients on a vent. I would say that is actually quite relevant to the “real practice of medicine” because (Psssst *soft whisper*) that’s what medicine is about…. solving problems and fixing them. *still soft whisper* we don’t want to keep them on the ventilator…. so we have to figure out how to get them off.

    I’m going to get a Noctor Pepper. It’s the off brand copy of Dr. Pepper.

  96. CommonPatient says:

    “All DNP programs require real world training at hospitals by the nurses, most of them spent either in the ICU or in the ER. While I was taking care of septic patients on ventilators, the med school students were in the biochemistry class learning the Krebs cycle. Not which is more practical to the real practice of medicine?”

    While MS3’s, MS4’s, residents, and attendings may not remember the specific steps of the TCA cyle, it is still a concept upon which everything they are expected to know are built. While the med students are studying this and learning the BASIC sciences of MEDICINE first, you are in the ICU learning how to follow orders of physicians. This very statement you made clearly shows the lunacy of your logic.
    While most of your “real world” training are spent in the ICU and ER, medical students rotate throughout all aspects of medicine (not nursing like yours) during their 3rd and 4th years. Then after all of that, they finally begin the grueling training in the specialty they choose.

    From your very own words everybody can see that NP’s education is vastly inferior to a DOCTOR OF MEDICINE. Your education is in NURSING. NURSING education does not need nor will ever need a doctorate level. I would even argue that it doesn’t need a master level. You are truly an insult to the real nurses out there who are doing one of the most noble professions one can do: taking care of patients.

    Where I work, nurses who are on leave because they injured their backs and shoulders turning and transferring patients are just salivating with the thought of going back to bedside. Whereas you, abandoning your colleagues, are making your fellow nurses work more with less man power. You are simply a nurse playing doctor.

    By the way, you still haven’t listed your curriculum or the program you are in. You tout your nursing education comparing it to a physician’s education; show us your “hard” classes you have to take.

  97. Mike says:

    I’m pretty sure Shelley is a troll… claiming that nurses have more clinical training hours than physicians? That part is so laughable that you can’t even argue with her or that kind of logic.

    Now, if Shelley is who she says she is, there is no need to worry. She will screw up so many patients that malpractice will be all over her in no time.

    Hey Shelley whatever happened to providing a more “cost effective” form of care? Please explain how your kind will save more money if you’re demanding equivalent pay? When you pay for a doctor, you are NOT paying for a service, you are paying for the expertise which can only be had by the years and thousands of hours of clinical training hours and basic science.

    Since DNP’s are claiming equivalence with physicians, the burden of proof is upon them to show they are just as effective, not the other way around. I don’t blame you Shelley, you nurses do need to rely on physicians for everything.

    Please show me a study, we are all waiting. =)

  98. kosmo says:

    Shelley, I have an idea that has not really been set forth on this post. I wanted your take on where all the knowledge you are using to practice “medicine” comes from. You were in the ICU managing sepsis, ARDS and on and on, who do you think defined those afflictions? Who designed studies to determine how best to treat those problems which created the flow charts you so admirably followed? I am confident in saying that you have no role in furthering medicine and our understanding of it because your education is not based in underlying mechanisms and pathogenesis, you will do what DOCS tell you to do because you have no other choice but to follow their recommendations. Who determines the “standards of care” you will need to meet as an autonomous DNP? You will follow flow charts, algorithms and concepts distilled and synthesized by DOCTORS either PhD or MD/DO. You should be proud of your education, you have achieved more than most by attaining a masters-like degree, but do not put yourself on equal footing with those you follow blindly in practice because you have not the power to see, your education simply does not allow it.

  99. IAMMD says:

    Now shelley may be right in saying that nurses have more “clinical hours” than a medical student, however 1)that stops being the case after even a 3 year residency of around 80 hours a week x 6 days, even allowing for the fact that some of the 3 year residencies are around 60/70.

    2)Nursing clinical hours consist of changing bed pans, wiping butts, and in the ICU pushing drugs the doctor ordered and paging the resident everytime the vent settings become out of whack

    again I have a great relationship with nurses (even NPs though in a sub-specialty practice they function as little more than clinical aids) I work with, I learned a lot and have been saved by them many times because they are really at the bedside more than us, but I dislike having a person with a masters degree (which is all a DNP really is) telling me they are equivalent to me, and more importantly I dislike having to fix their mistakes.

  100. Bob says:

    I’m a nurse in CRNA school. I support indy practice for allied health professionals, because I believe they are intelligent enough to consult others for help as needed. I won’t get into the educational differences between NPs, CRNAs, or other allied health (non-physician) systems of education – but even I can see multiple flaws and arrogance in Shelly’s post.

  101. Mr. Bean says:

    If Shelley and the likes want more responsibility and autonomy, let them have it. With that comes huge liability. I just hate to see a patient suffering as a consequence.

  102. Mr. Bean says:

    This is from Capella University:

    The DNP degree program is not a clinical degree program and is not designed to prepare advanced practice registered nurses for roles as nurse practitioners, clinical nurse specialists, certified nurse midwives, or certified nurse anesthetists.

    Field Experience Requirement: Minimum of 1,000 field experience hours.

    Residency Requirement: One five-day residential colloquium (DNP-R8016 – DNP Residential Colloquium).+

    Courses (each course 4 quarter credits unless noted)

    All courses taken in the following sequence:
    DNP8000 – Theoretical Foundations and Applications*
    DNP8001 – DNP Field Experience 1*+ – 1 quarter credit
    DNP8002 – Contemporary Issues in Advanced Nursing Practice*
    DNP8003 – DNP Field Experience 2*+ – 1 quarter credit
    DNP8004 – Investigation, Discovery, and Integration*
    DNP8005 – DNP Field Experience 3*+ – 1 quarter credit
    DNP8006 – Policy and Advocacy in Advanced Nursing Practice*
    DNP8007 – DNP Field Experience 4*+ – 1 quarter credit
    DNP8008 – Executive Leadership and Ethics in Health Care*
    DNP8009 – DNP Field Experience 5*+ – 1 quarter credit
    DNP8010 – Management in Advanced Contemporary Nursing*
    DNP8011 – DNP Field Experience 6*+ – 1 quarter credit
    DNP8012 – Nursing Technology and Health Care Information Systems*
    DNP8013 – DNP Field Experience 7*+ – 1 quarter credit
    DNP8014 – Global Population Health*
    DNP8015 – DNP Field Experience 8*+ – 1 quarter credit
    DNP8016 – DNP Capstone 1*
    DNP8017 – DNP Field Experience 9*+ – 1 quarter credit
    DNP8018 – DNP Capstone 2*
    DNP8019 – DNP Field Experience 10*+ – 1 quarter credit
    DNP-R8016 – DNP Residential Colloquium*+

    Source: http://www.capella.edu/schools_programs/public_service/dnp/nursing_practice.aspx

  103. kara says:

    How about everyone just SHUT THE HELL UP…who the hell cares…instead of fighting each other, you guys should combat the illnesses and diseases that plague the world…goodness…We are our worst enemy, if we all can just put our intelligent minds together, I’m sure this world would be a better place.

  104. Alex says:

    First of, I’d like to commend Shelly for posting her unpopular opinion on such an obviously (DNP) unfriendly site.
    1)I think NP’s do have a place in the US health-care system; I think that they are the perfect practitioner for treating patients with chronic conditions in clinics.
    2)There is an article written by the A.N.A. that states that there isn’t much difference in the outcome of patients treated by NP’s compared to patients treated by MD’s. That being said, the article was biased and it did have some logistic problems.
    3)By 2015 the A.N.A wants all NP’s to have a doctorate degree but it does not specifically state what skills they should be taught or what differentiates the DNP’s from NP’s who only have a certificate.
    4)Nursing theory is impractical (eg. an approved NANDA diagnosis is: Energy Field Imbalance)
    5) This article is interesting because it brought together the MD’s and DO’s that would normally just be feuding in the forums.

  105. Darth Nightingale says:

    Couple points from an RN who is considering being a NP.

    1. The NP concept is evolving and can play a valuable role in primary care. I personally would want a board certified physician in my back pocket when I practice as an NP. And not any ol’ MD either. As an RN who’s been around, I trust few physicians that do not have a bit of grey hair.
    2. Since most of you aren’t RN’s you don’t see our point of view. I work in a teaching hospital, and when I look at the incompetence of many of the resident’s, there is a part of me that say’s “I could do that.” I routinely save my patients from them. I‘ve worked in regular hospitals too where I once had a patient who was a friend of someone who’s father had TB 35 years ago and the patient got an ID consult from a board certified IM doc. I could do that too. (not that I would)
    3. The major thing nursing school really teaches is how not to kill a patient when you get your first job. The bulk of an RN’s knowledge comes from OJT so I think a lot of us feel we could “ learn as we go.” The flaw with that thinking is simply, that in order to get to the next level of anything field, you have to train with and compete against those better than you. For that reason I do think the DNP concept asinine. Nurses can’t teach nurses how to fulfill the role of a physician.
    4. We don’t see the argument that our hours as nurses don’t count. The good nurses like me don’t like to do anything unless we understand why we are doing something. Each day I work as a nurse I am learning things that will help me as an NP because I make a conscious effort to do so.
    5. Not every nurse does that. Some simply just do as they are told because of “doctor’s orders” and “tag and bag” the patient the next day because they are not inclined to be more rigorous and know why they are doing something. (Yup I’ve seen this.) I think therein lies the single most valuable aspect of the MD/DO route and why I distrust the DNP movement. The MD/DO pathway selects out the non-rigorous types.
    6. On the other hand, does anyone want a life or death decision made for them by a 23 y/o physician with 3 years experience a faux-hawk and rolling on2 hours of sleep in the last 36? (see point 2 above)
    7. My post is too long so I’ll shut my pie hole now.

  106. shelleyTheNPfutureDNP says:

    1. It is funny how the pre meds, residents and whoever else here is saying that the care is so inferior from a DNP because of lack of training, less hours, etc. but they have no hard, firm proof to back up their claims. Again PLEASE show me a study with worse outcomes by DNP vs MD/DO. Oh and telling me that it is my responsibility to prove the DNP is an equal………no it is not. All of you are making the claims that the DNP is inferior, so back it up with some evidence.

    2. As a DNP, we absolutely can be called doctor and introduce ourselves as such. We don’t need to say “Hi, I am Dr. of Nursing Shelley” any more than a physician needs to say “Hi, I am Dr. of Medicine Smith” or a dentist “Hi I am Doctor of Dentistry Smith” or a podiatrist “Hi I am Doctor of Podiatry Smith.”
    We earned our degrees and have a right to be addressed by our title, which is DOCTOR. The physicians want to degrade us even more by not letting us use the title we have earned.

  107. Superman1978 says:

    1: ShellyTheNPfutureDNP I have some issues to point out. As you well may have noticed, the number of DNP programs have exploded in the last 5 years. Very little data is going to be available (check that: compiled and available) to compare the levels of care between a physician and a DNP. However, as the article pointed out, there is no consensus regarding the training of DNP’s. This is a HUGE issue. How does a patient know that your DNP degree is equal to that of somebody else’s? Secondly you claim that it is NOT your responsibility to prove that DNP’s are equals and I say YES IT IS. With more emphasis than I can muster I have to suggest this. The overall lack of training suggests that the degree is inferior. And because I just pointed out that all these programs are vastly different, there are going to be vastly different DNP’s with different skill sets.

    2: When one introduces themself as a doctor in a dentist office, I think one can reasonably assume he/she is a dentist. When one does that in a podiatrist’s office, I think one can assume they are a podiatrist,etc. When one introduces themself as a doctor in a hospital, the patient is going to assume that he/she is a physician. DNP’s are NOT physicians and by saying that you’re Doctor such-and-such, you are alluding to something that isn’t true. There are many professions that need a doctoral degree but they don’t come off all half-cocked because now they’re a “doctor” (I immediately think of DPT’s, but there are several others as well).

  108. DNP=LicenceToKill says:

    Shelley, I thought that your online statistical analysis courses would have taught you something about how evidence based medicine works, but I guess even this is something better handled by a physician. You want hard evidence about something that can’t be proven, the majority of NPs work with physician backup, no matter how independent they think they are. The most independent NPs are the ones taking the easiest patients, and again cannot be compared to real doctos that are trained to deal with anything. There have been studies that have shown NPs drive up the cost of healthcare by ordering more tests…but it never was about saving money, it’s about the right to be called doctor to save your fragile ego.

    Of course, there is also the common sense notion that someone with lower academic credentials and online training would provide inferior care.

  109. MD Student says:

    Hey Shelley. What classes are you taking for your DNP? What’s your curriculum? What program? Any of it science based which is essential to practice medicine? What is the ratio of your science courses to others such as health policy, nursing theory, and statistics?

  110. DNP=LicenceToKill says:

    BTW, for all the noctors that are actually trying to suggest that nursing experience is like a residency, a lot of these np programs can be entered with NO nursing experience. Our patients are suffering at the hands of these quacks and it’s important that we get the message out there so that patients aren’t fooled into thinking that they are being treated by a real doctor.

  111. 789456 says:

    rofl

    “Field Experience Requirement: Minimum of 1,000 field experience hours.

    Residency Requirement: One five-day residential colloquium (DNP-R8016 – DNP Residential Colloquium).+

    Courses (each course 4 quarter credits unless noted)

    All courses taken in the following sequence:
    DNP8000 – Theoretical Foundations and Applications*
    DNP8001 – DNP Field Experience 1*+ – 1 quarter credit
    DNP8002 – Contemporary Issues in Advanced Nursing Practice*
    DNP8003 – DNP Field Experience 2*+ – 1 quarter credit
    DNP8004 – Investigation, Discovery, and Integration*
    DNP8005 – DNP Field Experience 3*+ – 1 quarter credit
    DNP8006 – Policy and Advocacy in Advanced Nursing Practice*
    DNP8007 – DNP Field Experience 4*+ – 1 quarter credit
    DNP8008 – Executive Leadership and Ethics in Health Care*
    DNP8009 – DNP Field Experience 5*+ – 1 quarter credit
    DNP8010 – Management in Advanced Contemporary Nursing*
    DNP8011 – DNP Field Experience 6*+ – 1 quarter credit
    DNP8012 – Nursing Technology and Health Care Information Systems*
    DNP8013 – DNP Field Experience 7*+ – 1 quarter credit
    DNP8014 – Global Population Health*
    DNP8015 – DNP Field Experience 8*+ – 1 quarter credit
    DNP8016 – DNP Capstone 1*
    DNP8017 – DNP Field Experience 9*+ – 1 quarter credit
    DNP8018 – DNP Capstone 2*
    DNP8019 – DNP Field Experience 10*+ – 1 quarter credit
    DNP-R8016 – DNP Residential Colloquium*+”

    lololol!

    A child could pass this curriculum and become a DNP.

  112. Lovanurse says:

    I’m done arguing with you crazy kids. I’m not gonna sit here and discount the Medical Degree because that’s not what I’m about. I appreciate a good Medical Doctor because alot of them precepted me with great integrity. I do want to mention, for anyone who is on here to get truthful information, that none of the core didactic courses that I’ve taken for my DNP were done online. Some of the people on here are misinformed. I posted my educational outline and we go to class, labs, and do rotations at hospitals and doctors offices just like any other clinical doctor. If these people (you know who you are) are a clear representation of how our future MD’s are gonna portray themselves, then their attrition rate for patients will be on a fast decline. Doctor is a term used for any profession. It is not designated for physicians only. So GROW UP and quit acting like 2 year olds. MINE, MINE, MINE!!!!!!!!!!!!!!! Good Luck in your future endeavors.

  113. DNP=LicenceToKill says:

    There’s nothing misinformed about these posts, the laughable curriculum that NPs take for the right to be called doctor has been posted directly from the school’s websites. I think the nursing students that are posting on here really don’t have an idea of what it takes to become a real doctor…their view of a doctoral program is doing a google search on nursing theory while having Oprah on on the tv in the background. Of course anyone who is gifted and well rounded would rather be an MD, an np is just a backdoor method to appease these inexperienced nurses’ egos.

  114. shelleyTheNPfutureDNP says:

    Of course there should be equal pay for equal work.
    How funny some of you med students and residents get upset for suggesting that.

    A quick example, I am going to be a hospitalist after I get my DNP. (Yes, a hospitalist just like any MD or DO is a hospitalist).

    Lets say I see a patient for a COPD exacerbation. I INDEPENDENTLY round on the patient for the 3 days they are in the hospital. I bill for the visit. I prescribe meds such as steroids and nebulizers and oxygen. I may even do an ABG myself, and bill for this.

    You really think that Medicare or insurance companies and not going to reimburse me (a DNP) the EXACT same thing that a physician (notice I say “physician” and not doctor, as a DNP is also a doctor) will get reimbursed?

    Considering that very soon, most states will say by LAW that a DNP can practice independently without physician supervision, then the insurance companies and Medicare will be obligated to pay me as a hospitalist exactly the same thing that my physician colleagues are billing for.

    1. MBBS to MD says:

      Lets say I see a patient for a COPD exacerbation. I INDEPENDENTLY round on the patient for the 3 days they are in the hospital. I bill for the visit. I prescribe meds such as steroids and nebulizers and oxygen. I may even do an ABG myself, and bill for this.

      Is steroids and nebulizers and oxygen are all what a COPD needs???? sigh….

  115. Mr. Bean says:

    Don’t get me wrong, I love nurses. However, a nurse pretending to be a physician, not so much. It is like a construction worker pretending to be a civil engineer because he has worked in construction for several years and has watched a civil engineer intently.

  116. IAMMD says:

    @shelley,

    again I have to point out that all this independent practice stuff that is being pushed for by the nursing groups is on the platform of “lower cost, and more access” the implication being that NPs/CRNAs and other mid-level providers will practice autonomously but in areas in which there are fewer physicians (rural) and for less money (i.e. lower reimbursement). If NPs get paid the same as doctors and want to work at the same places as a doctor, than there will be a lot of unemployed NPs as no hospital in their right mind would hire an NP when an MD is available. And Medicare can certainly reimburse you less for that COPD patient as you will be doing it while practicing “nursing” while the MD/DO will do it while practicing “medicine”. So before making inflammatory statements like you have been, perhaps check with your local union leader.

  117. Mr. Bean says:

    “You really think that Medicare or insurance companies and not going to reimburse me (a DNP) the EXACT same thing that a physician (notice I say “physician” and not doctor, as a DNP is also a doctor) will get reimbursed?”

    The main reason the health care system is eager to utilize non-physician providers is to cut costs. Therefore, it would be counterproductive if they paid these non-physicians the same. Insurance companies are not idiots. They a fully aware of the fact that your education is incomparable to a physicians. Does that make sense Shelley?

  118. medstudent says:

    Thank you Mr. Bean! you took the words right out of my mouth

  119. shelleyTheNPfutureDNP says:

    1. As regard to cost, an NP or a PA is a MIDLEVEL provider. Of course they will be much cheaper than hiring an MD / DO / DNP.
    One of the core reasons why NP and PA’s are hired is to save money.
    On the other hand, a DNP is NOT a MIDLEVEL provider. If by state laws it says they can practice independently, bill, and have hospital priveleges, that is NOT a midlevel provider. And yes, if they are NOT midlevel providers, and are a PRIMARY provider, they can bill the same for the same services an MD or DO does. A lot of you are confusing a DNP with an NP. That is like thinking an MD is the same as a PA.

    2. For years MD and DO’s had their differences. Many MD’s thought the DO’s weren’t as capable because of different schools, different degrees, different tests (USMLE vs COMLEX). A lot of MD’s didn’t want them in their practices or at their hospitals. With time this has changed and there is more and more acceptance by MD’s of DO’s. The exact same thing is happening with the DNP and I realize in the beginning it will be very difficult for MD and DO’s to accept. With time and experience working with us, the MD’s and DO’s will realize our fund of knowledge and clinical skills are equal to theirs and we will gain their acceptance. It will just take time. With time the MD and DO colleagues will realize that different education doesn’t mean inferior doctor.

  120. DNP=LicenceToKill says:

    Umm, DOs are accepted now because they follow a 4 year medical curriculum and take the same licensing exams as MDs (yes, DOs take USMLEs for allopathic residencies) Try again Shelley ;)

  121. Mr. Bean says:

    Shelley,

    Nice try! DO’s and MD’s go through a very similar or if not the same curriculum with the exception of the inclusion of OMM in the DO curriculum. You have to be insane to say that DNP education is equivalent to MD/DO education. In your curriculum I don’t see any science/medicine based courses. They are all administrative courses.

    “With time and experience working with us, the MD’s and DO’s will realize our fund of knowledge and clinical skills are equal to theirs and we will gain their acceptance.”

    You are simply delusional!

  122. MD Student says:

    Okay, there is something weird here. Shelley is claiming that DNP is the same as MD/DO but not the same as NP. Correct me if I’m wrong but isn’t the American Academy of Nurse Practitioners the one who came up with this whole DNP program? Isn’t there a resolution made by them that all NP will need to obtain their DNP by 2015? If I am correct in making this statement then Shelley is either a troll who’s talking nonsense just for fun or he or she clearly has no idea about what is going on in his or her own field.

    By the way, if DNP is really created by nurses to be the same as MD and DO, then the ones who came up with that idea are just as delusional as you. The man who founded osteopathic medicine was a PHYSICIAN, not a NURSE. His background was in MEDICINE, not NURSING.

  123. DNP=LicenceToKill says:

    I think Shelley needs to stop responding, she’s doing more harm for her cause than good. No informed patient is going to want to be treated by someone with the entitlement issues and inferior online training as these nursing students. Maybe that’s why they’re trying so hard to deceive patients and call themselves doctors, lol.

  124. Miguel says:

    even physicians that are not board certified after a X amount of years have trouble getting reimburse like board certified colleagues why the hell would the insurance company reimburse like a physician someone that didnt even go to med school or DO school?

  125. Lisa says:

    I truly do not understand the continued claims of NP and their right to be called doctor. As if the entire population are idiots, they feel the need to remind us over and over of the fact that one can obtain a doctorate in many fields. Yes, that indeed is true, as we all know. But we learn as small children that there is a commonly spoken dual meaning to the word “doctor” in the English language, and that is the MD/DO in the white coat who is going to provide medical care in a hospital/private office. These minds of these NPs are full of such denial that they ignore this massive point. In casual conversation, if one states, “I have a doctor’s appointment today,” any English speaker within earshot knows that person is going to see a medical doctor because he/she has some sort of medical problem. That person is not implying that he is going to see that Doctor of Philosophy at the local university or whatever. What is wrong with these people? I truly cannot believe the idiocy and that such a simple idea continues to be argued about.

  126. John says:

    As a medical student jumping through all the hoops to become a doctor, I wouldn’t mind working with and calling DNP “doctors” IF they went thru the same rigorous training as MD/DO physicians.

