DNP Collaboration

[Alyssa]

When we graduate with a DNP degree, we will be practicing medicine, and primarily working with physician colleagues. How can we as DNPs practice at the same standard of physicians but also integrate the nursing philosophy and our nursing background into our practice?

[Doctors of Nursing Practice, Inc.]

I must reply to your note and question this approach. After someone graduates with a DNP degree, they will have earned an academic degree. This degree does not in-and-of-itself authorize advanced practice nursing. Are you working to earn your Nurse Practitioner designation also?

A second concern I have with your statement is that you will be practicing medicine. This is not true. You may be in advanced practice nursing and have an NP credential but that is not practicing medicine – it is advanced practice nursing.

To say you or any nurse if practicing medicine is a falsehood. I put this out there as soon as I saw your note to help assure that all nursing colleagues are working toward a common goal: Improving health care outcomes in the context of our skills, education, license, and certification.

What do you think?

[Anonymous]

Thank you for your insight. As a student I am still learning how to navigate my future role. I am in a DNP-FNP program and as an APRN I will be guided by the DNP essential to provide care for my community. Wylie (2016) explains, “Two of the eight essentials that are most pertinent to enhancing an integrative approach as a DNP practitioner are: Essential I scientific underpinnings for practice and Essential VII clinical prevention and population health for improving the nation’s health”. As APRNs we learn why the DNP essential are essential. The DNP essentials are an answer to the IOM and the recommendation they had for APRNs. Even though we will not be practicing medicine NPs are an answer to the huge gaps and complexities in healthcare. In speaking to fellow NPs they have nursing fundamentals and are able to connect with patients in way that other healthcare providers are not. I believe our nursing background is our advantage to our community because as a current practicing nurse, I spend the most time with my patient and I am able to connect with them outside of their disease. This is something that I will carry throughout my career.

References
Wylie, N. (2016). Implementing Integrative Care as a DNP to Increase Patient Health Outcomes. Beginnings, 36(3), 14–15.

[Gabriela]

I appreciate the thoughtful insights both of you have shared. As DNPs, our role is indeed complex and multifaceted. While it’s crucial to recognize that a DNP degree equips us with advanced clinical skills and the ability to practice at a high standard, it’s equally important to acknowledge that our scope is distinct from that of physicians (something I am currently learning in school). Our practice is rooted in the nursing philosophy, which emphasizes holistic care, patient education, and preventive measures. Integrating our nursing background into advanced practice allows us to approach patient care with a unique perspective that complements the work of our physician colleagues and overall patient care. It’s also true that obtaining a DNP does not mean we will be practicing medicine but I didn’t think of it this way until reading this post. However, the expertise we gain through a DNP program enhances our ability to contribute significantly to patient outcomes, whether we’re directly providing care or working within a collaborative healthcare team. The goal should always be to leverage our education, skills, and certification to improve health care outcomes, respecting the boundaries and strengths of our respective roles.
I will add that, I worry about navigating the scope of practice as a DNP-FNP. On one hand, I am apprehensive about overstepping my professional boundaries. On the other, I fear that my role may not be fully respected by physicians, something I’ve already observed in the bedside settings. The goal should be collaborative practice, where the unique strengths of both DNPs and MDs are recognized and utilized to improve patient outcomes. Where MD’s and NP’s have mutual respect and strive for collaboration, recognizing that our different training and perspectives are what make our healthcare teams stronger and more capable of providing excellent patient care.

[Mayra]

Hi Alyssa,

This is a great question. As discussed during our seminar there are so many obstacles being exercised between NPs and Physicians in the practice. We discussed that NPs are precepting new grad NPs into the clinical practice because medicine can be different as our approach is considered more “nursing”. I think we are in a phase where many registered nurses are seeking advance education and physicians are being apprehensive with a new modern medicine that NPs now will be playing in healthcare. Of course this is not the case everywhere because many physicians will accept this transition to alleviate longer working hours for them, inpatient or outpatient.

[John]

Hello Alyssa,

Excellent and thoughtful question. From a legal standpoint, there are different standards for the nursing profession and the physician profession. However, for the DNP – Provider role, many job requirements may overlap with those of physicians. Within these requirements, DNP providers should aim to (1) continually learn the necessary knowledge in their field, (2) contribute to their field by participating in and/or investigating new research to incorporate into their practice, and (3) continually improve their skills and knowledge in their respective field of practice.

In addition, as nurses, we have the unique perspective of working with various teams. Although physicians also work with other teams, they primarily collaborate with physicians from other specialties. Due to their concentrated specialization, they may not have as much experience understanding the nuanced dynamics of working with staff not directly involved in executive clinical decisions related to diagnosing and treating patients’ health concerns. Such staff can include pharmacy, cleaning, food services, and various nursing staff. Nurses, on the other hand, regularly work with every team. This experience provides us with a unique understanding of how to improve healthcare efficiency and team dynamics, ultimately leading to better patient care. Also, RNs have learned the important skill of being patient advocates. From our inpatient experiences, we tend to have a holistic approach to treating patients, addressing every need during their stay, from understanding clinical requirements to something as trivial as food preferences. With this holistic knowledge, which I assume most experienced nurses possess, we can use it to inform our treatment decisions for patients.

-John

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