Making room for Dr. Nurse

[srcf5]

I just read and interesting article. What do you all think?
I do think that something needs to be done about the basic nursing programs. If thousands of qualified candidates are being turned away then why isn't more being done to encourge nurses to become nurse educators? I will never forget my Level 1 nursing instructor telling the class that as new RNs we would make more than she did as an MSN. That is so tragic. Educators/teachers, no matter the disciple should be paid more. Once again actions will only be taken retrospcetively rather than preventatively.

I remember also the talk of entry level nursing should be BSN and that would be the standard in the future. That was 15 years ago. I complete my BSN in 2005. My opinion is that an individual should aspire and achieve what they desire and are capable of. We as nurses who work the floor know the value of a capable good CNA. We also know how upsetting it is to work with the not so capable/good ones no matter the title. I don't think every nurse should be a BSN. I know RNs now who think it is beneath them to take a patient to the toilet, change their bed, or bath them. Pisses me off. That was basic level one care taught first. These are not hurgers we are flipping on a grill, these are human beings in need of care, compassion and competence, not condesention. If you don't want to take care of the patient, go work at McDonalds. Sorry, high up on my soap box again riled up.

Here is the link to the article.

http://encarta.msn.com/encnet/Depart...urse&GT1=27001

[DutchgirlRN]

Patients, for the most part, are very familar with NP's and PA's. I don't see the benfit of adding DNP? I definately don't think, as the article states, that they would be equalvalent to a primary care physician. My doctors NP is awesome but I know, as does she that she is not a physician. Dare I say it? It reminds me of saying that an MA is equivalent to a licensed nurse. NOT!

[poliopilot]

At the risk of sounding corny, I've always enjoyed helping people. If a task needs doing, I don't consider it "below" me; I just can't do the physical work any more. Teaching? I'd love to teach, but i don't have the credentials, and money to go back to school and get them would be a problem right now.

[nyapa]

Seems to be a push over here as well. And yes, those who are on the floor do earn more than lecturers/educators generally, though this is because the latter only work Mon - Fri whereas we get penalties for Late and Night shifts on top of our basic wage.

I was a hospital trained Enrolled Nurse (=LPN), which in those days was a one year course. Of course now it has gone to tertiary institutions. They have just upgraded it from a one year certificate to a 2 year course. Unbelievable. They still do the same amount of work, get paid the same amount of pay, work alongside ENs who are hospital trained (not many left now), or one year trained, but are expected to do an extra year.

I am an RN now. I would prefer to work on the floor. It is scary enough legally to care for ones own patients, let alone being in charge of a ward. Or an educator. And they really do deserve more pay, even if at times we do get p....d off with them...

[RN-AL]

If I may be blunt, as with nursing itself, please nurses, do not become educators unless you truely love the art of teaching. It is a hinderance to students and the profession.

Same for preceptors and educators in other setting other than higher learning institutions.

Teaching is a calling/gift just like nurses. Simply because one is a nurse, it does not equate being a teacher.

This is a passion of mine. I am going back to school to teach only because this is where my heart really is.

As for DNP, the higher education in one's specific area, I am all for.

My questions are, if CRNA get theirs, will they be able to do all cases, will NP be able to do all things with out the signature of a MD, will ....see my point. Why make it mandatory if the skills and abilities will not change along with the decision making and the abilites already capable of. Just a thought, but,...

I digress.

[NursingGuy]

Please allow me to throw my 2c in here as well.

I will agree with the MD's that CRNP and/or DNP's should clearly state they are not MD's... my feeling is, that if you want to be an MD, you'd have taken the time to go 4 years of med school, 3 years of residency, and be able to round for 2 hours a day, drive your BMW or Mercedes for the other 6 (except on golf days), practice unbelievably ILLEGIBLE handwriting, and save up enough money to pay for goodies for your hospital's unit staff every holiday season... which includes Hannukah, if you're astute enough.

