A Rose by Any Other Name…
Article Outline
“Hello, my name is __________, and I’m a nurse practitioner. How can I help you today?” Those words are spoken by nurse practitioners every day across the United States. For almost 40 years, nurse practitioners have been explaining who we are and what we do to anyone who will listen. We have talked with our patients, legislators, other health care providers, health- related industries, and the public with a single-minded goal: to define and describe the role and scope of practice of nurse practitioners.
Last summer the advanced practice nursing community became aware of legislation introduced to the 109th Congress by Rep. Sullivan of Oklahoma that sought to protect the public from “…misleading and deceptive advertising or representation in the provision of health care services.” This language appears in HR 5688, otherwise known as the Healthcare Truth and Transparency Act of 2006. NAPNAP has posted its concerns about this proposed legislation and what you can do in response on its Web page (www.napnap.org).
The topic I would like to discuss now is somewhat broader—first, how we represent ourselves to the public and our rights in representing ourselves and, second, what this means in terms of the delivery of health care.
Patricia Clinton, President and Fellow
As nurses, we enter our profession from many different academic backgrounds. Thirty- eight years ago, education for the new role of nurse practitioner began as a certificate program, sometimes housed in graduate programs and sometimes under the auspices of continuing education programs. In the early 1990s, the educational standard for most nurse practitioner specialties was raised to the master’s level. Those standards are being raised again as the practice doctorate, the DNP, becomes the educational requirement for advanced practice. With the conferral of that degree, the practitioner will be entitled to be addressed as “doctor.” And therein lies the problem.
Webster’s dictionary has several definitions for the word doctor; the first one states that a person who has received a doctorate degree from a university or college, as in doctor of medicine, dentistry, philosophy, or divinity, is properly addressed as Doctor. A physician, on the other hand, is a person licensed to practice medicine. The DNP will confer the doctorate to a nurse who has successfully completed a specified program of study and then may properly be addressed as Doctor. A nurse is and will continue to be licensed to practice nursing. “Doctor” is a title, whereas “physician” or “nurse” is a role.
PNPs and other nurse practitioners have provided the highest quality health care to hundreds of thousands of patients for three decades. We are now at a critical juncture in the health care delivery system in the United States. Predicted physician shortages are not expected to be resolved quickly or easily, and frankly, simply trying to produce more physicians is not the answer. Nurse practitioners, working independently and within their scope of practice, are and will continue to be an integral part of the solution for providing primary health care. In an editorial in the September 2006 issue of Academic Medicine, Michael Whitcomb, MD, not only recognizes the contribution of nurse practitioners but urges his colleagues in medicine to put aside opposition to DNP programs and expanded scopes of practice and to work with the leadership in nursing to help shape the next generation of nurse and physician health care providers (Whitcomb, 2006).
Those who study trends, the corporate world, and, most importantly, the public, understand who nurse practitioners are and what they do. I do not believe the public is confused; I think you share this belief. However, legislation such as HR 5688, which falsely claims that ample evidence exists wherein providers hold themselves to be medical doctors, doctors of osteopathic medicine, doctors of dental surgery, or doctors of dental medicine, only misdirects resources and energies that would be better spent addressing the real issues of a shortage of primary health care providers.
I have said for many years that there is more than enough work for both nurse practitioners and physicians. This belief is born out by data on the physician workforce that indicates significant current shortages and projected shortages. Those shortages, coupled with the consumption of more health care by baby boomers as they continue to age and the elderly population increases, foreshadow a future of shrinking resources and further decline in quality health care for consumers who demand the best. Complicating the picture is the ratio of primary care physicians to specialty physicians. Approximately one third of physicians practice in primary care and two thirds in specialty care. The reverse is true for nurse practitioners; approximately two thirds practice in primary care and one third in specialty care.
Meeting health care demands for the next few decades calls for new solutions and approaches. I welcome Dr. Whitcomb’s proposed strategies, such as training resident physicians and DNP students together in clinical settings. My experience as an educator of nurse practitioners is that all too often we are forced to compete for clinical sites. What a welcome relief it would be to use a truly collaborative model to educate future nurse practitioners and physicians so that the unique and complimentary contribution of each discipline becomes the standard of quality care.
With all due respect to Representative Sullivan, nurse practitioners who hold the PhD or DNP degree have earned the right to be addressed as Doctor. We practice nursing, not medicine. And in that practice, we deliver high-quality compassionate health care to our patients. When or if HR 5688 is brought up in the 110th Congress, I urge all of you to do the following:
Reference
PII: S0891-5245(06)00614-6
doi:10.1016/j.pedhc.2006.10.002