In defense of the DNP.

Contrary to the notion that the doctor of nursing practice (DNP) degree would confuse patients and the public, I believe that such a degree could and should provide much-needed clarity around independent practice issues such as prescribing, ordering tests, and completing forms ("Doctor of Nursing Practice--MRI or Total Body Scan?" July 2005: 278-281).

I have been in clinical practice as a family nurse practitioner (NP) for 8 years following 12 years as an RN in the hospital. I have developed a vigorous and challenging practice that involves independent management of many complex patients. I manage chronic pain conditions and have my Drug Enforcement Administration number and Schedule II authority. In addition, I have a Medicare unique physician identification number and can bill for services under my license. I am the hepatitis C clinician champion and receive referrals from NPs, physician assistants, and doctors to evaluate and treat hepatitis C. I have directed a diabetes collaborative effort at our health center and manage many diabetic patients. I am also the information technology clinician champion and have led our clinicians toward better use of technology for improved clinical practice.

My practice has become so noticeably like that of a doctor that patients often call me "doctor" (despite the fact that I always introduce myself as a "nurse practitioner"); even those in the healthcare community around me cannot get my title right. Certainly my name and professional designation are known throughout the places where I make referrals, order tests and procedures, and prescribe medications, yet roughly 60% of consult reports, refill requests, and other paperwork arrive with "Chris Stewart, MD" or "Dr Stewart" inscribed on them. Occasionally, too, I encounter "holdout" agencies that insist on a "doctor's signature," causing confusion and delay for those patients who have seen only me.

Clearly there are 2 issues here: independent practice rights and professional title. But having the professional title of "doctor" would, first of all, clarify for my patients and colleagues that I do have independent "doctoral" practice rights. Secondly, the availability of the DNP degree might push the issue for truly independent practice rights, removing the invisible walls that presently exist. I support the idea of maintaining the master of science degree for initial practice (for the NP) and adding to the curriculum for those of us who choose to seek the DNP degree. As a result, those who choose to maintain a less independent or focused role will be able to do so without having to go beyond the master of science degree, and those who wish to broaden their practice and independence can always seek the DNP.

I intend to earn this degree for precisely the reasons I've described, and I hope other NPs who have worked so hard to advance the NP role in their institutions will do the same.

Chris Stewart, NP, MSN 

Santa Rosa, Calif