    In other words, I would want the following:
    1. Take the MCAT
    2. Take the same amount of hours of basic science course work (ie biochemistry, anatomy, pathology, pharmacology, etc) and clinical clerkships
    3. Take 3 levels of board exams
    4. Complete a minimum of 3 years of residency.

    Until all of these are done, I just don’t think it’s fair and right for DNP to have the privilege of autonomously treating patients.

  127. induction says:

    Well said John

    1. FutureMD? says:

      John I completely agree with you. Now I am not yet a med student so I do not pretend to understand the rigors of their work load, but I think that if a DNP wants equal responsibilities, pay, and title, then they need to comply with the same requirements that MD/DOs do.

      Isn’t it at least logical to require the same final exam?!

  128. Darth Nightingale says:

    Just stop using the term “Doctor” and be done with it. It’s pretentious. And what’s up with the white coats? Zap those too… and don’t get me started on the stupid bears, bunnys and bows that nurses have on their scrubs.

  129. blah says:

    Shelley, I can guarantee that you will have to identify yourself as doctor or nursing when you come face to face with a patient, masquerading in your long white coat. It will be the law for you to do so and if you do not, you can bet the farm that their will be repercussions.

    I don’t think we should worry too much about this though. Just wait until one of these Noctors really screws up; it will be all over the news and the public will demand that they see a qualified physician.

  130. blah says:

    (my bad on the typos… it’s late). Goodnight future doctors… and Noctors too.

  131. Lisa says:

    Regarding DNPs not being midlevel providers… I agree that Shelley is delusional! The nursing body creating a new degree (DNP) and mandating all its NP members to get it by 2015 does not suddenly make them primary, independent practitioners, and it certainly does not make them professional equivalents to physicians. If I’ve followed correctly, there will no longer be NPs after this change is complete, just DNPs… same job, different (unnecessary) degree. You can title DNPs and MD/DO physicians whatever you want, but the fact remains that physicians have far more knowledge of medical science and clinical application than DNPs.

  132. bob says:

    Shelley,

    You keep restating the same old argument over and over while completely ignoring what people have posted. When people are in a hospital and someone introduces themselves as “doctor” while wearing a white coat it is MISLEADING if you are a DNP and do not clarify. There is absolutely NO arguing with that. We should start placing bets on what you are going to say next since it has become a broken record. Wait wait, I know what you are going to say! “Physicians don’t own the title doctor, there are other professional doctorates out there! Therefore I can mislead the public by introducing myself as doctor in a clinical setting!” Carry on.

  133. shelleyTheNPfutureDNP says:

    No Blah,
    Actually you are wrong. Show me a law please that states that someone with a doctorate degree has to introduce themselves with the title of their doctorate. Yes, I can’t tell patients that I am physician. That would be misrepresentation.

    However, I can absolutely introduce myself as “I am Dr. Shelley, who will be taking care of you today.” There is no fraud or misperception in that comment. I never said I was a physician. It is true I will be taking care of the patient. In addition I earned a doctor degree and have every right to be addressed as a doctor.

    By your logic, then dentists, podiatrists, psychologists…etc. all have to introduce themselves by what their doctor is in? MD / DO’s are the only ones who exempt from doing this?

    Why are the MD / DO’s thinking they have an exclusive right to the title of doctor? There are multiple providers in medicine who have the Dr. in front of their name.

    Do you realize it wasn’t that long ago that a lot of MD’s wanted DO’s to introduce themselves as Doctor of Osteopathy to their patients and not just plain Doctor? How silly does that look now?

  134. Mr. Bean says:

    Shelley,

    Do pharmacists with a PharmD introduce themselves as doctors? No! By not giving the patient accurate information, clearly shows your intent. Your online pseudo doctorate is not going to hold.

  135. n@nners says:

    shelley, delusion doesn’t even begin to scratch the surface.

    You comments are simply stunning, not one person here has said that (dentists/OD/podiatrists/insert your favorite profession here)can not use the term doctor. You are supremely ignorant if you can not differentiate appropriate settings to where titles matter. As a future DNP, introducing yourself to patients as Dr_______ in a hospital without stating that you are a nurse practioner is 100% unequivocally misleading your patients into thinking you are a physician plain and simple. If you would like to conduct your own trial, walk into any setting with “DR” professionals (I recommend a college english class, that would be really fun) and tell the class you are Dr._______ ready to assist all those in need. Come back to this thread and tell us how many were able to say “well of course this person is a DNP, it is so obvious”

    There was a time when MD’s wanted DO’s to introduce themselves as such, but the DO profession has long established identical, (let me repeat) identical programs with identical curriculum except for classes pertaining to OMT, of course. The two professions are identical now not because one side has complained and lobbied for equal treatment claiming unfair suppression of talents, but because the educational pathways have become the same. The DNP curriculum is severely lacking in both rigor and substance and has been created as a money/power grab.

    Your blind and obvious need for validation is the black eye to your entire profession. I have worked with many DNP’s whom I admire but have unfortunately seen an increase in those like yourself.

  136. John says:

    I was under the impression that DNP were supposed to introduce themselves as “Doctors of Nursing”. I clearly remember reading this somewhere when I first heard about DNP, although I can’t find the article anymore. I’m sure it’s out there if you search hard enough.

    Another thing, why are there programs that allow DNP to practice dermatology. I thought the whole purpose of DNP’s were to fill in the primary care gap. This just shows that the DNP have an agenda and that they say one thing, but mean another.

  137. DNP=LicenceToKill says:

    Shelley’s lack of reading comprehension is probably why she wasn’t able to get into medical school and had to settle for being a mid level practitioner. She keeps posting the same thing that has already been refuted by every other poster on here.

    If one of these quacks even tries to lay a finger on anyone I care about I will be calling my lawyer.

  138. mrdoc says:

    Shelley,

    As far as I know there are no LEGITIMATE studies comparing the competency of DNPs to physicians. However I think this provides a reasonable comparison of their knowledge bases. DNPs were given a simplified step 3 and achieved a 50% pass rate. If DNPs want equal practice rights they should undergo equivalent training and demonstrate equivalent competence.

    http://www.ama-assn.org/amednews/2009/06/08/prl10608.htm

    “The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that are important in health and disease and that constitute the basis of safe and effective patient care.”

    Physicians typically have a pass rate in the high 90s. Oh… this was also a voluntary exam for DNPs, imagine if all of them had to take it!!!…

  139. bob says:

    Come on shelley, you’re grasping at straws. No DO students don’t HAVE to take the USMLE, but they DO have their own exam that very very closely mimics the USMLE in content and difficulty that is also 3 steps.

    Do DNPs have to pass any standardized national examination? Not at all. In fact! You guys had a watered down version of step 3 and only 50% were able to pass that. Did you know that most medical students don’t even study for step 3 and have a much much higher pass rate? That should tell you right there that DNPs absolutely do not even remotely have the same knowledge base. If they can’t pass an easier step 3, which is widely regarded as the easiest of the steps, can you imagine them trying to pass step 1?

    You are doing nothing for your cause but turning more and more people against DNPs. I suggest you quit posting.

  140. RealMD says:

    This is such a joke. Why are we wasting out time talking to nurses? I waste enough of my day dealing with them.

    It’s so obvious that if someone who wants to work in a hospital and be called doctor went to nursing school, it’s because (s)he was too stupid or too lazy to get into medical school. Plain and simple

  141. shelleyTheNPfutureDNP says:

    “If one of these quacks even tries to lay a finger on anyone I care about I will be calling my lawyer.”

    You may be a med student, but your lack of even the basic understanding of the law shows you certainly aren’t law school material.

    You realize that a DNP is a licensed practitioner who in many states (and soon to be many more) can practice independtly. The DNP can write prescriptions and see patients according to state medical board rules.

    DNP=LicenceToKill, as a poor med student you obviously are locked up all day just studying and have never had much if any of an opportunity to experience the real world. Anyone who has lived in the real world would know they wouldn’t jump to the phone to call a lawyer (who will bill you about $350 and hour) for a DNP seeing someone in his family.

    If you want to spend your $350 an hour on a lawyer for a frivolous casel, then go ahead. I guess you are a med student who has a trust fund from your parents to be able to afford that. Of course you will learn a hard lesson that you can’t sue a licensed practitioner for doing something that they are trained and licensed to you.

  142. Equality says:

    I will gladly call any DNP my equivalent if they pass USMLE steps 1,2,3 and a medical specialty board certification exam.

  143. John says:

    ShellyDNP,

    I think it’s great that DNP are trying to fill in the primary care gap, BUT what’s pissing off everybody is that DNP’s act as if they’re entitled to treat patients autonomously w/out going through the same hoops that other MD/DO’s did. The hoops are there for a reason. It’s to make sure that those who do become physicians are tested and trained thoroughly so that patients get the benefit of having a competent doctor taking care of them. Doctors have lives on their hand and even though medicine is not perfect, at least patients know that these doctors have been thoroughly trained. On the other hand, most people do not know about the training DNP’s receive. Maybe the training they do receive is adequate and maybe it’s not, but for the most part, most people do not know and that’s includes MD/DOs. As this article states, MD/DO get about 3-6x more postgraduate training. I suppose if DNP’s took the MCAT, all 3 USMLE Step exams and completed a 3 year residency, then we could say that DNP’s can be trusted to take care of patients. However, until there’s a standardized method of determining the competency of DNPs, MD/DO’s will fight.

    Also, using the MD vs DO analogy. Yes, MD’s did not accept DO’s initially, but that’s because they did not know the extent of their training. It’s when MD’s realized that DO’s have the exact same training (plus osteopathic manipulative meidicine) as MD’s that they could all work together to heal patients.

    Finally, Shelly, your trolling attitude is not going to change the views of the people in this forum. You can use brute force to try to get back at people, but it just makes you look petty and frankly doesn’t help the DNP profession look any better. It just makes all other DNP’s look like they’re bitter and petty and that they just want a piece for themselves w/o putting in the work.

  144. MD Student says:

    I never understood why some nurses and other health care professionals want to be on the same level as physicians. If a nurse wants more responsibility, go to medical school. It’s that simple. If a nurse wants more responsibility but would rather have the supervision of a physician, go to physician assistant school. Other health care professionals have increase the level of their education (DPT, PharmD, Au.D.) but none have wanted to or claim to practice on the same level as a physician. Only nurses have done this. If a CRNA wants to administer anesthetics independently, become an anesthesiologist. If a midwife wants to deliver babies independently, become an OB/GYN. If a nurse wants to work in a rural area and treat colds, hypertension, diabetes, etc, become a family doctor.

    Shelley, I mean no offense in any way when I ask you this but why? Why didn’t you just go to medical school? Simple question.

  145. MD Student says:

    Also, there is no point in a DNP ever having to take Steps 1,2,3 and specialty board certification exams because if that is the case, they would just go to medical school. DO’s are accepted because they essentially go through the same training and schooling as MD’s. Nurses are nurses and that’s what they do is nursing. And Shelley, there is no shame is just nursing. It’s a noble profession.

  146. shelleyTheNPfutureDNP says:

    Equality says:
    April 18, 2011 at 4:11 pm

    I will gladly call any DNP my equivalent if they pass USMLE steps 1,2,3 and a medical specialty board certification exam.

    This is repeated over and over again.

    I guess most of you don’t realize that most DO’s don’t take the USMLE. They take the COMLEX when they train at their own DO hospitals. I know this because I was an ICU nurse at a DO hospital for 2 years.

    I bring up this point to point out that the MD’s now accept the DO’s even though MOST of them have not taken the USMLE. (Some did who went to allopathic residencies).

    However, it seems like the physicians on here want the DNP to take a test, the USMLE, to be viewed as their equal, that most DO’s never took (and they claim them to be their equal).

    This logic is totally messed up.

    If you are an MD who can accept a DO who never took the USMLE, then certainly you can accept a DNP who takes their own specialty board.

  147. MD Student says:

    Shelley, your logic = FAIL. While I don’t know the statistics on how many D.O.’s take the USMLE, the fact is that D.O.’s can PASS the USMLE with their form of education (which is essentially the same as allopathic). DNP’s can not pass even a simple version of USMLE step 3.

    “Last fall, the National Board of Medical Examiners began offering the voluntary DNP test, based in part on Step 3 of the U.S. Medical Licensing Examination. Step 3 is the final stage in the physician testing series. In January, the Council for the Advancement of Comprehensive Care — a nonprofit nursing group that contracted with the NBME to develop the exam — announced the results of the first DNP certification test, with 50% of candidates receiving passing scores.”
    This is an excerpt from:
    http://www.ama-assn.org/amednews/2009/06/08/prl10608.htm

    So M.D. equals D.O. DNP does not equal M.D./D.O.
    M.D. PHYSICIAN equals D.O. PHYSICIAN. DNP NURSE does not equal M.D./D.O. PHYSICIAN.

    By the way, what’s your curriculum? What DNP program are you in? Why didn’t you just go to medical school? Questions still without answers…

  148. superman1978 says:

    Shelly,

    DO’s have the option to take the USMLE in addition to taking the COMLEX, a test considered equal with respect to licensing physicians. Your argument in this case is as weak as the rest of your arguments. Please, stop trolling. You are honestly making DNP’s come off as petty with an inferiority complex.

  149. Kate says:

    Shelley, many DOs take USMLE, but that is not the point. You can amend Equality’s challenge to say that nurses could be equivalent if they pass USMLE or COMLEX, because that is the standard to which physicians are held. They are equivalent exams that award the same privileges once passed. What do you think about that? Can DNPs succeed at either of the physician licensing exams? I will be surprised if you actually respond to this head on instead of using avoidance tactics. Why don’t you and your classmates step up and produce some concrete results in the form of test scores to prove that you know as much as physicians?

  150. Mr. Bean says:

    Shelley,

    Please do yourself and your profession a favor and not compare DNP to MD or DO. COMLEX is equivalent to USMLE. Just because you took a few courses online on healthcare administration, social justice and public policy, doesn’t equate you to a physician. Now, go to your room!

  151. Putting In My Time says:

    Shelley,

    I believe the issue lies with the lack of an equivalent exam for DNPs. Is there a certification exam (save completing the program) that DNPs are required to take and pass? If not, the argument for MD/DO being roughly equivalent holds, as COMLEX is considered roughly equivalent to USMLE. I should note, this is not the same as a specialty exam, as an autonomous caregiver needs to have a foundation in all areas.

    The issue seems to be centered around the disparity in training hours between MD/DO programs and DNP programs. I have not read anything about differences in outcomes (if you know of any, please let me know). I would be interested in knowing the answer to the question MD Student posed. Why not go to medical school? It seems that your primary motives are :

    1) equal recognition
    2) equivalent pay
    3) autonomy

    There are a number of physicians who have put in a lot of hours and learned/experienced a lot more to get to the same point. Is there a clear reason outside of “it took less time, money and effort,” that one would pursue the DNP? Nevermind the title of doctor. It seems to me that unless there is a clearcut, logical answer to my question above, the DNP undermines the efforts of physicians. This alone should point to a clear difference in “doctor of medicine” and “doctor of nursing.”

    Just my two cents.

  152. Kate says:

    “It seems that your primary motives are :

    1) equal recognition
    2) equivalent pay
    3) autonomy

    There are a number of physicians who have put in a lot of hours and learned/experienced a lot more to get to the same point. Is there a clear reason outside of “it took less time, money and effort,” that one would pursue the DNP? Nevermind the title of doctor. It seems to me that unless there is a clearcut, logical answer to my question above, the DNP undermines the efforts of physicians. This alone should point to a clear difference in “doctor of medicine” and “doctor of nursing.””

    This is an excellent point and I would love to hear an answer from you, Shelley.

  153. Equality says:

    Ok, Shelly. I’ll take your NP exam and you can take my board exam. Let’s meet up later and compare scores and see who knows more.

    Afterwards, we can go on rounds together and show patients these scores and ask them who they would rather call doctor.

  154. Ridiculous! says:

    I am an undergraduate social sciences student in Asia. After reading this article, I am VERY proud that my country does not permit nurses from making independent diagnosis.

    No one would refute the fact that the nursing students at my (elite) university are intelligent, but they are not medical students and are not being trained to enter independent practice. A quick search of some American DNP programs tell me that they a) have little or no science coursework b) look much closer to a continuing education program in medical sociology c) severely lack academic rigor.

    http://www.georgiasouthern.edu/majors/14020.htm
    Follow the above link. 3.0/4.0 GPA? 83/120 on the TOEFL IBT? I’m sorry prospective DNPs, but this is just pathetic beyond belief. Let us mourn the deterioration of American healthcare.

  155. Michael says:

    Nevermind the advanced phase of training…. Let’s look at the beginning of training for future doctors and future nurses. The classes pre-meds take are much more involved/advanced. I am sorry, but doctors have a skill set that nurses will never have because, from Day 1 in college, the training/education a future physician receives is far more advanced.

  156. bob says:

    Shelley,

    Did you even bother to look at the article and see the number of clinical hours that each position accrues on average? You keep restating the same tired argument that all of us have already ripped apart. This tells me you have no idea what you are talking about and are incapable of debating this matter.

  157. shelleyTheNPfutureDNP says:

    Well all these physicians are so hung up on “We take the USMLE and you don’t.” and “You couldn’t pass our boards”…… blah blah blah.

    You all remind me of immature college kids who like to brag about their SAT scores. Well, once you are in college your SAT scores matter no more.

    The same thing with you residents and interns. Who cares what you got on the USMLE if you have no clue how to take care of sick patients on the floor of the hospital. On the USMLE you were able to regurgitate back the Krebs cycle or some cellular biology from your basic science classes. Do you realize that has no bearing on how you do taking care of sick patients, yet you continue to hold on to your glory of passing the USMLE and somehow think that makes you competent.

    I will give you some real examples. I am an ICU nurse at a major teaching hospital. (For all I know some of you reading this are the very residents I am talking about).

    1. I call a resident. I tell him “Your patients abdomen is getting more and more distended. It is painful to palpation. He is now vomiting.” He tells me “Oh just give him a dulcolax suppository”…… I get firm with this resident and say “He is getting obstructed, you need to come see him right now, you understand?” The next thing I know this patient is in the OR 6 hours later for a major bowel obstruction.

    Do I care that this resident passed the USMLE? Does it make any difference? This resident couldn’t know a bowel obstruction if it hit him in the face.

    2. I call a resident about a tachycardic patient. I say “Dr. Resident, your patients heart rate is 170.” The resident asks, “Is he anxious? Maybe he needs ativan?” I tell him “You need to get your butt here NOW, before this patient codes.” He tells me “Just give him fluids.” By this time I want to wring his sorry neck. “I tell him, he has CHF and if you give him fluids you will kill him.” Finally he comes. Next he tells me it is sinus tach. I tell him no it is SVT. At this time, I have had enough and just page his attending directly.

    Now does it matter again that this resident passed his USMLE? He is just another cocky resident that I had to put in his place.

    Now ask, who would the patient rather have taking care of them, a DNP who has practical experience dealing with real patients in real clinical scenarios or a physician who thinks they are entitled because they have passed the USMLE that covers basic text book science that is not applicable to real world medicine?

  158. superman1978 says:

    “Now ask, who would the patient rather have taking care of them, a DNP who has practical experience dealing with real patients in real clinical scenarios or a physician who thinks they are entitled because they have passed the USMLE that covers basic text book science that is not applicable to real world medicine?”

    Okay shelly the troll. Does a patient want a provider that goes through the motions because they’ve merely seen it in the past or do they want one that KNOWS what’s going on? Those things are taught because they ARE applicable to real world medicine. The foundations they lay result in an understanding of disease processes. The two examples you’ve mentioned were from residents, who we’ve mentioned abundantly are still in TRAINING. Board exams ask whether a future physician has met the requirements to START examining patients.

    And, you make my case for me. You mention that these two residents made mistakes. And that’s AFTER stringent testing before they are allowed to work with patients. I won’t even go into the pink elephant in the room regarding the 100’s of other residents that have been fine. Or the pure anecdotal “evidence” you give considering your insistence on showing real statistical evidence.

    But considering the amount of training involved with making a physician, it’s obvious that mistakes happen. Often by lack of training in clinical care. And since you mentioned it, since a DNP needs a mere fraction of the same experience before they can work, what makes you think that a DNP is better qualified? Or more qualified? If a physician with 1000’s of additional hours of training can make a mistake, what chance does a DNP have?

    And let’s call a spade a spade here. The only reason that DNP’s are even being considered anywhere to be allowed to practice without the supervision of a physician is due to the lack of physicians in primary care. That is it. If there were an abundance of PC physicians then this would never even be brought up. You claim that DNP’s deserve all these rights, etc. If a lot of states start allowing DNP’s to practice without physician supervision, then I pray you are right. Because if the rest of us are correct in our apprehension to have a less trained (in the science and the clinical aspect) provider, then people will die. I hope that I may be wrong but you are talking about people’s lives here!!!!! Don’t think you deserve all the rights and privileges of a physician based on “personal experience”.

    Being cautious about DNP’s in many aspects is the right course of action until you can show with unequivocal empirical data that a DNP has no more cases of malpractice than the average family physician.

  159. Kate says:

    Additionally, Shelley, the level of USMLE that can really be called into question here is step 3, which is a clinical exam (though of course physicians integrate their basic science knowledge to make clinical decisions) for which there has been a direct comparison in the form of practicing NPs taking a modified version. As we all know, half of the NPs failed. What’s particularly troubling about this is that these were practicing nurses. USMLE/COMLEX are minimum competency exams for physicians, and without passing them they cannot practice.

    I don’t find it particularly useful to compare yourself to a new resident, either. They are just beginning the thousands of hours of training they’ll undergo as a physician. And absolutely no one can argue that a nurse who can attend one of these advanced practice programs and earn a degree without having actually worked as an RN is anywhere near as prepared as a new resident. The difference in clinical hours and science education is vast.

  160. n@nners says:

    Shelley your type is all too common. The stuck up resentful nurse who thinks they can be a physician because of your nursing experience.

    Kreb cycle huh, as an ICU nurse I would think you would have come across the importance of biochem in many situations, or are you simply following orders and protocol without knowing a damn thing about what you are doing. I assume biochem is not taught in your NP curriculum. Good thing too, things like B1 deficiency and acid/base disturbances never present much in an ICU setting and it would be a terrible waste to be educated in the pathophysiology of the human body. After all, it must be wasted knowledge if an NP can run an entire ICU without some very basic science.

    How about this, get over yourself and learn to be a part of a team. If a resident isn’t as familiar with something as you are, what a great teaching moment and a way to better the care of the patient. Trying to show up residents only demonstrates your shallow petty character.

  161. MD says:

    So basically Shelley just wants to be called “Dr. Shelley.”

    You took those courses for the wrong reasons. If you are paying to receive more education in health admin, health policy, etc. to further your knowledge-base as a Nurse then more power to you. But, it seems that you are the victim of an inferiority complex and are doing this to call yourself “doctor.”

