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Should Nurse Practitioners with a Doctorate of Nursing Practice be Called Doctors?

Posted May 27 2010 8:43am 4 Comments

Nurse Practitioners – Doctors?

[Original post is published on The Health Care Blog ]

By Barbara Ficarra, RN, BSN, MPA

My recent post on The Health Care Blog , “Nurse Practitioners – Doctors?”  addresses the issues surrounding nurse practitioners obtaining a doctorate degree.

I’d like to thank all those readers of The Health Care Blog (THCB) for their comments.  Thank you to all the doctors for sharing their viewpoints and their voice.  While many comments were indeed honest, they certainly were strong opinions and the readers did not hold back their feelings.  While some comments were rather harsh, I commend those readers for commenting.

It was disconcerting that more nurses did not comment; however what’s more worrisome is the fact that a key nursing organization, American Association of Colleges of Nursing did not respond to my request as well as Yale University, which is one of the many universities offering a DNP program.

While some readers of THCB feel this issue is “stupid” it is indeed a real issue that nurse practitioners and doctors will be dealing with.

In fact, in the “Position Statement on the Practice Doctorate in Nursing” the decision called for moving the current level of preparation necessary for advanced nursing practice from the master’s degree to the doctorate-level by the year 2015, according to the American Association of Colleges of Nursing.

We would love to hear from health consumers too.  If you were a patient in a hospital, would you find it confusing that a nurse introduces herself or himself as a doctor of nursing practice?

(To view comments on THCB please click the link at the end of this post.)

In a recent post on TheHealthcareBlog, “ Nurseanonics ” by Maggie Mahar, she addresses the heated debate over the difference between a doctor and a nurse.

Mahar tackles the question that Legislators in twenty-eight states are dealing with.  Should a nurse practitioner (NP) with an advanced degree provide primary care, without an M.D. being in charge?

But another pressing question that needs to be addressed is:

Should nurse practitioners be called doctors (DNP)? (DNP is a Doctor of Nursing Practice.)

That is the question that I will address here.

I reached out to the medical community to get their reaction.

It’s not surprising that the immediate response of  some doctors when asked if nurse practitioners should be called doctors (DNP) is “No!” evidenced by Dr. Stangl’s comment.

“NO!  Nurse practitioners should NOT be called “doctors” because they are NOT!  While many NPs do an excellent job of handling certain types of problems in certain settings, they do not have near the depth or length of education that physicians do and should be credited for what they Do have, which is their nursing background and expertise.”  Susan Stangl, MD

Take a look at this comment that appears in Thehealthcareblog :

“An NP has mostly on the job training…they NEVER went to a formal hard-to-get into school like medical school,” wrote one doctor.

“I have worked with NPs before, and their basic knowledge of medical science is extremely weak. They only have experiential knowledge and very little of the underpinning principles. It would be like allowing flight attendants to land an airplane because pilots are too expensive. HEY NURSIE, IF YOU WANT TO WORK LIKE A DOCTOR…THEN GET YOUR BUTT INTO MEDICAL SCHOOL AND THEN DO RESIDENCY FOR ANOTHER 3-4 YEARS. NO ONE IS PREVENTING YOU IF YOU COULD HACK IT![his emphasis]”

It’s clear that for these doctors, the simple answer is No.

After all, why would doctors want additional prey in their territory?  Even with the shortage of primary care physicians , doctors aren’t looking at nurses to help fill the void.

The medical profession is quick to respond, and in some cases, with outlandish comments (evidenced in Mayer’s post) against a group of professionals who have earned an advanced degree.

I posed the question again to my (yes) colleagues in the medical community.

The question again:

Should nurse practitioners be called doctors (DNP)?

Doug Farrago, MD, explains:

“It is about the word DOCTOR. If you want to be a doctor, then by all means, I implore you to become one. We need you. The training is a bitch and; unfortunately, a gauntlet you have to get through. You don’t get that in NP school. You will be all the better for it, though. It really comes down to paying your dues. You just can’t call yourself one because you, well, just want to.

Nurse practitioners came about to strengthen the healthcare system by making them “physician extenders” not “physician competitors”. By going this new route the NP group has made this relationship uncomfortable at best. I will get “hate email” over this but I didn’t do anything. The NPs are blatantly changing their strategy, demanding to be called doctors and are in direct competition with us yet I know they will rip me for pointing this out. The bottom line is the you are not a doctor. You are an nurse practitioner. It is a fact and it is not demeaning to say it. It is just a term. Get over it. I call myself the KING of medicine but just because I call myself one doesn’t mean I am one. Or does it?”

