April 2, 2008

New Exam Will Test Nurses Trained to Perform More of Doctors' Duties

The line between doctors and nurses is about to get blurrier, The Wall Street Journal reports today.

As the nation struggles with a looming shortage of primary-care physicians, advanced-practice nursing has been gaining in popularity. Now a new “hybrid practitioner” model that would equip nurses with additional skills is being developed at about 200 nursing schools. Graduates would receive doctorates of nursing practice and would be trained to coordinate care in a variety of settings and using a variety of health-care workers.

Today the nonprofit Council for the Advancement of Comprehensive Care is expected to announce that the National Board of Medical Examiners will develop a certification exam for these nurses. The exam is to be based on the test that medical-school graduates must pass to get their licenses.

Some doctors, though, worry that the change could confuse patients and compromise care. The new breed of nurses would use “DrNP” after their name, and could also use the title “Doctor.”

“Nurses with an advanced degree are not the same as doctors who have been to medical school,” says Roger Moore, incoming president of the American Society of Anesthesiologists.

But nursing advocates say they’re not trying to take over doctors’ roles; they just want to ensure that when aging baby boomers and others need care, there will be enough people trained in primary care to meet their needs. —Katherine Mangan

Comments

1. The article suggests that these advance practice programs are still in the planning stages, but some are already turning out graduates with Dr.N.P. degrees. Columbia’s nursing school was first a few years ago (several of its own clinical faculty had already completed the coursework in anticipation of the state’s approval of the degree program; they received their degrees in 2004 or 2005), and I think a few others have at least begun enrolling students since then.

   — CU Alum    Apr 2, 01:02 PM    #

2. Here we go again… physicians worried about other people using the title” Dr.” I find this very interesting… they have no problem with their physician’s assistants (PA) using no title at all, but worry when a health care professional, such as an advanced practice doctorally educated nurse, with MORE education and MORE clinical experience than a PA, uses the title doctor. PAs have three years of school after college (some have less). Doctorally prepared nurses have to have a BSN or BA equivalent(four years), plus an advanced practice degree with a specialty board exam (1-3 years) and then, for the doctorate often are required to produce a portfolio of their clinical experiences or even a thesis or research(possibly another year).

   It has already been shown time and again that the care given by nurse practitioners is at least equal to the quality of care given by physicians. In the case of anesthesia, more than 70% of anesthesia in rural areas is administered by nurse anesthetists. WHY?? Do nurse anesthetists like rural areas better than physicians? NO, but many physicans would rather practice in high population, more lucrative areas of the country.

   Having taught both graduate med students and graduate nurse practitioners in anesthesia, I would rather have the DrNP put me to sleep!!

   — DrFunZ    Apr 2, 02:43 PM    #

3. DrFunZ,

   What is your point? You are all over the place.

   — DrNoFunZ    Apr 2, 02:49 PM    #

4. I believe that DrFunZ’s point is that physicians aren’t the only healthcare professionals who are entitled to use the title “doctor,” and I completely agree.

   — Jason    Apr 2, 03:55 PM    #

5. This is risky business, indeed. The public has just been trusting physicians for just over one hundred years. Now, a new form of “doctor” joins the ranks of primary care givers, i.e., DOs being the second. Beyond that,the majority of MDs in many areas of some states are foreign born and trained physicians who are waiting out the 3-year period to get a green card to go anywhere they want to practice medicine in the USA. The new DrNP degree will effectively kill the fairly new filed of medical specialization called Family Practice. The botttom line is that a nurse under any name or title is not, indeed, equal to a physician, espeically an MD. Confusing the public with this kind of jerrymandering of the healtcare system can only mean more confusion, and a lesser quality of care for unsuspecting patients of DrNPs.

   — JR    Apr 2, 03:58 PM    #

6. pt 1. Physicians should worry more about the level and experience of practitioners than about their titles.

   pt 2. Confusion is not really the issue… the issue is that physicians do not want nurses playing in their sandbox. The quality of care delivered by NPs is equal to that of MDs.

   pt 3. NPs provide care to underserved populations that are not always sought after by the majority of physicians.

   DrNoFunZ, I hope the above corrals my comments in a way that you can understand.

