On Making The Nurses Behave

Posted on June 26, 2009
Filed Under Primary Care in America | 3 Comments

Here’s a Podcast of this post:

 
icon for podpress  On Making the Nurses Behave [11:48m]: Play Now | Play in Popup | Download (36)

____________

DrRich does not quite know whether to be dismayed or amused by an article appearing earlier this month in the venerable trade journal, AMANews*, decrying (their word) the recent alleged propensity of Doctors of Nursing Practice (so-called Doctor Nurses) to sow confusion about the meaning of  the word “doctor.”

As a frequent purveyor of irony himself, DrRich is open to the possibility that the writer of this article meant to make the “physician leaders” quoted therein seem particularly whiny, in order to shed subtle light on the utter bankruptcy of their position. But alas, DrRich suspects instead that the article is presenting in an entirely straightforward fashion the actual behaviors and sayings of said physician leaders, in reaction to what they see as an overly-aggressive (and “not accurate”) stance taken by certain nurses as they seek to elevate their own profession. If this latter interpretation is the case, as DrRich believes that it is, then he is dismayed (and/or amused) to see that the medical profession’s strategy when defending itself against what it sees as an existential threat has apparently been reduced to the same strategy employed by the United Nations whenever it is faced with similar threats - the issuance of the dreaded Strongly Worded Letter.

The issue at hand, of course, is that Doctor Nurses (those members of the nursing profession who have achieved, through advanced training, the degree of Doctor of Nursing Practice, or DNP) insist on referring to themselves as “doctor,” and also that they have issued “misleading” statements implying that their certification examination (written and administered by the highly-respected National Board of Medical Examiners, NBME), is the same in content and format, and that it measures the same set of competencies, as the certification exams taken by physicians. Specifically, according to the AMA, statements issued by the Council for the Advancement of Comprehensive Care (CACC, the nursing leadership group responsible for contracting with the NBME) were “deliberately misconstrued to imply there was equivalence between nurses and physicians.” And also, of course, DNPs should stop referring to themselves as doctors.

To rectify this awful situation, the “AMA and dozens of state and specialty medical organizations are asking the NBME to mandate that nursing groups clearly spell out the differences between the DNP and physician exams.” (DrRich himself is well aware of this tactic, having used it frequently himself as a child, whenever his little brother was annoying him. Unfortunately, his “Mommy Make Him Stop” tactic seldom achieved its desired results.)

Furthermore, the AMA House of Delegates is threatening “to consider. . . a resolution proposing to explore alternative physician licensing testing options.” That’s pretty serious. When one threatens to consider a resolution proposing to explore taking some action, as DrRich calculates it that’s merely five steps away from actually taking the action. The poor nurses must be quaking in their old-fashioned, boxy white shoes.

One can easily perceive why DrRich initially wondered whether the AMANews article was employing an ironic tone.

It is pretty easy to predict the reaction of the nursing leadership - and also of the NBME - to such severe, strongly worded objections. It is very similar to the response the U.N. often gets from those tiny third world countries, whose behavior it dislikes, after it has threatened to explore the possibility of considering various resolutions of disapproval, etc.  In these cases the response to such threats is very often nearly the same, to paraphrase, Screw Yourself.

While apparently Mary Mundinger (DrPH, RN, dean of the Columbia University School of Nursing, President of CACC, and bugaboo of physicians everywhere) did not make herself available to the AMANews for a direct response, she was quoted in an earlier article as saying, “If nurses can show they can pass the same test at the same level of competency, there’s no rational argument for reimbursing them at a lower rate or giving them less authority in caring for patients.”

C. Fay Raines, PhD, RN, and dean of the University of Alabama in Huntsville College of Nursing, points out that Doctor Nurses are, in fact, doctors. “Transparency is important, but the term ‘doctor’ is not exclusive to physicians,” she says. DrRich finds truth in this statement, recollecting that his phys ed instructor in high school was cheerfully addressed as “Dr. ___” by one and all, upon the pain of five laps. If this individual deserved to be called doctor, then Doctor Nurses deserve the same honorific, by several orders of magnitude.

