Paging Dr. Nurse...

An interesting thing about the issue of the Doctor of Nursing Practice is that the news coverage and opinion pieces about it are mostly centered on what doctors think. Doctors, obviously, are not generally happy with nurses being called doctors. It is true that "Doctor nurse" seems like an odd title; however there is a valid point that pharmacists, dentists, and even many physical therapists are now doctorate-level clinicians but nobody gets up in arms about that. Doctors are obviously worried because we do frequently the same tasks, so DNPs infringe on their turf. But to me, that's neither here nor there.

I'm more concerned with what nurses think about it, and that information is a lot harder to find. I think the only nurses who write or publish in any venue are the ones behind this sort of thing.

In fact, the only published thing I could find was a statement called 'Advanced Practice Nurses Say "No" to a Mandatory Doctor of Nursing Practice Degree' (may require free registration at Medline) by Wendy Vogel, an NP in Georgia. Her statement, the readers' letters it generated, and her response to those letters are well worth reading. The upshot?

Increasing the education requirements will only sharpen the nursing shortage. In fact, other medical fields have already experienced this:

Nursing looks to pharmacy, medicine, and physical therapy and sees the need for a clinical doctorate to have "parity" with these professions. Yet, if one examines the Department of Health and Human Services' report to Congress about the pharmacy workforce, the conversion from the Bachelor of Science in Pharmacy to the Doctor of Pharmacy degree is deemed a major factor contributing to the nationwide shortage of pharmacists. We also see evidence in both pharmacy and physical therapy that required doctorates have severely influenced PhD enrollment. 

This seems so obvious that I don't know what the problem is. I've complained before that the shortage of nursing faculty in general is partly due to requiring Masters-level education even to be a first-semester clinical instructor. This is obviously absurd. When a nurse can make great money at the bedside, why would they expend the time, money, and effort to get their masters and then teach for minimal income? It's ridiculous. The only explanation I can find is that cushy academic jobs (in this case, those who run masters in nursing education programs) need a justification for their existence.

Is it the same story for the DNP? I think it probably is. Academic nurses, in this case the doctors who want to teach doctorate programs, need a justification for their existence. But it's going to ruin advanced practice nursing for the rest of us. As Ms. Vogel puts it:

So why would a new high school graduate want to consider a doctorate degree in advanced practice nursing? Why not pursue the career of a physician assistant...or a physician or a pharmacist? As with many careers in the healthcare field, nursing is fraught with shortages, decreasing reimbursement, increasing demands, burnout, and job dissatisfaction. When one compares the time commitment of education with the potential remuneration of each profession, nursing may very well lose.

Academic nurses have been fighting for forty years to be on a par with physicians. I don't think they realize that achieving that vision is going to be its own undoing.