Well I suppose it has come to this. The nursing professions have invented their own Doctorate, and are in many states according to the Pearson Report gaining independent authority for diagnosis and prescription rights. The AMA and AOA seem to have a problem with this as their Family Practitioners and other specialties will be in direct competition with a perceived incompetent generalist. I can see their point. In a different thread I posted this
"I have often thought about getting an NP, and have also looked at the DNP criteria, syllabi, and course content at several schools locally. My mouth dropped open in surprise. I agree wholeheartedly that there isn't advanced basic science and clinical coursework advantages in the DNP programs I looked at. I was even disappointed in many NP course loads. As such I think there needs to be a revamp in the DNP programs to sufficiently train them for their perspective roles as Primary Care Providers, essentially a new basic science program, and equivalent residencies in their direct specialty. But it should not necessarily be the same as an MD/DO training.
The allopathic and osteopathic professions are designed to be able to take on any specialty they may choose to enter, with various factors contributing to their decisions and positions as I am led to understand. However a DNP will never be a Cardiovascular Surgeon, they must know what they do in reports and progress notes, but the skill set is unnecessary. With that said, does a DNP need to know every single anatomical landmarkd within the human body to be an effective independent PCP? I am not positive this is the case. I have never needed to know the position of someone's ansa cervicalis, but I do, as this structure isn't even consistent within a certain person's body from left to right.
This point is directly related to other sub-doctoral specialties such as Dentists, and podiatrists. They are trained directly with the amount of knowledge and skill sets to demonstrate their respective competencies.
I have spoken with many physicians about this point, most of them agree that they would have much preferred to study in a program that directly related to what they were going into rather than the broad spectrum education they were given in Medical School and the intern/residency process, but not all ofcourse. Many have arguments against independent nurse practitioners in general. Their biggest hang up isn't related to competence or quality of education, but rather "If they can effectively do this, then why did I have to go to school and learn things that weren't directly related to my chosen specialty."
I believe the situation would be best served by the AMA and AOA if instead of directly opposing the invention of a third primary practice doctorate, than pushing, lobbying and supporting the education and perhaps creation of a DNP training protocol that directly trains nurses in this specialty.
These posts reminded me of a good point. Realize that some nurses have been in practice for 10 years and have learned, and experienced a great deal in patient care. We deliver the treatments, assess and reassess the patients condition far more than physicians do, and we repeatedly are sometimes called to inform interns and residents of appropriate treatments and recommendations by which they will ultimately be responsible for. We also go over the patients situation in more detail individually than any of the primary care or specialty physicians when taking care of acute and critically ill patients. Thus, while our initial training is lax compared to a MD/DO we still perform many of the same functions, and indeed share a great deal of the actual workload on individual patients. If say a nurse still wished to provide bedside care, but also wanted to be a primary care provider he/she with this degree might make that possible.
Say a critical care DNP writing her own orders, AND performing these tasks. That could eliminate much congestion in physician shortages, as the nurse, if trained and educated properly, might say start a central line, prescribe the treatments, and order the tests necessary to keep her patient alive and well. It is a possibility. This is a function I don't believe anyone has addressed yet. Primary care bedside nursing/healthcare, a subspecialty right there.
There definitely needs to be a better standardized entry test, and educational program for developing a true DNP program. Some students come directly from a BSN program while others have years of experience and are fairly competent. This new educational program would help to close knowledge deficits created with different nurses with regards to experience and education.
In short, there could be a great place for a DNP, in a clinic, at the bedside, in the hospitals supporting and collaborating with physicians to ensure a better patient outcome. DNP's will never be surgeons, so why have a surgical rotation? A DNP will never be a Cardiologist, so do they need a full track like an intern does, yes, as they need to know what to do after say a patient has a stent, to better coordinate the recovery efforts and deliver a good discharge from the hospital.
1) DNP's are here, and they aren't going anywhere, so let's get a good training system going for education and clinical work.
2) The AMA and AOA have already lost the battle of NP independence in many states (please see the 2009 Pearson report) and have historically failed to prevent other burdgeoning professions from grabbing their doctorates, please see historical references to DO's, DDS, DPT, DC, and several others. This is a fight that has yet to be won in finality YET!
3) Use your Lobbyists and pressure for better educational training of the DNP. This fight has been one with respect to the Chiropractic profession, they were forced to change their basic science curriculum to better reflect anatomy, physiology and other basic sciences. This is the really only feasible victory that will likely have any bearing in the long term.
But then I also had another idea.
If the AMA and AOA really want to fight against nursing why not fight where the nursing profession draws its greatest numbers, ie bedside patient care.
Frequently in some of these posts I see so many people pointing fingers nurses point at incompetent doctors and vice versa.