All kidding aside, I'm just a few weeks into my GN-ship, and already giving serious consideration to continuing right along to MSN and a CRNP track; possibly doing some teaching along the way. Why? Because in my "former life", I taught post-secondary level, along with other job lines, and loved teaching. But I feel that the only good NURSING teacher is an EXPERIENCED nurse who also has been TRAINED as an educator. In my recent school experience, I've had enough of educators who became nurses to teach nursing, and were so tough on the education side of the equation that we felt like we didn't learn anything beyond how to pass the tests, and also I've had enough of nurses who felt they could teach students just because they were nurses and could teach patients, with such nurse "educators" simply reading PowerPoints in classes like cue cards.

Don't get me wrong... the preceding examples were minority in my nursing school experience... the vast majority of my nursing teachers struck the excellent balance that's needed, and we learned a great deal from them.

Personally, I may one day aspire to DNP... maybe. And not just because I'd love to pull the new BMW in my driveway, or be able to call myself "Doctor" in public. If I aspire this high, it will be for one reason: my passion is NURSING, and whatever helps me personally to advance the practice of nursing is what I want to be able to do.

~ NursingGuy

[insenescence1]

This may hold no relevance to this discussion, but I don't claim to have the "passion" and "calling" for nursing that is often emoted as a slogan and catch phrase.

I do it simply because it's one thing I'm good at (I think), and I enjoy it, not because I'm passionate about it.

Truth is, I'd would be content to mow lawns so I could be outside all day, or just work as a movie extra every day...but of course I need the standard of living that at least a regular income from a job like mine provides.

I appreciate all the 'passion' nurses, but I am not critical of people who eventually feel the need to "get paid" and to take care of sick people because they have the skill and demeanor, and want job security and a decent-paying recession-proof job.

[flip_rn]

Many of the NP's at work have mixed feelings about the DNP. For one, many complain that the additional degree may not translate to a higher salary at this point since the program is new. Many NP's are also fearful of the implications of having a doctorate degree and how this can affect relationships with physicians who are already on the fence about the title of Dr. Nurse. Many also question the need to acquire a so-called "practice doctorate" when the courses offered in many DNP programs across the country are not clinical in nature but are mostly about nursing theory, research, epidemiology, leadership, and management. The author of the article cites Dr. Mundinger who developed one of the first DNP programs in the country over at Columbia University. From what I understand, this program is heavy on clinical training and includes a year of residency.

Neverthleless, the American Association of Colleges of Nursing is proposing a mandate of making the DNP the educational requirement to practice as a NP by 2015. NP's educated at the master's level prior to that are able to practice beyond 2015 via a grandfather clause. There is so much speculation as to how this degree will change the practice of NP's. However, one should remember that state boards of nursing will still dictate what an NP can and can not do based on scope of practice defined for each state of jurisdiction. Advancing education for NP's to the level of a doctorate will not change scope of practice, legislation at each state level will.

[Hmmm-about-that]

I agree with the "sexy Gnome". I care about people as human beings. I also know I am very good at what I do and am aware that I can and do inspire others. I've had people express this to me.

Was this my "calling" ... doubtful, but I do enjoy it. I believe if one does "enjoy" what they do that it is easy to inspire others.

In a nut shell: enjoy it, share it, and take your education as far as you want. Do it for yourself, not the degree. Be aware not to get caught up in the BS. (yes, the curse not the degree)

[NursingGuy]

I was walking into work the other night, and as is my techno-geek habit, listening to some podcast or other. One of the topics was on nursing and the implications of new nursing degrees, the shortage, etc. etc.

And I remember thinking... NP's sort of straddle some nebulous fence between "more than a staff nurse" and "less than a doctor".

Will the new requirement of doctorate for NP change physicians' thinking? Probably not. I can rattle off names of a few doctors I know who would probably be more incensed that a NP has a doctorate and by all rights, should be addressed as "Doctor ___".

But by the same token, maybe I'm looking at this from the wrong angle. I wonder how many NP's out there, who may attain the DNP degree regardless of grandfathering, would even care if people called them "doctor _____". Speaking for myself, it'd be a cute thing to refer to myself as at social gatherings, but in day-to-day practice, I'd be more apt to think "I started out a nurse, I will always be a nurse, no matter what degree I have."