And as for the NBME (the “mommy” in the “Mommy Make Him Stop” tactic), representatives of this organization also saw fit not to talk to AMANews. But in an earlier response to physicians’ concerns about its underhanded collaboration with the nurses’ attempts to confuse poor, unsuspecting patients, the NBME said, “Current and future patients of these nurse clinicians deserve a system that assures them that the clinician providing services meets appropriate quality standards. Our support for the DNP assessment process helps provide that assurance.”

Well.

What are the AMA and other physician organizations supposed to do when their traditional and time-honored methods of putting nurses in their place - blustering and fulminating at them from their elevated position of authority - no longer work? DrRich is put in mind of video of the Romanian dictator Ceausescu, taken mere moments before his summary execution. DrRich recalls the look on his face at the moment it begins to dawn on him that that he really is no longer in charge, and that he is, in fact, well and truly screwed. The article in AMANews presents a similar visage to the world.

DrRich’s message, which he has delivered many times before, is to individual physicians (especially to those of the primary care persuasion) and not to their professionally bankrupt organizations. Your leadership has allowed your profession - primary care medicine - to become devalued to the point where it is not logical, feasible, or ethical for you to try to block the ascent of nurses. Well-trained nurses can follow prescribed treatment guidelines every bit as well as you can - probably better. You should do nothing to impede their sincere attempts at getting the advanced training they need, and the professional certification they deserve. It appears that they will be supplying primary care to American patients - possibly most of the primary care - in coming years. The rear-guard actions of your professional organizations to prevent this will fail, and will merely make you look ridiculous. Just read the article in AMANews to see exactly how ridiculous.

You are fighting history when you try to impede these nurses. The nurses are just fulfilling their rightful destiny in a technological society, where new knowledge and new tools allow individuals with progressively less special training to carry out jobs that heretofore required experts. Rather than wasting precious time and energy trying to hold back those behind you, figure out how (DrRich suggests how here) to parlay your superior training and knowledge - and it is superior - into a new role within the healthcare system, one where you and the doctor-nurse-primary-care-practitioners (whatever they end up calling themselves) can complement each other rather than compete with each other. This would be the best thing for you, for the nurses, and for the patients.

Oh, and get yourself some new leadership.

*DrRich is among the large majority of physicians who is not a member of the AMA. In fact, to the best of his knowledge none of his physician friends or acquaintences are members of the AMA, either, at least, not that they’ll admit to. He does, however, read the AMANews regularly, inasmuch as DrRich remains intrigued with the schizophrenic machinations of the AMA, in its need to seem politically relevant (resulting in sundry liberal-sounding statements of principle), while at the same time being obligated to strive mightily to hold the old guild together.

“Say Hello To My Little Friend”

Posted on June 22, 2009
Filed Under Gekkonian Rationing | Leave a Comment

Help For All Doctors and Patients From Dr. Wes

Posted on June 17, 2009
Filed Under Uncategorized | Leave a Comment

Why Implantable Defibrillators Are Still So Expensive

Posted on June 16, 2009
Filed Under Cardiology Topics, Investment "advice" | 4 Comments

Embracing the Death of Primary Care Medicine

Posted on June 11, 2009
Filed Under Primary Care in America | 14 Comments

The Death of Primary Care Medicine Is Official

Posted on June 7, 2009
Filed Under Primary Care in America | 13 Comments

Advice to Medical Tourists From the American College of Surgeons

Posted on May 29, 2009
Filed Under General Rationing Issues, Investment "advice" | 3 Comments

In Defense of the Anti-Obesity Movement - Part II

Posted on May 24, 2009
Filed Under Cardiology Topics, Obesity and rationing | 9 Comments

In Defense of the Anti-Obesity Movement - Part 1

Posted on May 21, 2009
Filed Under Obesity and rationing | Leave a Comment

This Time There’s No Plan B

Posted on May 15, 2009
Filed Under Gekkonian Rationing, General Rationing Issues, Uncategorized, Wonkonian Rationing | 2 Comments

keep looking »