    Look, 1000 hours experience in a clinical setting is hardly comparable to the hours put in by an MD/DO in their training (without even diving into the details of the basic sciences that are lacking in your curriculum). 1000 hours = 6 months at a 40 hour week. 3 months if you would have been doing the 80 hours a week I was doing during my internship. So, AT BEST, that would land you in the position of a former nurse that got to play “intern” for 3 months and then stopped training.

    Look. You want to call yourself “doctor” when you address all the nurses in the hospital, thats fine with me. In fact, call youself Doctor in front of me. But never compare yourself as an equally trained professional capable of autonomous practice. Your training makes you more qualified in health policy and administration than me. It does not make you more qualified to diagnose, that is FOR sure.

    “Every need, has an ego to feed..”

    Stop worrying about playing doctor, and be a good nurse. You want to become good/qualified to diagnose or cut? Become a Physician doctor.

  162. MM says:

    Future Noctor Shelly,

    For every anecdotal story you can give me involving a resident (who has NOT been fully trained) making an error I can give you 10 involving a DNP (who HAS been fully trained) making stupid mistake.

    Just recently my sister called telling me she was feeling nauseated from a drug her DNP had put her on during a recent visit in which she requested something that might help with her acne (more accurately, a few small non-inflammatory comedones on her forehead – nothing a real doctor would even attempt to prescribe anything more than a topical retinoid for). I asked what drug she was taking and was shocked to hear that this DNP had put my sister on a regular course of tetracycline for nothing more than a few whiteheads.

    If DNPs can’t even handle something as simple as acne in an outpatient setting, how can they possibly be trusted with dealing with the complex cases that physicians are expected to manage on a daily basis? The answer is, they can’t. If you want to be a doctor, you have to be properly trained. The pathway to becoming a DNP does not prepare one adequately enough to practice independently and it shows.

    If being called a nurse the rest of your life really bothers you that much and since you’re already smarter than all the doctors you work with, why not go to medical school? Your obvious inferiority complex wouldn’t handle having to explain your title to all your patients anyhow so save yourself the heartache and go to med school.

  163. sevOD says:

    Can’t argue with stupid.

  164. CommonPatient says:

    Fortunately I have never came across any nurse who claims to know just as much as a physician or more just by WORKING as a nurse. They will all say that yes it gets to the point where they would know what the doctor will do next in a normal scenario but they all admit that if something out of the norm happens, they wouldn’t know what to do next. Most of the nurses I work with are great and they love their jobs. They get injured transferring heavy patients and turning them but look forward to getting back to beside doing what they went to school to do which is NURSING. They offer their advice to physicians but never say anything like “He is getting obstructed, you need to come see him right now, you understand?” or “You need to get your butt here NOW, before this patient codes.” That crap is just condescending and it serves no purpose. Shelley, you definitely have an inferiority complex. If you didn’t want to go to medical school, then quit trying to act like a doctor (doctor is synonymous with physician in the hospital and clinics). If you couldn’t get into medical school, then I’m sorry for you. Try harder.

  165. MM says:

    CommonPatient – There are plenty of nurses who think they are outright smarter than the doctors, and they’re all signing up to get their online DNP degrees.

  166. shelleyTheNPfutureDNP says:

    Hey guys,

    I sincerely apologize for the trolling that’s been going on. I’ve come to realize I have an inferiority complex and that I really can’t seem to let go of an argument. I think I have OCD personality disorder as well. Anyway, I decided that I’m going to medical school now because I finally saw the light and realized that the DNP program is just an agenda pushed by the nursing organization in order to gain more power and autonomously that we don’t deserve anyway.

  167. DNP=LicenceToKill says:

    Part of the reason medical school is so rigorous is because life as a doctor is also vigorous. These noctors that got their doctorate while stuffing their face with cheetos and watching Oprah will be poorly equipped to work in a decision making capacity. I think some of these Internet trained pseudodoctors are going to be shocked when their lives turn out nothing like they expected it to.

  168. CommonPatient says:

    Exactly MM. Deep respect to the nurses who work their tails off at bedside and work WITH doctors instead of claiming to be as qualified or better than physicians with an inferior online “doctorate” degree.

    Nurses like Shelley claims to work with their “physician colleagues” but instead they are undermining physicians and trying to replace them with an inferior degree. They are insulting all physicians by claiming their online doctorate is equivalent to a M.D. or D.O. degree. A slap in the face to all of those who sacrifice their youths, putting the prime of their life on hold and spending a quarter of a million dollars on the education to PROPERLY treat patients using the concepts of medicine and not nursing.

    Shelley, you are not doing what you went to school for. Instead you are leaving your fellow nurses behind and trying to play doctor with an online degree in policy, statistics, and nursing theory.

  169. DNP=LicenceToKill says:

    I knew Shelley was a troll ;). There are definitely some real NPs out there that are endangering our patients with their ignorance, it’s important that we fight this thing…a patient deserves to know if they are being medically assessed by someone who was trained through online correspondence at the local community college.

  170. MM says:

    Congrats Shelley. Now when you become a real physician you can feel good inside knowing you didn’t become a doctor by sneaking through the back door.

  171. Eforest says:

    Sure, nurses get a lot of practical experience. And I’ve learned a lot from the nurses I work with. However, I’ve been surprised by the lack of knowledge. A nurse asked me whether a patient’s pupils should get bigger or smaller in response to light. I explained. Another wasn’t sure if a third nerve palsy was the same as Bell’s palsy. Another nurse decided that my patient’s headache was due to “gas.” Another nurse, after a patient coded, insisted that she’d been saying for “weeks” that the patient should be in the unit. She’d said no such thing and the patient’s code was a surprise to all involved. The nurse was making these assertions but did not know why the patient had come to the hospital, the nature of his ongoing medical problems, or the events that had led to the code. It’s best when we all work together.

  172. Carly says:

    I’m currently in nursing school getting my BSN. It’s a second degree program, and my first degree was in Biology. My nursing instructors have talked a lot about the DPN program, and it has been presented to us that the program is nurses attempt to keep up. I don’t know anyone that compares the education that it takes to become a DPN to that of a MD! I think the DPN is going in a good direction to further educate nurses that are in the health care provider role. They will be just like nurse practitioners are now except with a little bit more education and a different title. Also, if I go and get my DPN in the future, it will be because in 2015 all of the nurse practitioner/nurse anesthetist/nurse midwife programs are going to the DPN format. If that is the case, I do not want patients to call me Dr. because it is confusing to them. Physical therapist are “Dr’s” but no one calls them Dr. I am about to graduate and during my clinical experience I have seen a lot of bad nurses and bad doctors, but the thing that I think harms more patients than anything is the huge disconnect between the different levels. No nurse should treat a MD like he/she knows more than him/her, and no doctor should treat a nurse with so much disrespect that the nurse is afraid to contact them in an emergency. In all honesty a hospital can not run without MD’s or without nurses.

  173. Carly says:

    Excuse me, I wrote DPN but I meant DNP.

  174. O Gurl says:

    “Many Advanced Practice Registered Nurses (APRNs) currently hold doctoral degrees and are addressed as ‘doctors,’” he says, adding that other expert practitioners such as clinical psychologists, dentists, and podiatrists, also use this title.”

    Oh c’mon. I think most lay people know the difference depending on the context. If you are seeing someone for a root canal and they call themselves Dr, you can assume he/she is a dentist. If you are seeing someone for psychotherapy and they introduce themselves as Dr, you can assume they are a psychologist. If you are taking your cat for shots and someone introduces themselves as Dr, you can assume they are a veterinarian. The difference is these advanced nurses will be calling themselves Dr in a medical context. That is confusing and misleading.

  175. MD Student says:

    “No nurse should treat a MD like he/she knows more than him/her, and no doctor should treat a nurse with so much disrespect that the nurse is afraid to contact them in an emergency. In all honesty a hospital can not run without MD’s or without nurses.”

    Well said!

  176. RealMD says:

    If nurses must have more training to “keep up”, why the necessity to call the degree a doctorate? What is the next step after the DNP needs more training? Super-Doctor in Nursing?

    A doctorate implies a certain level of education and effort- much more than the DNP programs require. It is insulting to MD/DO/PhD/DVM/VMD/DDSs who earn the title doctor through blood, sweat, tears, AND INTELLIGENCE.

  177. shelleyTheNPfutureDNP says:

    First of all the last post with my name in it was not me. I guess it is a compliment for someone to impersonate me if they feel they can’t win this debate the old fashioned way.

    Anyway………

    Many people have stated that the true measure is the Step 3 USMLE and that DNP’s took a test like that and only 50% passed.
    Talk about a biased study.

    I am going to tell you physicians something you already know but I will reiterate it because it is being used for bias.

    The Step 3 USMLE tests clinical knowledge across every specialty, peds, medicine, surgery, psych, OB / GYN and on and on.

    When we get an NP or a DNP, it is FOCUSED. It is not on every specialty under the sun like the USMLE tests on. For instance my DNP will be focused on adult acute care.

    Of course if I am getting a Doctorate degree in acute adult care, I am not going to do well with questions on peds, OB /Gyn, surgery, psych, etc.

    When the doctors quote that test result, it extremely biased. It is like saying it is surprising that a dermatologist wouldn’t be able to pass a cardiology boards. Well of course…..but they certainly know dermatology.

    On the same hand, I know adult acute care as well as anyone. You want a test on adult acute care and I am confident I could score as well as any physician.

    This is nothing against physicians. Many of good and capable.
    What I am emphasizing is that just because DNP training is different, doesn’t mean it is inferior. Physicians who discount the amount of real clinical hours we receive as nurses before ever going back to school to get the DNP are naive, to say the least.

    So many of you physicians have such big egos that you can’t possibly accept that a DNP could know clinically just as much as you.

    It is sad that we can’t just all get along and work side by side and take care of patients. The use of DNP’s is where medicine is going and everyone better get used to it real fast.

  178. DNP=LicenceToKill says:

    Circular arguements Shelley, we’ve already discounted everything you’ve said but you keep stating the same thing. Nursing experience is not adequate medical training, and even if it was all DNP programs accept student with NO nursing experience.

    The reason your intelligence isn’t respected is because you received a doctorate online that had no clinical relevance whatsoever. You would fail a similar licensing exam that real doctors take because you have never learned how to treat a patient.

  179. superman1978 says:

    “The Step 3 USMLE tests clinical knowledge across every specialty, peds, medicine, surgery, psych, OB / GYN and on and on.

    When we get an NP or a DNP, it is FOCUSED. It is not on every specialty under the sun like the USMLE tests on. For instance my DNP will be focused on adult acute care.”

    Sorry Shelly, you once again have such inept (or deliberate) knowledge of the subject that you speak before you think. That test is SIMILAR to the Step 3 but not the same. It’s been developed FOR DNP’s. Therefore, it is FOCUSED on what you are supposed to know. Once again, you make my argument for me.

    “What I am emphasizing is that just because DNP training is different, doesn’t mean it is inferior.”

    I couldn’t agree more. In fact, I think it is far superior in certain areas. In particular….Nursing (duh). But to say it’s on par with medical training? You’re delusional. Of course it’s inferior. It’s not medicine!!!!!

    “Physicians who discount the amount of real clinical hours we receive as nurses before ever going back to school to get the DNP are naive, to say the least.”

    But, as noted time and time again, you don’t get abundant clinical hours. Perhaps a non-traditional student that goes back to school after a decade working in the clinical setting has an adequate amount of experience. But look at the article again. Look at all these online degree programs. Stop urinating on me on calling it rain!!! According to this data, a future DNP needs ~15,000 less hours of training. Talk about naive…

    “So many of you physicians have such big egos that you can’t possibly accept that a DNP could know clinically just as much as you.”

    It’s not our egos that get in the way but our responsibility to our patients. The training is not on par with real medical training. While DNP’s may have something real to offer, don’t pretend a DNP and a physician are equals. Nurses and Physicians offer different levels of care.

    “It is sad that we can’t just all get along and work side by side and take care of patients.”

    But that is EXACTLY the reason we are apprehensive. We want to take care of patients RESPONSIBLY. This doesn’t appear to be adequate to take care of patients in a responsible manner.

    “The use of DNP’s is where medicine is going and everyone better get used to it real fast.”

    Unfortunately, medicine is using DNP’s in a role they have no reason to be there for. So no, we will not get used to it. And what happens if we don’t get used to it? The reason I ask this question is the tone in this last statement has an “or else” inuendo attached. I’ll tell what happens if we just don’t get “used to it”. Less patients will die. This is not to say DNP’s don’t have a role to play. But I think the curriculum should be more stringent and even then, they must be supervised by a licensed physician.

  180. frustrated says:

    Actually, Shelly, according to this article which highlights several DNP programs:

    http://www.ehow.com/list_6602325_bsn-dnp-programs.html

    many DNPs go into family practice. Which is NOT focused. You SHOULD know everything under the sun as a general practitioner. So taking in consideration all of the DNPs that go into family practice, how come 50% of all DNPs still failed the watered down Step 3?

  181. n@nners says:

    Shelley the NP training isn’t FOCUSED, it is LIMITED.

  182. Almost M2 says:

    “Of course if I am getting a Doctorate degree in acute adult care, I am not going to do well with questions on peds, OB /Gyn, surgery, psych, etc.”

    What if a woman comes in with an ectopic pregnancy?

    What if someone comes in after a suicide attempt or has psychogenic symptoms?

    What if they come in with stomach pain that turns out to be from eating metal?

    OMG a patient just came in convulsing from overdosing on some common-ish PSYCH med you never heard of! Doctor what do we do?

    What if a women comes in with horrible pain from endometriosis?

    Do you think that someone who understands surgery will be able to make smarter referrals?

    An adult with with a congenital heart defect comes in…is peds so useless now?

    Hey Doc I got this __________ surgery a few years back…. does this have anything to do with what I have? Should I really be taking that medicine? Will that interact with my drugs my pysch prescribed me?

    1. MBBS to MD says:

      Dude, you think she understood even half of what you meant?

  183. JLambert says:

    When will this one sided conversation end?

  184. David says:

    DNPs just want to be called “doctors” because they have an inferiority complex and were to dump/unintelligent to get into medical school to become REAL doctors such as MDs and DOs.

  185. David says:

    *dumb

  186. Mike says:

    Shelly, when I take step 3 it will be as a surgical resident and not as a student. While my training will be focused on surgery, I am still required to have minimum level of knowledge in each field that allows me to function at the physcian level. Just because I will be focusing on the surgery aspect of the patient doesn’t mean I won’t have any patients with other medical issues that change the way I manage that person’s care. If you think as an acute care DNP you won’t have patients who have had surgery, have pysch issues, are pregnant or have any one of a variety of other medical problems that you don’t think you have to know about because your degree is focused on acute care than I think you may wind up having a tougher time practicing solo than you think. Just because there is a specialist working to manage the patient’s specific issue doesn’t mean you don’t have to understand why they are managing the patient the way they are and how that affects what decisions you make in managing your aspect of the patient’s care. Every physcian from every specialty has to pass step 3 which ensures a minimal level knowledge across all fields. Having a focused level of training should have nothing to do with why someone can’t pass step 3 what so ever. If they can’t, then it only proves their knowledge base is lacking. Also, board certification is the testing taken to ensure minimal abilities in an individual’s specific field, not step 3.

  187. DOResidentInCA says:

    The scope of practice between NP’s and Physician Assistants are very similar–so much so that there are “Primary Care Associate” programs which allows graduates to sit for both PA licensure as well as NP licensure and be dually licensed. (PA-C,FNP)
    Stanford University has collaborated with Foothill College and has had this program for years. (http://pcap.stanford.edu/)(http://www.foothill.edu/bio/programs/primary/)

    Since NP’s are pushing for the DNP, will Physicians Assistants also follow suit? Will they then become DPA, a Doctor in Physician Assisting? An assistant that is so skilled in assisting that they should gain the title of doctor? At least PA’s are traditionally trained under the medical model.

  188. PharmD but no Doctor says:

    DNP’s just want to be called doctors to validate their worth. I have a news flash for these so called “Doctors”, a “doctorate” does not equal a “doctor”. I am about to receive a Doctor of Pharmacy degree, but I will not be a doctor nor will I call myself a doctor. I merely have a fancy degree in my selected field, just like anyone who gets a PhD. But, by the DNP’s standards, the next time we need to seek medical advice, anyone who got a PhD in Communications should be qualified.

    Why don’t these nurses get over their ego? If they did then they might actually start to do the additional training to become better nurses rather than trying to prove how incredible they are.

  189. Ryan says:

    The entire problem is that in any field aside from medicine, a “Doctorate” is simply a level of educational training. However, in the Healthcare Profession, “Doctor” is both a level of training AND a *job title*.

    You simply cannot divide the implication of physician from the title Doctor in this profession, because they are one and the same.

    I think it is fantastic that nurses wish to seek further training and applaud them for such. However, giving them the title of “Doctor” is the same as giving someone that works in a cubicle the title of C.E.O., it simply doesn’t work that way. I am not saying that nursing is a menial position, just that their job title is that of a Nurse, not Doctor.

    As to those that wish to have complete autonomy and rights over patients that a physician has, they should have become physicians, and still can.

  190. Kate says:

    Shelley, you need to re-read Mike’s post (two above mine) to better understand why your arguments regarding Step 3 make no sense. Step 3 is not a specialty board, which is what you seem to be equating your “adult acute care exam” to. Physicians must prove their knowledge in all aspects of medicine before being allowed anywhere near a specialty board. The claim that you don’t need broad medical (nursing?) knowledge to practice adult acute care is quite frightening. I don’t understand how “adult acute care” is even considered a focus…that’s almost as broad as you can get. Rightfully so, because aren’t you DNPs supposed to be practicing primary care? I’m pretty sure you should be trying to convince us that you could pass more exams rather than one in just one area.

  191. Mr. Bean says:

    Shelley,

    Your illogical arguments made me shove my head into the toilet. Then, for a second I actually thought you were gone. Therefore, I lifted my head out of the toilet. Only to my dismay, I noticed that you were still around. I shall, therefore, shove my head back into the toilet.

  192. shelleyTheNPfutureDNP says:

    Many a night in the ICU I have saved the butt of a poor resident and saved the lives of a patient.

    Just last week I had a abdominal post op patient. He was running a fever for the past two days. The resident puts in his notes for 2 days that it is a “post op fever.”

    The patient meanwhile is starting to have worsening abdominal pain and his blood pressure is slowly falling. I page the on resident. He again tells me it is “post op fever.” I tell him very bluntly, “I have seen thousand of post op surgery cases, and this is not a post op fever.” Next thing I know I have to page him again. I am more firm and tell him “Get your butt here now, stop making excuses and see this very sick patient.” Next thing I know the patient emergently back in the OR to drain an abscess.

    The moral is, it doesn’t matter what this resident got on the USMLE. He doesn’t know how to take care of a real live patient.

    All of the people here who just say the nurses are just taking orders are delusional. Many times me and fellow ICU nurses have saved patients like the above scenario.

    For any of you saying that we have an “attitude” or should be “kinder” or “teach” the resident, this is not our job. Our job is saving a patient who is crashing. If we have to be blunt and in the face of the resident about it, so be it, at least we saved this patients life.

    So few of you physicians seem to get this.

    1. MBBS to MD says:

      If you are a competent adult acute care “doctor”, why did you have to call the resident in the first place?….

  193. frustrated says:

    I’m sorry, but am I missing something here? How come you keep bringing up residents who are not LICENSED PHYSICIANS? Yes, it’s not unbelievable that an ICU nurse with many years of experience knows more than a few (select) residents who just started their training. But they are practicing under the supervision of an attending! Are you really going to say that you have just as much training and knowledge as a practicing attending? THAT is what the point of all of this is. When you go out in the real world and you are on your own, whether it is a graduating resident or a DNP, you better know how to work autonomously. Being a resident is very different from this, so your argument is moot and frankly, delusional.

  194. Kate says:

    Yeah… I mean, Shelley, a resident is in training practicing with supervision, aka not autonomously. If you want to function as a physician, why don’t you just go to medical school? I don’t understand.

  195. Almost M2 says:

    Sounds more like a communication issue rather than a knowledge issue. As soon as you said dropping BP I thought of internal bleeding or sepsis. What was the drop in the BP?

    All of that could have been prevented if the resident came down to look at the patient… Assuming that you are an experienced nurse and kept on calling, I would probably take a look (but then again I haven’t had clinicals yet, so who knows).

  196. MD Student says:

    A resident is a physician still training and some will have screw ups. They have been through 4 years of medical school and some will spend 3 to 7 years in residency before they can practice AUTONOMOUSLY. You think a nurse taking online courses in nursing theory, statistics, and health policy will be just as good as an attending (a doctor who has FINISHED 4 years of medical school and 3 to 7 years of residency)? Your logic is laughable. An intelligent nurse who wants to do more would go on to physician assistant school or medical school.

    Again, prove us wrong. What is your curriculum? What program are you in? Why not just go to medical school. You keep saying the same thing over and over like a broken record. You still haven’t answered these questions.

  197. superman1978 says:

    Okay Shelly, let me show you a few things you have said:

    “It is sad that we can’t just all get along and work side by side and take care of patients”

    But then you said:

    “For any of you saying that we have an “attitude” or should be “kinder” or “teach” the resident, this is not our job. Our job is saving a patient who is crashing. If we have to be blunt and in the face of the resident about it, so be it, at least we saved this patients life.”

    But isn’t part of “working side by side” to the benefit of the patient is to pass along the knowledge you have learned to the young resident? I wish I could say your hypocrisy astounds me but it’s abundantly clear you have a huge chip on your shoulder. And honestly, telling a resident (or anybody you are NOT in a supervisory role) to “get your butt here” is completely unprofessional and wreaks of disdain and disrespect. Do you actually think a coworker (not a subordinate) is going to respond to that? Grow up. While that story may sound good to your friends that don’t know any better, it shows an apparent lack in the skills needed to effectively work in a clinical setting.

    Here is a question for you: Do you really think that physicians feel “threatened” by DNP’s to work autonomously? Or is it more likely that the lack of training calls into concern the health and well-being of our patients? If the first question is true, then we should rejoice. Because then, we don’t really need physician’s at that level. Why go through the training and cost to be a doctor when somebody with far less qualifications (and salary) can do an equal job? However, if the second question is indeed correct, then we have a real problem.

    Stop telling us these stories of residents (who are still going through their training. I don’t know why you go back to that. They’re trainees!!! Of course they’re going to screw up!! That’s why they’re being supervised! And every single time you talk about these residents that have 1000’s of more hours of training, you put the nail in the coffin of your own argument. If these people with far more training than a DNP can screw up, what makes you think you are going to do better? You are no different just because you have the title “nurse”.

