PhDoctor?

An interesting discussion came up at lunch yesterday regarding the previously mentioned Doctorate of Nursing Practice. Someone in the program posted an AMA resolution on the use of the titles "Doctor" and "Resident" in clinical practice*, which led to a deluge of negative comments directed at the docs, whether they support the position or not. (Weirdly, a lot of people also seem to think that the AMA is still only comprised of stodgy old white men. While I’m no Milton Freidman, I see the problems with the organization. Still, there’s a little denialism going on if we actually believe that it hasn’t diversified and made some important changes, and contributions, over the years.) In any event, I’m sure the position of this organization on the DNP goes without saying. But it’s hardly the point. The argument from the master’s entry students has largely been that the DNP is a great coup for nurses, that it seeks to put the advanced practice nurse on par with those they see as their medical doppelgangers. To me, both of these positions are misdirected and fairly uncritical, but my saying so led to some definite winking and spitting in my direction. Though I'm cursed, I'd like to clarify.

First, I recognize that the DNP provides the opportunity for APNs to seek higher level education and to complete a residency in his or her chosen specialty. This is a very good thing. It is also a good thing that we have the chance to earn a degree beyond the terminal master's that isn't specific to research or policy. It's important that we can further our clinical practice in order to teach the next generation of nurses. My fear, however, is the requirement for the APN to seek out a clinically-based PhD. And I believe I doubt with sound mind. We’re not doctors and we don’t treat under the medical model. Physicians and physician’s assistants treat under this model, and both practices are distinct from nursing.

The more critical point, however, is a glaring one that can be demonstrated in the master’s entry program, and that is to whom this advanced practice is available. It’s not necessarily the best nurses, nor, as we’ve been repeatedly told since we were admitted to UCSF, the best and brightest individuals, but those who have and have had the resources to pursue an advanced practice degree.

Let’s expand our practice to make the most of those who are best for the practice and best for the patient – not turn advanced practice nursing into another place to demonstrate privilege. Seriously.

* I'm just going to be frank here. We're not doctors; even with a PhD we're not MDs. The whole "Dr" title for the PhD recipient has always made me a little woozy. Just remember, if I go into cardiac arrest on some form of public transit, don't ask if there's a doctor on board. I don't want some anthropologist hovering over me as I die.