Well the medical profession has a history in the early 1960's of creating a new limited scope profession to aid in short falls of physician coverages, I mean the PA's.
Since this time the PA profession has multiplied and flourished with subspecialties of their own and have enjoyed many physician perks.
The point is that there is a precedent for the medical profession to invent a lower tiered provider when the time warrants it.
I propose that the AMA and AOA conduct a new profession invention related to direct bedside patient care to compete with the nursing monopoly in that healthcare sector.
Why do this? For many years the Nursing profession has been largely autonomous. They have their own education systems, their own boards and as such the physician boards and state medical organizations have little power to dissuade changes that nursing implements that impact patient care.
With this in mind let's take a moment and examine what the medical professions can do to hinder further encroachment on their respective turfs, or at least produce a greater impact on bedside care.
1) Invent a BSM, or a bachelor's of science in Medicine education program across the country. The BSM is a tiered limited scope professional who takes care of patients at the bedside whether in critical care, acute care, or in any other respect where an RN might practice.
2) They would be trained completely different from Nurses, in utilizing complete pre-healthcare sciences, and directly trained in the various sub-specialty environments where bedside care is required, including procedural, clinical and clinical didactic courses in Emergency Medicine, Critical Care, Acute Care, Pharmacological interventions, Advanced assessment and patient monitoring, Psychological interventions etc. without training in nursing fluff courses like "nursing theory" or "nursing leadership" or "nursing research".
3) Courses wouldn't be relabeled with the Nursing primer, they simply are what they are.
4) Science courses such as gross human anatomy, biochemistry, clinical nutrition, could also be added to enhance understanding of the human body, as well as clinical psycology to enhance the understanding of human behavior in and out of the clinical setting.
The Registered Medic profession would be directly overseen by the medical boards of their respective states, and not the nursing boards. This would give physicians direct influence to the education, clinical competences, and developments for bedside care.
The RM lisence would have to be written into the Medical boards jurisdiction and should the nursing profession not embrace, and indeed stop the encroachment of physicians onto their turf, simply file an antitrust law suit agains them. It worked for the chiropractors.
This would work to solve several healthcare dilemmas.
1) There is a terrible nursing shortage. If this BSM was created it could help to alleviate this shortage for bed side care. As the Nursing profession seems to think they can encroach on the primary care markets, then likewise should be true for the medical professions.
2) The nursing profession has a HUGE monopoly over several areas in healthcare, including bedside nursing. This would allow direct physician involvement in the care of patients.
3) The BSM would allow the medical professions to engage in higher premiums and reimbursements for a BSM under their employ.
What do you think? Is this viable?
"I have often thought about getting an NP, and have also looked at the DNP criteria, syllabi, and course content at several schools locally. My mouth dropped open in surprise. I agree wholeheartedly that there isn't advanced basic science and clinical coursework advantages in the DNP programs I looked at. I was even disappointed in many NP course loads. As such I think there needs to be a revamp in the DNP programs to sufficiently train them for their perspective roles as Primary Care Providers, essentially a new basic science program, and equivalent residencies in their direct specialty. But it should not necessarily be the same as an MD/DO training.
The allopathic and osteopathic professions are designed to be able to take on any specialty they may choose to enter, with various factors contributing to their decisions and positions as I am led to understand. However a DNP will never be a Cardiovascular Surgeon, they must know what they do in reports and progress notes, but the skill set is unnecessary. With that said, does a DNP need to know every single anatomical landmarkd within the human body to be an effective independent PCP? I am not positive this is the case. I have never needed to know the position of someone's ansa cervicalis, but I do, as this structure isn't even consistent within a certain person's body from left to right.
This point is directly related to other sub-doctoral specialties such as Dentists, and podiatrists. They are trained directly with the amount of knowledge and skill sets to demonstrate their respective competencies.
I have spoken with many physicians about this point, most of them agree that they would have much preferred to study in a program that directly related to what they were going into rather than the broad spectrum education they were given in Medical School and the intern/residency process, but not all ofcourse. Many have arguments against independent nurse practitioners in general. Their biggest hang up isn't related to competence or quality of education, but rather "If they can effectively do this, then why did I have to go to school and learn things that weren't directly related to my chosen specialty."
I believe the situation would be best served by the AMA and AOA if instead of directly opposing the invention of a third primary practice doctorate, than pushing, lobbying and supporting the education and perhaps creation of a DNP training protocol that directly trains nurses in this specialty.
These posts reminded me of a good point. Realize that some nurses have been in practice for 10 years and have learned, and experienced a great deal in patient care. We deliver the treatments, assess and reassess the patients condition far more than physicians do, and we repeatedly are sometimes called to inform interns and residents of appropriate treatments and recommendations by which they will ultimately be responsible for. We also go over the patients situation in more detail individually than any of the primary care or specialty physicians when taking care of acute and critically ill patients. Thus, while our initial training is lax compared to a MD/DO we still perform many of the same functions, and indeed share a great deal of the actual workload on individual patients. If say a nurse still wished to provide bedside care, but also wanted to be a primary care provider he/she with this degree might make that possible.
