The main distinction between the terms NP and DNP is that nurse practitioner is a career or job title, while the Doctor of Nursing Practice is a graduate degree. The relationship between [doctors and nurses] is a major determinant .. lower than clinical nurse specialists and nurse practitioners (Table 4). Developing a good collaborative relationship took time and improved .. A controlled trial of the multi-disciplinary doctor-nurse practitioner.
MD vs. NP: Putting Egos Aside
A survey of primary health care NPs identified that many bi-directional referrals occur between NPs and family MPs or MPs working in community health centres, but only one-way referrals from NPs to specialists were observed [ 18 ]. It appears that collaboration can range from an intense relationship and regular knowledge exchange between NPs and MPs to a more distant and superficial co-existence of services provided by NPs and MPs [ 19 ].
No matter what form of collaboration is in place, a number of factors can influence the functioning or failure of collaborative practice between NPs and MPs. Literature reviews [ 20 - 26 ] and primary research [ 27 - 31 ] have highlighted a number of barriers and facilitators to collaborative practice and perceptions of health professionals of working in collaboration.
These relate to funding issues, traditional role allocation, legislation, personal experience with and attitudes towards collaboration and organisational aspects [ 32 ].
The existing reviews focus on collaboration in multidisciplinary teams, in hospital settings and collaboration between general nurses and MPs. Collaboration between NPs and MPs in primary health care may differ to other settings and roles, because NPs bring increased autonomy to the clinical setting that may challenge the traditionally MP dominated domain of primary health care, where nurses have long been working to support the MP and perform delegated tasks [ 2433 ].
Therefore, this literature review aims at summarising the existing evidence about the views and experiences of NPs and MPs with collaborative practice in primary health care settings. Since this review aims to aggregate data of qualitative and quantitative evidence and not to re-interpret findings, an integrative synthesis was the method chosen for this literature review [ 34 ]. Methods A number of methods are available for the synthesis of qualitative and quantitative evidence [ 3538 - 42 ].
A majority of these methods focus on effectiveness or intervention reviews and add findings of non-experimental research to the synthesis of trials in a separate step parallel or multi-level synthesis.
They suggest an integrated approach that is reflected in the simultaneous process of synthesising data from quantitative and qualitative research under themes that were addressed in studies using a variety of designs and methods.
Relationships Between Nurses and Physicians Matter
We drew on principles described by the Joanna Briggs Institute [ 43 ], the Cochrane Qualitative and Implementation Methods Group [ 38 ] and the thematic synthesis approach for qualitative data developed by Thomas and Harden [ 37 ] for literature reviews on participant views. The latter matched the purpose of this review that also looked at views and perceptions. Eligibility criteria Studies were included in the review if they focused on a population of NPs nurses with a postgraduate certification and an advanced level of practice autonomy [ 4445 ] and MPs in primary health care settings.
Study designs that generated qualitative or quantitative data were included. Opinion papers and anecdotal reports were excluded.
Information sources and search strategy The following databases were searched: The review also contains grey literature such as theses and dissertations.
When available medical subject headings or index terms were used in each database. The inclusion period of papers comprised the years from January to September to ensure the inclusion of papers that reported collaboration between NPs and MPs from countries where the NP role has been implemented for a much longer time and collaboration may be at a more advanced stage than in other countries [ 46 ]. No language restrictions were applied.
One reviewer examined the full text of potentially relevant papers for final inclusion or exclusion in the review. Reference lists of included papers were screened for eligible studies. Assessment of methodological quality A separate appraisal tool was used for each included study type [ 35 ].
The following were chosen due to their brevity, clarity, appropriateness; and because their items covered the most common assessment criteria of other tools: Data extraction Firstly, study details such as the methodology, the population and the context of the study were extracted from each study and organised in an evidence table Additional file 2: Secondly, findings were extracted from the primary sources into a spreadsheet and grouped under one of the outcome categories: Findings to be extracted from qualitative studies for the purpose of this review were themes, key concepts or results and conclusions developed by the authors of the papers [ 3751 ].
- Nurse Practitioner vs Doctor (Physician)
- M.D. vs. N.P. - Let’s Put Egos Aside And Patients First
- Knowing the Differences Between Nurse Practitioners, Physicians and PA’s
No direct quotations of individuals were extracted since they were considered raw data and not the outcome of an interpretative process undertaken by the authors [ 52 ]. A separate table was created for relevant quantitative data and organised under the same outcome categories as the qualitative data. Many facilities employ nurse practitioners in settings where they will assess, diagnose, treat, prescribe, and get paid a smaller salary than a doctor would for performing those same tasks.
Especially amongst the twenty-three states that allow NPs to practice independently without physician oversight, there is a big movement towards equal pay grades between the two providers. So what is the best thing to do? Pay all providers giving the same service the same wage? Or calculate salaries that are commensurate with schooling, training, and scope of practice?
From a corporate perspective, the answer is easy.
Relationships Between Nurses and Physicians Matter
Companies will always find an excuse to tip the pay scale to their benefit, and level of education is a perfect pretext. A second point of contention is in regards to title. Academia and medicine happily share the prefix of Dr with distinct paths and practices. However, when it comes to the world of patient care, this title is part of a heated debate. Doctorates of Nursing Practice earn their doctorate degree and with it, the Dr prefix.
However, when standing in front of a patient in a clinical setting, some argue that it is deceiving for a DNP to introduce themselves as doctor, even unacceptable if they passively allow patients to use the title.What are the roles of physician assistants, nurse practitioners, and medical assistants?
No matter who you are or where you stand on each argument, it can be said that ego lies at the center of the feud. But in order to grow and move forward in a progressive way, we must put down our egos and work on the kinks in our own system, and for nurses, the first step could be examining the NP education system.
The academic framework for nurse practitioners undergoes a lot of scrutiny from the physician sector due to its stark difference in structure from medical school and residency.
However, it is important to give a voice to the nurses who feel the shortcomings of advanced practice programs. By facing the weaknesses in the NP academic model, we can fix them and grow stronger for the sake of patients and the profession. Nursing education can sometimes be abstract, and nurses have voiced that this has translated into the realm of advanced practice nursing.
Concerns exist in regards to some curricula and there are claims that the NP curricula fall short of providing illness mastery. For example, some semesters may be heavier on nursing theory and lighter of pathophysiology and pharmacology.