  198. eschoolgirl says:

    Why is it Shelly that you cannot understand that while there are situations in which you are correct I am sure there are times on the floor when you or fellow nurses have been wrong. I work on a nursing floor and have seen multiple times when we nurses have noticed something that needs to be called to attention. The flip side of that is that all of the residents that work on our floor are very responsive. I LOVE the doctors and residents that work on our floor. While we all make mistakes we do all work together. Maybe youy need to find a new hospital to work at because the problems you are incurring do not come in to play ever where we are. We are frineds with our docrors and residents. We all respect eachother for the job each of us is there to do. If you want to be a doctor be one. I am a nurse and I am against this program. If my family member goes into see a doctor then I want them to see a MD not somebody who thinks they can practice like they are one!

  199. eschoolgirl says:

    Just to elaborate. Nursing school is great! We learn to work on the floor and give care for patients. These people are already diagnosed. We give continuing care to patients to see that they recieve the best outcome possible, but we take our cues from the Doctors. I think that it is wonderful we get to report to the Doctors; they all seem to care greatly about any info we can give them. Our Doctors even ask the CNA’s what thet have noticed. I love my job, and yes I am in my second year of the Bio program so I can go back and hopefully get into med school. I would never consider myself qualified to give a Doctor recommendations for the care of a patient. We are supposed to be support care givers to the Doctors just as the aids are to the nurses. I know my place and I am fine with it. Nurses are a great asset to the Doctors if we do our job and only our job. Shelly do not make the profession seem like we are on some kind of unjustified power trip!!!

  200. MM says:

    Future Noctor Shelly,

    I just want to second what superman has already iterated and point out that this discussion isn’t about DNPs fighting to increase their scope of practice to a level of a resident. This discussion is about DNPs vying to become practitioners that are fully independent of physician supervision. In other words, DNPs are arguing that they should have the same practice rights as attending physicians.

    As was pointed out, it isn’t exactly fair that all of your anecdotes involve residents since this article is comparing the training a DNP receives compared to a fully licensed and board certified attending. DNPs do not want to be equal with the residents, they want to have attending status.

    When is the last time you told an attending to “get his butt down here” to save one of your patients? When is the last time an attending at your institution didn’t realize a patient was crashing but you did?

  201. The Real "Shelly" says:

    Here’s my info:

    Shelly Keener

    Location: Joplin, Missouri Area

    Current Job: ED RN at Freeman Health System

    Past job: ICU-RN at St. Johns Hospital

    Education:
    PSU MSN-NP 2008 – 2009

    Duration of Education: Three semester to complete MSN

  202. observation says:

    It seems the DNP degree is not as holistic as the ads say. What would Dr. House in this situation? :)

  203. eschoolgirl says:

    Maybe some of you have noticed my aka on here. eschoolgirl! I picked that because of the newest Rambo: with the motto… live for something or die for nothing. I hope we are all on here for the betterment of the healthcare we can provide. I do not agree with everything on here but anyone who wants to push the health feild forward desereves a chance. We do not all have to have the same degree, but we do need to try to get along. I am guilty too, but looking at this I want to be the mature person who says sometimes we have to agree to disagree. I myself have said things to “this” Shelly, but I would love to see what else could be said wihtout including her. Thanks for all new post!

  204. shelleyTheNPfutureDNP says:

    All of you student doctors or residents or MD / DO’s can talk all day about that you think the DNP isn’t as qualified as them to see patients independently. You all pretty much repeat the same things over and over (USMLE, clinical hours, we take biochem and cell biology and you don’t, etc, etc.).

    You can keep talking and talking all you want. Please take a look at reality.

    1. By law 13 states say DNP’s are allowed to see patients independently. That is expected to increase dramatically in the next 20 years to possibly all 50 states.
    Keep on complaining that the DNP’s aren’t qualified, but the LAW says we are and we will be coming to a neighborhood near you very soon if we are not there. The law is on our side. Sorry.

    2. Likewise the same LAWS, that say we can work independently also say we can have hospital admitting privileges. Talk all you want, we can and will see hospital patients on our own. The law is on our side. Sorry.

    3. There is no LAW that says we can’t be addressed as DOCTOR when seeing patients. The law states we can’t misrepresent ourselves and say we are a “physician” or a “surgeon” or for instance a “cardiologist”. That is false misrepresentation. Calling our selves DOCTOR to patients we are treating is not misrepresentation. Of course someone will bring up “but you can get a doctorate in History and you can’t tell a patient you are a doctor if you did. Well the DOCTOR in DNP is specifically designed for patient care so it is not misleading. Again, the LAW is on our side. Sorry.

    4. The MD /DO’s get in their head that they have a monopoly and somehow a patent that they are the one and only ones who can see patients independently. There are other providers who can and will see patients independently. There are LAWS that ensure that we can work independently as DNP’s. See #1 and #2 above.

    5. All you complainers here better just keep your traps shut and get used to the way medicine is going and try to make things better. You are doing yourselves and your patients no favors by condemning nurses and other providers of care. It actually makes you look very low and insecure.

    1. Calling you out... says:

      I was going to reply to this, but I realized that Shelly is just a troll trying to illicit a emotional response. As a medical student I look forward to working with the nurses who know their responsibilities and limitations in the medical field. As for you… may God watch over your patients.

    2. MBBS to MD says:

      It might do you and your patient some good if you get yourself examined by a psychologist, before you go in to your “independent” practice…

  205. bob says:

    It is obvious she is delusional. Sadly, this will do nothing but turn more people against DNPs.

  206. Ubiquitin says:

    At the end of the day we all know who we are and what our degrees actually entail.

    Healthcare professionals and the public will always have their ideas and assumptions of what DNPs are and the individuals who pursue this degree. I believe that DNPs, regardless of their personal beliefs (Equal among physicians or not), will have a very long emotional battle ahead of them.

    Shelley speaks from a very idealistic point of view but she does so from a protected environment (academia). The real world is harsh.

  207. bob says:

    Hard core research huh? May of those were “patient satisfaction” surveys. Wait, I suppose this would be hard core accordting to a DNP who has little if any science background. Also, I guarantee if anyone looked thoroughly at these articles, they could be ripped apart on many levels.

    Keep talking, you do more damage to your cause with every ridiculous post.

  208. superman1978 says:

    shelly, I start to grow bored of this argument but I’ll drop one more response to your delusions. You claim that “the law is on our side”. The law also used to state that blacks and whites had to be separated in public facilities. My point, you ask? Just because the law says so isn’t an excuse to claim it is right. Those laws are being passed not because DNP’s are equal as doctor’s, but because there are a lack of physicians. And also, when you call yourself doctor in a clinical setting without saying what you are a doctor of, it IS misrepresentation. People are going to assume when you say doctor, you are an MD/DO. Right or wrong, that’s reality.

    Just, stop already! What you don’t seem to realize is every time you attempt to justify your beliefs, 10 or more people mercilessly dissect your argument until nothing is left and you appear only to be delusional and inept. DNP’s have a role. Learn it, love it, embrace it. But don’t think you can do more than you really can.

  209. shelleyTheNPfutureDNP says:

    Lets get down to some hard core research. Once again I challenge my med student / resident / physician colleagues to provide just one, and I mean just one, study that shows that NP’s / DNP’s / CRNA’s provide inferior care to doctors. I am not talking about your opinion (“But you don’t take USMLE step 3 so there!”). I am talking about a research study.

    Below I am providing evidence of among dozens of studies that have shown that care provided by NP’s / DNP’s / CRNA’s is at least equal if not better than care provided by MD / DO’s.

    Do physicians deliver better care than Advanced Practice Registered Nurses?

    The media sometimes suggests that physicians deliver better care than Advanced Practice Registered Nurses (APRNs). Is that true?

    Not according to most scientific studies, which have found that care by APRNs is as good as or better than that of physicians.

    Some recent press articles have openly disparaged or devalued the care of APRNs relative to that of physicians. And the government’s slogan for their “Take Your Loved One to the Doctor” media campaign completely ignored APRNs.

    However, the following studies and articles show that the care provided by APRNs merits at least as much respect as that of their physician counterparts.

    Patients at nurse-lead atopic eczema clinic had greater improvement of symptoms than those at physician-lead clinic

    October 5, 2007 — A nurse-lead dermatology clinic for children with atopic eczema had a “significantly greater improvement in severity of eczema” than children who attended a physician-lead dermatology clinic. In one measure of treatment adherence, the children’s use of wet dressings was 76% in the nurse-lead clinic compared with only 12% for the children in the dermatologist-lead clinic. However, it does not appear as though the study controlled for the length of time spent. Nurses spent 90 minutes in individual and group sessions with patients, and physicians spent 40 minutes with patients, though it is unclear if this was all individual or some group time. See the article…

    Cochrane Database reports on benefits of nurse vs. physician care

    April 28, 2005 — In an article entitled “Substituting Nurses For Doctors Results In High Quality Care, Few Savings” researchers report that “[m]any primary care responsibilities can be safely transferred from doctors to appropriately trained nurses…[y]et there is little proof that such a shift reduces physician workload or health-care costs. see the article…

    Nurse Midwives credited for second lowest hospital C-section rate in New Jersey, despite serving high-risk community

    March 28, 2005 — Today the Courier News (New Jersey) ran a generally very good piece by Stefanie Matteson about the nurse midwifery program credited with helping the Muhlenberg Regional Medical Center achieve the state’s second lowest rate of Caesarian sections, despite serving a low-income urban patient population that is more likely to have high-risk pregnancies. The article highlights the nurse midwives’ care model, presents key data and includes good comments from relevant persons, though it could have focused a bit more on the midwives’ clinical skill, as opposed to the admirable “cultural climate” they create. more…

    Multiple studies find no differences between care delivered by Nurse Anesthetists and Anesthesiologists

    2006 — See the American Association of Nurse Anesthetists’ web pages comparing the care of Certified Registered Nurse Anesthetists to that of Anesthesiologists. A number of studies have found no significant differences in patient outcomes based on professional background. See the AANA web pages.

    Nurse Midwife care equal in morbidity at a lower cost, with more favorable outcomes and fewer interventions

    June 2003 — The American Journal of Public Health published a study funded by the US Agency for Health Care Research and Quality of low-risk patients receiving collaborative/birth center/midwifery care who had comparable morbidity, preterm birth, and low-birth weight rates to patients receiving physician only care. Collaborative care also resulted in more favorable outcomes and a lower cost to the health care system through spending less time as an in-patient, fewer C-sections, episiotomies, inductions, and vacuum or forceps assisted vaginal births, and more prenatal services delivered despite the lower cost. more…

    Nurse-midwives transfer embryos at least as well as gynecologists

    May 2003 — A clinical trial of 102 patients randomly assigned to receive embryo transfers from nurse-midwives or gynecologists found that clinical pregnancy rates were similar–31% for midwives and 29% for gynecologists. The study subjects had a high acceptance rate of midwives on a questionnaire. Bjuresten, K., Hreinsson, J. G., Fridström, M., Rosenlund, B., Ek, I. & Hovatta, O. (2003). Embryo transfer by midwife or gynecologist: a prospective randomized study. Acta Obstetricia et Gynecologica Scandinavica, 82 (5), 462.

    London patients rate nurse-led GYN clinics significantly higher than physician-led clinics

    April 2003 — London scientists found that nurse-led GYN clinics had significantly higher patient satisfaction scores than physician-led GYN clinics. Patients rated nurse-led clinics higher in quality, competence, provision of information and overall satisfaction. Miles, K., Penny, N., Power, R. & Mercey, D (2003). Comparing doctor- and nurse-led care in a sexual health clinic: patient satisfaction questionnaire. Journal of Advanced Nursing, April, 42 (1), 64.

    Meta-analysis: NP patient satisfaction higher and care equal to or better than MD care

    April 2002 — In a meta-analysis of 34 clinical studies published in the British Medical Journal by Horrocks, Anderson & Salisbury comparing care by NP’s and physicians, researchers found that patients were more satisfied with their care if it was delivered by a Nurse Practitioner (NP) than by a physician. Compared to physicians, NP’s read X-rays equally well, identified more physical abnormalities, communicated better, gave patients more information and taught patients how to provide self-care better. NPs also “undertook more investigations” and spent significantly more time with patients, 14.9 minutes vs. 11.2 minutes for physicians. See the study.

    Nurse experts interviewed on nurse practitioner and physician care differences

    January 14, 2002 — Linda Aiken Ph.D., RN and colleagues give a compelling interview to Medscape on differences in care delivery between nurse practitioners and physicians. See the interview.

    Physicians: higher patient satisfaction; NP patients: lower blood pressure in study

    January 2000 — M. Mundinger et al. from Columbia University School of Nursing published a randomized clinical research study of 1316 patients in the Journal of the American Medical Association (2000). The study compared care between nurse practitioners and physicians. Patients answered a satisfaction questionnaire after initial appointment and were examined 6 months and 1 year later. At six months, physicians received a significantly higher satisfaction rating (4.2 vs. 4.1 on a 5.0 scale). There were no utilization differences, and the only health status difference was that patients with high blood pressure who were cared for by nurse practitioners had significantly lower diastolic blood pressures. See the abstract.

    Advanced Practice Nurses: better compliance, higher satisfaction in meta-analysis

    November 1995 — Brown & Grimes from the Univ. of Texas at Austin School of Nursing published a meta-analysis of 33 randomized studies comparing the outcomes of primary care patients of nurse practitioners (NPs) and nurse midwives (NMs) with those of physicians in the journal Nursing Research. Patients of NPs had significantly greater patient compliance with treatment recommendations compared to physicians. In controlled studies, patients of NPs had greater patient satisfaction and resolution of pathological conditions than patients of physicians. Most other variables were similar. NMs used less technology and analgesia during labor and delivery than did physicians, and the two groups of providers had babies with similar outcomes. Nursing Research 1995 Nov-Dec;44(6):332-9. See the abstract.

    NPs–better patient education, care continuity, knowledge about disease, less waiting

    October 1995 — Langner & Hutelmyer published the results of a patient satisfaction survey of 52 HIV-infected primary care patients at an urban medical teaching clinic in the journal Holistic Nursing Practice. Patients of nurse practitioners “fared more favorably” in clinic waiting time, provider knowledge about the disease, continuity of care, and patient education when compared to physician providers. 1995 Oct;10(1):54-60. See the abstract.

    Nurses in ENT clinics provide more cost-effective care than physicians

    March 2004 — The article does not appear to have specifically studied patient outcomes beyond cost-effectiveness of care. However, cost-effectiveness can in any case encompass positive health outcomes. See the abstract: Uppal, S., Jose, J., Banks, P., Mackay, E., & Coatesworth, A. P. (2004). Cost-effective analysis of conventional and nurse-led clinics for common otological procedures. Journal of Laryngology & Otology, 118 (3), 189-192.

    1. MBBS to MD says:

      State the statistical significance of your data please?

  210. DNP=LicenceToKill says:

    Can you verify that this noctor’s name is Shelly Keener? If that’s who this troll really is then she’s also 52 years old…that might explain why she’s so bitter and stubborn. Can’t teach an old dog new tricks. I love how someone with no scientific background tries to analyze studies…everything she posted as proof is ridiculous, lol.

  211. MD Student says:

    Just because the law says nurses can practice independently doesn’t mean the general public would rather see a nurse than a doctor.

    If the government wants to grant a bunch of wannabe doctors the freedom to practice independently without knowing anything about medicine other than what the nursing lobbyists says with bogus satisfaction surveys and studies, then fine, whatever. But for the sake of all patients I hope you all are able to properly diagnose and treat patients. If, God forbid, all 50 states grant your wish, expect the level of malpractice against nurse practitioners to rise. After that, the real doctors are going to wash their hands of nurse practitioners and you all are going to be left on your own. You want the white coat, take it. You want the title of doctor, take it. But you will not take the years of sacrifice and hard work that these people put into their education to become a properly trained physicians. You are not working with your “physician colleagues”. You are undermining everything they have worked for and endangering and misleading your patients.

    I never understood why nurses want to diagnose and treat patients when they originally went to school to care and nurse patients. But if nurse practitioners want to help out with the physician shortage, that’s all fine as long as it’s under supervision. We’re talking about patients lives here. Complete autonomy for someone who isn’t properly train in the science and practice of medicine is dangerous.

    Shelley, why don’t you just go to medical school? Still no answer…

  212. DNP=LicenceToKill says:

    The reason none of these noctors go to medical school is because they can’t. They don’t have the academic strength or dedication to meet the standards of medical training. To an np life is all about taking short cuts and feeling entitled to a paycheck.

    Being an np is a fallback plan for those who can’t become doctors. The fact that these intellectually inferior nurses are being put in a position to harm society is very scary. There’s no point in trying to be politically correct about it, these nurses are putting their ego ahead of patient safety and that is nothing short of evil.

  213. Another guy says:

    I’m sorry but after looking through those “hardcore” articles, I had to call into question your definition of research. Several of those articles aren’t even from a scientific journal!!! And then several of them are from Britain. The reason that’s an issue is that their training is extremely different than the training conducted in the US. And then a few more are based on patient satisfaction?!? Heck, even one is an interview ONLY!!!! That is NOT hardcore research Shelly!! Out of the dozen or so articles you cite, only two could be considered applicable research toward your argument.

    Here’s the further problem: most of us aren’t claiming that DNP’s don’t have a role. They can do a lot of things regarding patient care. However, not one of those studies you have just pointed out takes into account your two main arguments. Mainly: title of doctor and autonomy. Not a single article gives any supporting evidence to suggest that a DPN working independently is better or worse with respect to malpractice claims, etc.

    Nice try, but next time don’t cut and paste data from one of your instructor’s power point presentations telling you how cool DPN’s are.

  214. MM says:

    Shelly –
    Nothing you’ve cited so far is anything close to “hard core” research. Studies involving subjective patient surveys are next to meaningless when you’re trying to analyze morbidity, mortality, and actual patient outcomes. Studies involving surveys/polls are extremely vulnerable to bias especially when the study is designed by a particular interest group.

    Since you asked, here is one research study that shows that nurses provide inferior care when compared to board certified doctors. There are actually several out there but since you only asked for one and since 3,000 research studies wouldn’t convince you that nurses really don’t have some inborn magical gift that enables them to deliver superior care without having to go through formal training beyond a few months of nursing school followed by a year or so of online modules, I’m only going to waste my time posting this one:

    Abenstein et al published an article in The Journal of Anesthesia and Analgesia in June 1996 which demonstrated a INCREASED incidence of anesthesia-related DEATHS when the anesthesia was delivered by a nurse anesthetist working alone and independently of physician supervision when compared to a board certified anesthesiologist. They also found an increase in number of adverse events (death plus severe morbidity) when anesthesia was delivered by a nurse anesthetist working alone.

    This was a real study using real numbers, real patients, and real outcomes. Not some misleading patient survey report put together by a noctor trying to increase his/her scope of practice. You can download the full paper here:
    http://www.anesthesia-analgesia.org/content/82/6/1273.full.pdf

    Shelly, I know this won’t convince you of anything – nor would all the studies in the world. I just hope that others who do not have such a deep sense of entitlement will read this and realize that we are putting patients in danger by allowing them to be treated by providers who have not gone through the appropriate level of training.

  215. skeptical internist says:

    Here is another aspect that has not been noted yet by
    the med students and residents on this board:

    The “studies” invariably cited by the noctors, like Shelley, involve
    only the COMMON and frequently seen medical problems presenting
    in an adult population. For example, Mary Mudinger’s study is frequently
    cited by the noctors, but involves only a study of asthma, diabetes and
    hypertension.

    The POWER of a study required to demonstrate, in clinical practice,
    the multiple deficiencies of noctors-masquerading-as-real-doctors
    is enormous- so large that cost is prohibitive.

    Further, the noctors do NOT truly work independently, so that,
    when they actually admit that a patient presentation is beyond the scope of
    their training, the noctor will refer to a real physician. Thus, this is
    a CONFOUNDING factor that tends to invalidate the conclusions that
    all noctors strive for: “we are just as good as real doctors.”

    As Joseph Gobbels in Nazi Germany knew well, the BIGGER the LIE,
    the more OFTEN IT IS REPEATED, the more likely the public and the
    state legislators will believe it.

    You can count on Noctors repeating their claims over and over again,
    based on this principle.

    Further, Noctors stress hand- holding of patients and comforting
    patients via their Nursing training- so OF COURSE patients will find
    higher satisfaction- this is a patient EMOTIONAL RESPONSE to the
    noctor- this is then presented by noctors as “scientific evidence”.

    Noctors, then, know little medicine, take lots of time hand-holding
    “their” patients, refer to real doctors when they recognize their own
    ignorance, generate warm and fuzzy feelings in patients by virtue of these
    activities, generate multiple surveys to prove warm and fuzzy feelings
    in patients, dress those survey findings up as “scientific results”,
    and then use those results to undercut and denigrate real doctors.

    They then demand equal pay, title and status for “equal” work,
    while lambasting real doctors for objecting to their outrageous and ridiculous
    politically correct arguments.

    The USMLE deficit of noctors is the most practical approximation of a
    study of clinical patients of sufficient power to demonstrate exactly what the
    USMLE DOES demonstrate: Noctor ignorance.

    This story is as old as humanity itself:

    The noctors suffer from intense jealousy of the learning and
    privileges that real doctors worked so hard to attain. They want all the
    status and pay of real doctors, but not the work, dedication, sweat,
    or scientific training to achieve it. Shelley is virulently imbued, IMHO,
    with the green-eyed monster of real-doctor envy.

  216. H2do says:

    This happened today:
    Np: The pt has gram negative bacilli the culture report says enterococcus. Doctor-what?! She repeats it twice then doctor points out that the enterococcus implies that these are cocci and not bacilli. she looks clueless.

    I have come across many such situations. I have been on two clinical rotations where there was an NP in the practice and it seemed to me that they practiced medicine from a book. Going into the office to look up simple things. In all this time I have never seen an attending open up his Harrisons or Cecils so he can figure out how much amoxicillin to give.

    I understand the importance of Nurses and we definitely would no be able to function qigong them but there is a reason why there are medical schools and nursing schools they are not all created equal. An architect and a builder can not do the same thing.

    I think it is ridiculous that it has come to this point in medicine. Physicians need beter lobbyists. Nurses need short pink coats.

    So many times My patients havE confused their np as a physician.

    I just wait for the day when the nursEs can practice independently and be sued.

    Also they might need to reevaluate this shortage of docs because there seem to be about 2 new med schools opening up every yr

    I’d honestly take more IMGs than nPs

  217. WavingWhiteFlag says:

    As a nurse practitioner, I would like to say that I am very aware of the differences in training of the respective degrees.

    1) With the increasing number of insured Americans and the growing senior population there is plenty of space for all MDs, DOs, RNs, APRNs, and DNPs in the medical profession.

    2) I believe that calling a DNPs DR.Smith is misleading and very confusing to our patients.

    3) I believe that APRN and DNP can and do carry a substantial amount of responsibility and should be respected.

    4) I would also like to say I am very grateful to my MD counterparts and all of the expertise they bring to the table. They are an invaluable resource to me.

    5) I think one of the most important things for all providers to understand is there will be times in every career when one must seek out the advisement of a colleague, or a mentor. We all have our strengths and weaknesses and we should be aware of them. Because in the end our patient’s best interest is what we are all hoping to serve.