During the first month or so of my job as a Nurse Extern/PCT while I was in school(which I'm now coming to the last week of before moving on to another facility), I remember a practitioner I did not know, looking over a patient's chart one morning. She asked me a question about some particular point about the patient's care, and I gave her the answer, closing my statement with "doctor", since I assumed she was one. White coat, well dressed, didn't see any embroidery on the coat and couldn't read her title on her name tag. She looked at me and said, "you're new here, aren't you?" I replied yes, and she said, "I'm not a doctor, don't insult me like that. I'm a nurse practitioner."

Maybe more NPs have that same attitude... I know I just might.

~ NursingGuy

[insenescence1]

The DNP program is a great idea, but will overall have little impact on nursing as a profession. It's greatest benefit will be on the health-care system itself, where the system is becoming more specialized and expensive...and DNP's should find a niche in filling in the gaps in primary care. Possibly in education and hospitalist/intensivist roles as well.

But improving the nursing profession will not be accomplished by just pushing up on the upper levels of education, but by also pulling up on the lower levels.

[NursingGuy]

Amen, insenescence!

~ NursingGuy

(PS: you're working night shift too, huh? )

[pianogirl]

Coming from another medical field and now part way through a nursing degree and wondering if it is right for me I have a differnt perspective. First, not all medical doctors are MD, some are DOs and at this point in time thought to be equivalent. This was not always the case. Back in the early eighties my ex husband was advised NOT to go to a DO school as they did not have the same recognition as MDs and could not get the same jobs. This is obviously not the case at the present time.

IF nursing steps up to the plate and makes the DNP hard enough to aquire and especially if it includes includes a residency they will no doubt eventually earn a very high level of respect most likely as the level of a "regular doctor". What will be hard to predict is whether the nurse practioners specialties will take off. I suspect that presently the health care system is selecting for MDs and DOs to get into specialty practices (much higher reimbursement). With the long residency requirements. I also suspect that primary care will continue to pay much less owing in part to the ability of one to get into practice without a long residency ( ie NP). From most all of the studies that have been done NPs do just fine in primary care so there is really no reason to use exclusively people (MDs) that have put outt so much time ans therefore expect substantial reimbursement.

Note that Pharmacist and Audiologists and I believe most Physical therapists are getting doctorate. There is no doubt this elevates their status, especially with patients but one cannot deny with a doctorate that they are "experts".

Further as the cost of health care is exurbadant (check my spelling on that one) I am certain that thousands of companies are looking for ways to bypass the human component in health care. It is simply the most cost effective way to lower expenses. Moreover, for technical things machines that are adequately designed make less mistakes, are more predictable and cheaper. Therefore, I suspect the RN of the future will be doing less "technical" work and more patient and technology management. That will require smart educated people.

There is a movie with Adam Sandler where it shows several generations of his future life. I cannot remember the name of the movie. In the movie he is in intensive care. The person taking care of him, who is obviously a nurse is spending a lot of time looking at the machines that are regullting his breathing etc and is covered head to toe except for his face in what appears to be a sterile setting. Very much like a high level research lab (the ones they use for pathogens that are airborn and fatal. I really believe this is the medical environment of the future. Reread my post in twenty years. Technology is SPEEDING along.

[vivkirkbride]

If I may be blunt, as with nursing itself, please nurses, do not become educators unless you truely love the art of teaching. It is a hinderance to students and the profession.

Same for preceptors and educators in other setting other than higher learning institutions.

Teaching is a calling/gift just like nurses. Simply because one is a nurse, it does not equate being a teacher.

This is a passion of mine. I am going back to school to teach only because this is where my heart really is.

As for DNP, the higher education in one's specific area, I am all for.

My questions are, if CRNA get theirs, will they be able to do all cases, will NP be able to do all things with out the signature of a MD, will ....see my point. Why make it mandatory if the skills and abilities will not change along with the decision making and the abilites already capable of. Just a thought, but,...

I digress.

During my training to be a nurse we were taught how to educate. Patient education is part of everyday nursing care. If the patient doesn't learn what we teach, the consequences could be life threatening. Therefore, I think our teaching skills, combined with our knowledge of the Art and Science of medicine are excellent. We must have excellent communication skills. We must encourage, inspire, support and assess at all times. Failure to teach (yes, a vital part of nursing, call it an art or a skill) will most definately result in disease and even death. As to fail to teach in the classroom will result in an "F", or low FCAT scores. Nurses are teachers it's part of our profession.