   — DrFunZ    Apr 2, 04:00 PM    #

7. There is plenty of primary care to go around and research demonstrates that care given by NP’s is equivalent or better than MD’s. The opposition from physicians is primarily economic, since quality is not an issue.

   — Betsy Frank    Apr 2, 04:01 PM    #

8. I disagree with #5. The training a DrNP will have will be similiar to, and will often exceed, that given to MDs. My experience thus far in life has been that highly trained nurses are more capable of performing the varied duties involved in primary care than most MDs I’ve encountered. I for one believe this is an excellent move for healthcare and patients. No MD knows everything there is to know about medicine (and despite what many MDs I personally know think, they’re not gods either), and they’re overwhelmed with patients in most places. Yes, there are times when you need to bring in an MD (often not just an MD but a highly trained specialist), but for most routine aspects of primary care, a well-trained nurse is more than sufficient.

   — bee    Apr 2, 04:05 PM    #

9. I’m not a betting person, but I’d be willing to bet that the “research” that “demonstrates that care given by NP’s is equivalent or better than MD’s” was done by nurses. It is absolutely ludicrous to even suggest that care provided by a nurse of any preparation is anywhere near that of a physician’s. It’s like cigarette companies telling the public for years that their products were completely safe, just as automobile manufacturers did for their unsafe fuel inefficient polluting products. Malpractice suits against Dr.NPs will take care of these wannabe a physicians.

   — JR    Apr 2, 04:13 PM    #

10. To begin with, I believe only about 2/3 of licensed physicians are fit to practice medicine. Nurse practitioners (and I assume PA’s, although I’ve never used one of those) are even worse. I have NEVER had a nurse practitioner come up with a correct diagnosis, including the time I developed KIDNEY FAILURE as the result of misdiagnosed rhabdomyolysis. No thanks, whenever my primary care physicians try to pass off one of their nurse practitioners on me, I head for an M.D. or D.O. at the local doc-in-the-box.

    — Susan    Apr 2, 04:19 PM    #

11. 1. Does one study demonstrate that care is comparable? What kind of patients, what conditions, over how long? Certainly the care of an ear infection can be generally cared for by someone with less training but more complex conditions may not.
    2. Dr FunZ implies PAs have less education than NPs or DNPs – not true and one should look at the details of the education (e.g. clinical hours) not just the length of time.
    3. PAs do not advocate for independent practice and work with supervision of physicians.
    4. Finally, what is best for patients and for the health care system in general?

    — TM    Apr 2, 04:24 PM    #

12. JR –

    True, SOME of the research documenting equivalent outcomes of care provided by NPs and MDs were done by nurses – but much of the research was done by collaborative interdisciplinary research teams. NPs have been providing quality and affordable primary health care for decades – since the late 1960s. Sometimes a physician specialist is necessary – but sometimes the best care is provided by a nurse practitioner whose focus tends to be on the total quality of life experience desired by the client and his/her family.

    And the entire argument about titling is just silly!

    By the way, national certification examinations for NPs have been in place for nearly two decades – so this exam is nothing new. NPs are not physicians and they should not be taking physician-prepared/dictated exams – just as physicians are not qualified and should not be required to sit for nursing certification exams. And quite frankly, most physicians couln’t perform successfully on nursing exams.

    So how about if both groups simply recognize that they operate differently and effectively, sometimes even playing in the same sandbox!

    — TDD    Apr 2, 04:59 PM    #

13. TDD –

    I hold a Ph. D. from an Ivy League university. My focus is history of medicine. The primary reason MDs use the title Dr. as well as the designation MD after their names is to prevent confusion with those of us who are the real doctors, or persons holding the terminal degree for researchers called the Ph. D.

    When it comes to the public, allowing more than one professional group to use the professional designation “Dr.” in a healthcare setting will mislead Joe Public, just members of this group already confuse PAs with Drs. As another commentator has astutely pointed out, it is one thing to treat an ear infection, and another to deal with medical issues that can be life threatening if not terminal when not treated in a timely manner.

    Currently, the few states that do allow ANP to practice unsupervised by a physician, even fewer require the follow-up with a patient including looking into one’s death.