    6) I hope I am seen as an asset and not a hindrance to my fellow APRNs and MDs.

  218. superman1978 says:

    Well said WavingWhiteFlag!!

  219. Observer says:

    I’m pretty sure that nurse Shelly copied-and-pasted this “article” of “hard core research” from: http://www.truthaboutnursing.org/faq/aprn_md.html

    When it comes down to it a DNP’s education pales in comparison to that of a family practice physician. All of the pre-professional experience of RNs is nursing, not medicine. There is a huge difference. I’m not knocking on nursing, I believe nurses are an invaluable and necessary aspect of most health care facilities, especially hospitals.
    Yes there are numerous studies pointing out the fact that ARNPs handle routine ailments in the same fashion as a physician. It seems to me however a nurse’s aid could use wikipedia and have the same outcome in a lot of cases…

  220. simplystated says:

    The real winners are the attorneys who collect on malpractice claims.

    The real losers are those MDs/DOs who do not accept insight or assistance from other disciplines. Their patients and their medical licenses expire prematurely.

  221. JM says:

    DNP = I stayed at a Holiday Inn express last night.

  222. Maryland8 says:

    h2do, If you are a doctor, you aren’t bringing much credibility to our practice. First of all, many physicians look up mg/kg/dose for medications for pediatric patients, and they would be making an error to not do this to be sure they are not overdosing a young patient. It never hurts to take time to double check a dosage for a small baby, and if NPs are doing it while we are not, then shame on us. Secondly, joking that nurses should wear short pink coats is rude and belittling, and if you haven’t started your residency yet (I’m assuming you are a medical student if you are in fact involved in medicine at all, which you surely might not be) you will soon learn that nurses are an invaluable part of patient care in a hospital setting, and they can help you look very good at your job. If you are rude and cruel to them (as many of us found out in our residencies), you can forget about them helping you in any way other than what they are contractually obligated to do. One nurse didn’t tell a resident colleague of mine that a patient was actually a female, and let the resident call the patient “sir” about four times during OR consent until the patient blew up at the resident for calling her a male because she had short hair. He looked pretty stupid. If the nurse had any ounce of respect for him, I’m sure she would have said on her way into the room “hey- you called her a “him” to me just now, she’s a woman!” and saved him from this patient refusing to see that resident again during her hospitalization. Seems simple, but things like this will happen to you every day if you don’t treat nurses with respect in the hospital.
    NPs are advanced practice nurses who, in my experience, are very capable of providing primary care to patients at our practice. They come to me with questions at times- I’ve also gone to them with questions. It’s all about collaboration.

  223. e-diggity says:

    @MM

    You say “You can download the full paper here” but that link just takes you to a review. You’re right that the review was published in 1996, but the article they cited (the one you’re talking about) seems to be a 1981 journal article that analyzed deaths from 1969 to 1976.

    If you read the review that you linked to, this is what you find:

    Death rate
    Nurse anesthetists alone: 1:20,723 (0.00482%)
    Anesthesiologist alone: 1:24,500 (0.00408%)

    So here’s what you’re splitting hairs about:
    Less than a THOUSANDTH of a percent difference…
    From data in just one state…
    35+ years ago…

    Get a life! There are much more important problems in healthcare than this B.S.

    (For the record, I’m someone who is not a nurse of any sort, nor am I on track to become a nurse of any sort.)

  224. e-diggity says:

    Interesting to note:

    The study in question was done in one state:
    North Carolina

    The rate of deaths from anesthesia in surgeries with anesthesiology teams:
    1 in 28,166

    State where the zip code “28166” is located:
    North Carolina

    Coincidence? Or will this be the subject of an X-file…?

  225. paralegal says:

    I will be your attorney since I can do everything a lawyer can do. Because of this, I am entitled equal pay.

  226. Master Science says:

    I have a MS in biophysics and deserve to be called Professor since I can do everything the guy with the PHD in biophysics can do. I expect the same pay too.

  227. RT says:

    When I get my DRT, I will be equal to any pulmonologist!

  228. D.Th says:

    Hello dear patient,

    I will be your doctor. Let us pray to the lord!

  229. Thomas33 says:

    Well said paralegal, master science, and RT. I understand that there is a place for nurses of all sorts, and if this position is understood, they can be invaluable to society. However, if these DNP’s, like Shelley, want equal pay, equal autonomy, and want to be called “doctor”, then they should be prepared to put in the many years of hard work and simply go to medical school.

  230. e-diggity says:

    God, I *love* SDN-logic:

    MD: “I’m a doctor.”
    SDN: “Okay.”

    DO: “I’m a doctor too!”
    SDN: “Okay.”

    DPM: “I’m a doctor too!”
    SDN: “Okay.”

    OD: “I’m a doctor too!”
    SDN: “Okay.”

    PhD: “I’m a doctor too!”
    SDN: “Okay.”

    DPT: “I’m a doctor too!”
    SDN: “Okay.”

    DVM: “I’m a doctor too!”
    SDN: “Okay.”

    AuD: “I’m a doctor too!”
    SDN: “Okay.”

    DDS: “I’m a doctor too!”
    SDN: “Okay.”

    DMD: “I’m a doctor too!”
    SDN: “Okay.”

    DNP: “I’m a doctor too!”
    SDN: “HOW DARE YOU BESMIRCH OUR SACRED TITLE?! A POX ON THY HOUSE! WE WILL BURN THIS WEBSITE *TO* *THE* *GROUND* BEFORE WE LET YOU INTO OUR CLUBHOUSE!”

  231. re: e-diggity says:

    You are absolutely correct, EXCEPT in a hospital setting.

  232. CommonSense says:

    Umm, none of the other people with those degrees are fighting for autonomy in practicing medicine. They are also not claiming to be equivalent or even better than physicians. Also they are addressed as doctor in their respective offices and clinics, not a hospital or clinic where patients are expected to see a physician when they are in to see the doctor.

    By the way, DPT, PharmD, and AuD in hospitals don’t address themselves as doctors to their patients. They say their first and last name and then their profession. Just like nurses say their first name (last if they so choose) and then their profession. Physicians say Dr. so-and-so. It’s just common sense.

    Same argument over and over but yet the logic is ridiculous. A doctor is a doctor and a nurse is a nurse.

  233. nowitsfound says:

    Corporate will let everybody know who gets what.

    Most of you docs or wannabes are already just another employee number. Tell me, what kind of “fight” are you capable of putting up anyway? You have no decision making power, your employer will decide what works best for them and you (you wannabes don’t even grasp that this is your reality). Sure this should upset you, but MDs gave it all up when they caved and crossed over to the dark side to join the huge corporate networks. So, the spot you are in is really all your fault.

    Nurses don’t want to be doctors — MDs aren’t really in an enviable spot these days. I sympathize, as I think that as time goes on and the whole advanced practice thing gets back from it’s shakedown cruise, it might be something to envy. After all, the polls say almost none of ya are signing up for FP anymore. So why the whining?

  234. DNP=LicenceToKill says:

    Nurses don’t want to be doctors? Then why are they trying to be called doctors and do everything that real doctors do without receiving the proper training or education? Sorry, corporate isn’t going to save you from the big, bad MDs who think your licence is a joke.

  235. Common Sense says:

    “Nurses don’t want to be doctors??? Are you kidding me? This is what this entire topic is about! Two issues here: 1. DNPs demand to be addressed as doctors and 2. DNPs demand full autonomy with equal pay and privileges as physicians.

  236. A Dr like Dr Pepper's a doctor says:

    Here’s an idea. You want to be addressed as doctor? You want to practice medicine autonomously? Go to medical school. It’s that simple.

  237. nowitsfound says:

    No, I’m not a DNP.

    What I am telling you youngsters is that your future employer will make all decisions. FYI, life as an MD is not like it is on TV. Best you understand that it is not ever about you it’s about the company. You like everybody else, are easily replaced.

  238. Thomas33 says:

    Nowitsfound,

    Have you read the estimates about how short we will be on PCP’s in 2014, after many more people in the population gain health insurance? I’m pretty certain doctors will not be easily replaceable.

    That shortage is the basis for the efforts to produce more mid-level providers, like DNP’s. While they have their place and sure can help out, I feel there needs to be a bigger emphasis in training more medical students in the United States. Every year, we fund way more residency positions than we have graduating medical students, and these positions are filled by graduates of medical institutions outside the United States. Many of these countries, for instance Ethiopia and the Phillipines, need doctors more than we do in the US. It is also unfair to the many qualified American medical school applicants who apply to school every year and are not fortunate enough to be accepted.

    Once we expand medical education and train many more doctors in this country, then you might be able to argue that doctors are easily replaceable.

  239. nowitsfound says:

    You missed points:
    1. If your employer (hospital) can find a “better” way (pay you less, or have less of you), and all that with less hassle (for them), you bet that will be supported heavily — they got the money and they got the power. Everybody’s roles are being altered. You know this is true.
    2. FP is a very unpopular specialty. Medical students simply do not want to do it. Unless you guys choose it, yup it will either go unfilled or go to FMGs. I suggest you do something to encourage US Med students to take FP, or come up with another solution, yesterday.

  240. JM says:

    If you think all this bad…try dealing with nurses in the military, who are NPs or higher, have higher rank than you, are old and cranky, and get paid more to do less…..its far from wonderful. Minus that….I love military medicine.

  241. Thomas33 says:

    Nowitsfound,

    What would you suggest that I do to encourage medical students to choose family practice? I think the solution to this problem lies with a far greater scope of people than me.

    Here’s a thought… Maybe family practice is getting more unpopular because people with far less training and far less debt than MD’s or DO’s may soon be receiving the same title, same respect, same autonomy, same pay, same priveleges, etc. Who wouldn’t be pissed off in this position?

    And just for the record, in my program, family medicine was a very popular choice among the students.

    Like I said before, I believe medical education needs to be greatly expanded to fulfill the upcoming demand. I also believe the government should be respectful of primary care physicians, and Medicare should not reimburse midlevel providers at the same rate as physicians. With talks in the healthcare field of emphasizing more preventive medicine, the prospect of “medical homes”, and many more people in the United States gaining health insurance and the ability to seek care, I see primary care as becoming a more attractive choice among medical students. Hopefully, legislation concerning the autonomy/pay of midlevels won’t hurt that.

  242. DNP=LicenceToKill says:

    I honestly don’t mean this to be offensive, but nowitsfound sounds old and out of touch with today’s reality. Telling people in the medical profession to go into family medicine just because they should isn’t the answer. With the costs associated with attaining a doctoral (real, not dnp) degree, choosing family medicine isn’t a feasible option for most (considering the overhead costs of running a practice, malpractice, decreasing compensation, etc).

    It’s okay though, the nurses will just take a few online classes in health administration for their dnp degree and somehow be able to take over primary care ;)

  243. nowitsfound says:

    All this altruism comes to a screeching halt, huh. Yeah I am older than you guys ;P, enough that I’ve been in both business and healthcare, professionally in the real world for a few years. You just have this “we are precious” idea, that is simply not shared by your employers to be. This is normal for where you are in the process, you will live and learn. It’s best to always look at things as they are, good and bad. That’s the only way you can begin to control what happens to you. Best.

  244. Darth Nightingale says:

    I just want to get my Masters. I don’t want to be called Doctor either. I prefer the proper title of Master.

  245. lowbudget says:

    shelleyTheNPfutureDNP says:
    April 21, 2011 at 10:54 am
    “Keep on complaining that the DNP’s aren’t qualified, but the LAW says we are and we will be coming to a neighborhood near you very soon if we are not there. The law is on our side. Sorry.”

    Wait until you get sued. You’ll see how on-your-side the law is at that point.

  246. Rphinthedust says:

    Bravo to NP’s. Allopathic doctors had enough years to increase the number of medical school grads, and they did not. Instead they prevented new medical schools from opening.

    Nurse practitioners and PA’s can take care of 90% of all health care needs. Their time has come.

    MD monopolies are being busted by the new anti-trust bomb.

  247. skeptical internist says:

    Confusion between educational and other standards
    required to practice a profession and “monoploy”:

    Rphinthedust is confused by the meaning of monoploy.

    Only lawyers practice law-do lawyers have a “monoploy”?

    Engineers “practice” engineering-do engineers have a “monoploy”?

    So with accountants and numerous other professions.

    MDs always had DOs- who played “Avis” to MD’s “Hertz”- the DOs
    had to “try harder” to gain their recognition.

    No one economic trust practices medicine. That is NOT what this
    debate is properly about. MD groups compete with each other all
    the time. And Congress sets the overall number of residency spots
    available via reimbursement (Medicare) mechanisms.

    Rphinthedust- your ‘argument’ is just an absurd straw man, and is
    NO justification for lowering practice standards.

  248. RN-PhD-Canada says:

    Hello All,

    Great comments.

    I also find the DNP movement in US to be very interesting.

    Of course, the posting is extremely biased. For instance, the posting noted that DNP do not get any education in anatomy. However, it should be noted that education of DNP should include those that were recieved as part of the Bachelor of Nursing Program, which almost always includes anatomy, physiology, microbiology, organic chemistry etc. Also, the posting does not consider the fact that many individuals who earn DNP, already have years of practical experience, which has strenghtened and contributed to their knowledge base.

    It must be noted that medical doctors and nurses are quite different career path, However, with both contributing to health outcomes. The other issue is the discourse that almost always attributes the word doctors to physicians. I believe DNP, need to define themself, not to take on the role of medical doctors but to contribute to health outcomes as doctors (of nursing). The path will be different and this is what should be understood. With the current literature and knowledge, it is becoming obvious that contributing to health outcomes, cannot only be focused on medicine. Consideration of social determinants of health and system factors is extremely important. This is where the art and science of nursing come in and this is where advanced practice can have an impact.

    I must say though that for us (nurses) to have an impact, there needs to be a standardized education requirement/content as well as a link of courses to health outcomes.

    Thank you,

  249. Bob says:

    I’m a non-traditional pre-dental student. Recently took a class with pre-nursing students at a community college. The only questions they EVER asked of the instructor was “will this be on the test?” or similar questions to that effect. Furthermore, the pre-nursing students do NOT take classes for science majors–they take “introductory chemistry,” not general chem (let alone organic or biochem), which is really high school level chemistry. Even their intro bio class is a one-semester class for non-science majors (history, poli sci majors, etc. mixed in with future nurses). No wonder the DNP programs are so heavy on social “science” and policy fluff–their students never got a solid undergraduate foundation in science. And these people who never even took real college-level chem, let alone organic chem, are going to be telling patients which organic chemicals they should put in their bodies. Need I add that, unlike PAs, they don’t even have to be indirectly supervised in many states? I have great respect for nurses as long as they practice NURSING–they’re very good at that and they are absolutely essential. They often have saved people’s lives. But they are NOT prepared to practice medicine, and they never will be until they overhaul the undergrad prereqs required for future nurses. Until then, they will continue building on a foundation of sand.

  250. Bob says:

    In response to “RN-PhD Canada”: The claim that pre-nursing students take anatomy, biochem, etc. is extremely misleading. The anatomy that they take is part of a two-semester sequence of combined anatomy & physiology, and the grading standards are a joke. I got an “A” without studying at all. The tests are mostly multiple-choice questions so easy that you can figure them out with nothing more than basic logical reasoning and a general science background. The essay questions are announced in class several days before the tests are given. The “biochemistry” she refers to is even more bogus–it is watered-down biochem that is added on to the second semester of “introductory” chemistry (high school level). These classes are a joke. Furthermore, once nursing school starts, no more anatomy, physiology, chem–maybe some pathophysiology or pharmacology, but you can imagine how watered-down those courses are when they’re built on an essentially high-school-level foundation.

  251. Bob says:

    Aside from being a fake doctorate, the DNP is actually self-destructive (as is the DPT for physical therapists): it adds an additional educational requirement–at ENTRY level–that essentially erases the financial benefit of becoming a PT or APRN. Unless you’re independently wealthy, you’ll be crushed by a doctor-style level of loan debt along with a midlevel’s salary–a very good salary UNLESS you have huge loan debt. This financial self-destructiveness is overlooked in the name of an obsession with status, prestige and independence. Meanwhile, nurses who simply want to become midlevel providers and help people in need, are screwed.

  252. Caddypod says:

    This is a great concept. There are too few PCPs and extenders who are NOT nurses lack the skill and compassion that nurses can bring to patient care. This degree was available several years ago and hopefully it will spread as we see the diminishing numbers of MDs and DOs going into primary care. The podiatrists, DPM could have filled this gap but that profession is reamarkably disorganized and has made no strides toward filling a void that is truly needed.

  253. NPmarriedtoMD says:

    If more physicians didn’t seek opportunities outside of primary care, the need to fill these roles wouldn’t be present. The analytical breakdown of training between a Family Practice Physician and DNP is not accurate. Prior to becoming NPs, nurses do go through undergraduate training, which does include clinical and didactic content. Unlike medical students, who may not even major in a medical related field, prior to entering medical school- there is a lack of medical education in those early years. Nurses undergo rigorous undergraduate training as well as graduate training. The table is not all accurate. Some NP programs require a minimum number of years of direct clinical experience prior to entering NP school. For example, nurse anesthetists and even some family nurse practitioner programs require at least 2 minimum years experience in a critical care or direct patient care setting, respectively, before applicants can even apply. Another false pretention noted on the table is that DNP programs don’t offer clinical hours. That is very misleading as there is not 1 DNP program that lacks clinical requirements. I think the AAFP can’t quite accept that the need for primary care is there and that innovation needs to play out in this situation-to fill the gap in healthcare. If no other physicians will step into primary care positions, we need to find other qualified providers to fulfill this need. Just like any other provider out there, whether a MD, DO, PA, or NP, there are those that are good and those that are bad. I’ve been to several MD’s that apparently lack clinical and communication skills. How about the MDs that are foreign? If they underwent training from abroad, it’s not like they were trained based on U.S. evidence-based guidelines? Most MDs don’t getting the training in public/health policy. When they eventually enter into clinical practice, they haven’t the slightest clue how policy dictates reimbursement and practice management. There needs to be a collaborative partnership accross multiple disciplines to find a way to approach this crisis in health care. Instead of feeling theatened or territorial about who this health care field “belongs” to, there can be a better way to approach this. I believe various educationally-prepared providers can contribute quality care with different sound approaches that will ultimately lead to optimal patient outcomes.

  254. […] title of "doctor" has its own critics, claiming the the prefix confuses and misleads patients. When making an appointment for healthcare, […]

  255. hmmmmm says:

    NPmarriedtoMD————–you made my argument for me. Like you mentioned “Some programs” require certain benchmarks be attained before admission is granted……….. The NP degree has ZERO, absolutely ZERO continuity of standards between any of the programs sprouting from the ground to quickly cash in on the fad. Some schools require GRE, some require none, some want years of nursing experience, others will happily hand you a “Doctorate” in exchange for paying the lofty fee and taking classes ONLINE for 2 years.

    Medical school is standardized and competitive, there are competencies that need to be reached even before you start from day 1 as an MS1. From there you have school, boards, rotations, more boards, and finally residency, all of which regulate who is ready and more importantly who is competent to practice in a desired field.

    Not sure where you get your info from but foreign medical grads can not just come to the US and open up a medical practice. They have to complete an American residency just like everyone else in their desired field. It doesn’t matter if you’ve been in practice for 20 years in India/Mexico/Africa/Russia……., you want to practice in the US get a spot in a residency program and start over.

    The US needs more physicians to enter family practice plain and simple.

  256. Sun says:

    “others will happily hand you a “Doctorate” in exchange for paying the lofty fee and taking classes ONLINE for 2 years.”

    This is my perspective on the dangers of degrees/programs like this. Scary that blatantly for-profit programs should have such a role so high up in the health care system. That’s a lot of responsibility to be riding on online classes.

  257. Mike says:

    The title “Doctor” is not confusing nor is it the domain of MDs and DOs, why is this such a difficult concept for clinical doctorate prepared (MD/DO) individuals to grasp? MD and DOs enjoy the sole ownership of the title “Physician” and if they want to separate themselves they should use it instead of doctor. Lets stop pretending that this bill has ANYTHING to do with transparency and be honest and say it has everything to do with PHYSICIANS trying to protect their slice of the healthcare pie by making as much separation as possible b/t themselves and everyone else. Suck it up buttercup, DOCTOR is reserved for those who EARN a doctorate degree, they are entitled to use it anywhere and anyway they so choose.

    Pathetic.

  258. bob says:

    No, pathetic is taking online classes that are watered down versions of real classes and claiming to be a “doctor” and the equivalent of a physician.

  259. Izzle says:

    Anyone who claims to be a doctor who does not have an MD or DO cannot practice medicine in this country without physician supervision, if you or those you know encounter anyone who claims to be a doctor who has not completed the appropriate medical schooling residency or board examinations, can be sued for fraud, misleading the public, public endangerment, intent to harm the list goes on…. A doctorate in archaeology can not treat patients medically neither can DNP’s.

    Pursue legal action if these atrocities continue, if I get a single patient referred or managed by a DNP or a PA who has been given a diagnosis, prescription, or even a physical exam I will press charges, especially if they have received monetary gains while acting as a physician!

  260. GenSurgNP says:

    “Anyone who claims to be a doctor who does not have an MD or DO cannot practice medicine in this country without physician supervision,

    Pursue legal action if these atrocities continue, if I get a single patient referred or managed by a DNP or a PA who has been given a diagnosis, prescription, or even a physical exam I will press charges, especially if they have received monetary gains while acting as a physician! ”

    True. No one can misrepresent them self or their degree in ANY field. But, NPs can and do work without physician supervision everyday. In many areas NPs work with physician collaboration and not supervision. NPs diagnose, prescribe and treat MANY illnesses on a daily basis and do it well within their scope of practice. Suing would quite simply be a waste of your time since these providers are practicing well within the law.

  261. nabil says:

    If you are a person who wants to do primary care so bad (including diagnosing, prescribing medicine, etc, etc), why not just go to medical school and go into family practice? Why bother with this DNP business?

  262. hmmmmm says:

    “why not just go to medical school and go into family practice? Why bother with this DNP business”

    People will always try to find the path of least resistance to get what they want. Why enter medical school when you can go through the exponentially easier nursing path and have your lobbying group complain on your behalf.

  263. soontobenp says:

    @hmmmmmm: “People will always try to find the path of least resistance to get what they want. Why enter medical school when you can go through the exponentially easier nursing path and have your lobbying group complain on your behalf.”

