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Saturday, April 21, 2012

Doctor Who

Pioneers, that's what we are, but then, when haven't nurses been at the forefront of innovation?  The increasing complexity of the health care environment, the movement to doctoral entry for other health care professions like pharmacy and physical therapy, and the projected shortage of competent, qualified health care providers demands a terminal degree in nursing.  For too long the pie-in-sky degree attainment for nursing was the Masters, the required degree for practice as an advanced practice nurse practitioner.  Current health care needs demand a doctorally prepared nurse.   Prior to this decade, terminal nursing degrees existed, the DN, doctorate of nursing and the PhD in nursing, but those are academically focused.  The need for a practice doctorate exists.   In 2006, the American Association of Colleges of Nursing (AACN) published The Essentials of Doctoral Education for Advanced Nursing Practice  outlining the competencies required by practice doctoral programs.  The AACN also called for the entry level nurse practitioner to by doctorally trained and this qualification be implemented U.S. wide by 2015.  Read Me

Of course the backlash has been rough and steady.  Many existing nurse pracs disagree with the suggested change citing discrepancies among pay and possible "second class citizenship".  That is not a totally invalid argument.  Ask any practicing certificate or associates of nursing (ASN) nurse how she feels working alongside BSNs and MSNs.  We can all admit to a little degree-envy.  The biggest backlash, however, originates from the physicians' medical associations.  Many claim nurse practitioners want to replace medical doctors.  Others think we'll all have to compete for a spot in the health care pool.  Yes, health care resources are finite.  Patients are not.  Many specialties are sorely neglected such as primary care and OB.  Primary care physicians refer to themselves as a "dying breed" yet worry publicly and voraciously against primary care nurse practitioners. 

One of the heaviest hitters is the Kentucky Medical Association (KMA).  They have a bright, inviting website encouraging patients to seek qualified health care and declares, "Not everyone called "doc" is a medical doctor."  The site further warns against receiving potentially unsafe, unqualified care from chiropractors, optometrists, midwives, nurse practitioners, pharmacists, psychologists, and any health care provider without an MD or DO behind their name.  Hmmm...where are the physician's assistants?  KMA Nastiness

Sadly, Kentucky is not alone.  In most states, medical associations have successfully lobbied to limit the scope of practice of nurse practitioners.  Most require agreements with collaborative physicians.  Should your collaborator move, quit his practice, die, or lose her license, the NP is without a job immediately.  Even though NPs are reimbursed at a lower rate than physicians (Medicare pays 85% of the doc's rate), many medical doctors continue to view NPs as a threat to their livelihood.  The threat intensified with the advent of the DNP.  PhDs in nursing are doctors.  PhDs in anything are doctors!  But the doctor of nursing practice conveyed upon nurse practitioner who look like medical doctors, diagnose like medical doctors, prescribe like medical doctors, the title "doctor".  Suddenly became a hideous threat to the health care of our nation destined to fool unsuspecting patients into believing we are medical doctors. 

Therein lies the most offensive part of the whole debate.  If I wanted to be a medical doctor, I would have gone to medical school.  I wanted to be a nurse.  Nursing was an informed choice for me.  With nursing, I can focus on the patient and how the disease, illness, or injury process affects the patient, his or her family, and community.  Nursing is a holistic practice.  We are rich with our own theories and concepts, evidenced-based practices and interventions.  I can't even blame the era into which I was born.  The 70s were ripe for feminism and equality.  If I wanted to be a medical doctor, I would have.  Instead, I wanted to be a nurse.  And GI Joe....Wonder Woman....a television reporter....a hand model for Palmolive (yeah, I was a weird kid)...a writer...and a mom.  I've accomplished five of those things.  I still hold out hope Palmolive will call me yet.

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