    This isn’t about “playing in the same sandbox.” That’s belitting the matter. This is about an attempt by the profession of nursing to engulf a larger portion of the healthcare business without having to accept the longterm responsibility, i.e., a patient’s untimely death due to inadaquate care over time.

    Would you also advocate allowing a paralegal the privilege to argue a murder case before jury trial?

    The nursing profession has a long distinguished history dating just over 150 years. Indeed, nurses should be more concerned with doing away with the phethora of 2-year associates degrees than trying to take over the part of the medicial profession that specializes in Family Practice, as in AAFP.

    — JR    Apr 2, 05:16 PM    #

14. If nurses want to act as physicians, they should complete premedical course requirements as well as the MCAT exam and compete with the thousands of other medical school applicants for a slot. There are many nurses who have become legitimate physicians in this manner, and not a DrNP by taking a few extra courses.

    — DS    Apr 2, 05:19 PM    #

15. I say anyone who gives rectal exams has earned the right to be called Doctor.

    — marci    Apr 2, 06:53 PM    #

16. Our nursing program at Troy University was just approved for a new DNP program. We’ll begin teaching students in this program in the spring of 2009. I think this is a step in the right direction for the medical profession.

    — Stephen    Apr 2, 08:57 PM    #

17. I would like to see MD’s do a portion of the work done by Nurses. Nurses are often performing the work of the MD without the compensation. The MD would be lost. It should comforting to know that there is another group of health professionals ready to jump in and provide quality care to the patients. The issue is really not about the competency level of the Nurses, because we all know they will be competent, the real issue is will we now begin to receive equity in pay.

    — MMD    Apr 3, 08:02 AM    #

18. Maybe we should just call them physicians and nurses and leave off the doctor part, as in, “Is there a physician in the house?”

    I think the quality of the DNP program will depend on the quality of the nursing program offering it. Not every nursing school offering a nurse practitioner specialty is equiped to offer a quality program. Maybe it’s the same with medical schools.

    — CH    Apr 3, 08:28 AM    #

19. Maybe we should care more for our patients than be concerned with title or ego. What ever happened to wanting to practice medicine in order to help others?? One should get satisfaction in knowing that they helped someone live a better life then whether or not they were called by their correct title.

    — RS    Apr 3, 09:04 AM    #

20. Advanced practice nurses are willing and able to do the unglamorous work of primary care for a lower salary than most MDs; otherwise we would not have a shortage of primary care physicians. New medical school grads are often saddled with heavy debt, and therefore have to go into more lucrative areas of medicine to stay afloat. Unless the government gets involved and starts planning for the ‘coming generational storm;, nothing is going to change, and we will be awash with dermatologists and plastic surgeons (where the $ is).

    — ExRN    Apr 3, 09:29 AM    #

21. I know that physicians-in-training amass large loans, but they get automatic financial aid and they have a stable career to look forward to. I wonder if the attraction for high-paying specialties isn’t so much necessitated by simply “staying afloat” (#20), but more about “paying off the loan as fast as possible to get started on enjoying the luxurious lifestyle as soon as possible”. By way of comparison, I came out of undergrad + PhD school with a pretty good sized loan and, while it took me years to pay it off, it was paid off eventually. As a result, I have a hard time feeling sorry for the “low-paid” GP/PCP who is STILL going to make roughly 4x my salary to start.

    — PreMedProf    Apr 3, 10:04 AM    #

22. JR is so passionate about this issue— may not have disclosed everything about himself. Well trained NPs are the best healthcare providers that I know; and osteopathic physicians are better than MDs who are maniacally egotistical in the face of their incompetence and non-caring attitude. Give me a break, MDs want to control NPs in the same manner as they control and bully PAs. MDs should spend more time developing their bed-side manners and the insurance industry should reimburse NPs for primary care services at the same rate as they do physicians. It seems that the insurance industry and MDs collude against NPs to restrain trade.

    — Sol    Apr 3, 10:08 AM    #

23. Wow, this is really deja vu all over again! In the 70s, I published a series of articles when I was with the PHS on the turf wars between the medical profession and the then new “professions” of PAs and NPs. One of my articles, in fact, was titled, “The PA: To Practice or Not to Practice.”

