Discussion in 'Clinicians [ RN / NP / PA ]' started by contessa54, 11.08.06.
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Wow! Congrats on the tuition reimb.!
Thanks. I took a lower paying job (by about 30K than the other offer) because I really liked the people. To be frank, I grew up with money and an extremely privileged lifestyle. Thanks to the bank of Grandma & Grandpa, our retirement is set for us so money doesn't impress or motivate me with regard to my work. My decision was based purely on how well I felt I "clicked" with the people I met. However, I picked the best grad school that would have me and it is pricey. Student loan debt on top of a rather low salary was worrying me because we would like to provide the children some of the privileges that I enjoyed! My husband and I are very pleased that our leap of faith is paying off. I am so very, very lucky. I have to pinch myself some days!
You are good at creative writing and I respect that. However, I was addressing my comment to one person. I'm sure there are many others who have more than one tool in their toolbox. Then again, others are just tools, lol!
You mean like the patient I saw last week, while my doc was gone? She had been through 35 sessions of TMS from another outside doc...which didn't work...and was now scheduled for ECT at another location. Luckily, she had to wait for a bed. I saw her one frgken time and found out she had never been on an adequate trial of antidepressants and was currently on one which had worked the best for her. I immediately increased it and when I handed her off to another doc she agreed. Thank goodness she dealt with the angry doc who called when he found out what was going on. The ECT is now on hold and the patient may be seeking another shrink. Is this the straws you're talking about. Or maybe you're talking about my other options if nothing works for this lady...you know all "scientific" options have been exhausted? Tell me then what you propose, caring, compassionate person.
Thanks. I'll be meditating tonight. You'll be pleased to know I recently finished "Transforming Therapy with Shamanic Energy Medicine." It was a heck of a lot more fun than "Guide to Rational Prescribing: Neurophysiology and Drug Mechanisms of Action" and "Clinical Pearls in Psychopharmacology" which I also recently finished.
By "we'd do it" who do you mean...allopathic medicine? Has it been "proven" in extensive clinical trials over many years? I used to get regular free acupuncture from students. At one session a student completely knocked out tennis elbow and golfer's elbow in my left elbow. In one more session the pain also disappeared in my right elbow. I'd been suffering for a year and my ortho doc was about ready to do surgery. Turns out this "student" was already an experienced acupuncturist, having been family trained in Korea, and was going back through school to get licensed in the states. Anecdotal? Yes, but I'm that anecdote and it worked. Never had a problem since. So how many acupuncture patients do you think give a hoot about meeting rigorous scientific criteria or have you also considered why they are going else where other than their allopathic physician? Why? Why?
Come on, there are plenty of perfectly legitimate alternative therapies and you guys know it, you just want to gang up on Zenman. There is a MD (yes!) NMD in my office who does acupuncture for chronic pain patients and migraineurs. I've never heard anyone* deny the efficacy of acupuncture. WTF? I have had plenty of cancer patients over the years tell me that reiki was effective for some of their symptoms as well. I've never been sick or in more pain than that caused by a stubbed toe, so I couldn't say. Well childbirth I guess, but guided imagery/relaxation was sufficient to deal with that. Somehow it never works when I stub my toe though, what's up with that?!
I don't think there is anything legitimate about homeopathy, I'll admit that. Most of the others I have heard about seem to have a place, however.
*ETA: I mean anyone knowledgeable and/or objective. I am discounting the addicts who didn't want any alternative to their oxys!
Sure, acupuncture has been proven to work. But you don't need to be trained - sticking needles randomly is just as effective.
People underestimate the value of a good placebo - I wish it were considered ethical to prescribe placebos in the US.
So if relying upon anecdotal evidence for treatment is what the advent of the DNP will bring us, that's a prime argument against it.
If there are any DNPs out there who respect the scientific process, I'd speak up now before these jokers further tarnish the reputation of your degree.
Unfortunately humans are involved in research which usually means some ulterior motive.
I've never used homeopathic medicine but this just came out. Haven't read it yet.
Your articles prove the opposite of your point.
If anything they show we need to be more skeptical about new therapies, not less.
Nowhere is it suggested that there is a conspiracy to disprove alternative medicine, rather it describes the well-known bias for positive results, especially when there are financial conflicts.
Just like with drug companies cooking the books for their pet pharmaceuticals, most trials showing efficacy for alternative techniques are performed by people with an investment in that technique.
And the article about homeopathy - expert opinion is the lowest form of evidence, and a government body in Sweden might not even count as that.
Homeopathy is about the purest form of hokum you can find, and there are no well-controlled, double-blinded randomized studies proving its efficacy. You will get the same effect giving someone water as you would with a 10e-7 dilution of any medicine in water, as long as both practitioner and patient do not know the difference. It's pure placebo effect.
