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Science Forum Index » Medicine - Nursing Forum » Article: A doctor and a nurse, all in one package
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| Dan C |
 Posted: Mon Apr 28, 2008 12:36 am |
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Article on the University of MN's first DNP grads.
Note complete lack of mention of ADNs.
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http://www.startribune.com/business/18292444.html
As the health care system gets more complex, a new kind of hybrid
practitioner is beginning to work at your local clinic.
By CHEN MAY YEE, Star Tribune
Anne Boisclair-Fahey is used to patients doing a double take when she
introduces herself.
She begins by carefully explaining she's a nurse practitioner, then adds
"You can call me Dr. Anne."
Get ready to meet a new kind of hybrid at your local clinic: the doctor
nurse. They sport name tags with the letters DNP for doctorate of
nursing practice.
Seen as one answer to the looming shortage in physicians, doctor nurses
take the nurse practitioner concept to yet another level. Doctor nurses
are trained in finance, health policy and systems know-how in addition
to core clinical expertise. They can do a lot of what many doctors no
longer have time to do in an increasingly complex health care environment.
While doctor nurses are still a rare breed nationally, that's about to
change dramatically. The first class of 24 doctor nurses graduated in
December from the University of Minnesota's School of Nursing, one of a
handful of schools at the forefront of this trend. All have returned to
their jobs or new positions, some with expanded roles and pay.
Now more than 90 nursing schools have introduced DNP programs and 200
more are about to start. Beginning next year, the University of
Minnesota is converting its entire master's of nursing practice program
into a doctoral course, meaning any nurse practitioner who passes board
exams will be a doctor nurse.
"They are designed to work in collaboration with physicians," said
Connie Delaney, dean of the School of Nursing, "so that very expensive
physicians and specialists can spend their time on other things."
But some physician groups worry that the increasingly fuzzy demarcation
between doctors and nurses may be confusing for patients at best, and
unsafe at worst.
A looming void
Experts are forecasting a shortage of physicians in the country by 2020
because the population has grown even as enrollments in medical schools
have remained flat.
What's more, 36 percent of active physicians are older than 55 and most
will retire by 2020, said Edward Salsberg, director of workforce studies
for the Association of American Medical Colleges. A new generation of
physicians is less willing to work the long hours usually associated
with the profession.
The shortage is already showing up in primary care, which includes
family medicine, pediatrics and internal medicine. This year, U.S.
medical graduates filled just 1,156 of 2,387 residency positions
nationally in family medicine; the rest were filled by foreign medical
graduates. Primary care doctors are paid far less than specialists.
Against this backdrop, nurse practitioners are "a phenomenal
alternative," Delaney said.
There is a parallel movement in dentistry. Dentists are in short supply
in rural areas of Minnesota, and there is a proposal moving through the
Legislature to allow dental hygienists to drill and extract teeth, and
prescribe medication without a dentist on site. The Minnesota Dental
Association opposes the proposal, saying it jeopardizes safety.
Some doctors object
For years, physicians have resisted the notion of a doctor nurse.
The American Academy of Family Physicians, for example, wants it made
clear to patients that nurses with an advanced degree are not the same
as doctors who have been to medical school.
"With four years of medical school and three years of residency
training, physicians' understanding of complex medical issues and
clinical expertise is unequalled," said the academy's president, James King.
Macaran Baird, head of the Department of Family Medicine and Community
Health at the University of Minnesota, says he's not worried about that.
He points out that turf battles are not uncommon in the hierarchical
world of health care.
However, he noted, there's no guarantee that doctor nurses will go into
primary care unless the gap between payments in primary care and
specialty care narrows.
Otherwise, he said, "we have the same risk of them going where the money
is."
Projects show potential
For some nurses, the new title is a validation of what they've been
doing for years.
Registered nurses, or RNs, are those with a bachelor's degree in
nursing. Nurse practitioners have a master's in nursing practice and can
see patients and prescribe drugs, just like doctors.
According to Delaney, there is already an 80 percent overlap between
what nurse practitioners do and what primary care physicians do. The
remaining 20 percent includes minor surgeries such as appendectomies or
vasectomies. Nurse practitioners may also specialize in fields such as
family practice, psychiatry, pediatrics, gerontology or midwifery.
Doctor nurses extend that nurse practitioner role even further with
training positioning them for leadership roles in health organizations
or teaching.
The three-semester program costs $14,500 for Minnesota residents and
$23,500 for nonresidents. Most of the work is Web-based, with students
coming to campus for several intensive weekends of work. So many nurse
practitioners in the first class were able to add the doctor nurse
credential while continuing to work part time.