    I find your comment totally insulting and degrading to the nursing profession as well as to other healthcare specialties. Many nurses originally choose to do nursing because they feel more comfortable with the nursing model and philosophy in contrast to the model of medical training taught in traditional allopathic and osteopathic medical schools. Many others choose nursing because they have experienced various negative life circumstances that make the M.D./D.O. degree somewhat unattainable for them. In my personal experience, I like how I can continue to challenge myself in the medical field by increasing my education by going at my own pace, i.e. first by starting with my bachelor’s in communications, then by pursing my second bachelor’s in nursing, then pursuing my master’s in nursing, and who knows, getting my DNP. I love learning and am content with being a professional student the rest of my life, and going to medical school is not the ONLY route to be a professional (and HARDWORKING) student. Seriously, every person has a different reason for pursuing their field in medicine and to belittle it the way you do is frightening, especially if you are a medical doctor. I would hate to be working with you if you are this disrespectful to your colleagues. Just because you chose (or may have chosen) to become an MD or DO does not mean that you are the most hardworking and wise member of the medical community.

  264. Why such resistance? says:

    Nurses with an advanced education and training who hold a DNP should be allowed to call themselves doctor end of discussion. Physicians are not the only healthcare professionals entitled to use this title of advanced training. If patients get confused we (APN’s) can easily clarify our role. I would introduce myself and say: “hello Mrs. X, I am Dr. Jane, your Nurse Practitioner! Physicians can introduce themselves and say: hello Mrs. X my name is Dr. Smith your Physician. I really don’t understand why there is so much resistance. Patients can be educated about the differences. They are not all as incompetent as some may believe them to be. I chose to become a nurse because of the differences in philosophy of each profession. Not that any profession is better than the other. Physicians and (APN’s) are both valuable to patients in delivering quality care.

  265. hmmmmm says:

    @soontobenp—— No one is arguing the fact that there are many different pathways in healthcare as well as the hard work people put in to attain their desired degrees. That’s great you are self motivated and want to better yourself through education now and in the future, a trait unfortunately lost in this country. You may find my opinions frightening, but what I find frightening is the belief NP’s hold that their graduate education somehow prepares them for independent practice. The NP degree is being furthered by legislation, not education.

    No joke, I had an NP try to convince a close friend of mine that an episiotomy was performed AFTER the birth of the baby and that she is confusing this with a C-section—-This coming from an NP working in an OB/GYN clinic. I recently had a chat with an NP about something as simple as a TENS unit describing the physiology behind it and I might as well have been trying to teach calculus in Japanese. Her curriculum didn’t cover the basic anatomy/physiology found during your first day of nervous system physiology as a first year med student.

    In no way am I saying all NP’s are like this and I have met many, like yourself, who work diligently to further their education. My opinions stem from the complete lack of standards to not only enter NP programs (GRE/no GRE, some don’t require interviews) but the lack of continuity of curriculum’s across the board.

    As you had mentioned there are many different routes a student can take to be a hardworking professional and this is absolutely not limited to medical students. But claiming educational equality and demanding equal practice rights is laughable and most importantly down right dangerous to the patient.

  266. superman1978 says:

    @whysuchresistance?
    While I agree with you that patients in general would understand that a NP is not the same as a physician (at least in name), I still don’t think it’s a good idea for a DNP be referred to as doctor in a clinical setting. For starters, that would really only be applicable in an outpatient/office visit scenario. A patient admitted to the ER or ICU may not really understand the particulars, especially if one is in need of emergent care. A reasonable question would be: if the family could decide between the board certified physician or the DNP, who would they desire to be their provider? I’m not asking that question based on competence, but what the patient and family would want. Secondly, while a solid percentage of the population has some kind of formal education, the vast majority do not have a degree outside of high school. What that essentially means is that when they hear “doctor” they think “physician”. A big deal? Probably not but these “little” things can start to add up. Third (and this is by far the most serious concern) is that there is little in the way of a unified curriculum between the different methods of training for a DNP. Research has showed that online courses are mostly much less effective than in person, in class training. In other words, having the title doctor and earning that same title are very different. Fourth, a DNP is NOT equivalent to a MD or DO. Their increased scope of practice is based on population needs, not competance. Because of that, something as simple as introducing oneself as a doctor appears to be misleading the patient, even if the caveat of “your Nurse Practioner” is given. Some of these things seem small while others are genuine, serious concerns. But when look at as a whole, one has to come to the conclusion that there are serious concerns with the title of doctor being bestowed in such a haphazard fashion.
    Physicians are, by training, a rather conservative bunch. This is a good thing. This ensures that whatever treatment we give, whatever therapy we prescribe has stood the test of time and reliability. The rather brash and eager push to award the DNP to as many NP’s as possible is a genuine concern. These programs must prove that they aren’t degree mills and as their graduates go into the workforce, they must prove that they are worthy of this grand title of respect. It took DO’s nearly a century to earn that respect, a process that continues. Why do DNP’s feel that they should be given that same premise without surving the test of time?

  267. word says:

    “Just because you chose (or may have chosen) to become an MD or DO does not mean that you are the most hardworking and wise member of the medical community.”

    True. But it does mean that he is the most educated, most knowledgable, most capable and best trained (by far in terms of both time and depth) to PRACTICE medicine. And without any intentions to disrespect the profession, but chances are the MD/DO did have to work harder and sacrifice more (time, finances, effort) in order to get to where he stands. How about a little respect for the sacrifices made by physicians?

    Everyone should know his or her place and accept the role given as opposed to wanting something that has not be earned fairly. It’s simple. You can practice medicine when you jump through all the hoops and over the hurdles that one must conquer on the path towards becoming a physician. If you want the reward, you have to play that game. It’s simple.

    Nurses are nurses.

    Physicians are physicians.

    If you want to be called doctor, FINE… but don’t think that brings you any closer to practicing medicine. You’re still following physicians’ orders.

    KNOW YOUR PLACE… be proud of this place and respect those who have pay their dues to be your superiors.

  268. word says:

    I also think it’s hilarious that so many use this “I chose nursing because of the philosophy” reasoning as if they were deciding between medical school or nursing school and this philosophy they speak of was the deciding factor. Well, there you go… you CHOSE to be a nurse, so be it.

    Regardless, I’m not too concerned over all of this. All it takes is ONE costly mistake from ONE D.N.P. for all of this encroachment to end (and it is encroachment regardless how one tries to sugarcoat it. Nurses want more autonomy and believe their job can somehow occur without having a physician one rung higher than them on that ladder to the top. Lawyers know what is going on and they are licking their chops, just wanting to jump at their first chance to make bank off of this scenario. And it will be an easy win in court. (“So, DOCTOR nurse Smith, you earned your doctorate online? Case closed).

    So, to all you have paid your dues to practice medicine, worry not; this will work itself out in the long run.

    Oh and just for the record: While we may all seek equality as human beings, the truth is that in the medical arena, physicians are superiors to nurses. That said, we all have a boss to answer to.

  269. word says:

    “Many nurses originally choose to do nursing because they feel more comfortable with the nursing model and philosophy in contrast to the model of medical training taught in traditional allopathic and osteopathic medical schools.”

    And most of are not capable of performing an academic level deemed necessary to succeed in medical school. Like it or not, it’s the truth. The education of a nursing student pales in comparison to that of a pre-medical student, forget that of the medical school curriculum and residency training that follows in the the 7-10+ years AFTER undergrad.

    AMAZING how people can talk themselves into believing that nurses are somehow equals to physicians in the medical profession. Wishful thinking much?

  270. word says:

    “In other words, physicians routinely receive 15,000 to 17,000 more training hours than DNPs.”

    THIS. This should be explained to patients when educating them about the differences between Doctor nurse Smith and Doctor physician Jones. Most of the general public doesn’t have the slightest clue about medical education in this country. When they see a white coat, a stethoscope, and hear “doctor” they think they are talking to physicians.

    Example: My step-mom was being treated for end stage terminal cancer at Sloane-Kettering in NYC. Two people in white coats came somewhat regularly into her room throughout the week to speak with her about tests, procedures, results, etc. Both introduced themselves as “doctor” and referred to each other as such. I was curious during one of these conversations, so I peeped a bit closer at their I.D. tags only to see that both were N.P.s.

    When they left the room I turned to my step-mom and father and said “You know they aren’t physicians right?” Neither of them had a clue and even challenged me on it. The next visit by these two cleared any doubt. Obviously, these two never clearly defined their titles. By referring to themselves as “doctor” in a medical setting they mislead people into believing they were something they are not! Did they have bad intentions? No. They were actually extremely nice, knowledgable, competent, and helpful. However, patients perceived them to be something they are not.

    Lines need to be CLEARLY drawn. Luckily a few states have adopted color coded I.D.s that are very loud in announcing the level of medical professional one is.

    I’m not even going to go into the legitimacy of the D.N.P. diploma mills that are popping up like acne in the 8th grade.

  271. bob says:

    You guys are all pathetic. That table is not accurate. In the end it comes out to patient outcomes. There will always be good and bad NPs/MDs. Suck it up, time has changed and so has health care. In the end, I’ll be making enough money to invest it and have a great family to care for.

  272. BananaManWill says:

    Hey, wanna have some fun…. stir things up… I’m going to throw the cat in the water…..

    While nurses are fulfilling a greater role in primary care, how about they let paramedics move into their role? Let’s see what kind of response we get from that.

    For years, nurses have fought to keep other healthcare providers out of “their roles”. How many emergency rooms and hospitals do you see staffed primarily with paramedics? Many hospitals receive a severe backlash from the nursing staff when they try to allow other professionals to fill their nursing needs due to a shortage of RNs or the inability to pay nurses. And yes, you can pay paramedics less because it would still be more than what they make on the ambulance. According to Ms. Shalala, (see link 1 at end of post for reference to another article on this topic) “When you do the same job you ought to be paid the same”. A nationally registered paramedic is just as capable of a nurse with equivalent years of experience. I base this off both program standards for EMS and nursing programs, which includes standards for didactic and clinical training; paramedics actually receive MORE hours in training in some programs (not all RNs have to complete Bachelor or Associate programs). Paramedics even have a greater scope of practice in some states than nurses. (links at end of post)

    So, nurses out there, are you going let other professionals into “your roles” as you try to climb the ladder?

    1. http://www.studentdoctor.net/2010/10/nurses-push-for-bigger-role-gets-powerful-ally-2/
    2. http://www.coaemsp.org/
    3. http://www.aacn.nche.edu/accreditation/

  273. Trent Steele says:

    18000 hours > 6000 hours. Also, these nurses have a hard on for being called doctor apparantly. I have received a doctor of pharmacy degree, and I would NEVER introduce myself as DOCTOR Steele to a patient. There is no doubt that the word confuses a patient. Even if you follow up your I’m Doctor X, your nurse practioner, they will still think you are a physician. Yes, you are technically a doctor and so are phds, but going around a hospital calling yourself a doctor in front of patients is a recipe for disaster. If you must be called doctor on a daily basis have your students address you as such… WHILE AWAY FROM THE PATIENT! Patient comes first not the title! /rant

  274. TC says:

    I think having there is nothing wrong with having a DNP degree, but the training itself is still not equivalent or standard to having an MD. Personally, if a DNP addresses his/herself as a “doctor” to be a patient in a clinical setting it’s misleading. Whereas, if a nursing student or any student addresses a DNP as “doctor” in academic setting that would seem much more appropriate.

    Pharmacists with a PharmD would not address themselves as “doctors” unless they were teaching another student in academic setting.

    While DNPs can and will be a great asset to the medical team, I just hope that DNPs realize that their limitations and scope of practice just as any medical professional whether it’d be a physician in different specialities, a pharmacist, an optometrist.

  275. Anathema132 says:

    I agree with many of your comments above. This talk of a doctorate degree is also a smoke screen. The main issue is that the government wants physicians and medical doctors out of practice to instill a more socialized form of healthcare. Since the AMA and others derailed the first attempt of reform by the Clintons in the early 1990s, physicians have a big bulls-eye on their back. (Not to mention that Bill Clinton’s mom was a CRNA and he started the opt-out issue by executive order for her – not by popular vote!)

    Realize this is pushed by the state and national nursing unions of several million strong (second only to the teachers union) with lobbyists in every state legislature. In addition, they have friends in high places to publish biased and bascially pseudoscientific research to further their agenda. These so called studies published by no-name researchers don’t appear in a peer reviewed scientific journals but rather health policy journals which are typically not objective but very partisan. In addition to Obama administration policy wonks, the FTC is on their payroll as well.

    The DNP degree, which is basically a masters-level degree, is just a political tag provided by the nursing unions to further their interests by trying to become the gatekeeper to patients and further degrade patient-physician interaction. I know the nurses who reply or blog always point fingers at physicians – they are bad, they have no bedside manner, etc….but there are just as many or even more nurses who are poor clinicians and interact poorly with patients (given that there are more nurses). But the media has their back including the NYtimes which continues it’s physician-bashing agenda this week.

  276. Really Now? says:

    @Trent Steele “Also, these nurses have a hard on for being called doctor apparantly.” LOL… I wonder if you think even the female nurses “have a hard on”. Your comments are SUPER professional, right? Are you representative of the presumed “superiority” of MDs? You may want to also look into mastering basic spelling. /LOLOL

  277. Akrish says:

    Why not creating more medical schools instead of increasing the intake of DNP Programs to fill the shortage of Primary Physicians? After all, there is a quota for Dermatology/Plastic Surgery and not everyone can fit into their match and will eventually settle for FP?

  278. akrish says:

    It is a disgrace really…

  279. StatingTheObvious says:

    It took 217 posts to achieve Godwin’s Law….SDN, you are slipping. As for the topic at hand, I think Shelly has posted enough to demonstrate how the DNP is a political move and not a clinical degree.

  280. JH says:

    As a DNP student at a major University, brick and mortar institution, I would like to leave some comments. First, it is so disheartening to see the two separate professions bashing each other. The I’m better, no I’m better, 2 year old mentality is thankfully nothing I have witnessed in person. Although, I have witnessed overinflated ego’s on both sides, and each side not appreciating where the other is coming from. The comparisons I have read between the two schools of training in this article I feel are absurd. I personally, don’t see the point of comparing apples to oranges. I’ve seen numerous comments to the effect that medical training is deflated, and that there are many more hours required than the table reflects. However, nurse practitioner training is severely deflated in these tables as well. To begin with I did my undergrad training in a brick and mortar traditional school as did the majority of nurses I know. Although, there are numerous online schools, and non-traditional schools, I can tell you these are not respected by nurses, and many hospitals will not employ these individual’s right out of school. After completing my 4 year degree, in 5 years and 165 credits with many courses in the physical sciences I began to practice as a nurse. After 12 years as an RN (roughly 25,000 hours) with the majority in critical care I decided to return to school and obtain an advanced degree. I am in my 3rd year now of my DNP program, acute care specialty. So far I have completed over 1200 clinical hours, and had two years of advanced pharmacology, pathophysiology etc with absolutely no fluff, theory nursing crap that some of my undergrad classes consisted of. Hard science, of how to recognize altered physiological processes, the treatment(s) and/or how to find the treatment or who to refer to with rationale and reasoning. Is it easy? Um, yeah, a walk in the park, I’m sure anyone can do it……..haha. Does it compare to medical school? No. Working side by side with medical students and residents I can tell you, I know I lack the fundamental education that they received in the sciences, and have a much greater concept of what is going with the physiology of any disease. However, we both analyze/interpret the same laboratory data, perform same physical exams, and come up with the same plan for the treatment of the majority of diseases we encounter and treat.

    I graduate in May, where I estimate that I will have around 30,000 hours at the bedside, with at least 2000 hours in the advanced practice role. How does that compare to medical education? It doesn’t…..apples and oranges. I have no desire to be called doctor. I’m a nurse, and there is a distinct difference. However, I also have no desire to call anyone else doctor. Personally, I believe the title should be reserved for academia and that any clinician should introduce themselves by first and last name and title. Im John Doe, your physician/surgeon/nephrologist/pulmonolgogist/nurse practitioner/pharmacist/physical therapist/dietician/whatever. Doctor Doe, tells the patient nothing about you, and what you are actually there to do. This simple introduction tells the patient what you are actually there to address and ques them into the pertinent questions they have for you. In a clinic this may not seem necessary but in the acute care setting, the patient has no idea who you are. I have witnessed this scenario numerous times.
    Dr: I’m Doctor Doe
    Pt: Is my heart going to be okay?
    Dr: I’m not your cardiologist
    Pt: Well, um, what are the long term effects to my lungs?
    Dr. Im not your pulmonologist.
    Pt: Well what do you do?
    Dr: Im here to talk about your dialysis
    Pt: oh, so your the nephrologist, I see…..

    The tradition of “Doctor” for the purpose of respect, authority etc. is outdated. Even as a student I am on a first name basis with the physicians I work side by side with. The occasional physician I have encountered that demands they be called “doctor”, are usually the ones that have no respect of there peers, patients, nurses, and is the only source of respect they actually perceive, although none is given. I’m not sure why on blogs and forums physicians are so adamant about the title, and in real life the wonderful people I know of each profession work together, and play together outside of work without the constant pissing contests.

    The only reason I can tell for the pissing contests by physicians is the thought that nurses are trying to practice outside their role, or ultimately practice within a physicians role and to make the medical training they endured obsolete. It seems that nurses get into the pissing contest due to the under recognition of the actual rigor of completing an education as an advanced practice nurse from physicians. However, this is not my intention, nor the intention of any advanced practice nurse I have ever met and worked with to be called “doctor”, work as a “doctor”, or be paid like a “doctor”.

    Ultimately, I feel that each profession should recognize the contributions that each make to the health care, understand the role of each, and work together for the benefit of patients and society. Of course, to my detriment, I’m obviously more pragmatic and a realist, and what else would we have to complain about if we all got along.

  281. John Doe says:

    JH,

    What I gather from your post is that physicians should stop introducing themselves as doctors because nobody refers to DNP’s as doctors. Is that correct? :)

    It’s not that people don’t appreciate what nurses bring to the table, the problem is when nurses complete this pseudo “doctorate” program and start equating it to MD or DO program.

    1. JH says:

      John Doe, In the simplest context yes. The use of “Doctor” from a physician, nurse, Ph.D, lawyer, pharmacist, implies to the lay people that the user of the word is the know all end all with all the answers. “Psueudo Doctorate”, really? Is that because you dont believe that the Nursing Doctorate is equivalent to the medical doctorate? Or because you believe its an overinflated degree and the nurse who has spent the rigourous time of study, as I have, does not deserve the title because they are nurses? Again, I dont believe the Nursing Doctorate is equivalent to the medical doctorate, as I outlined in my earlier posting. I dont think the medical doctorate is equiivelant to a Ph.D, in any field. Again, the two are different. It seems to me physicians do not want to give nurses the recognition of a doctorate, because they think it will belittle what they have learned. But more than that it seems physicians do not want to lose the tradition of a profession that has dominated another profession on the basis of gender inequality. Nurses are the hand maids of the medical profession, right? and what kind of progressive, very well educated profession such as physicians would want to let go of tradition, and the perceived power with that.

      1. fdsfsdf says:

        No it is because the “doctorate” is a joke degree full of fluff classes that do not expand ones clinical knowledge. How are you missing this obvious fact?

  282. JH says:

    fdsfsdf

    I think you are mistaking “obvious fact” for that of your opinion, without any substantive evidence. I must have picked up logic and reasoning in all those “fluff classes”, eh?

    1. fdsfsdf says:

      If you really can’t see how bloody obvious it is that the coursework does not expand upon ones clinical knowledge in any significant way, then it is absolutely pointless to have any further discussion with you. Your blindness and ignorance won’t be remedied by anything we state.

  283. aslan says:

    So I think JH has hit the nail on the head. Granted I’m pre-med (class of 2016!) but most doctors I shadowed introduced themselves by name (“Hi, I’m Jon Schmozby”) or not at all (“What seems to be the problem to day?”) and I felt like the lines of communication were opened up more by the introduction by name. Who wants to confide in Dr. Bigmanoncampus? I would rather tell my embarrassing medical problems to Jon, my MD/DO, or even my DNP for that matter. I also feel like the big issue is lack of standards across the profession. JH and thousands of others are getting competent, thorough training, but there are some that are not- and that worries me. If there was a national board certification for DNP’s I think this discussion would have ended a while ago. And while we’re talking about training and job overlap- I also think that MD’s should be able to complete DO residencies if they complete OMM training like DO’s do. Just my two cents on two very hot topics, one of which no one asked about… Bottom line- everything in health care is going toward a doctorate-level education (DPT, PharmD, DNP, etc) so the only way to keep confusion out of it is to change our language. Happy New Year!

    1. JH says:

      fdsfsdf – Again, you are stating your opinion, of nurses, of a degree, etc. of which, you have presented no real information or data to support. Therefore, what am I blind and ignorant to? Your lack of supportive information and data? Because, I do not share your unsubstantiated opinion, I am blind and ignorant? Your argument is weak and a fallacy.

      aslan- I agree with your assessment of a lack of standards across the profession. Unfortunately, this is one of the nursing professions weakest points. With an MD/DO/PharmD, one can expect a certain level of knowledge, experience, skills, etc. Nursing has so many different levels of nurses, any other healthcare professional has absolutely no idea what they can expect from any nurse. Even NP schools vary in the amount of time, course work, clinical hours, etc. Personally, I feel that the current minimum for NP’s at the masters level is set to low. Some schools ride these minimums, while others have greatly expanded on the minimum, However, In 2015, this is going to change, and the DNP will be the minimum requirement for licensure as a NP. In essence, in 2015 there will be a national board certification for DNP’s. Good luck with med school, and I am glad I can look forward to working with physcians that have an open mind, and appreciate other professions.

  284. Gary W says:

    Nurses, join the Age of Greed! This is a transparent attempt by the nursing profession to grab a big chunk of the 30-40 million new insureds coming into the healthcare system in two years. They assume that MDs can’t handle the rush, so the field will be wide open for Noctors to represent themselves as Doctors, and make a lot more money without meeting the intellectual and clinical rigors of acquiring a MD.

    But 30-40 million new insureds does NOT translate into 30-40 million new patients. A majority of them don’t have insurance because they don’t get sick. The DNPs may find that they are too good to be nurses and too under-qualified to be doctors. Obviously that’s no problem for nursing schools and professional bodies. It is the DNP grads who will bear the brunt of this massive miscalculation of demand.

    I think state governments will regulate DNPs like they do PAs – i.e. require them to be .supervised by a MD and to identify themselves as DNP, not a doctor.

  285. Catherine says:

    I’m a nurse practitioner who is currently working on my DNP, and I never plan on introducing myself to patients as their doctor. I’m still going to be their nurse practitioner and they should understand the difference. Technically speaking, anyone who has earned a doctorate degree (dentists, pharmacists, physical therapists) can introduce themselves with the doctor title. That doesn’t mean you actually should if it’s going to confuse the patient into assuming that you’re their physician. My husband is an MD and while I completely respect the profession, I chose to be a nurse practitioner because of the nursing aspect of it. Similarly, my husband became an MD because he wanted to study medicine. We both know that while the scope of practice for NP’s may be similar to physicians in some ways, it’s not the same. The goal of the DNP is not to compete with MD’s, but rather to develop the nursing profession. For example, the standard of practice for pharmacy was once a bachelor’s degree, but now it’s a PharmD. Does that mean pharmacists are trying to be physicians? No, it just means that those who have earned the degree have completed the highest level of education and training for that profession. As with the nursing, the DNP degree provides that additional level of knowledge for a nurse practitioner, but that doesn’t suddenly make them a doctor/physician. As much as I respect my fellow nurse practitioners, you have to realize that a DNP is not equivalent to an MD. At the same time, it is completely inappropriate for anyone to say that nurse practitioners “aren’t as good” or “don’t know anything”. There are many different roles in healthcare and they exist for a reason; no one can do it all and treat everyone. Despite what our titles are, as professionals we should all respect each other and work together, not against each other.