Seriously, you're embarrassing potential future DNPs and discrediting the very degree you're trying to promote.
Well, actually I didn't have a point other than to always be wary of any research, which is why I said "Unfortunately humans are involved in research which usually means some ulterior motive." But thanks for your input.
To me the power of the mind is tops and you don't have to worry about prescribing a placebo, just use words.
SDN is a cess pool of trolls. Don't think its like that in the real world. People will say anything because they're hiding behind a computer. I guarantee you for the brief time they're not behind their laptop they are losers with no life and no friends.
I don't recall the class in medical school where we were taught to "degrade or belittle nurses " ; I must have slept through that one in second year.
Regardless, the traditional teamwork approach to medicine is what is taught in medical school. However, the radicalized NP no longer believes in this paradigm, having set up independent NP led family practice units (i.e. completely independent of physicians).
Frankly, I really don't care what NPs or DNP's call themselves. What I do care about is the fact that these mid levels consider their training equivalent to that of family physicians when their training is of dramatically lesser i) quality and ii) quantity.
I definitely feel like in certain depts/areas that there is a growing gap in teamwork between medicine and nursing. Our dept. fosters a pretty good working relationship between medicine and nursing, though we admittedly do not employ NPs or PAs on our unit...so I think we are able to side-step a lot of the issues mentioned above by having some pretty clear lines of who does what. I think it probably gets dicier in PC, IM, etc...where it is a big mix of everyone.
No, they are "doctors" by degree and hence would be referred to as such in academic and/or nursing settings. It is a fact that they are doctors -- the debate is over whether or not to use that title in clinical settings.
To illustrate the humor of how certain physicians get worked up over other clinicians "stealing" the doctor title and long white lab coats from them when they (historically) were the ones that stole the title "doctor" from academicians and the long white coats from laboratory scientists -- ironically -- to give themselves more credibility (the exact thing they are accusing other clinicians of trying to do). I just find the irony humorous. You don't?
So patient confusion is OK with you then if it is convenient. From that, I assume you are OK with the patient that calls a PA or NP "doctor," considering the hassle of explaining the differences in training between a mid-level and a physician, especially when a patient is writhing in pain from a kidney stone or pancreatitis. Seriously doubt that patient would be interested in an explanation of graduate medical education in this country.
I have never stated that an NP should refer to themselves as "doctor" without adding the "nurse practitioner" qualifier.
Prove it. Is there a nut-job NP or two that would says this (e.g. Mundinger)? Sure. But the idea that such is prevalent among mid-levels is absurd. Along with your expert ability to cite anecdotes as proof for your arguments, you are also quite adept at creating strawman arguments.
Please don't throw PAs in there. I have never yet heard a PA who suggests we should have independent practice. We work for you. Period.
Yeah, PAs get a foundation in basic sciences too. It's basically a path to become a permanent resident with a shorter training and a bit more flexibility.
Not for me, but I respect those who do it (and if I were female and wanted a family, I probably would have considered it).
There should be a serious accelerated path from nursing to MD, but it doesn't sound like the DNP is it.
Wow, how silly. I actually "threw PAs in there" because the one instance I can think of where a MLP was insisting they were as skilled as a physician was a PA. Sorry. My point is that these people are few and far between. If you'd like to pretend it's just nurses, then whatever.
Also, not sure if the "you" was referring to me, but I'm not a physician.
I come at this conversation very late and as an outsider, as I am involved in neither nursing nor medicine (I am a social worker). However, I have read (or at least tried to read!) this entire thread over the weekend because I find the topic really interesting...
And I haven't seen anybody directly and constructively address a specific question that seems to be underlying a lot of the conversation:What is the primary, core difference(s) between the scopes of practice with regards to both medicine and nursing? And if professionals disagree about this, can they/we agree to disagree and move forward?
I don't personally know the answer to this question, but clearly there are differences. I suspect from what I have seen that MDs and DNPs would answer very differently, and that their respective licensing boards would also answer differently.
But it seems important to know where people stand on this question before you try to have a conversation based on that, because if you don't know for sure where people start, how can you ever go anywhere together?
I currently work with an MD (two days a week), an ARNP (three days a week), as well as a lot of mid- and lower-level nursing, social work, and other professionals (such as me). If we were so concerned about others' titles, education, and perspectives all the time we'd never get anything done.
By the way, I don't mean any disrespect to any person or profession in this thread. I admittedly do not know as much as many of you, but these are my observations from my own work and from this thread.
The scope of practice will vary for nursing in different states. I look at it like this:
Medicine=Navy Seal sniper (cream of the crop with the most training)
Nurse Practitioners=ARMY sniper (doesn't know as much but can still kill you dead)
It is SDN policy to disagree and never find a happy medium. This place is a source of stress relief for some and a source of amusement for others. And yes, in the real world most people just work together.
