Not Everyone in Nursing Agrees With Doctor of Nursing Practice Concept

Physicians' collective blood pressure may have spiked after the Wall Street Journal published the article "Making Room for 'Dr. Nurse'" on April 2.

"As the shortage of primary care physicians mounts, the nursing profession is offering a possible solution: the 'doctor nurse,'" the article begins, highlighting the growing number of doctor of nursing practice, or DNP, programs in U.S. nursing schools.

Much of the article advances the viewpoint of Mary Mundinger, R.N., Dr.P.H., dean of New York's Columbia University School of Nursing. The article says that DNP programs equip graduates with skills "equivalent to primary care physicians." Mundinger characterizes the graduates as "hybrid" practitioners with more skills, knowledge and training than a nurse practitioner with a master's degree, and she says DNPs are being trained to have more focus than doctors on coordinating care among many specialists and health care settings.

The DNP's primary aim isn't to usurp the physician's role, Mundinger says, but instead is to deal with the fact that there simply won't be enough physicians to care for patients with increasingly complex care needs. It is not yet clear whether the DNP model of nursing practice will worsen nursing workforce shortages.

It's important to note that some nursing stakeholders don't agree with Mundinger and others behind the DNP concept. The WSJ article itself acknowledges this split in nursing, noting that the American Academy of Nurse Practitioners wants to ensure that its members won't be marginalized or required to return to school for a costly advanced degree.

Indeed, the American Association of Colleges of Nursing's own statements say that the DNP degree does not expand the scope of practice and does not prepare candidates to practice medicine. A "frequently asked questions" document about the DNP on the association's Web site says that "nursing and medicine are distinct health disciplines that prepare clinicians to assume different roles and meet different practice expectations. DNP programs will prepare nurses for the highest level of nursing practice. Transitioning to the DNP will not alter the current scope of practice for advanced practice nurses as outlined in each state's Nurse Practice Act."

It also is important to note that this is a broad physician-nurse issue. Although AAFP President Jim King, M.D., of Selmer, Tenn., was quoted in the WSJ article and provided a counterpoint to Mundinger's views, the truth is that the DNP issue isn't something family medicine is grappling with alone. The AMA Scope of Practice Partnership, to which the AAFP belongs, has established a task force to explore this issue further. The AAFP will continue to work with this coalition of national medical specialty organizations and state medical societies and in other collaborative venues to ensure the Academy is addressing members' needs.