About One DNP

I earned my "terminal practice" degree in nursing from the University of Tennessee Health Sciences Center in a journey of excitement and challenge. It inspired me to advocate for an all encompassing clinical credential rather than continuing the hodgepodge of nonsensical initials. I hope these entries will provide entertainment and insight into the Doctor of Nursing Practice experience, which will soon be the entry standard for all advanced practice nurses.

Friday, October 15, 2010

Thursday-Night-Fight Highlights

Laaaaaadies and Gentlemen! In this corner, weighing in at 30% of the advanced practice nursing psych professionals wearing APRN badges. In this corner we have 70% of the advanced practice nursing psych professionals wearing CNS badges. And our referee tonight is the general public wearing a hospital gown and bracelet reading "so you are a nurse with a some extra training or something?" This is a mortal combat match. The winner of this round will face off against the biggest opponent to advancement and awareness of nursing practice - no, it is not the AMA, it is a giant mirror.

Now that I got that off my chest . . .

I get it. If I were a CNS with a decade or more of practice I would feel invalidated by the position that the NP will be the basis for advanced practice nursing. I would feel "there are more of us than their are of you, so you should change to OUR title." I would be nervous that, without having the NP designation after my name, that I will loose parts or all of my ability to practice. And I would feel resentful that after thousands of hours of clinical work, I may have to go back to school and take another damn standardized test, not to continue practice, but to have all my bases covered.

Yep, I would have a big fat chip on my shoulder.

Nevertheless, I believe merging the CNS and APRN role into one designation in the future (not retroactively - some folks got stuck on that argument 8-track and couldn't get off no matter how many times the phrase, "not for those currently in practice, this is for those coming in the future" was used) and focusing on lifespan rather than specialty populations makes good sense for several reasons.

  • "So a nurse practitioner you see for colds, but the serious stuff like blood pressure you need a doctor."
  • "You guys are like physicians assistants just without the science background, right?"
  • "Oh yeah, my daughter is an RN - are you going to go for that when you are done?"
We have enough problems trying to explain our "mid-level provider" role to the public without having to explain several of them. Heck, I never heard of a CNS before nursing school and am still not entirely sure what the difference is between NPs and CNSs outside of psych. The argument that we just need to keep all the credentials separate and let the public slowly adjust is illogical - the public has already had a few decades and it has not assimilated. People are busy enough without having to figure out a myriad of differing professional credentials that essentially mean the same thing.

When the provider is lifespan educated, all doors to practice are open even if you want to specialize in a particular population or psych disorder. This way, a patient who started seeing their provider at 14 can keep seeing them into their 30s if both agree it is in the patient's best interest.

Moreover, we need image control. The good-old-boys medical network presents a cool, calm, collected front of intellectuals. We present a hormonal, defensive, fragmented group of providers who maybe were not smart enough to be doctors. Seriously, chiropractors encroach on the MD conscripted "doctor" title and get nearly no political flack for it because even their smarmy ethics get more respect than our uppity-handmaiden persona. The ANA needs a PR firm - it would probably enhance what our lobbyists do 10-fold.

I have argued this from the DNP angle ad nauseam. If the DNP is the single designation for advanced practice by the time all of us have returned to the dust, I feel we have done our job. In the meantime, the NP role in the psych multidisciplinary team has established itself well in the decade it has been in existence. Our peers in other specialties are phasing out the CNS as the NP becomes the dominant degree, and while psych does tend to be slow to adopt change, there is no need to separate ourselves for the sake of preserving a title. Other professions, like the MD and the PsychD and the DPT, may have specialty focus beyond their core training, but their is no role confusion or use of multiple credentials within the same education levels as there is with nursing. Being different is great if you are in the business of fashion or retail or sports, but in healthcare, conformity is a good thing - Iit fosters "brand awareness."

It costs a lot of money to create certifications exams and state licensing. The less there are, the less expensive the fees will be. Or slower the fees will rise, at any rate. I imagine testing may evolve to some sort of module model at some point, but in the meantime streamlining is more cost effective and can result in greater speed and delivery of the application, testing, and certification process.

If nurses run the healthcare system, nobody seems to know it. Stratified as we are, unity through every educational level of the profession is a challenge, but it is attainable and it has to come from the "top" down. We must make our scope and standards clear in order to lobby for uniform advance practice rights in EVERY state. We cannot accomplish this with 31-flavors of advanced practice nursing.

I do not endorse the medical practice model, however I do endorse the medical designation model of one, all encompassing practice credential. I also believe the generalist-to-specialist education model provides a solid foundation to which all of us can relate to. I would not go so far (yet) as to say all of us need to be FNP certified first before becoming CNMs or CRNAs, but we should have a good chunk of our didactic education the same as well as some form of uniform clinical component.

Ultimately, we need to do whatever is necessary to result in full autonomy and the elimination of physician oversight of our profession. This strength will allow us to advocate for RNs and LPNs who we must still consider our professional responsibility to promote and protect. Our stratification is unique compared to other health care disciplines - we decide if it works to our advantage or our demise.

1 comment:

  1. Hi Nick Croce here, APNA Executive Director! I saw your BLOG and hope that you will continue to voice your views. The more folks that discuss the future, the brighter it can be.

    Be Safe,