OK, I believe this is where we need to dissect the question.

Although the question is simple and direct, it is being answered very quickly, without stepping outside the box.

Doctors have a tendency to stay within their own territory.

Yes, Dr. Farrago it is about the word “Doctors.”

So when the question, “Should nurse practitioners be called doctors (DNP)”? is asked, the immediate reaction from most doctors, adamantly is “no!”.

When you think about the question, the answer makes sense; a nurse is a nurse, so how can a nurse be called a doctor?  That is the black and white response, but like many questions and areas in life, there’s more than black and white, we need to look into the gray areas for a different approach.  We need to step outside the box.

Remember, the question is should nurse practitioners be called doctors (DNP)?

It does not ask if nurse practitioners should be called medical doctors.  (In that case, there’s a simple answer and that would be no, not unless they attended medical school and obtained the Doctor of Medicine Degree.)

Kevin Soden, MD, medical journalist has this to say,

“This is a fairly straightforward answer. A nurse practitioner should not be called doctor unless they have gone through a well-defined course of study showing mastering of a prescribed content like any other doctorate program. The danger that I can see for the lay public is the confusion that may arise if a person gets a doctorate degree in nursing and when they see patients, they or their staff refer to themselves as doctor. The average patient might think they are seeing a medical doctor with more advanced training in diagnosis and treatment. It’s important that the patient be educated in this regard.”

Here’s an interesting comment by Michael Blumenfield, MD -

“I see more downside to upside to calling NPs “doctor” in the hospital setting. It would suggest to patients that nurses who were not NPs were somehow not as important, responsible or critical to the patient’s care. In fact at times the opposite is true i.e. in trauma and critical care units etc as well as other places [take out psych] such as psych units etc where they have just as important roles and have had as much training as NP. I see this as even more important than the blurring of identification with physicians which might create some minor problems. Nurses deserve a great deal of respect which I believe that they have. I would hope that the hospital environment not become the place for working out political agendas.”

Time to scrutinize the question

Let’s look at the history.  What does doctor mean?

Doctor originates from the Latin word (gen.: doctoris) which means teacher,  it is abbreviated “Dr” or “Dr. and it’s used as a designation for a person who has obtained a doctorate-level degree.

Doctorate “is an academic degree or professional degree that in most countries represents the highest level of formal study or research in a provided field. In some countries it also refers to a class of degrees which qualify the holder to practice in a specific profession, such as law or medicine. Examples of the former are the Ph.D. (Doctor of Philosophy) and the S.J.D. (Doctor of Juridical Science), while examples of the latter include the U.S. degrees Doctor of Medicine, and the Dutch Professional Doctorate in Engineering.”

Doctorate dates back to the Middle Ages, the Medieval Era as a license to teach. [ Source:  Wikipedia ]

The first university, the University of Bologna, was founded as a school of law by four famous legal scholars in the 12th century, and the first academic degrees were all law degrees, and the first law degrees were doctorates as stated in Wikipedia.

Theology, law, and medicine were the earliest doctoral degrees.

“The term “doctor” refers to an individual who has earned a degree of Doctor of Philosophy, or Ph.D.  Beyond academia and in the classical professions, such as medicine and law, professional doctorates emerged such as the Doctor of Medicine M.D. (an abbreviation of the Latin Medicinæ Doctor), Doctor of Osteopathic Medicine D.O.’”

“While many US lawyers and physicians who pursue purely academic and research careers in law and medicine do so after having earned a J.D. or M.D., respectively, these degrees are considered professional doctorates because most who earn them pursue careers as working professionals. In more recent times, other professional doctorates have emerged such as the EdD (usually held by school administrators), the DBA and the DPA (nearly always earned by prior recipients of the M.B.A. and the M.P.A., who continue to pursue ongoing professional careers in business and public administration) and the Doctor of Physical Therapy (DPT.)”

“There are other health professions such as physical therapy, podiatry, dentistry, chiropractic medicine, optometry, and veterinary medicine, where the title “doctor” is used professionally.”

What is the issue?

First, it is true that some doctors can be territorial, but is this really the issue?  I had a long conversation with a good friend of mine who’s a medical doctor and not surprisingly, he’s not a proponent of nurse practitioners being called doctors.

