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Return to table of contentswhether they are managing this role in a safe, effective,and responsible manner.” 10 In addition, two nursing professorsrelaying the results of a 2004 survey of practicingNPs reported that only 10 percent of those surveyedperceived that they were very well prepared for actualpractice as NPs after completing their basic NP training,while a full 51 percent perceived that they were onlysomewhat or minimally prepared. 11 These findings suggestthat the limited clinical training required for NPs(it can range from 500 to 720 hours), even with theirprior RN experience, does not provide NPs with anadequate clinical foundation for independent practice.The clinical experiences of NPs are not comparable tothe two years of inpatient clinical training that medicalstudents undergo during their third and fourth yearsof medical school, plus the three years of full-time,intensive residency training for physicians in theprimary care specialties.What began in the late 1960s as a way to provide basicprimary care services and advice to people in regionswhere physicians were scarce has opened the door forNPs, with the assistance of various NP advocacy groups,to demand that they be allowed to deliver the samemedical care that physicians do—primary and specialtycare—albeit under the auspices of advanced practicenursing. Furthermore, nursing schools are now preparingfor the American Association of Colleges of Nursing’s2004 mandate that by 2015, all entry-level advancedpractice nurses (APNs), including NPs, attain a doctoratedegree, the Doctor of Nursing Practice (DNP). Notably,the DNP degree is not academic- or research-orientedlike a PhD degree in nursing, nor is it comparable to aDoctor of Medicine (MD) or a Doctor of Osteopathy(DO) in its didactic or clinical content quality or rigor.Nonetheless, the DNP graduate, prepared for clinicalpractice (unlike the scholarly PhD in nursing), mayconceivably introduce himself or herself as “doctor” inthe health care setting, where patients may be confusedas to a provider’s credentials.NP advocacy organizations continue to lobby for immediatescope-of-practice expansions and developmentof DNP programs, even while some APN advocateswarn that the profession is moving too fast. Take, forexample, a conclusion drawn by nurse researchers whoexplored how NPs in Washington state adapted tonew regulations allowing them in 2001 to prescribeSchedule II drugs under joint practice agreements withphysicians, and in 2005 to prescribe those same drugsindependently. By 2006, these researchers determined,42 percent of NPs in the state had not applied for U.S.Drug Enforcement Administration endorsement toprescribe these drugs. In fact, the researchers reportedthat some of these NPs indicated they did not want theresponsibility of having to deal with potentially drugabusingpatients. Instead, many of these NPs stated they“wanted additional education about controlled substancesto feel more competent with prescribing thesemedications.” 12 As a result, one researcher concludedthat “NPs need preparation for a new scope of practicelong before legislation actually passes.” 13The time is ripe for legislators, health care policy analystsand nurses to thoroughly assess the quality of NPtraining in relation to the scope-of-practice expansionssought at the state level. It is the AMA’s position thatpatient safety should always be the foremost concernwhen any health care profession attempts to secureauthority to provide services that may or may not becommensurate with its education and training. Importantquestions to consider while exploring this moduleinclude:• Is the NP educational system currently ensuring thatNPs are adequately trained to provide appropriatecare for patients?• Are NPs being granted scopes of practice for whichthey are not adequately prepared?• Why is there not—as there is for physicians—a singlenational exam that would evaluate all NP graduates’competency to provide patient care?• Are nursing education resources being spent wisely inlight of the nursing shortage that has already affectedmany regions in the United States? There are toofew nurses with graduate-level degrees to teach theincreasing number of baccalaureate RN candidates10. Cipher D, Hooker R. Prescribing trends by nurse practitioners and physician assistants in the United States. Journal of the American Academy of Nurse Practitioners.June 2006, Vol. 18, No. 6, p. 6.11. Hart A, Macnee C. “How well are nurse practitioners prepared for practice: results of a 2004 questionnaire study.” Journal of the American Academy of NursePractitioners. 2007, Vol. 19, No. 1, p. 37.12. Kaplan L and Brown MA. The transition of nurse practitioners to changes in prescriptive authority. Journal of Nursing Scholarship. June 2007, Vol. 39,No. 2, p. 187.13. Id. p. 190.Scope of Practice Data Series: Nurse practitioners • II. Introduction6