Nurses Called ‘Doctor’
2023; Lippincott Williams & Wilkins; Volume: 45; Issue: 11 Linguagem: Inglês
10.1097/01.eem.0000995420.35784.f6
ISSN1552-3624
Autores Tópico(s)Medical Research and Practices
ResumoFigure: DNP, doctorate, California, attorney general, nursing practice, Chamberlain University, nurse practitioner, physicians, surgeons, dentists, optometrists, podiatrists, chiropractors, clinicians, staffing, Envision, DeVry Education Group, National Council Licensure Exam, certificationFigureA recent article titled “Should nurses with doctorates be called doctor? Lawsuit targets Calif. rule,” reported on litigation filed by Jacqueline Palmer against the California attorney general for the right to call herself “doctor.” (Washington Post. July 18, 2023; https://tinyurl.com/5466edzk.) Ms. Palmer introduced herself to patients as “doctor” and embroidered her lab coat with “Dr. J. Palmer, FNP-C” after graduating from Chamberlain University with a doctorate in nursing practice (DNP). She recently stopped doing this because another nurse practitioner in California with a DNP paid $20,000 in a civil settlement for describing herself as a doctor. Only physicians and surgeons can use “doctor” or “Dr.” under California law. Ms. Palmer's suit seeks to change that. Other online news outlets picked up this story, some favoring Ms. Palmer's position by pointing out that other nonphysician health care providers utilize the term “doctor,” including dentists, optometrists, podiatrists, and chiropractors. (NewsBreak. July 19, 2023; https://tinyurl.com/2sdjxdd8; Pacific Legal Foundation; https://tinyurl.com/2p8z3sjs.) My colleagues and I have received referral calls from DNPs who introduce themselves as “doctor” over the past few years. South Carolina does not allow NPs to practice independently, and the NPs in my hospital do not introduce themselves as doctors. I previously described how intense lobbying pushed California to pass legislation allowing nurse practitioners to function independently. (EMN. 2021;43[3]:1; https://tinyurl.com/38cm6kr4.) California joined 29 other states allowing NPs to practice without physician oversight at that time. I then reported on how the physician staffing company Envision was advertising that it could save hospitals money by staffing emergency departments entirely with NPPs. (EMN. 2021;43[7]:1; https://tinyurl.com/2p9mtecu.) Chamberlain's Controversy The Washington Post article on Ms. Palmer stated, “After 14 years in the classroom earning several degrees, Jacqueline Palmer wants to call herself a doctor.” I immediately thought: What education did she get during those 14 years? Was it all in health care, or did she start another career path before switching to health care? It takes 11 years (undergraduate, medical school, and residency) to sit for the board certification examination with the American Board of Emergency Medicine. Why did Ms. Palmer need 14 years to get a DNP? An internet search for Ms. Palmer revealed no additional information regarding her education, and it is unclear how much clinical experience she acquired before graduating from Chamberlain University with a DNP. Chamberlain University claims a 130-year history of teaching nurses on its website, but it did not use the name Chamberlain until it was acquired in March 2005 by Adtalem Global Education, Inc., a for-profit global education provider headquartered in the United States. Adtalem Global Education was formerly known as the DeVry Education Group. (Chamberlain University. https://tinyurl.com/ye2b337j.) The name was changed after several scandals involving misleading claims by DeVry University about its graduates' career opportunities and future income. (New York Times. Feb. 16, 2022; https://tinyurl.com/yymry4tw.) Chamberlain University is a private entity that focuses on nursing education. It advertises that it is the largest nursing school in the country, with 24 campuses across the United States, in addition to online options. (Chamberlain University. https://tinyurl.com/267u8hm6.) Its acceptance rate to the school of nursing is 92 percent. (Chamberlain University. https://tinyurl.com/4zmkd9s4.) The acceptance rate for Chamberlain's DNP program is not available online, but I wrote in a past column that many similar U.S. DNP programs have 100 percent acceptance rates. (EMN. 2021;43[2]:1; https://tinyurl.com/mw9e559p.) Chamberlain has been involved in controversy. The Texas Board of Nursing stopped the enrollment of new students at Chamberlain's Houston campus in 2017 due to the high failure rate of its graduates on the National Council Licensure Exam. (Houston Chronicle. March 12, 2017; https://tinyurl.com/4j8rn3kr.) I reviewed the curriculum for their doctor of nursing practice program to get an idea of a Chamberlain graduate's educational experience. The entire curriculum is two years long and can be completed online. This curriculum does not have a single course that teaches clinical medicine. Sample course titles include Scientific Underpinnings, Applied Organizational and Leadership Concepts, Topics in Advanced Practice Leadership, and Fiscal Analysis & Project Management. (Chamberlain University. July 2021; https://tinyurl.com/mpjzaxkn.) I am not passing judgment on the quality of these courses or the need for educating health care providers on these topics, but how do these courses provide an NP with the ability to provide a higher level of clinical care? A couple of courses in the DNP curriculum titled “DNP Project & Practicum” may have some clinical basis, but this only occurs in the latter part of the second year. 700 vs. 12,000 Hours The applicant has to be a registered nurse with a master's degree in nursing to apply for a DNP from Chamberlain, so I looked at the master's degree in nursing offered by Chamberlain. There are nine specialty tracks, three clinically based: family nurse practitioner, psychiatric-mental health nurse practitioner, and adult-gerontology nurse practitioner: acute and primary care. The other six tracks are nonclinical, including health care policy, nurse executive, and nursing informatics. (Chamberlain University. https://tinyurl.com/48xe629w.) The first year of the three-year curriculum for the clinical MSN degrees does not contain a clinical course. Instead, course titles include Foundational Concepts and Advanced Practice Roles, Healthcare Policy and Leadership, and Population Health, Epidemiology, and Statistical Principles. Courses in the second year focus on clinical medicine, including pharmacology, pathophysiology, and diagnosis, and the second-year curriculum consists of 250 clinical hours. The third year is primarily clinical work of 450 additional clinical hours. (Chamberlain University. https://tinyurl.com/yc8hx95b.) An NP who completed Chamberlain's three-year MSN program and two-year DNP program would accumulate five years of post-undergraduate education and 700 hours of clinical training. Does this consistently prepare them for independent clinical practice? By contrast, a graduate of a physician residency program has at least seven years of post-undergraduate education with roughly 4000 hours of clinical training in medical school and 8000 hours in residency. Then they sit for a specialty board certification examination. NPs are not required to complete residency training or sit for a certification examination in their area of practice. NPs can practice independently in 14 states immediately after graduation without additional training. (EMN. 2021;43[3]:1; https://tinyurl.com/38cm6kr4.) And we have all seen that they can leave one discipline of medicine and immediately enter another without demonstrating clinical competence. How did it come to the point where physicians, the most regulated professionals in our society, must provide specialty boards, state medical boards, and hospital credentials committees with mountains of evidence demonstrating our clinical competence while demonstrably less educated clinicians can freelance around the health care system with comparatively little oversight? And how does the lay public differentiate the quantity and quality of education between two competing groups when both of them introduce themselves as “doctor?” DR. COOK is the program director of the emergency medicine residency at Prisma Health in Columbia, SC. He is also the founder of 3rd Rock Ultrasound (http://emergencyultrasound.com). Friend him at www.facebook.com/3rdRockUltrasound, follow him on X @3rdRockUS, and read his past columns at https://tinyurl.com/EMN-Match. Share this article on X and Facebook. Access the links in EMN by reading this on our website: www.EM-News.com. Comments? Write to us at [email protected].
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