    I have to agree with the writers who have linked this issue to economic factors. The real public policy issue here is not whether NPs should be given a doctorate or not. The issue is whether they have the competence that is needed to provide quality healthcare. If that issue is decided in the affirmative, the public interest must demand that the professions take a backseat and permit these folks to assume greater responsibility in delivery of health services.

    — harris cohen    Apr 3, 10:11 AM    #

24. “Blurrier”????? What’s next? “Blurriest”?

    — John    Apr 3, 10:54 AM    #

25. #22 “JR is so passionate about this issue— may not have disclosed everything about himself. Well trained NPs are the best healthcare providers that I know; and osteopathic physicians are better than MDs who are maniacally egotistical in the face of their incompetence and non-caring attitude. Give me a break, MDs want to control NPs in the same manner as they control and bully PAs. MDs should spend more time developing their bed-side manners and the insurance industry should reimburse NPs for primary care services at the same rate as they do physicians. It seems that the insurance industry and MDs collude against NPs to restrain trade.”

    Sol, such an unbalanced tirade would indicate that you have something to disclose as well.

    — JohnS    Apr 3, 12:13 PM    #

26. #25 I’m in full agreement JohnS. Perhaps DrNPs would like to take over the paliative care aspect of a patient’s life. As for me, I’m an historian, as well as a doctor as in Ph. D. and nothing more.

    — JR    Apr 3, 12:18 PM    #

27. JR

    NP Practice is governed by regulatory bodies that demand that they stick to a defined scope of practice – which is not true of physician regulation – an ENT specialist can start doing plastic surgery with limited training (and I can cite the case where this actually happend, to the everlasting regret of his patients). And when NPs commit malpractice or negligence, they are disciplined by the Board of Nursing in those states that have been smart enuf to recognize that NP practice is the practice of a form of nursing. And, while this is not true in all states, in many states, NP practice is legally carried out without physician scrutiny – but rather with NP—>MD collaboration.

    I agree that there are economic overtones to this discussion. I once had a physician tell me that if NPs entered the health care market in a big way that physicians wouldn’t be able to afford to furnish their offices with nice furniture. HE never once mentioned quality or safety of care.

    And on another topic, it has always seemed confusing to me that both the degree and the license are identical for physician practice. It is possible to have an MD and use the term Dr. but to also not be legally authorized (licensed) to practice medicine. Smae thing doesn’t apply to other fields in health care – to call yourself an RN or an ANP requires that you hold the legal authorization to practice in that field!

    — TDD    Apr 3, 12:21 PM    #

28. TDD, again.

    Your simplemindedness, and lack of overall knowledge concerning advanced degrees are glaraing. For example, a person holding an MD is a doctor whether that person holds a licence to practice medicine or not, just the same as a person holding a Ph. D. is a doctor regardless of what they do for a living, i.e., college professor, researcher, or socialite.

    The death of the patient of an ANP’s private practice who shows up at an ER with a severe pain in their abdoman, who is then admitted to the hospital, then dies 2 weeks later of complications due to colon cancer is reviewed by a member of the hospital’s physicians holdilng privileges at the hospital. Sadly, the review of the patient’s death is limited to the physician who provided care while the patient was hospitalized, and not the ANP’s lacking care that ultimeately resulted in the patient’s untimely death.

    Herein lies the difference between a nurse, regardless of level of practice or degrees, and that of a physician. Unless hospice is involved, meaning the paitent’s condition is limited to paliative care, the physician’s responsiblity is to prevent death.

    The latter is not part of the definition of the word nurse as it is culturall defined here on Planet Earth.

    There is no place for ignorance, willfull thinking, nor self promotion in medicine. Get a comprehensive education before you open your mouth, or put words in print. Anything short of that isn’t worth the hot air, or trivia that comes forth.

    — JR    Apr 3, 12:37 PM    #

29. JR in comment #28 attributes the death of a patient to the work of a nurse practitioner.

    Do your not know that many many patients died due to physicians “lacking care”. It happens in nursing and medicine.

    I always found it interesting that physicians will acknowledge that a fellow physician is incompent and should not be practicing. However they will do nothing as they do not want to ‘take away his/her ability to make a living”.

    Where is the regard for quality of care for the patients? Where is their concern for protecting the public? State Nursing Boards responsibilies are to protect the public, what does the State Medical Boards do??

