Friday, November 23, 2007

Are Nurses With a Doctor of Nursing Practice Degree Called "Doctor"?

Are Nurses With a Doctor of Nursing Practice Degree Called "Doctor"?



Question:
I am thinking of going back to school to earn a DNP. If I earn this degree, can I be called "Doctor" when I practice? How must I identify myself to the public as a nurse practitioner?




The Clinical Doctorate

Practitioners, employers, credentialers, and the public may soon notice that the title "Doctor" applies to many health practitioners who are not physicians or dentists. The clinical doctorate (doctor of nursing practice [DNP]) signifies completion of a clinically focused, rather than research-focused, advanced degree program. Beginning in 2015, the DNP has been targeted as the accreditation standard for advanced practice nursing in accordance with the American Association of Colleges of Nursing (AACN) guidelines.[1] Whether schools and colleges of nursing will revise their program offerings in time to meet this deadline remains to be seen, but clearly the tide is turning toward doctoral preparation for allied health professions at the advanced practice level.

In this regard, nursing follows other professions, such as medicine, physical therapy, pharmacy, clinical psychology, and naturopathy. The call for interdisciplinary practice and education, envisioned by the Institute of Medicine in its report Health Professions Education: A Bridge to Quality, predicts that more professionals with the title "Doctor" will be working together in the same settings.[2] Many of these professionals will not be physicians.

Current Law

According to the 2007 Pearson Report, only 7 states (Georgia, Illinois, Maine, Missouri, Ohio, Oklahoma, and Oregon) have statutes or regulations prohibiting a nurse practitioner (NP) or other doctorally prepared health professional from using the title "Doctor.[3]" Several other states have provisions in law allowing nonphysician healthcare professionals to use the title "Doctor" as long as they also include their title of licensure or specialty (NP, physical therapist, etc) in patient communication. The American Medical Association (AMA) has identified use of the professional title of "Doctor" as a topic for legislative initiative on behalf of its membership. Resolution 211, passed by the AMA House of Delegates, accused nurses and other "nonphysicians" with doctoral degrees of misleading patients "to believe that they are receiving care from a doctor.[4]" The resolution states further that the AMA resolves to work with individual states to "identify and prosecute those individuals who misrepresent themselves as physicians to their patients.[4]"

Although the AMA resolution has no binding effect on individual state law, it does indicate intent to mount a campaign that challenges the abilities of nurses and other health professionals to claim the title "Doctor," even if a degree is earned and recognized by the public.

How Can I Approach This Question in My Professional Setting?

The first recommendation is to clearly understand what your state titling law, generally found in your state's Nurse Practice Act, requires that you must call yourself. Although all NPs are required to meet registered nurse (RN) licensing requirements, in Utah, the RN license is expired when the NP is granted. Check with your state Board of Nursing to determine whether the practice title in your state is "ARNP," "CRNP," or whether you should use a specialty title, such as "FNP." Professionally, this is the title that you must use on all materials that you present or hold out to the public. There may also be a requirement that "RN" is used for any nursing practice.

National certification titles, such as APRN-BC, CNM, or RNC, designate that a certification exam was passed, but these titles do not tell the public whether you currently hold a state professional license. Similarly, professional degrees, such as MSN or PhD, are earned titles that may be legally used in any setting, but do not by themselves tell the public clearly in what capacity you are licensed to practice. Using these titles in addition to your legal title of licensure may or may not be required when practicing in a clinical or academic setting.

The second recommendation is to begin working with other health professionals in your employment setting to implement nurse-positive language as advised by the Center for Nurse Advocacy. They rightly note that the way nurses refer to other professionals models language that is then adopted by patients and by the media. As the Center for Nurse Advocacy observes, "media, like most people, often use the term doctor to mean physician. Although this usage is deeply ingrained, it gives many people the impression that physicians are the only health care workers who can earn doctoral degrees.[5]"

Clearly, this is not the case, as more advanced practice nurses seek doctoral degrees for professional or clinical goals. Be ready for the discussion where you practice; understand and use your licensure title appropriately and assertively; and initiate nurse-positive language where you practice. The AACN has a document that reviews talking points in response to the AMA Resolution 211 that could be used in the workplace, or by your professional organization, to introduce the concept that doctorally prepared nurses are likely to be a strong presence in healthcare for many years to come.

In summary, you must always use your legal title of licensure in the state that you practice in your communications with the public. You may use your academic degree credentials in all settings, to indicate educational credentials. You can legally use the title "Doctor" in conjunction with the appropriate licensure title in the majority of states. In states where the legal statutory language is unclear, your professional organization on a state or national level should be contacted to initiate appropriate legislative or interpretive action, so that you may confidently use the title you worked diligently to earn.


References
1. American Association of Colleges of Nursing. Commission on collegiate education moves to consider for accreditation only practice doctorates with the DNP degree title. 2005. Available at: http://www.aacn.nche.edu/Media/NewsReleases/2005/CCNEDNP.htm Accessed July 22, 2007
2. Institute of Medicine. Health Professions Education: A Bridge to Quality. Washington, DC: National Academies Press; 2003. Available at: http://www.nap.edu/catalog/10681.html Accessed July 22, 2007.
3. Pearson L. The Pearson Report. Am J Nurs Pract. 2007;11:2.
4. American Medical Association House of Delegates. Resolution 211 (A-06). June 13, 2006. Available at: http://www.ama-assn.org/ama1/pub/upload/mm/471/211a06.doc Accessed July 22, 2007.
5. Center for Nurse Advocacy. Should we refer to physicians as "doctors"? Available at: http://www.nursingadvocacy.org/faq/nf/physician_vs_doctor.html Accessed July 22, 2007.

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