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The doctor of nursing practice: recognizing a need or graying the line between doctor and nurse?

The distinction between doctor and nurse has been historically visible to patients, and the scope of practice for each healthcare provider has been clearly marked by a wall of separation rooted in state law. In fact, even the titles by which these providers have been addressed have remained constant, with the term "doctor" being reserved for reference to physicians. With the advent of the new doctor of nursing practice degree, however, the clear distinction between doctor and nurse is in jeopardy. Moreover, accompanying the push toward a practice doctorate for advanced nursing practice is a call for the expansion of the scope of advanced nursing practice. The urgent questions at hand are the following: First, is a practice doctorate necessary or even appropriate for advanced nursing practice? Second, should the scope of advanced nursing practice be extended at this time? In addition to the increased educational requirements placed on aspiring advanced practice nurses and the associated increase in costs of obtaining the requisite education, requiring a practice doctorate for advanced practice nursing risks blurring the line between doctor and nurse and creates a potential for patient confusion. A true need for requiring a practice doctorate for advanced practice nursing has not been demonstrated. Moreover, the states should tread carefully when considering expanded roles for advanced practice nurses to avoid creating conflict within the medical community. Considering the level of qualification of today's medical school applicants, perhaps we should be training more physicians to meet the demand head-on rather than creating a separate practice doctorate to fill the gap.