    — R. Patterson    Apr 3, 02:01 PM    #

30. Parents, or just about anybody, are encouraged to learn CPR; a small, but very essential, medical procedure that saves a lot of lives. So, Dr. NP will expand medical care to many.
    My Wife is a good nurse; she has worked as a psych, a med. surgical, an L&D nurse and is a good mother. She is quite knowledgeable and has excellent practical experience. This category of nursing care should be rewarded with a title of Registered Nurse, Multiple Leveled Expertise and Experience (RN MLEE).
    Furthermore, I would like to see a revolutionary medical school, which uses English, instead of Latin, to describe medical conditions. This will demystify medicine and allow more people, with Latin phobia, like me, to apply to medical school.
    Konfor masanje

    — Konfor Masanje    Apr 3, 04:18 PM    #

31. Judging from many of the above comments, I see that the “War of the Roses” continues unabated between the nursing and medical professions. Instead of stepping back and looking objectively at this development from the “public interest,” the squabbling persists based on the “private interests” and turf considerations of the contending players.

    — harris cohen    Apr 3, 04:51 PM    #

32. JR, as a highly educated man, I am abhorred at the method of name calling and belittlement you resort to.I have been in the nursing profession for over 30 years. I have worked with excellent physicians and physicians I would not send my dog to. The same holds true for nurses, nurse practitioners, professors, mechanics, etc. As a researcher, look at the evidence based data bases, Cochrane data, Embase, etc. and decide for yourself but…..enough of the belittlement and name calling, respectfully, AV

    — av    Apr 3, 06:06 PM    #

33. Well, titles do not equal competence in any field. Right now, for instance, a sawbones from some school far to the south on an island I can’t spell provides excellent care for my mother. His pretensions, however, far outweigh the reputation of his school. Once he had the gall to ask me what sort of doctor I thought was. The withering fire I returned caused an immediate retreat. “I’m the sort of doctor whose intellectual ancestors were saving western civilization while yours were cutting hair and opening veins to heal folks,” I growled. A doctor is, after all, a teacher whether one holds a Ph.D. or an M.D. If some rectal-checking nurse receives a Dr.N.P., the title is his or hers with respect from this potential examinee.

    Oops. I did my two martini editing. Please re-read my post & hold the laughter……

    — Jeremiah    Apr 3, 07:10 PM    #

34. Jeremiah, Cheers to you! av

    — av    Apr 3, 08:20 PM    #

35. Thank you, av, with the caveat that a pat on the back is 16 inches from a kick in the butt……..

    — Jeremiah    Apr 3, 09:04 PM    #

36. Isn’t that the truth! av

    — av    Apr 3, 10:03 PM    #

37. JR—

    You have a PhD in the history of medicine? What kind of field is that? I’m not sure I’d tell people that if I were trying to make myself look like an expert…what stopped you from getting the M.D.? Lack of interest….or perhaps lack of talent? I’ve always found advanced practice nurses to be compassionate, knowledgeable, and ready to consult with a physician when diagnoses/treatment plan fell outside of their areas of expertise. What’s to say nurses with the DNP degree won’t do the same? Clearly the real issue here is use of the title “Doctor.” Medical doctors (and professors of “the history of medicine”) just need to get over it.

    — ek    Apr 4, 02:50 PM    #

38. Rest assured that it is far more difficult to get an offer of admission into an Ivy League Ph. D. program in history regardless of focus specialization, than any medical school. The latter requires a technical knowledge as well as smarts, whereas holding a Ph. D. in history from a credible university requires far more than being gifted in the sciences to prepare to be a body mechanic regardless of brand, i.e., M.D., or DO. As for the DNP, Medical Doctors may have to start using the professional designation to avoid being confused with a Nurse Practiioner Doctor. As for the field of hitory focused on the History of Medicine, check out the AAHM’s quarterly journal. Any valid field profession has a history, and as such, that requires properly trained historians to interpret the profession’s history, so as to avoid myth building like one so often hears in the profession of nursing. Regardless, you can’t become an MD, or take a Ph. D. in a highly selective university without jumping through mega hoops. Sadly, this is not the case for becoming a nurse, where a plethora of 2-year associates degrees programs in communiy colleges turn out a bumper crop of graduates annually.

