The University of Utah is transitioning to a doctoral program in nursing. The move, experts say, is consistent with principles of 21st century health systems. And it's part of a growing national trend.

The Doctor of Nursing Practice is the first new degree offered by the U.'s College of Nursing in 30 years. There are 62 such doctoral programs now enrolling students nationwide and more than 60 others in the works.

The hope is that it will not only thoroughly prepare students for theadvances in medicine, but respond to the needs of the public to ensure quality and safe health care, said U. College of Nursing Dean Maureen Keefe.

"The big push from the national data set is that the health care of the public would be improved if we had good, strong interdisciplinary teams that are well-prepared and will work together," Keefe said. "Outcomes would be better if we really work together well and in our own scope of practice."

The American Association of Colleges of Nursing is asking schools to transition master's-level advanced nursing degrees into the doctoral degree by 2015. Increasing complexity of health care, availability and growth in scientific knowledge as well as the use of sophisticated technology have created the need for more clinical hours, which results in the advanced nursing degrees.

Proponents say the doctorate degree will better prepare its holders to meet needs created by a projected shortage of family practice doctors and will also expand the field of nurses with advanced degrees qualified to be on nursing college faculties, which will in turn be able to train more students to reduce nurse shortages.

Increasingly, advanced-practice nurses are filling primary-care medicine roles across the country, especially as newly trained MDs head for more financially lucrative specialties, eschewing family practice. The shortage is further complicated by the fact that a large percentage of family practice MDs are expected to retire within the next 15 or so years.

Current nurse practitioners, nurse anesthetists, clinical nurse specialists and nurse midwives, who all hold advanced nurse-practice degrees, would be grandfathered in.

The U. will turn out its first 32 DNPs this December, with another set of nearly 100 beginning next year. The school has received more applications than it can accommodate, and officials are optimistic about the response and about the results so far, Keefe said.

"They are already great clinicians, but they ask different kinds of questions, and they are thinking more broadly," she said. "They have gone from being one-on-one to making a bigger impact."

While doctors applaud the move to train more nurses, they are less enthusiastic about the choice of a name. The so-called doctor-nurses wear name tags that designate themselves as "DrNP." And because they hold a doctorate, they may introduce themselves as "doctor," to which some doctors object.

"Nurse practitioners already serve as primary-care providers, so it doesn't change their roles," Keefe said. "We're not interested in misrepresenting who we are. We are part of a team."

Dr. Mark Bair, president of the Utah Medical Association, is not sure patients will pick up on the differences in training if nurses call themselves "doctor" in recognition of their doctoral degrees. When someone meets a family practitioner who is an MD (medical doctor) or a DO (doctor of osteopathic medicine), said Bair, an emergency room physician in Payson, the patient knows that individual got an undergraduate college degree, then completed medical school and a three-year residency. That's consistent throughout the country. The new nursing programs require far less and lack consistency.

Other doctors share the concern. "It's an undeniable fact that a nurse with a graduate degree does not have the same education and training as a physician who has completed medical school and residency training, and it's misleading for nurses to introduce themselves to patients as a doctor," American Medical Association board chairman, Dr. Edward L. Langston wrote in a letter to the Wall Street Journal in April. He also noted training inconsistency. "While one DNP graduate may complete a two-year program including a one-year residency, another can complete the program entirely online and without any patient care."

The U. has proposed a curriculum based on national requirements, made up of core nursing courses, clinical practice and courses specializing in organization, community and population. It is projected that to earn a doctorate following a master's degree, students will need to complete four additional semesters, or 33-36 credits. To earn a doctorate following a bachelor's degree in nursing will take students about nine extra semesters, or 75-90 credit hours. Keefe said the hours are equivalent to doctoral programs in other disciplines.

Courses will be offered on campus, as well as on an executive level, including intense weekend class work and online, and all will do a capstone project. It is unknown how the degree will affect salary ranges, Keefe said, as "those things are market-driven."

"We do have a critical need for nurses prepared at all levels," she said, adding that opting for a DNP is a "personal choice."


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