Say a critical care DNP writing her own orders, AND performing these tasks. That could eliminate much congestion in physician shortages, as the nurse, if trained and educated properly, might say start a central line, prescribe the treatments, and order the tests necessary to keep her patient alive and well. It is a possibility. This is a function I don't believe anyone has addressed yet. Primary care bedside nursing/healthcare, a subspecialty right there.
There definitely needs to be a better standardized entry test, and educational program for developing a true DNP program. Some students come directly from a BSN program while others have years of experience and are fairly competent. This new educational program would help to close knowledge deficits created with different nurses with regards to experience and education.
In short, there could be a great place for a DNP, in a clinic, at the bedside, in the hospitals supporting and collaborating with physicians to ensure a better patient outcome. DNP's will never be surgeons, so why have a surgical rotation? A DNP will never be a Cardiologist, so do they need a full track like an intern does, yes, as they need to know what to do after say a patient has a stent, to better coordinate the recovery efforts and deliver a good discharge from the hospital.
1) DNP's are here, and they aren't going anywhere, so let's get a good training system going for education and clinical work.
2) The AMA and AOA have already lost the battle of NP independence in many states (please see the 2009 Pearson report) and have historically failed to prevent other burdgeoning professions from grabbing their doctorates, please see historical references to DO's, DDS, DPT, DC, and several others. This is a fight that has yet to be won in finality YET!
3) Use your Lobbyists and pressure for better educational training of the DNP. This fight has been one with respect to the Chiropractic profession, they were forced to change their basic science curriculum to better reflect anatomy, physiology and other basic sciences. This is the really only feasible victory that will likely have any bearing in the long term.
But then I also had another idea.
If the AMA and AOA really want to fight against nursing why not fight where the nursing profession draws its greatest numbers, ie bedside patient care.
Frequently in some of these posts I see so many people pointing fingers nurses point at incompetent doctors and vice versa.
Well the medical profession has a history in the early 1960's of creating a new limited scope profession to aid in short falls of physician coverages, I mean the PA's.
Since this time the PA profession has multiplied and flourished with subspecialties of their own and have enjoyed many physician perks.
The point is that there is a precedent for the medical profession to invent a lower tiered provider when the time warrants it.
I propose that the AMA and AOA conduct a new profession invention related to direct bedside patient care to compete with the nursing monopoly in that healthcare sector.
Why do this? For many years the Nursing profession has been largely autonomous. They have their own education systems, their own boards and as such the physician boards and state medical organizations have little power to dissuade changes that nursing implements that impact patient care.
With this in mind let's take a moment and examine what the medical professions can do to hinder further encroachment on their respective turfs, or at least produce a greater impact on bedside care.
1) Invent a BSM, or a bachelor's of science in Medicine education program across the country. The BSM is a tiered limited scope professional who takes care of patients at the bedside whether in critical care, acute care, or in any other respect where an RN might practice.
2) They would be trained completely different from Nurses, in utilizing complete pre-healthcare sciences, and directly trained in the various sub-specialty environments where bedside care is required, including procedural, clinical and clinical didactic courses in Emergency Medicine, Critical Care, Acute Care, Pharmacological interventions, Advanced assessment and patient monitoring, Psychological interventions etc. without training in nursing fluff courses like "nursing theory" or "nursing leadership" or "nursing research".
3) Courses wouldn't be relabeled with the Nursing primer, they simply are what they are.
4) Science courses such as gross human anatomy, biochemistry, clinical nutrition, could also be added to enhance understanding of the human body, as well as clinical psycology to enhance the understanding of human behavior in and out of the clinical setting.
The Registered Medic profession would be directly overseen by the medical boards of their respective states, and not the nursing boards. This would give physicians direct influence to the education, clinical competences, and developments for bedside care.
The RM lisence would have to be written into the Medical boards jurisdiction and should the nursing profession not embrace, and indeed stop the encroachment of physicians onto their turf, simply file an antitrust law suit agains them. It worked for the chiropractors.
This would work to solve several healthcare dilemmas.
1) There is a terrible nursing shortage. If this BSM was created it could help to alleviate this shortage for bed side care. As the Nursing profession seems to think they can encroach on the primary care markets, then likewise should be true for the medical professions.
2) The nursing profession has a HUGE monopoly over several areas in healthcare, including bedside nursing. This would allow direct physician involvement in the care of patients.
3) The BSM would allow the medical professions to engage in higher premiums and reimbursements for a BSM under their employ.
What do you think? Is this viable?
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