Hi all, I'm a crusty old (okay, 27yo) ICU nurse-turned-MSII. I posted this on a different forum~
What I hear from the nursing sector is this: you can do everything a doctor can, you can call yourself doctor, you can get paid about as much as a doctor, you can have better hours, and you don't even have to worry about the liability (generally all true). Plus it takes less than half the time (also true)! That implies that nurses don't need the extra education, licensing exams and residency to do what doctors do.
I would love to see nursing have a doctorate for clinical practice, however, their scope and GOALS of care need to be more specific than they are currently. This is the difference between nurses and, say, physical therapists or counselors or physicists. A physical therapist does physical therapy. A nurse practitioner does....whatever their physician lets them do. Nurses need a job description that clearly delineates what they do specifically that is more appropriate to be handled in their own realm than in the physician's.
Nurses with a terminal degree should NOT be dependent on physicians to practice their separate field. If a case is out of their realm of expertise, they should consult that physician just like a family practice doc would consult a cardiologist. A question here or there makes perfect sense (docs do that amongst themselves all the time), but shouldn't mean the doc is ultimately responsible and liable.
Furthermore, keeping nurses dependent on physicians for their practice further perpetuates the stereotype of the nurse-as-handmaiden.
I hate to see my former profession seems to strive so hard to be just like physicians, when they have so much to offer that can be done better and differently than physicians (including provide patient education, manage certain patients, and perform some procedures). Why not embrace it, standardize it, and practice it independently?
~It seems to me there are two kinds of nurses that want to go for the DNP. Nurses who've always wanted to be nurses and are quite smart and want to learn the most they can but still be in clinical practice (the nursing PhD is geared more toward research). Then there's nurses who wanted to be doctors first but were concerned about family commitments or the sacrifice involved or were too old to go for MD (that *was* me).
~IMHO, nursing is a COMPLETELY SEPARATE field that shares some overlap with medicine. I thought the reason for advanced practice nursing was to manage straightforward cases in areas where there were provider shortages, with the understanding that NPs could spend more time with the patient and focus on prevention and wellness. I have no idea why on earth nursing is even interested in practicing medicine.
~Re: NPs working "under" a doctor. No way, Jose. I have a few nurse friends who became NPs and can't wait for me to become a doc so we can "practice together". That would be all well and good, but as long as I am responsible and liable for their decisions, I really do not feel comfortable with that. I know what nursing is like: you have 5 mins to get your point across, so you leave "impertinent" information out. BUT since you don't know what you don't know, there is no way you would know what you missed, and the physician has absolutely no idea what actually happened in the clinic or how the patient even presented. *The nurse just wants you to sign the chart so s/he can practice however s/he wants.* Hello! Nurses love charting "Dr. ____ notified of the above." They think it absolves them of any liability....oh wait, it kind of does currently.
~This mess is in part due to physicians passively agreeing to the NP model. By signing their charts and agreeing with their care provision, you are basically saying that their care is equivalent to your level. By not seeing the patient yourself, or agreeing to be the physician-of-record without knowing what is actually done, you are saying that the NP is an appropriate substitute. Therefore, by your enabling, the NP feels confident to take on ANY case independently. You haven't given them any sign that they can't.
~I think if we actually gave NPs independent rights (along with full liability), they would realize they're in over their heads and do a little self-regulating, at least on an individual level. If not, patients will suffer, and it will take that much longer for the problem to correct itself (legally and credentialing-wise).
~I wholeheartedly agree with the PP who went to nursing school--nursing education doesn't hold a candle to medical education. Not even close. If RNs want to be just like doctors, then they can start 4-year (rigorous, medically-oriented) DNP schools with minimum 3-year residency requirements, CME, and all 3 steps, just like the DOs did. I personally think that would be a shame, since nursing can offer so much outside of medicine.
(ps-in my state, nurses aren't even required to do continuing education to keep their licenses!)