Their student projects showed the scope and promise of combining a nurse
practitioner's clinical skills with a doctor nurse's new awareness of
health care systems. One student developed and implemented a standard
screening for asthma patients during clinic visits, to ensure proper
follow-up care. Another devised a plan to institute regular bathroom
breaks at school for kids who wet their pants because of medical problems.
Karalee LaBreche, a psychiatric nurse practitioner for Ramsey County who
was in the first class of doctor nurses, looked for ways to get
emergency medication to those who needed it, including going to their
homes. As a result, fewer patients showed up at the emergency room, a
very expensive option.
The project won her an award from the International Society of
Psychiatric-Mental Health Nurses.
More pay, promotions
For some, the new doctor of nursing practice degree has opened doors.
Six graduates have since been offered new positions or promotions, and a
few have gotten modest salary increases, said Sandra Edwardson, director
of the U's DNP program.
For Nicole Lynch, a psychiatric nurse practitioner at Abbott
Northwestern Hospital in Minneapolis, the added training as a doctor
nurse brought expansion of her role beyond outpatient care to inpatient
care, too. For Boisclair-Fahey, who specializes in pediatric urology, it
meant a 3 percent raise and an invitation to sit on a major board.
The proliferation of titles has caused some confusion.
Lynch explained her title to a child patient, who quickly twisted it
around to "Nurse Doctor Lynch."
Most of the time though, she said, they just stick to "Miss Nicole." |
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| Mortimer Schnerd, RN |
| Posted: Mon Apr 28, 2008 8:15 am |
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Guest
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Dan C wrote:
Quote: Article on the University of MN's first DNP grads.
Note complete lack of mention of ADNs.
---
http://www.startribune.com/business/18292444.html
As the health care system gets more complex, a new kind of hybrid
practitioner is beginning to work at your local clinic.
Here's the response I sent the author:
This is certainly news to me. I took the NCLEX (the national boards that EVERY
registered nurse must pass in order to be licensed) back in 1992 and was
promptly licensed as a registered nurse after graduating from an associate's
degree program in nursing. My license says "Registered Nurse". My license is
good for practice in 23 states; soon to be 24 states, including your neighboring
Wisconsin, North Dakota and Nebraska.
The pay is exactly the same in any hospital I've worked in since graduation. I
am paid for the job I do; not for the preparation I've received. If there are
any limitations to my degree, it's in the scope of opportunities available. For
example, public health departments almost always require BSNs. For working at
the bedside, all you need is a license and a pulse.
I will remind you that regardless of what requirements may be listed for a job,
the employers will take what they can get. As a result, there are plenty of
nurse managers out there who only have a diploma or ADN. Every one of them is a
registered nurse.
As for the DNP program, don't expect to meet one of them in a hospital setting
any time soon. They are wandering away from nursing and becoming akin to a
physician's assistant. When I think of nursing, I think of hospital nursing,
which is the only kind I've ever done. I'm talking about starting IVs, giving
meds, changing dressings, inserting catheters and offering bedpans. All that
other stuff you described.... well, to me, that's not really nursing. It's
something else. And I've noted over the years that the more education a nurse
seeks, the further away from the bedside a nurse gets.... and the less of a
nurse they become. Odd, isn't it?
--
Mortimer Schnerd, RN
mschnerdatcarolina.rr.com |
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| Candide |
| Posted: Mon Apr 28, 2008 9:01 am |
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"Mortimer Schnerd, RN" <mschnerdatcarolina.rr.com> wrote in message
news:doSdnelO_IJwUIjVnZ2dnUVZ_rignZ2d@giganews.com...
Quote: Dan C wrote:
Article on the University of MN's first DNP grads.
Note complete lack of mention of ADNs.
---
http://www.startribune.com/business/18292444.html
As the health care system gets more complex, a new kind of hybrid
practitioner is beginning to work at your local clinic.
Here's the response I sent the author:
This is certainly news to me. I took the NCLEX (the national boards
that EVERY
registered nurse must pass in order to be licensed) back in 1992 and
was
promptly licensed as a registered nurse after graduating from an
associate's
degree program in nursing. My license says "Registered Nurse". My
license is
good for practice in 23 states; soon to be 24 states, including your
neighboring
Wisconsin, North Dakota and Nebraska.