    — JR    Apr 4, 04:53 PM    #

39. The DNP is not just for NPs! It is a doctorate that incorporates the practice model for educators and administrators as well. Are the MDs going to come to my college and test me on educational practice? What’s next? Re-writing our licensure exam to fit their needs? Maybe the MDs would like to write an exam for the other doctorally prepared professionals who may be working in health care agencies, such as pharmacists, social workers, and psychologists? For nursing, this is an inappropriate action by the BME and intrudes on the province of the nursing boards. Maybe the medical professional should start worrying about how they police their own group to maintain quality practice!

    — PC    Apr 4, 06:40 PM    #

40. JR: You beat me to the post on medical history. Most fields of the history of some sort of profession are too important to leave to the practitioners. Consult Ida Tarbell on that. But the second part of ek’s post makes good sense to me. Unfortunately, your assault on ADN programs left me amazed. What research is there to support this contention? Thanks.

    — Jeremiah    Apr 5, 06:16 AM    #

41. Jeremiah’s # 40.

    For a good reference on the plethora of titles physicians used around 1900, Paul Starr’s Social Transformation of American Medicine comes to mind. Oddly enough, as Starr points out even after MD’s included DO’s in the traditional MD degree, less than 75 years later, the DO emerged as a full-blown separate degree.

    Herein is the dilemma for the DNP degree, meaning, it is just one more degree to add to the heap already existant , e.g., 2-year Assoc. Nursing, to B. Nursing, MS Nursing, Ph. D. (a research degree) in Nursing, and now the DNP. As far as Joe Public is concerned, a nurse is a nurse regardless of credentials or additional titles.

    To that end, it would be in the best interest of the field or profession of nursing, as well as healthcare in general, for nursing to adopt the one degree, DNP, and clean up the plethora of other degrees associated with the profession. Beyond that, if nurses truly want the DNP to be the degree, like MD is for physicians, and JD is for lawyers, then the profession needs to close about 3/4 of the current degree programs, and limit those offering the DNP to university’s with credibility. In otherwords, a former teacher’s college turned regional univeresity should not be allowed to offer the DNP, whereas currently all of these so-called universities now offer the BS in Nursing.

    I’m not assaulting anything. I’m saying to the profession of nursing that there is need to clean up the profession where the academy is concerned, then move forward with the DNP as the stand alone credential to become a nurse. And, keep the field of nursing focused on just that nursing, and stop trying to be a pseudo physician, i.e., drugs. Indeed, paliative care is currently, and in the immediate future one of the most pressing needs in the healthcare business. It is my opinion this should be a cocern of the filed of nursing, and not physicians who goal is life, and not making someone comfortable as their life comes to an end.

    Without establishing the DNP as the sole degree for the practice of nursing, the profession is stretching itself far too thin in the academy. There was a time when lawyers didn’t have to go to college or graduate from a law school. These days, both are required, and there’s just one degree accepted, the JD. I’m all for the DNP degree, but only if it is, indeed, the degree that leads to practice, with all the other current degrees, save the research degree, i.e., Ph. D. in Nursing, shut down. This is a big challenge for the profession of nursing. I’m of an opinion that the profession is up to the challenge.

    — JR    Apr 5, 09:18 AM    #

42. JR, such an authority and historian! Perhaps you should look into another higher education program to research nursing to educate yourself so that you don’t make such an idiot of yourself with the previous commentaries. It would also be beneficial to you to use spellcheck. After reading your comments it was not clear as to your contribution to society. Correct me if I am wrong, is your contribution ignorance or sarcasm. Love and nurturing are lost entities to many—such as yourself. Wishing you the best of health so that you may never have to experience the wonderful art of nursing.

    — CD    Apr 7, 05:36 PM    #

43. CD # 42. Your comments speak for themselves, and as such, so does the profession of nursing. It really is time to measure up, and stop pretending that the nursing as a profession is a mess, with those at the top schools trying to emerge as a separate class of nurses via the DNP. If nurses want a class structured profession based upon level of education, then so be it. Beyond that, if nursing is an “art” and not indeed a science, then it is doomed from the get go like American education’s delimma with the so-called “craft of teaching” adhered to by Schools and Colleges of Education over a teacher having a firm grounding in the subject matter taught. Again, your words speak for themselves, and glaringly so.

