Doctorate as the Entry Practice Level

I’ll be the first to admit that I have scoffed at the concept of the doctorate being required for entry level into nursing practice. My greatest cause for criticism was the fact that we pay more for our education than we can afford to pay off after entering practice. Yes, I am entering my doctoral program with a 120K debt and no vision of increasing my salary upon completion (maybe I’ll integrate a donation button at the conclusion of this post!).

As I read through The Doctor of Nursing Practice by Lisa Chism, I am humbled by the planning and implementation of so many nursing leaders whose innovative vision has paved the way for nursing practice, beyond the bedside nurse, and all accomplished in essentially a single decade. Our profession is in need of its own science so we can stand on our own two feet. Praise the Lord for our PhD nurses; however, our profession requires not only new knowledge, but nurses who can work to utilize this knowledge. The doctorate in nursing practice prepares nurses to be leaders in practice, not in education or research.

Disciplines such as audiology, chiropractics, dentistry, medicine, pharmacology, psychology, and physical therapy require a practice doctorate for entry into practice. Nursing is a practice discipline. We do require bedside nurses and we do require PhD trained nurses for development of nursing research, but I humbly agree that advancing the profession towards a doctoral entry level for independent practice is necessary.

If doctoral trained nurses are denied prescription privileges or hospital privileges, but my associates with doctoral medical training are granted such authority, or if medical doctors are identified as the supervisor of all other doctorate specialties, then what we have before us can not be denied as anything other than a medical monopoly.

Currently in the state of Indiana, Nurse Midwives are only required to hold a bachelor’s degree in nursing and with a midwifery certificate can practice and collaborate freely within their scope, but must have a written collaboration with a physician for prescription privileges. I propose we move to license doctoral trained nurses as independent practitioners, holding independent prescription privileges, with the right to acquire hospital privileges as equal partners within the healthcare infrastructure. Those without a doctorate would continue to practice as they do currently today, within the bylaws of their employer; however, midwives who choose to self employ could find success, free of current restrictions we each face today (and earning enough to pay off their debt!). Win. Win. Right?

Do not go where the path may lead; go instead where there is no path and leave a trail. ~Ralph Waldo Emerson

Be Sociable, Share!
Food For Thought

Food for Thought

"It is much more important to know what sort of patient has a disease than what sort of disease a patient has."

Sir William Osler


Food for Thought

"Happiness is underrated and critically important to health. Seriously! Unfortunately, many people just have no idea how to be happy."

Aviva Romm

Food for Thought

"Physicians simply do not have time to be what patients want them to be: open-minded, knowledgeable teachers and caregivers who can hear and understand their needs."

Snyderman and Weil

Food for Thought #1

"They say that time changes things. But you actually have to change them yourselves."

Andy Warhol

Food for Thought

"To think is easy. To act is hard. But the hardest thing in the world is to act in accordance with your thinking."

Johann Wolfgang von Goether

Food for Thought

"Birth isn’t about avoiding one set of realities in favor of another. It’s about embracing all facets of birth--contradictory, messy, or unpleasant as some might be--as vital to the whole."

Rixa Freeze PhD

Food for Thought

"Why I appreciate being a certified nurse-midwife, as opposed to choosing another route for midwifery: I feel learning the science is vital so the art of midwifery is safe and effective."

Dr. Penny Lane, nurse-midwife

Food for Thought

"When the debate is lost, slander becomes the tool of the loser."


Food for Thought

"To accomplish great things, we must not only act but also dream; not only plan, but also believe."

Anatole France

Food for Thought

"Science and uncertainty are inseparable companions. Beware of those who are very certain about things. There are no absolute truths in biological sciences - only hypotheses... 'We need to train medical students and residents more in the art of uncertainty and less in the spirit that everything can be known or that it even needs to be known.'"

Grimes (1986)

Food for Thought

"American physicians are rewarded for doing things to patients, not for keeping them well."

Grimes, 1986

Food for Thought

"The false idol of technology. 'Having a widget screwed into one's scalp has become an American birthright.'"

Grimes, 1986

Food for Thought

"Between 1985 and 1987, a hospital instituted a successful program to reduce its cesarean rate. The rate fell from 18% to 12%, losing the hospital $1 million in revenues - no small sum in those days."

Goer & Romano, 2012, p 37

Food for Thought

"Obstetricians are much more likely to perform a cesarean when they wrongly believe the baby weighs 4000 g or more based on sonographic estimates than when the baby actually weighs this much but the obstetrician did not suspect it."

Goer & Romaro, 2012, p 35

Food for Thought

"If you play God, you will be blamed for natural disasters."

Marsden Wagner (2006)

Food for Thought

"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you know and what you don't."

Anatole France

Food for Thought #3

"Birth is not only about making babies. Birth also is about making mothers - strong, competent, capable mothers, who trust themselves and know their inner strength."

Barbara Katz Rothman PhD (1996)

Food for Thought #4

"Believe there is always, always, always a way. When you have exhausted all possibilities, remember this: you haven't."

Thomas Edison

Food for Thought #5

"All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident."

Arthur Schopenhauer

Food for Thought #2

"Yet you brought me safely from my mother’s womb and led me to trust you at my mother’s breast."

Psalm 22:9