  286. NurseR says:

    When I finish my BSN at Georgetown in a few months (following a BA from Dartmouth) I’m looking at 3 years in ICU as a condition of my full scholarship, then 4 years at Columbia for a DNP (if things go according to plan). Yes, 4 brick and mortar years, including a year long residency. (http://sklad.cumc.columbia.edu/nursing/programs/dnpFAQ.php#8). Have I proved my IQ, GPA, and test scores are good enough to join the ridiculous “who’s is bigger?” contest??? Or am I just some “dumb nurse”?

    Nursing isn’t medicine. Anyone who pretends it is insults not only physicians but also nurses!!! We have a unique role, and according to the proposed health care changes, we’re getting more responsibility whether the AMA or ANA membership likes it. (I don’t know why people think that this is supported by nurses…trust me, many hate it. Don’t see the point in all that “book learning.” Go to allnurses.com and google the DNP. Enjoy)

    Right now, you don’t even need a bachelor’s degree to be a nurse. Some of us are working very hard to change that and introduce a different model. Rigorous courses. More training. More hard work. Stricter standards. Residencies. Please, for the good of the whole system, don’t hurt us in a push to professionalize. Everyone wins when nurses get more education. In this day and age, we need a lot more time in classrooms before we are safe.

    The DNP is part of this push. We aren’t doctors. Not even close. I know that, and I knew that was the choice I was making when I turned down the Columbia post-bacc. The battle was lost with the introduction of the NP years ago. It’s a fact that nurses are going to be tomorrow’s PCPs.

    You’re all absolutely right. Online courses in giving hugs and nursing theory are not going to help. But, just dismissing the whole field doesn’t fix that. Let’s look at the current situation and the legislative trends, accept that the field is shifting, and work together to figure out how to make sure people get appropriate care from well trained providers.

    I hope you all can understand that me doing wellness visits doesn’t at all take away from you doing heart transplants. Our expanded scope should give you more time to deal with the complex stuff. I promise, the ones leading the way with the DNP aren’t dummies. We’re at Yale, Columbia, Vanderbilt, Georgetown, etc. We’re not going to go rogue and try and take on more than we can handle. What we do believe in (and here my jesuit school values are going to come out) is that people need more primary care than they are receiving, needs providers with lower patient loads, and need providers who have the time and training to deal with all the messy psychosocial issues that muck up getting better. We’re nurses because we want to do home visits, we want to educate about lifestyle, we want to be at the bedside making sure people are clean and warm and safe, and get to do that all night long. Exactly what primary care use to be.

    When I thought about med school, I kept saying that I just wanted to be a country gp– know my patients, run a little practice, do all that day-to-day stuff that keeps people patched up. Be home for dinner. Medicine no longer has that role, not that I’ve seen. There’s a need, and we’re simply trying to fill it.

  287. Army Nurse says:

    Some of the MDs on here are absolutely despicable and their insecurities shine through in their berating of nurses. “Noctor” really? grow up. I busted by butt in nursing school… Took a year of anatomy, microbiology, bio, chem, patho, pharm, health assessment, nutrition, OB, peds, psychiatric nursing. I took over 20 credit hous 4 semesters in a row. Graduated with a 3.8 gpa and hardly any sleep…while on top of it all doing ROTC. Oh and wait we rotate through Peds, OB, med surg, psych, critical care, community settings. I’ve watched open heart surgeries, put in an A-line (the nurses did it better then the docs in Landstul, Germany!) into a sedated wounded warrior as just a NURSING STUDENT That is just a BSN and it was wide known at my school that nursing was one of the hardest undergrad degrees….us and engineers last ones in the library. Soon I’ll be qualified to put in a PICC line and be ACLS qualified and know how to run codes (it’s all algorithms) Most nurses stand in the background and are proud to be the patients biggest advocates. One of our jobs is to catch a doctors mistake whether it be an order or medication dose. WE PREVENT DOCTORS FROM KILLING YOU. Especially unexperienced interns. I met an intern in the ICU at Walter Reed say to the overworked, fatigued nurses, “let me know what orders you need, I’m just here to write orders.” That intern is going to do amazing. Nursing assistants I work with (who change the bed pans, and perform ADLs) I’ll do anything for…I’ll help them clean the poop, turn a pt, make a bed. You know why? Because I have respect for them and one of my first nursing school lessons in a nursing home was never be too proud to provide basic care for a pt even though I’m an educated professional, I’m humble. P.S. if you want to dive into history lets talk about how more women survived L&D with nurse midwives who washed their hands then doctors who skipped that step back in the day. Infection control and improved pt outcomes can be directly contributed to our profession’s historic heros. We put the human being back in the pt.

    Everyday on the floor I learn something new and how to better critically think and I listen in on rounds (yes the 5 minutes a day a doctor spends with my pt) After 5 years of med surg experience I want to take a 4 month intensive critical care course and then get my DNP. I’ll be able to have my own practice in most states, interpret labs, diagnose, and prescribe. Doctors and nurses are two different professions.

    Two of my best friends are in med school. I’ve met some doctors I am in complete awe of and admire. Others I wish I could ban from ever touching a patient because they have absolutely no people skills or compassion.

    Also my undergrad school’s graduate level program starts out with advanced patho, pharm, assessment. I don’t agree with online DNP classes and think the DNP needs to be better regulated

  288. Real MD (female) says:

    If you want to be called “Doctor” in the medical field – go to medical school. And then you can pay outrageous malpractice insurance premiums too!
    The “you chose to go to medical school and I chose to go to nursing school” argument is absurd. Nursing school is minimal training compared to medical school. If you wanted to be a doctor, why didn’t you apply to medical school, get accepted, attend for four years, apply for a residency, get accepted, work 120 hours a week for 3-5 years, apply for specialty training, get accepted and work 120 hours a week for another 3-5 years? That’s what it takes to know eoungh medicine to be addressed as “Doctor”. Get over yourself – you’re a nurse. And you’re probably a VERY good nurse. But you’re NOT a doctor.

  289. shelleyTheNPfutureDNP says:

    Now that residency hours are down to 60 hours a week, the MD/DO’s should stop using their argument of more hours equals better training.

    When I was an ICU nurse, I could work 4 shifts a week, and put in more hours a week than the residents are now putting in theses days. The vast majority of DNP’s will have 3-4 years of ICU experience before they start one day of DNP school.

    Residents are now working 8 and 10 hour shifts at the teaching hospital I am at with the new 60 hour a week restrictions. The nurses work 12 shifts in the ICU.

    Now who is getting more hours of training?????

    1. NeatoMD says:

      Shelly,
      You might want to recheck that info. Your hospital may have a limit of 60, but the law is still 80 hours and only interns (1 year residents) are limited to 16 (not 8 or 10) hour shifts. The rest of us still work the 24+ hour shifts. It’s unfortunate that by insisting that DNP applicants have certain years of working experience, that people such as yourself are equating this nursing experience to doctor experience. That’s like saying that after you gain enough years of experience as a doctor, you ought to be given a master’s in nursing. Or, perhaps more extreme: a person who sits on a jury in a trial enough can be a lawyer. No nursing experience, ICU or not is equivalent to experience as a physician. Your last 12 hour shift in the ICU as a nurse watching urine output and critical calcium levels last week was not equivalent to my 30 hour shift in the ICU actually managing those sick patients. Not because of the shift length, but because they are two wholly different jobs.

      In essense, this is what your argument looks like to a physician: “I was a flight attendent for years on a 747. So, I think I should be able to fly them. I even flew a small plane on a flight simulator once! I know I’m ready.” How would you feel about letting that person be your pilot?

  290. MD Student says:

    Army Nurse:
    “I’ll be able to have my own practice in most states, interpret labs, diagnose, and prescribe.”
    Then he or she follows with “Doctors and nurses are two different professions.”
    How does this make any sense? You are a nurse wanting to “own your practice, interpret labs, diagnose, and prescribe” which is essentially what a physician does and then say that nurses and doctors are two different professions. PA’s “interpret labs, diagnose, and prescribe” but they do it under a supervision of a physician. That’s two different professions. You want all the privileges of a physician AND autonomy? Go to medical school. You want privileges but don’t want the responsibility of autonomy? Go to PA school. You want to take care of patients at the bedside and do the day-to-day things to take care of patients? Go to nursing school. Every nurse here who argues for NP autonomy are right about this: every profession has their role in the health care team. However, if the nurse’s role starts to blur with the physician’s, then there’s a problem. You can’t use PharmDs, DPTs, ODs, etc as an argument for DNP. Their field does not overlap with that of a physician. DNPs do. You may ask, “What’s the matter med student? Afraid we’re stepping in your turf?” You’re damn right I am. For the patient’s safety AND the EARNED right to practice medicine autonomously, I am both afraid for the patients and furious. I am furious that I am working hard to earn my M.D., yet nurses can go to nursing school and also get every privilege and autonomy as a physician. Am I saying nursing students don’t work hard? Absolutely not. However, most of you have stated and agreed that nursing school is not at the same level as medical school. So please, if you want to practice medicine and do it without supervision, go to medical school.

    For those who are arguing that you have countless hours as a nurse before going into DNP school, that argument is weak. You can’t equate hours working as a nurse to hours working as a resident physician. The two totally different jobs have two totally different thought processes. Remember, every profession has their role in the health care team. You said it yourself. So a nurse working in the ICU for 4 years is not the same as a resident physician in the same amount of time. With this said, I challenge anybody to find a physician who was a former nurse to come forward and say that going from nursing to medicine is a lateral move. I guarantee you will not find a single one. For those who agree with me that nursing and physician are not equal professions, why are you arguing so hard for privileges and autonomy of a physician? More access to primary care for the population? Simple. Go to medical school and become a primary care physician. Medical schools are expanding class size every year. New medical schools are opening up. You want to practice nursing model instead of medical model? Nurses provide a more holistic approach? Absurd! And frankly insulting! So by this argument you are saying MDs and DOs don’t treat the patient but treat the diseases? Hell we might as well get rid of physicians since this nursing model is far superior! So again, why argue for privileges and autonomy if you believe physicians are nurse practitioners are two different professions?

    Army Nurse:
    “I met an intern in the ICU at Walter Reed say to the overworked, fatigued nurses, “let me know what orders you need, I’m just here to write orders.” That intern is going to do amazing.”
    I am sorry but you are completely wrong. That doctor is going to be terrible. A physician who is just here to “write orders” is not going to be amazing. If you think this construe an “amazing” doctor, then I beg you to not even become a NP because your sense of an “amazing” doctor is warped.

    Lastly, there is a shortage of bedside nurses. Something to ponder while all of you rush to get your DNP.

  291. shelleyTheNPfutureDNP says:

    What you don’t seem to realize is that legally, the DNP’s can see patients independently in 28 different states. That number has been increasing and will continue to increase. We can independently write prescriptions without a doctors supervision and can see patients and make diagnoses and refer for labs and x-rays and give antibiotics just like any physician. Legally we can do this.

    How arrogant of doctors to think they have a monopoly in patient care. Just because they go to different schools than we do, doesn’t mean they are the one and only ones who can treat patients. It is all about the insecurites of these doctors and the beliefs that we will somehow steal their patients.

    There have been no studies at all which have shown inferior care privided by an NP as opposed to a physician. In fact a number of studies have shown equal, if not superior, care.

    It is an old, tired argument to repeatedly say, “if you want to be a doctor and treat patients, go to medical school.” There are plenty of NP’s in my program and myself included who could have gone to medical school if that is what we have wanted. Just because a doctor gets into med school doesn’t mean they are some how intellectually superior to NP’s. Believe me, there are plenty of very bright NP students who could have gone to med school if that is what they wanted to do.

    Many NP students have chosen this as a career choice as opposed to being a physician. Although this is a separate path to treating the same type of patients, the philosophy is a little different. No offense to physicians, but treating patients is not all about the organ dysfunction. It is also about treating pain, psycho social issues, depression, anxiety, family issues, and assessing how the patient will function when at home. Unfortunately a lot of our physician colleagues have not been trained in this.

    Studies have actually shown that many patients are more satisfied after seeing and NP and DNP than a physician. Repeatedly this is shown in patient satisfaction surveys. NP’s and DNP’s have been shown to have better communication skills and spend more time with patients than their physician colleagues.

    No study has ever, ever shown increased mortality or prolonged hospital stays and increased complications from patients in hospitals taken care of by an NP as opposed to a physician.

    The facts don’t lie. Sorry.

    1. Calling you out... says:

      Anybody can make up facts… where are your studies, your sources, your proof? Using such a strong statement as “The facts don’t lie. Sorry.” yet not having any sources, is laughable especially when you have been wrong with your “facts” in other posts… I think your posts are just hurting DNP’s and their position more than helping them. For your own good and the good of your future profession, I would have to advise you to stop posting…

    2. lmesina says:

      ” the philosophy is a little different. No offense to physicians, but treating patients is not all about the organ dysfunction. It is also about treating pain, psycho social issues, depression, anxiety, family issues, and assessing how the patient will function when at home. Unfortunately a lot of our physician colleagues have not been trained in this. ”

      Actually, being a current medical student, we DO learn all those things. You think Medical school curricula stays static? haha =)

    3. Harry says:

      Great argument!
      It’s like saying, “So what if apples and oranges grow on different trees? They are after all fruits! That basket of apples has been sitting next to baskets of oranges longer than the basket of new oranges has! Besides, the LAW has made it acceptable for apples to be called oranges!
      So now we must call apples by the name “orange” and no one can argue that apples don’t look, smell or taste like oranges. In fact, apples look, smell and taste more like oranges than do oranges themselves!”

      With such a brilliant display of reasoning skills by you, I can see why you have to stomp your feet and throw tantrums to demand that DNP be given equivalence to MD/DO.

  292. Someone else says:

    I’m my community, prompt cares were previously staffed by Emergency trained MD’s. About a year ago, the staffing model changed such that the prompt cares were staffed by APN’s, etc. Overall, the care at the prompt cares has remained satisfactory. However, the ED has increased patient volumes from this by about 12% last year and then 9% this year. The patient satisfaction scores decreased by about 10%. Revisists increased as well%. These changes weren’t significant enough that the staffing model was changed, but there was a public outcry like you wouldn’t believe.

    Patient satisfaction is highly based on time spent with patients. Providers who spend more time sitting and listening to patient’s tend to score higher regardless of their traning. Because of this, simple patient satisfaction suvey’s show that many patient’s preferred their medical student to an attending because they sit and listen for longer periods of time. One would be hard pressed to say this makes them better clinicians.

    I don’t think a lot of people are buying into the equivocal studies by the allied health professionals because if you look at the motivation behind the studies it would be seen as similar to Pfiezer publishing on it’s new drug. You take it with a grain of salt. Despite there being many published articles regarding this topic, no truly objective studies of potential to prove equivocal care with significant power exist. Many studies compare “Junior physicians” aka first year residents to fully trained, experienced nurse practitioners. Considering that the most commonly cited study shows that they were equivocal, that isn’t saying much about nurse practitioners considering that the group they were compared to aren’t licensed to work independently in any state.

    Physicians aren’t worried that NP will steal their patient’s This simply is not the case. They welcome the assistance from allied health professionals. They simply want to keep patient’s safe. We can and do work together every day to heal patients. The scary thing to physicians is that some practitioners believe that they actually do have equal or superior overall training than physicians.

    Considering that most providers know their limits, this isn’t usually a problem. However, when the “the facts” get in the way, those few but important things that those providers don’t know that they don’t know can be truly scary.

    Also, this reader would appreciate if Shelley could educate us on what exactly pain, Depression, and Anxiety are and how to treat them. At first, I thought it was truly impossible that her “physician colleagues have not been trained in this.” I too was amazed when I looked through some medical textbooks and found that these topics were not at all present! What an oversight by physicians! Indeed, this remarkable discovery of these novice medical conditions may truly save physicians as a specialty. No, appologies needed Shelley! Your facts speak for themselves and I am truly in your debt for this discovery!

  293. STOP ALREADY says:

    Close to a year and Shelly still has the time to come on here and post ridiculously long rants of well… ridiculousness. Lots of free time eh? Must be working hard and catching up on those journal studies…

    Let’s keep it simple. The physicians practice medicine. The nurses provide care on a level of nursing. That’s it. End of story. Get over it. Use the limited time you have on this planet in this life doing something that is worthwhile instead of attempting to convince everyone that you are plain crazy and in the process making your profession look horrible.

    Accept truth. It smooths out the ride of life so-to-speak.

  294. […] and this degree allows the nurse practitioner to prescribe medications. As of the end of 2011, 154 DNP programs were operating in the […]

  295. JN311 says:

    Another thing that needs to be realized is: Not all anatomy, physiology, pharmacology, etc courses are created equal. The courses in medical school are much, much more comprehensive, detailed, rigorous, with higher expectations than their counterparts in nursing school. Thus, you can’t take into account just the number of years/hours of training alone, because the years aren’t created equal.

    The AACN has constantly tried to make physicians look like the “bad guys” interested in only protecting their salaries. But the truth is, it’s the nurses that are trying to increase their salaries by lobbying politicians and changing laws to allow them to “play doctor” and therefore earn physician salaries without the rigourous and demanding training necessary to become a safe physician. If patient care was the nursing profession’s primary interest, they would continue to work as true nurses given the much more dire need and shortage of floor/icu nurses. Instead what, they have been trying to do is circumvent the system by changing laws through lobbying to allow more autonomy while tricking patients into believing that they are equivalent to physicians. In the end, it’s patients that pay.

    1. lmesina says:

      ^^ +1 ^^

  296. Efren Molina says:

    Would you mean that if you are a graduate of DNP you can prescribe and administer medication without doctors prescription? like for example a patient will come to the hospital asking your assistance to administer Ceftriaxone 1 gram?

  297. a. says:

    Ouch! I was looking online at pros and cons of DNP degrees and I came across this. Jeez, all of you — DNPs, RNs, and MD/DOs — calm down, PLEASE! Some of the things you’re all saying are ridiculously hurtful & inflammatory. I agree that DNPs should be allowed to be called “Doctor”, but obviously they should also include that they are a nurse practitioner! If the patient is confused they should clarify. If someone has worked hard to obtain a doctorate level degree, well then it’s justified to be called doctor. If a social worker or other member of the hospital had a doctorate degree and introduced themselves as “Dr so&so, the social worker who will be helping to care for you” is it really much different than “Dr so&so, the nurse practitioner who will be helping to care for you”? I don’t get it. I think that some of yall need to fess up and call it what it is — jealousy over the title. I understand. MD/DOs work insanely hard for years and years. They deserve their title of Doctor & all the responsibilities and rights that come with it. With that being said, I don’t see how DNPs are hurting anyone by wanting to be called “Dr so&so”. They have a doctorate! For those worried about DNP’s pretending to be MD’s and taking MD’s roles: I know that if I became a DNP, I would not want to act as an MD. That’s not what I would have been trained for. I think DNPs will be helpful in sifting through an enormous patient load, treating those that are not complex or serious and sending those who are onto the MDs. I don’t see how this is a bad thing. It gives the MDs more time to focus on the cases that really need their expertise, and it relieves them of the cases that are sort of a waste of time. It also saves quite a bit of money, since DNPs can be paid less than MDs (the person saying that DNPs will be paid the same as MDs – not true. In fact, that is why insurance companies like DNPs — they can pay them less! And why SHOULD DNPs be paid the same amount? They don’t have the same training. It makes sense to pay a bit less). To the MDs who are worried that DNPs are trying to “take over” the MD job, please don’t feel that way. Maybe there are a few DNP blowhards out there, but I know that I am smart enough to know when and what I don’t know. If I became a DNP, I would be more than happy to refer a patient to an MD who was more knowledgeable. I know there must be other rational people out there like me.

    Also, it seems like there is a good deal of confusion about the education req’s for DNPs & MD/DOs. DNP programs are NOT all online! (At least the good ones). The DNP programs I was looking at do not have online classes, and do require clinical hours. They were 4 years long full time. To those saying nurses don’t take micro, orgo, biology, chem, anatomy etc, I’m not sure if you’re just referring to associates degrees or not. I know that all BSNs are required to take those classes. I can’t comment on the MD/DO education because I don’t know anything about it, but I know that it is FAR more extensive than a DNP. No one with a brain would argue that point!

    And to those dismissing experience as an RN, I don’t think that’s fair. There are many nurses who function fairly independently and work together with MDs – not just mindlessly completing orders. Again, to the sensitive MD students here, I am NOT saying this qualifies as MD training. I am saying that not all nurses are idiots who just do task after task, not understanding why (although yes there are many).

    Furthermore, to the jerk-offs who said things like “the only reason to be a nurse is if you’re too stupid or lazy to go to med school”, I am actually laughing at you as I type this. I’m not brilliant, but I did go to a top 20 university, and I’m not an entitled rich kid who got in because Daddy knew someone there (and no I’m not a minority, so you can stop that line of thought right now). I’m also not some community college fail out who took 10 years to get an associate’s degree in nursing. I am NOT stupid. I am NOT lazy. There are many reasons I did not go to med school, and none centered around laziness or stupidity. It had to do with values & priorities, and what I want out of my life. First, I actually WANT a life — I don’t want to spend it in school or at work. I want flexibility, time with my family, a chance to pursue other interests. Getting a BSN and then taking things from there (whether going into administration, switching careers, or continuing on to a DNP) made more financial sense and fit in line better with my values and priorities in my life. As shitty a job as nursing can be, they do get paid pretty well, and there are many different careers into which a BSN can be parlayed. Plain and simple though, I don’t want my job to be my life. That’s fine if you disagree – those are your values. The world needs people who value their job over other aspects of their life. But those values are not mine. I find it so disgusting that someone would call someone lazy or stupid simply because they have different values and priorities in life. I would never call someone a frigid, friendless, pathetic workaholic for wanting to make their job a priority! Another reason is that I just can’t afford it, even if I wanted to go. As I’m sure many of you are all too aware, medical school is an enormous expense. ENORMOUS. It is not one that I could ever realistically afford. If I did have a burning desire to be an MD, I’m sure I could figure out a way, but it would leave me in debt for years and years, and financially would be a terrible decision. Being debt free is a big priority for me, so again – a clash of values. Furthermore, I don’t know if I want to stay in healthcare. Like I said in the beginning, I’m only looking into getting a DNP, I’m not committed by any means. I’m not sure if it’s what I want. It would have made no sense to go to med school if it wasn’t something I loved and knew I wanted to do for the rest of my life. Another reason, and I know I’ll get feminists jumping down my neck at this one so cool your damn jets right now, is that I want to have children. I don’t see that happening if I decided to become an MD. And yeah yeah, you can have them after you’re finished, after you’re established & have paid off loans , but at that point you’re what – 35? 40?– and you’re searching around for fertility docs. Not what I want for my life. Again, this is a value/priority thing. If you don’t mind not have children or waiting until you’re much older, power to ya. But don’t look down on me for having a different desire. And DON’T confuse that for stupidity or laziness.