He said, “The problem as I see it is that the academic term “Doctor” is distinctly different than the common understanding of “Doctor”.  Having Nurse Practitioners use the term “Doctor” just mixes up the two uses and is confusing for the majority of people. If somebody wants to be a common “Doctor” then they need to go to medicals school and residency.”  He adds, “…territorial is irrelevant. PATIENTS go to their DOCTOR.  That is just common vernacular that has developed over several centuries.”

While medical doctors aren’t the only doctors; does the issue become academic vs. institution.

Is it okay to call a nurse practitioner “Doctor” when he or she is in an academic setting and NOT in an institutional setting?  Shouldn’t it go both ways?

Heated Debate

This ostensibly will remain an intense heated debate.

Kevin Pho, MD, founder of KevinMD writes a blog addressing the role of nurse practitioners.

“Merely bringing up this idea brings out the worst in turf battles, with most discussions devolving into nurse versus doctor cat-fights ,” writes Kevin Pho, MD.

Cat-fights we can do without – team is the best approach

KevinMD writes, “…doctors and nurses have to realize that it’s the patients who come first, and to care best for them, a team-based approach is needed.”

Will this debate lead to cat-fights between doctors and nurses?

As health care continues to change, perhaps it’s time we move out of the box and greet the DNP, the doctor, the teacher, the doctorate as a health care provider.

If DNP is a Doctor of Nursing Practice, that simply means that they are teachers of nursing practice; it does not mean they are medical doctors.

And yes, in regards to Dr. Soden’s comment, what simply needs to be done when the DNP sees a patient is to introduce her or himself and make it clear that she/he is a Doctor of Nursing Practice, not a medical doctor.

DNP will be an asset to patients, but it’s important to realize what Dr. Blumenfield points out.  There are many exceptional nurses who provide excellent care and they may not be an NP or DNP.

It’s important to note that there are health care professionals who believe that by obtaining the highest level of learning, that they should be called doctors.

“OF COURSE THEY SHOULD BE CALLED DOCTORS,” says Michael Butler, DC, MS, R NCS T says in an email.  He adds, “THEY PASSED CERTIFICATION OF HIGHER LEVEL OF LEARNING. THE PATIENTS THEY SERVE RECOGNIZE THEIR EXPERTISE.”

Bonnie Marting, DNP, ARNP replies:

“Regarding the question of whether NPs should be called doctors: Using the term “doctor” implies a higher education than the masters prepared nurse practitioner. It is an excellent opportunity to introduce the patient to the ever-evolving world of healthcare and the extent of the education this type of healthcare provider has. It does not confuse one with “physician”, simply clarifies.”

Bottom Line

We need to tread the waters very carefully here.  The last thing health care needs are fighting nurses and doctors.

Both groups are professionals with advanced degrees and we need to recognize that each entity in health care is unique and special.

While medical doctors aren’t the only doctors; does the issue become academic vs. institution.

Is it about titles and territory?  Or is it about the patient?   It’s vital that in the 21st century and with changing health care policies, that it’s time that both doctors and nurses work together as professionals for the good of the patient.  No matter the title and the number of degrees, it’s vital that communication with patients is transparent and that they know who you are and are not misled.

Questions to think about

  1. In a hospital setting, should medical doctors be the only doctors allowed to use the title doctor?
  2. Lawyers can technically be called doctors since they obtain a Juris Doctorate degree, but they do not use that title. Should the same go for nurse practitioners that obtain the Doctorate of Nursing Practice (DNP)?  Should they obtain the DNP but not be called doctor in a hospital setting to minimize any confusion to patients?
  3. Will patients be confused by a nurse practitioner calling themselves doctor?
  4. If nurse practitioners are very clear in introducing themselves as a doctor of nursing practice, will that alleviate the confusion?
  5. Should nurse practitioners be called doctor only in an academic setting and not in a hospital setting?
  6. Is it time to change the “common vernacular” of Doctor?  – Doctor in a hospital setting does not necessarily now mean medical doctor since the advent of the DNP.
  7. Should Colleges and Universities along with the American Association of Colleges of Nursing present an ad campaign to the general public to educate them on the new title of nurse practitioners?  After all patients should not be misled, and transparency is critical.

—–

Facts about The Doctor of Nursing Practice

By 2015 nurse practitioners will hold a doctorate or a DNP according to the American Association of Colleges of Nursing .

