Doctor, Doctor, Nurse, Doctor

US Navy 031027-N-0000W-001 Family Nurse Practi...
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We just want to be doctors without having to go to medical school. Yes, that’s it.  I want to be called Doctor Nurse Ensign—or maybe Ensign Doctor Nurse if I ever work in the Navy and want to really confuse people.

Disclosure: I have a master’s degree preparation for being a Family Nurse Practitioner, with a practice doctorate in public health, a DrPH. The DNP—Doctor of Nursing Practice—the newish practice doctorate in nursing—did not exist when I went to nursing school. I am quite happy with my combination of alphabet-soup letters/degrees given my focus on health policy for marginalized populations. If the DNP had existed when I went to nursing school—and if it had been the only option for becoming a nurse practitioner—I suppose I would have done that but still obtained my MPH—Master of Public Health. The two disciplines complement each other well. In my experience, the MPH provides more uniform, concrete, and useful skills than does any degree in nursing—even the DNP in its current incarnation.

Earlier this month there was a NYT article entitled, “When the Nurse Wants to Be Called ‘Doctor’” (by Gardiner Harris, 10/2/11).  It is an excellent, well-balanced article. I also recommend the Well Blog version with interesting reader’s comments/ a longer blog post by Barbara Ficara on the Healthcare Blog.) The NYT journalist discusses how nurse practitioners are moving towards having DNP’s as entry to practice and are asking to be called doctor. Harris writes, “Doctorates are popping up all over the health professions, and the result is a quiet battle over not only the title ‘doctor,’ but also the money, power and prestige that often come with it.”  Pharmacists moved to entry-level practice doctorates in 2004, and physical therapists are moving towards it as well. He says that nursing leaders say the push for the DNP has nothing to do with their fight for expanded scope of practice and higher salaries for advanced practice nurses—but rather with the pressures to keep current because “knowledge is exploding.” Not surprisingly, many physicians are fighting back. Physician lobbying groups around the country are pushing for increased state and federal legislation restricting anyone without a MD or DO (doctor of osteopathy) from using the title ‘doctor.’

As Harris points out in his article, there are no data to support the value added of a doctorate over a master’s degree in terms of quality of care provided by nurse practitioners. And it takes one to two years longer to obtain a DNP vs. a master’s degree. Health economists are concerned this can translate into increased costs for patients and longer wait times to access primary care providers. This disturbs me since the nurse practitioner role was developed specifically to help address access to care issues for the poor, the elderly, rural, and other marginalized populations. It is why I chose to become a nurse practitioner.

Hope is grammar. Hope Dies Last.

Don Quixote and Sancho Panza by Honoré Daumier
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These are two of my favorite aphorisms on hope. The first is from the literary critic George Steiner. The second is from the title of Studs Turkel’s book Hope Dies Last: Keeping the Faith in Difficult Times (The New Press: 2003), and is a phrase he attributes to Jessie de la Cruz, a co-worker of Cesar Chaves. I have been re-reading Terkel’s book, concurrently with Cervante’s Don Quixote Of The Mancha—Shelton’s English translation version from 1611. They go together well.

In the Introduction to Hope Dies Last, Terkel writes: “Hope has never trickled down. It has always sprung up.” He points out that positive change, transforming despair into hope, has always been a bottom up, not a top down affair and is often initiated by groups of troublemakers: activists. The rest of his book is a series of oral histories of a variety of current activists in the US. In one chapter, Linda Stout, the Executive Director of the Amherst-based Peace Development Fund is quoted saying, “Our big challenge is the people’s spirit of helplessness. Power corrupts absolutely, but so does powerlessness.”

Not to make this a Hallmark moment, but I have to bring in a very concrete source of hope I have for the future of nursing. Graduation. Yesterday I had the great honor of seeing many of my most amazing students graduate from our nursing school. I got to hood three newly minted Doctor of Nursing Practice/FNP students who I know are going on to change their parts of the world. One did his research work on both maternal survival and HIV care at the Hope Center in Nairobi, Kenya. Another did her research on cervical cancer prevention in rural Costa Rica. A third did her research on CAM/Integrative Medicine modalities in academic research medical centers in the US. Another student I was blessed to work with did her master’s research on kidney disease and kidney transplants in African-Americans. She’s now on her way to start in a terrific FNP program in the South. And the crop of new BSN students—well, hopefully you will get to read some of their essays they wrote for my health policy class in Narrative Matters sometime soon. Including an excellent essay on men in nursing by a man in nursing. There are many hidden and not-so-hidden nurse activists in the graduation class of 2011. Godspeed! And remember what Don Quixote said (OK—it was really what Peter O’Toole said in Wasserman’s screenplay The Man from La Mancha): “When life itself seems lunatic, who knows where madness lies? To surrender dreams—this may be madness; to seek treasure where there is only trash. Too much sanity may be madness! But maddest of all: to see life as it is and not as it should be.” Go change the world. And health care. And nursing.