    Ok. phew. In summary – stop hurling insults. You sound like insecure 16 year old boys when you do it (both ends). And recognize that there IS a place in the healthcare system for DNPs. Obviously, it is not the MD’s role. But there is a role for DNPs. As for DNPs who are going on and on about being the same as MD’s: snap out of it. You aren’t a MD. That’s ok. Your job is important too. Now drop the animosity and start working together!! (And again: no, I’m not a DNP. I might not ever become one, especially after this vitriolic display. I just can’t STAND stupid, mean, petty arguments. )

  298. Derek says:

    Nurses trying to get more education is a plus.

    Any attempts to fool the public into thinking they are seeing a traditional doctor is a minus. DNP’s will try every trick in the book to call themselves doctor. Later they will call themselves “physician” much like optometrists call themselves “optometric physician”. Even rug cleaners call themselves “rug doctor”.

    Perhaps, the German way of calling someone “Herr Professor” or “Herr Doktor” should be a model. The DNP could call themselves “Nurse Doctorates” or “Nurse PhD’s”. Actually “Nurse PhD” is the best solution. It highlights the effort that the DNP put in and doesn’t fool the public.

  299. Derek says:

    The DNPs are trying every trick in the book to fool the public. They will say “we have x years”. Funny…if they add one year of school, they’ll say “we have more training than medical schools!”

    The DNP residencies are nothing like medical residencies. So a 1:1 year comparison is deceptive. The same goes with optometry residencies are no where comparable to ophthalmology residencies.

    Trickery will hurt the DNP profession in the long run. If they do the legwork, they will naturally gain respect. Surgeons did this 300 years ago. Before, they were savages and worked in hair salons. Eventually, they gained the respect that even exceed some internists. University of California Irvine is another example. They were a DO school and converted to a MD school. Now the UCI degree is valued and even better than many other med schools.

  300. Geoff says:

    As a PharmD whose career progression is at a dead end due the obvious rivalry between professions, I believe the DNP is a better career progression. Med schools allow no mid-level access. The MCAT and repeating all the prerequisites is the only pathway. MD’s have less respect than NP’s at my institution. In this rural area, the MD’s in ambulatory and inpatient are 80% foreign-born. I won’t comment what countries, but the people clamor to see the NP’s. What hole has the medical profession dug itself into when foreign docs and 24 year old residents have become the face of the profession to many?

  301. nance says:

    This DNP movement is absolutely nothing new. I am not sure why everyone here is so shocked by it. If they want to dilute an already sub par degree let them. They are the same as chriopractors, hollisticians, podiatrists, optometrists etc. Let them build their nurse practitioner diploma mills imagining that they can practice medicine without ever actually learning real basic science at the college level let alone medical science –> http://www.usmle.org/pdfs/step-1/2012content_step1.pdf (topics of what real physicians learn during just the first two years of medical school; note that each topic listed may account for just the heading of an area which is covered in a standard medical school curriculum by 100s/1000s of pages of notes (in my medical school our module exams occur roughly every 3.5 weeks and each module exam week consists of 5-7 days of 4hr long exams covering 800-1500 pages of notes. We are systems based so at various point of the year we were taking/testing on up to 11 classes at a time. Also at the end of each course we were expected to know everything (biochemistry final –> 4,700 pages, physiology final–> 2,300 pages etc etc) and pass these finals while learning and testing on new modules. Each DNP program basically makes up its own curriculum and calls it a day. Its actually pretty sad that this is actually even a discussion/argument. On another note I think that CNA’s and LPN’s are equally if not more qualified to perform the same tasks as BSNs/MSNs even though they received half the amount of schooling. Anyone agree?

  302. bryce says:

    If NP’s want to be responsible for providing independent care to patients why don’t they do it like the DOs did? Osteopaths decided to create curriculums in which they learn and test on exactly the same MEDICAL courses as MDs (and by this I am talking they learn it at the same level, using the same books, taking the same board certification exams, etc) while complementing it with the major principles of osteopathic medicine (OMM, preventive medicine, whole body approach etc). Because of this MDs look at DOs as their equals. Why? Because they decided to learn medicine before practicing medicine. Why don’t the NPs practice some integrity and commonsense and do it the right way: promote a single national accreditation committee which standardizes and oversees established curriculums (similar to the ACGME and LCME) which includes medical courses incorporated with the principles of nursing? Then they can take the USMLE just as the DOs do and if they pass all three then sure allow them to apply to US residency programs.

  303. RN to MD trauma surg says:

    I am ashamed to read some of these blatantly ignorant comments being posted here. I thought that being a medical student would help cultivate critical thinking skills. I worked 6 years in a critical care unit caring for some of the most advanced patients. I have also become a trauma surgeon. I have witnessed many physicians who’ve stepped into the critical care unit who had no clue, and a majority were those with residencies in family/primary care. These residencies have limited critical care rotations, yet they are allowed to write orders that could potentially hurt someone. I know this because I have stopped a lot of them before going through. The right question one should be asking would be, “what are the (non-biased) statistics about patient outcomes with DNPs versus MD/DO?” If you cannot find any causation or link, then you can truly state that the doctoral nursing program should not be considered a viable option for primary care. The truth of the matter is, when it comes to primary care there is a lot of shuffle to specialists and a lot of routine. I am not attempting to downplay the role of a primary care physician; however, I am pointing out that this is a position that can improve with the introduction of nurses.

    If I were your attending and I heard you speak in such an ignorant way in regards to a nurses role, I would shift your rotations for the next week to follow a nurse in an intensive care unit, trauma bay, or transplant unit. You would be amazed at what you would learn. It is a shame some of you are too proud to look to them as an asset.

    1. RN to MD trauma surg says:

      The nurse practitioner curriculum from Rush Univserity in Chicago. This mirrors almost all nurse practitioner curriculum. DNP is an extension after that provides leadership geared classes, not a program meant to replace physicians:

      Also, some of these classes are shared with physicians.

      Graduate Nursing Core

      NSG 521
      NSG 522
      NSG 523
      NSG 525
      NSG 625B Health Assessment Across the Lifespan Lab: Specialty 1
      Organizational and Systems Leadership 3

      Applied Epidemiology & Biostatistics for Nursing Practice 3

      Research for Evidence-Based Practice 3

      Health Assessment Across the Lifespan 2

      Advanced Practice Nursing Core
      Subtotal 12

      Advanced Physiology 3
      Advanced Pathophysiology 3
      Advanced Pharmacology 3
      Diagnostics for the APRN 3
      Transition to the APRN Role 3

      DNP Core
      Subtotal 15

      Leader as Change Catalyst in Evolving Healthcare Environments 3
      Healthcare Economics, Policy, and Finance 3

      NSG 604A DNP Project Planning I 1
      NSG 604B DNP Project Planning II 1 NSG 604C DNP Project Planning III 1 NSG 605 DNP Capstone (168 Clock Hours) 2

      Specialty Curriculum Content
      Subtotal 11

      Population Assessment and Health Promotion Frameworks 3
      Population Intervention Planning, Implementation, and Evaluation 3
      Major Psychopathological Disorders 3

      1. Here is the link to said website.

    2. JFried says:

      Rude comments come from both sides. Yes, arrogant physicians look down on nurses. But arrogant nurses will also badmouth about physicians. It’s interesting that you are quick to correct those arrogant physicians, but fail to even acknowledge the mud being thrown in the other direction. Shelley in particular has made some ridiculous comments.

      Point is: there are rude physicians, and rude nurses. They are both wrong. Ignore their comments/trolling, and look at the more concrete arguments.

      For example, one of the points here is that DNPs are trying to practice INDEPENDENTLY.
      We often speak of nurses having important roles in the healthcare team, as the physician’s eyes/ears, as an interface between physician and patient, as a means to provide more patient-focused care to complement the disease-focused care of physicians, etc. All these are important roles, but they are in collaboration with physicians; they are NOT independent roles.

      Nurses often say: “We are different, we practice nursing not medicine, we are not better or worse, just different.”
      True, so by that logic, how could you interchange a physician with a nurse? They are DIFFERENT disciplines, after all. Different training from the bottom up, different experiences, different skill sets, different areas of expertise…so therefore, they have different jobs and different roles.
      Nurses can’t do a physician’s job, just as physicians can’t do a nurse’s job.
      There are some specific procedures that can be performed by either nurse or physician (so there is some overlap), but you can’t take an ENTIRE job (family physician) and get a nurse to do that job.

      Take home messages:
      1) Nurses are important
      2) Nurses are not “inferior” to physicians
      3) But, nurses are different from physicians (not inferior, just different). That means you cannot interchange nurses with physicians. If you are short on family physicians, then train more of them. If you are short on nurses, train more of them. Don’t interchange the two.
      (UNLESS you modify nursing education so that nurses can show equal competency in physician licensing exams. You cannot just take a nurse, given them some additional training, and stick them into a physician’s role without a standardized competency test to ensure equal proficiency).

  304. Mr. Bean says:

    I guess from one of the postings above:

    Foreign born = bad physician???

    Are you a redneck?? :)

  305. Simple Solution says:

    Here is a simple solution to this issue. Future physicians, hire only PA’s. PA’s are better trained (trained in the medical model) and same scope of practice as DNP’s. Plus they don’t have a chip on their shoulder or a hard-on to be called “doctor” and confuse patients.

    1. RN to MD trauma surg says:

      Really? So 2 years of medical classes constitutes greater training? There is hardly a difference in NP vs PA. NP at least have field experience that is actual hands on and autonomous versus PA’s who can use a position such as a nursing assistant to count as credit towards hours worked for PA school. The fact of the matter is, there is just as many PA’s with chips on their shoulders versus NP’s. In fact, there are doctors as evidenced by all of the rude, and blatantly non-factual posts! I am all for anyone furthering their education. I welcome it with open arms. Do I agree that DNP’s be called a doctor in the hospital? No. However, I do not think that people should discredit their practice based on an article written by someone who clearly has a one sided opinion. This person doesn’t even have all of her facts straight!

  306. e-diggity says:

    SDN is the worst place on the internet, filled with the worst people who will argue about absolutely anything.

    if you think there are problems with the NP field — and i’m not saying i disagree — what the hell do you think you’re doing to fix it by having this argument here? this argument is literally the stupidest thing i’ve seen all year.

  307. Adam says:

    I think the DNP degree is definitely gaining popularity and becoming more useful as highly educated nurses take on similar roles to doctors. The medical landscape is ever-changing but keeping a high level of education ensures that you will remain relevant in the professional world of research and practice.
    http://typesofnurses.net/

  308. Mr. Bean says:

    DNPs should have a great place in medicine. They are good at giving scrotal massage. :)

  309. Liz says:

    Of course this is a complete joke…and ultimately serves no purpose other than to further water-down healthcare and education.

    Still, I smile every time I read an article about DNPs pushing for equal reimbursement, or pushing to get into specialties themselves by creating DNP derm residencies etc

    The ONLY virtue a DNP could hold in the healthcare system over a DOCTOR would come from being CHEAPER and going into PRIMARY CARE

    They don’t see over-interested in this though long-term..and that will be their undoing

  310. >. says:

    Shelley: “No offense to physicians, but treating patients is not all about the organ dysfunction. It is also about treating pain, psycho social issues, depression, anxiety, family issues, and assessing how the patient will function when at home. Unfortunately a lot of our physician colleagues have not been trained in this.”

    And you are? With your fluff classes and minimal number of training hours? Physicians are trained in all of the above, by the way. Just look at the basic science curricula and clerkship training, a fraction of which DNPs receive. You’re so delusional, you must be trolling.

  311. JWall says:

    “Doctor of Nursing” is like saying I’m an “expert novice”
    The degree itself is an oxymoron.
    They will be making dollars without making any sense.

  312. seattledoc says:

    Only in the U.S. would such a preposterous idea like turning nurses into faux-physicians even be discussed seriously by those in governance, let alone actually become reality. Pretty sad state of affairs in the medical field in this country where all sorts of sham doctorate level degrees allow non-physicians to deliberately and deceitfully claim the title of “doctor” to patients who don’t know any better.

  313. Wynettern says:

    As a RN I have to say that the DNP program is a horrible horrible idea…….Patients will be mislead as this is is inevitable……I don’t hate doctors as I see many doctors or posers are saying ugly things about nurses….There are many intelligent nurses and fact is there are s some real crappy and even unintelligent doctors too…Nurses do not make a living cleaning shit as we have aides that do this for us……..Also, not everyone wants to be a doctor ok…….get over yourself…..I do believe that people pursing a DNP do though and SHOULd go to Medical school instead….You physician will find that many nurses are actually also oppose this DNP program….. I take nothing from you guys because I respect the amount of schooling you guyy have a NP nor DNP can compare…..so the hostility isn’t necessary as the world knows who is one the frontline of healthcare….I can not believe some of you are even physicians displaying such classless behaviors on this post…..

  314. Nick says:

    I think you all miss the point. As a practicing FNP and back in school in training to become a CRNA, I can tell you that my training in anesthesia is VERY RIGOROUS! We take micro, phys, patho, biochem neuro, pharm etc….. We are trained in a unique curriculum preparing us to be independent providers! This is because we are sent to desolate zones and in many instances don’t have a physician (anesthesiologists) as back up! So for those of you stating that we only ale ethics and research, look again my friend! If I were to gain a a DNP I would sure use the title Dr. I would introduce myself as Dr. Xxxx your nurse anesthetist.

    I do agree with many in that I feel that the DNPcurriculum should for the most part be standardized across the country, however schools should be given some liberty within the “extras” . Meds schools are mostly the same, but no 2 schools have the “exact same curriculum. There is a great bit of diversity even within medical education. The term “Doctor” is not reserved for physicians. In fact the Latin origin of the word actually translates to “teacher”. If patients are confused by the use of the word, they should make it a point to understand. One shouldn’t assume because you hear “doctor” that your being treated by a physician. There are too man professions using the term these days to safely make that assumption (I.e. dentists, podiatrists, chiropractors, pharmacists, physical therapists and on and on)

    It’s simply a title declaring ones education level within a given field of education. It is NOT a defining characteristic related to scope of practice. For example a masters prepared NP has no difference in scope of practice than does a doctor ally prepared NP. State practice acts dictate scope. several states have rescinded “supervision” of NP’s by MD’s or DO’s and had nothing to do with the DNP. It’s all about statistics related to the safe and effective care provided by NP’s. of course there are good NP’s as well as bad ones. You find this in any profession. I have met many MD’s that I wouldn’t let treat my dog. Just because you have an MD degree does not make one all knowing (no degree confers that status) I just wish people would quit getting caught up in the turf wars and focus on hats truly important (I.e. quality patient care)

  315. Psych Do says:

    We can fix this easily. If the DNP’s want full practice rights and autonomy they should be required to pass Step 1, 2, and 3. Including the CE portions. Then they should have to take family practice boards, er boards etc. I doubt 1% would make it through. Everyone wants to be a doctor ( have the headaches of chasing down Medicare and Medicaid reimbursement, 80 hour weeks, practice overhead, licensing recertification) but they don’t want to go to medical school. Just another give everyone a trophy for participation scheme. I once saw a custodian at the hospital change his own bandaid, he participated in care maybe we should make him a doctor. It’s simple, unless you have a STATE ISSUED MEDICAL LICENSE you should not be called doctor!

    1. wbraccock says:

      Funny, for someone calling his/herself ‘psych DO’, guess you never learned about the ego, or your just letting yours live to its fullest. Surely no stupid nurse could ever accomplish even half of what you and your brilliance have accomplished. I agree they should allow NPs to take the USMLE’s, I guarantee 90% would pass considering 90% of doctors now practicing in this country went to medical school at Waziristan community college and they seem make it through.

      1. Psych DO says:

        @wbraccock

        http://www.amednews.com/article/20090608/profession/306089978/1/

        You might want to check your ego. This article should put your 90% passing idea in perspective. Physicians take three sets of licensing exams (then specialty boards later, and multiple residency exams). Step 3 is considered the easiest and the most clinical of the steps. And as you like to spout nurses are superior clinically. However in a cut down simplified version of step 3 commissioned by the CACC (a nursing group) there was a 50% pass rate. So you guys can’t even pass a simple version of our most clinically oriented tests. Everyone wants to do the job of a doctor but you don’t want to put the work and sacrifice in. How is it even a comparison ( I will compare something I know — psych) that a DNP comes out and starts “practicing” psych straight out of school is better prepared than a person who just went through 4-5 years of psych residency, specialty boards, and seen thousands of psych patient in this time. Your over inflated ego is what will kill a patient, because you think you are equal. I am all for equality but not when it puts patients at risk. And your attitude towards foreign medical grads is reprehensible, they are extremely hard working and sacrifice a lot and face a lot of adversity to get where they are in medicine. You have no idea because you want our job but want to do it the easy way. Nurses are an integral part of th medical system, but hey have a specific role. If you want to be the lead person in charge of patient care go to medical school, you obviously think you are smart enough to do it so why waste time getting a nursing degree ” hoping ” you may be able to practice independently one day.

      2. >. says:

        Yeah not really, considering Caribbean schools boast a 40-80% first time pass rate depending on the school, and they actually have taken the medical curriculum. People study for the USMLE for six months and still fail it, so I’m betting the pass rate for nurses who haven’t taken the curriculum would be less than 30%.

  316. >. says:

    My issue is that in a clinic, it is misleading to call a nurse a doctor. Even if you hold a doctorate, it has a different meaning on the wards. At the hospital, we don’t call the radiation physicist a “doctor,” even though he has a PhD, and we don’t call the medical research PhD a doctor either. When we are formally introducing them, then yes, we use the term “doctor.” But in front of patients, it is misleading. The hospital I work for actually has a policy on this very thing, so I wouldn’t be surprised if that will become common all over the place (i.e. only calling physicians “doctor”). We call our DNPs “nurse,” or just by their first names, and it’s not demeaning at all. And by the way, almost all the physicians and nurses I work with go by their first names, so it’s not like it matters anyway. Everyone knows who everyone else is. Only the pretentious tools go by “Dr. So-and-so,” unless they are introducing themselves to their patients. And in that situation, it is obviously misleading to call oneself a doctor if you are a DNP. And those of you who insist that nurses have an inferiority complex, I’m not so sure this is the case. Most nurses I know are proud to be nurses, and it’s a honorable title to be called “Nurse.” And for those that do have an inferiority complex, you should know that some doctors have an inferiority complex when it comes to other doctors. FPs sometimes feel inferior to the Cardiologists, and the Cardiologists sometimes feel inferior to the CT surgeons. Heck, some FPs are jealous of the CRNAs who make $30,000 more per year. I’m not saying they should feel inferior, but some do. The grass is always greener on the other side. Just be happy with who you are, and if you aren’t happy, go to medical school if you think that will help. I can guarantee if you’re the kind of person who has an inferiority complex, becoming a physician won’t solve all of your problems.

  317. sirius says:

    Physicians THINK they understand how much of a problem this kind of advanced practice nurse expansion is. They don’t REALLY get it. Else they would mobilize forces more. I just think many docs feel like they can just go about the lives and look the other way, and this will never be a major threat. It is. It’s a threat to medicine and to patients and society. I am saying this, and I am a nurse. OK, this movement is politically radical. And many of the AP nurses speak double talk. We’re not physicians, but we should be allowed to practice independently without physician/medicine regulatory supervision as they practice medicine, to whatever degree. They admit they did not go to medical school, and that’s it’s not the same education and experience, and yet, they want to practice medicine without the appropriate input of medicine. It makes no sense. These folks are radical, and you just can’t reason with them. All you can do as physicians is to start mobilizing and taking proper action. If physicians don’t start getting dead serious with this, they will lose out and so will patients. It’s just something that docs are complaining about from time to time, but it’s not something they really want to invest a lot of time and money in stopping. Maybe it’s the current political environment that is slowing some forces of medicine down, but the situation is not looing good. Institutions of higher education are loving these programs and all the enrollment in them.

    1. Nick says:

      Wow such comments from a nurse, shocking that you would disregard th advancement of your own profession! You ought to be ashamed of yourself. The idea that you just propagated regarding all APN’s as radical is the most ridiculous thing I’ve ever heard in my life. I will agree that there are radicals with the DNP movement, but no more radical than any other movement that is passionate about advancement. Your obviously bitter about something and taking it out on your own profession. What’s the problem did you have academic issues advancing past the LPN licensure? I can tell you as a Family Nurse practitioner (now back in a second masters program for nurse anesthesia) that I enjoy the collaboration I have with my physician colleagues. Not EVERYONE is opposed NP advancement. When I was working as an FNP in pediatrics, the pediatrician that I worked with offered me partner status in his practice. He wanted me to open a second office that would have been run by ME with relate collaboration if needed. I do like the idea of having a collaboration agreement that offers me someone to turn to if I don’t know the best course in a given situation. It’s really no different in my opinion than physicians collaborating on a case (except its physician to physician obviously). The idea that the DNP is going to change the scope of practice for ANP’s is obscured. That’s not its intention. It’s simply a terminal degree to provide NP’s with ore education. In my opinion, healthcare should be “team” oriented and I also feel that anyone who disagrees with that is ignorant and dangerous. I agree that physicians typically have more education than ANP’s but that does not in any way negate the role of he NP. I can tell you firsthand that my ANP programs were very intense. Many of my classes were he same classes (literally) as the med students (same comingled class). The nurses in the classes scored just as well as the med students. Being a nurse does not somehow indicate an inferior IQ to physicians. As far as the “term” doctor, if you look back to the roots of the word, it means teacher!! I agree that title protection is important. No one should be allowed to portray themselves as something they are not. But “doctor” is not title protected under law. Physician is, nurse is, RT is etc… etc… There should be NO issue with a doctor ally prepared NP using the title doctor in the clinical setting as long as licensure distinction as an NP s made clear. If I were to introduce myself as doctor x ill be your nurse anesthetist today, where’s the role confusion? Maybe it’s the public that needs education regarding the ever evolving healthcare education arena. As far as the statement that many NP programs are online? That’s a misnomer. Yes many programs have online didactics but ALL clinical hours are done in clinics and hospitals. If you take a second to look, duke Cornell and Brown have been collaborating to create an online medical school much in the same manner, where didactics are taught online and clinical clerkships are completed in clinics and hospitals! There is NO NP program that offer a completely online ANP licensure!! So do your homework before you get online spewing crap

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