Doctor of Nursing Practice (DNP) Programs

A couple more…

Yale University School of Nursing

New York University College of Nursing

Your turn

What do you think?  Should nurse practitioners be called doctors (DNP)?

Barbara Ficarra, RN, BSN, MPA is the executive producer of the Health in 30® Radio Show and founder of Healthin30.com , a featured writer on Huffington Post, and an administrative head nurse at a teaching hospital.

Comments (4)
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I think you have a bias because you are a physician assistant and not a nurse practitioner. Would you dare address a biology professor who holds doctorate without "doctor" or any other professor? I think not, if you want to pass the course.  Doctor addresses the educational level and not the profession.  MD is a medical doctorate, it is not a PhD and not researched based, it is CLINICAL BASED. The DNP is the same for nurses, Clinical based, it is the highest level of nursing practice in a clinical setting. If we are going to get to the point and facts, If a DNP is still addressed as a NP or CNS then someone holdingt a MD should only be addressed by "physician".

 

ALOT, OF MEDICAL DOCTORS THINK THEY ARE GODS OF THE WORLD B/C THEY GRADUATED FROM MEDICAL SCHOOL, BIG DEAL. THEY DONT UNDERSTAND THE RIGORS OF A NURSING PROGRAM ALONG WITH THE ADVANCE TRAINING AND, SO ON.

I THINK THAT IF A PERSON GRADUATE WITH A DOCTORAL DERGREE. THEY SHOULD INDEED BE CALLED DOCTOR IN ANY SETTING AS LONG AS THEY CLARIFY, WHETHER OR  NOT THEY ARE A NURSE PRACTIONER, OR ANY OTHER PROFESSIONAL.

This is a very interesting debate. While I have the utmost respect for members of the medical community, I believe that we are allowing ourselves to become insulting of one another. I entered a Diploma school of nursing at the age of 17 which was a 3 year program. My particular school not only had rigorous entrance requirements but also stringent program requirements. Because of academic standards my class lost approximately 50% of its members.

I then went back to school for my BSN. This took another 2.5 years to complete.  I am now in a Master's program to obtain my MSN as a Clinical Nurse Specialist. This has taken me 4 years to obtain. The reason that all of the advanced degrees took so long to obtain is because I was also raising 3 beautiful children, maintaining a home, working as a nurse full time and the other multitude of obligations that life threw at me.

As a result of my practice in nursing, I have performed in multiple nursing roles for the last 27.5 years. I take the stance that while I am considering obtaining the DNP in the future, I do not need the title of 'doctor' to validate my role as an advanced nursing practitioner. While I agree that the use of the title is the priviledge of anyone who obtains a doctorate degree, in my opinion the debate has become who has the right to utilize the title 'doctor'.

While physicians may think that attending a rigorous medical school makes them a better practitioner, I beg to difer. Neither of our professions can positively impact patient care without the other. I have had the priviledge to work with many fine physicians over the years but I have also had the misfortune of working with some that should never have been allowed to practice medicine.

I think that rather than debate who should be able to use a title, we should be working at creating a collaborative environment to not only enhance patient care but also to positively impact patient outcomes. Nurses need to feel empowered to make the difference in the lives of their patients and I personally believe that pursuing advanced practice degrees is the only way to achieve this goal. Does an advanced degree make me a better nurse? Yes and no. Nursing's goal has always been to provide patient care and comfort. Now we are stepping out of the box to evaluate what best practice is and to substantiate our care with validation of effectiveness and outcomes.

I would just like to say that I am proud to be a NURSE and that while advanced education lends to my professional growth, I am proud to wear the title of NURSE.

Tanya L Spiering, BSN, RN, CPAN, Regional Director for the American Society of PeriAnesthesia Nurses and practicing as a Clinical Practice Leader.

Anyone that gets a PhD holds the right to be called a doctor..Researchers, professors, writers, NURSES, etc. I am shocked at all the comments from these doctors. One doctor mentioned that the nurses never had to go through getting into a "competitive" medical program. That Doctor has never tried to apply to a nursing program (masters, doctorate program or even a bachelors). To get a BSN is a 4-year degree in itself, plus 2 more years of clinical experience, and then a 5 year program to officially become a Doctor of Nursing Practice. It takes a LONG time to become a DNP! Those Pracitioners WORKED for that title. Get off your high horse (to whoever disagrees that they deserve to be called doctors)!
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