Probably not the best analogy.
Ya got to keep it in context of the post. Don't start screwing it up like a journalist.
Very true. Used partially as a source of amusement here. However, the info gathered from some on here is useful and insightful
Never have truer words been written by this poster.
Spot . friggin. on.
He should now retire this avatar in a blaze of glory.
So, if I'm following this correctly, Zenman is saying that Nurse Practitioners can kill you, but not nearly as quickly and efficiently as a physician can, and Ghost Dog wholeheartedly agrees.
Who says Green Beret/SF snipers know less than SEALs? Pfffffffffff
Just FYI for the LECOM 3-yr PA to DO I did have to have MCAT and all the usual prereqs. I did get Physics 2 waived but they did that by substituting one of my myriad bio/chem undergrad electives (I had a BS Bio with genetics, full year o-chem, full year gen chem, Biochem 1 & 2, cell bio, etc etc plus PA courses).
Not what I would call a back door but we are talking PAs vs DNPs...not the same at all.
That's just it - I think they should still need to take the MCAT, USMLE, etc.
There are some very smart people who become nurses for purely financial reasons.
They should be able to take evening classes for prereqs and then take the MCAT for admission to a somewhat accelerated program.
I don't see anyway this could work. They don't take the level of anatomy or Physiology that we take in medical school as well. Also they have no biochem,patho,embroy...etc... so what would you be willing to accelerate? I can understand if you wanted them to be able to clep out of parts of Essentials of Patient Care 101 but even that is a stretch due to it being a totally different mind set of being the one in charge Vs. the one who is following orders.....
1.5 years of preclinicals and 3rd year. (4th year of med school is mainly for people considering specialties + interviews and vacation.)
Would have to include built in residency placement, eg some primary care place that would otherwise go unfilled.
Let's be honest, there's a lot of filler in medical school that could be cut or compressed without sacrificing quality.
I agree about the majority of this but what would you cut from preclinical years? Why not make them just do a program like Texas tech and lecom(not the pa to do version)
Most med schools are switching to 1.5 years of preclinicals, so nothing would be cut.
Which "most" are you referring to?! Do a convenience sample of 10 med schools, MD or DO...go to their websites and look at their preclinical curriculum. I think you'll be hard-pressed to find any that have less than a standard 2 years of preclinical education.
Don't forget that WHO standards stipulate minimum number of weeks in medical school for accreditation...the LECOM PA-to-DO track is just a few weeks longer than the minimum.
Would I like to CLEP out for H&P (which I have taught for several years to PA students, including this past fall in my M1 yr) and Medical Ethics? You betcha. But probably not gonna happen. And sometimes the easy A is a nice GPA buffer.
The top MD programs are switching to 1.5 years, and they tend to be trend setters.
UPenn is the first I knew about, but it seems like a dozen more at least have joined them in the past few years.
Well now, that's interesting...I will look. Curriculum innovation is certainly an idea way overdue in medical education! So do they extend the clinical rotations or what? More protected board review time? My program works only by cutting out virtually ALL vacation and most elective rotations. I'm all for it because I save a year of tuition and that year's opportunity costs but I will be SO ready for vacation when I graduate in May 2014. I may just have to take that whole month of June off! I have been doing independent board review since January of this year because I want to do as well as I can.
Nope, I think the main point is to put people in the hospital earlier.
They're probably selling it from a patient care angle, but in my opinion the main advantage is that people will get more opportunities to check out different subspecialties.
The previous system, some students had to start applying to residencies before they had the opportunity to do an elective in their top choice specialty.
I think a lot of the schools switching to 1.5 preclinical years are also pushing back Step 1 to 3rd year, but not sure.
Step 1 in third year would be rough. I could only imagine doing Gen Surg or IM and trying to study for Step 1(doing that now) as well as gearing up for Step 2 right after.
I believe they do Step 1 after third year.
That's a bit insulting to Army snipers
Way to completely miss the analogy. Why is it that the biggest complainers and anti-NP folks are always pre-med?
Lol sorry but I know plenty of med students docs and pas that dislike dnps we are just quiet about.
NPs tend to be in politically powerful positions, even if their clinical skills aren't up to snuff. People generally choose their battles.
Oh I got the analogy. It just wasn't a very good one. It's more like
MD/DO = army/navy seal sniper
NP = 12 year old kid with a BB gun
This reminds me of the psychiatrist who called me after I cleared his physician patient with BPD to go home. "She's the most dangerous, suicidal patient I've ever known!" Really, dumb butt? Let me get this straight. She's a physician and knows many ways to kill herself yet has not in 10 tries. Does this tell you something?????
I don't have a BB gun but, but I can really surprise you with a .22, especially with seven 25 round mags.
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