The pay is exactly the same in any hospital I've worked in since
graduation. I
am paid for the job I do; not for the preparation I've received. If
there are
any limitations to my degree, it's in the scope of opportunities
available. For
example, public health departments almost always require BSNs. For
working at
the bedside, all you need is a license and a pulse.
I will remind you that regardless of what requirements may be listed
for a job,
the employers will take what they can get. As a result, there are
plenty of
nurse managers out there who only have a diploma or ADN. Every one of
them is a
registered nurse.
As for the DNP program, don't expect to meet one of them in a hospital
setting
any time soon. They are wandering away from nursing and becoming akin
to a
physician's assistant. When I think of nursing, I think of hospital
nursing,
which is the only kind I've ever done. I'm talking about starting
IVs, giving
meds, changing dressings, inserting catheters and offering bedpans.
All that
other stuff you described.... well, to me, that's not really nursing.
It's
something else. And I've noted over the years that the more education
a nurse
seeks, the further away from the bedside a nurse gets.... and the less
of a
nurse they become. Odd, isn't it?
--
Mortimer Schnerd, RN
mschnerdatcarolina.rr.com
Just more BS from the nurses in lab coats who spend their days trying to
find ways to be anything but a lowly "nurse". For all amount of time
they spent in nursing programs adding a litany of initials behind their
names, they could have gone to medical school, completed post grad work
and been what they seem to most desire, a physician. But then they would
just have "MD" after their names, and what would they do with all that
remaining space?
Not content to get rid of caps, starched whites and jump into scrubs and
or lab coats (better to blend in with physicians and look
"professional", instead of like the hired help). Then we then had
"nursing diagnoses", after all that is what doctors do.
These same nurses harp on about Linda Aiken's work about how mortality
and morbidity rates decrease when patients are cared for by BSN degree
nurses over ADN nurses. Columbia University trumpets their program as
the next logical progression for the profession and will bring increased
prestige to nursing.
Associate and hospital programs had to go because in the eyes of the lab
coated nurses only four year degree nurses are well rounded enough and
possess the analytical skills required. Nursing is no longer a practical
profession, so the theory goes, RNs need to THINK (imagine that).
So let me see if one has this correct, in order to be taken more
seriously as a nurse, one has to become a "doctor".
What the above article and indeed those dreaming up these programs fail
to address, is the reason so many physicians are leaving primary,
family, OB care practice in the first place. Tired of being sued, long
hours, "low" pay and such docs are falling over themselves to get into
the former unsexy areas of ENT, dermatology, and plastic surgery. Open a
swanky and plush office space, spend a few hours per day giving botox
injections, hair transplants, perhaps LASIK, and don't forget selling
private label skin care, and one can be home in time to hit the greens.
Work is rarely covered by insurance, and patients pay up front, so no
forms and heavy administrative costs.
So what will happen? These new fangled nurse-doctors will be stuck with
the screaming ill masses, fighting insurance companies, filling out
forms and probably getting paid less than the doctors who previously did
the work because she is a "nurse".
Soon they will get bored and find yet something else to call themselves.
Candide |
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| Andrew Heenan |
| Posted: Mon Apr 28, 2008 9:28 am |
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Dan C wrote:
There's been similar stuff for years:
"They are designed to work in collaboration with physicians," said
Connie Delaney, dean of the School of Nursing, "so that very expensive
physicians and specialists can spend their time on other things."
Says it all really; they want cheap doctors, and there's always a nurse
happy to do a Dr's work for half the salary.
Andrew |
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| Norminn |
| Posted: Mon Apr 28, 2008 11:15 am |
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"Doing what physicians no longer have time to do"? Screw that. Outlaw
plastic surgeons and let them do what nurses no longer have time to do.
They can start with bladder training and work their way up. Save nurses
eons of time. |
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| Mortimer Schnerd, RN |
| Posted: Mon Apr 28, 2008 8:58 pm |
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Candide wrote:
Quote: Just more BS from the nurses in lab coats who spend their days trying to
find ways to be anything but a lowly "nurse". For all amount of time
they spent in nursing programs adding a litany of initials behind their
names, they could have gone to medical school, completed post grad work
and been what they seem to most desire, a physician. But then they would
just have "MD" after their names, and what would they do with all that
remaining space?
I look forward to the first time I meet one of these pseudonurses and they ask
me to call them "doctor". I'm sure I'll come up with something colorful to call
them.
As it is, I have always called MSNs by their first name. If they want to be
called a nurse by me, they'll have to put up with that.
--
Mortimer Schnerd, RN
mschnerdatcarolina.rr.com |
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