    — JR    Apr 8, 07:29 AM    #

44. Doctors, nurses, what about pharmacists. They do carry the “Doctor” title also. If I have a problem, I talk to my pharmacist first. Doctors know about 1/5 the drugs that pharmacists do. I work at a pharmacy and I have seen doctors make so many mistakes. The pharmacists have to then catch the mistake, correct the doctor, and they get no credit for it. Pharmacists know what the problem is and how to treat it. Doctors know the problem and usually check a computer for a good treatment (half the time the drug that looks good is no longer made or has not yet been made) or prescribe a drug they recently heard about from a drug rep that had no prior education. You can become a drug rep with any degree (I’ve even heard of an art student becoming a rep!). I will not put any medication in my body unless my pharmacist approves it first. Why argue about giving one person all the power over your health. They should all play a part and work together in your treatment. Get second opinions on everything (a doctor that got C’s in all his/her classes can still pass the liscense exam the same as someone who got A’s = who do you want treating you?). Consult your doctor and pharmacist before putting medications (compounded chemicals) into your body where they don’t normally exist.

    — staci    Apr 8, 10:48 AM    #

45. Dear JR, medicine is also known as an art. I guess as a medical historian you should have known that. As you so clearly stated the “art” of any profession makes that profession doomed; then we may have something in common between those professions and anyone related to such. I am amazed that you can actually use a computer. I can see you writing with a chisel and hammer based on your historian mindset (the distant, distant past). Just a reminder, we are in the present heading into the future. Step out of your historian world and foresee the upcomimg wave of medical and nursing neccessities in our communities. You may need to be trained and jump through hoops to get further in your so called profession. Usually that kind of skillis are given to circus animals. In the medical/nursing profession we are educated and skillfully prepared for the challenges of the profession. Achieving a title or degree does not make you an expert. As Staci stated earlier, someone with a minimal requirement can achieve the same title. However, what you do with the materials learned is what makes a difference, not the school or program attended. As to the myths in nursing, medical myths and quackery seems to outweigh them. Once again, step into the present to foresee the future. You do have a computer-try surfing the web for advances in nursing care or when you leave the cave perhaps speak to people in reference to care rendered by a nurse. You may be surprisingly shocked and amazed as to the dynamic, compassionate, nurturing, educated and truly dedicated people involved in the wonderful “art” of nursing. Yes, one rotten apple spoils the bushel, that is present in every profession. Reiterating, best of health to you!!!!!

    — CD    Apr 9, 12:12 PM    #

46. CD # 45. Your most recent post as noted above is without a doubt marked by the most glaring lack of a broad liberal education in the arts and sciences, a must for anyone prior to entering a profession, at least here in the USA. Beyond that, you have documented that at least one nurse, assuming that’s what you call yourself, is indeed one of the most ignorant people on planet earth. How dare you degrade me in such a fowl manner. If that’s what being a nurse is all about, then as my better half who is an MD puts it, “they’re all under educated wannabes who think they know everything, but when the truth be known, they don’t know squat.” If you represent what the country can expect from those pursing the DNP, then lawyers take note, you’re going to have a hay day dealing with the malpractice suits against the new DNP.

    — JR    Apr 9, 03:27 PM    #

47. Dear JR, LET THE TRUTH BE HEARD LOUD AND CLEAR! So called professionals like you and your BETTER half are astoundingly “THREATENED” by nurses! I guess in your broad liberal education no one explained to you what assumes stands for :) . Psst- do some research- it’s colloquial. Congratulations you almost succeeded. Lawyers already have a hay day with the MEDICAL malpractice suits. Ironically enough some doctors blame nurses for their mistakes.Can you imagine what would happen if nurses stop policing the doctors: How many more mistakes would be made with their erroneous, illegible orders. God Bless America and the Nurses that save our lives. Perhaps you and your BETTER half should continue jumping through hoops. However, be careful that you don’t fall you might be taken care of by a nurse-WOW how lucky!!!!!!!! On second thought, make sure the hoops are in the USA!

    — CD    Apr 10, 06:47 PM    #

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