NP scope of practice (FNP, ACNP, or emergency subspecialty)

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NursingStudent16

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Hello everyone,

I am in nursing school and work as an ER tech. I have also posted this in a nursing forum, just wanted to get a different view. I am just curious to know a little bit about the scope of practice of NPs in the ER. I know some of the courses in NP school, depending on the program, can teach some pretty invasive procedures (intubation, central line, chest tubes). If they learn these procedures, why do they/are they not allowed to perform them in ED's? It just kind of seems like a waste of learning them if those cases just get handed over to the MD. I know flight nurses can perform these procedures, even without having a master's degree (unless they are flying with a resident, for the most part). I don't know, the question just kind of stumped me.

Thanks to all who answer!

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I know some of the courses in NP school, depending on the program, can teach some pretty invasive procedures (intubation, central line, chest tubes). If they learn these procedures, why do they/are they not allowed to perform them in ED's? It just kind of seems like a waste of learning them if those cases just get handed over to the MD.

I don't know how it is for other docs, but for me, the procedures are part of the fun of being an ER doc. So as long as it's my license on the line, I'm going to do the fun part of the job.
 
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Because we're better at them.
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Because we're better at them.

While I don't disagree with that statement, I don't know how that RCT is relevant to it. It was looking at physician-staffed HEMS v. ground for trauma patients. Nothing to do with nursing or line placement or other invasive procedures in the ED.
 
I can clean teeth. Why should I have to go to dental hygiene school to work in a dentist's office? #struggle

Wouldn't education be more streamlined and effective if everyone could just do whatever they wanted?

Why can't nurses place chest tubes when an MD is around? Because it's not their job. If everyone could flood whatever market they wanted at will, people would stop working hard to improve society. There has to be a reward at the end of medical school or it's not worth it. Why would I take on so much risk if I'm not guaranteed a job afterwards?

Society is not playing musical chairs with careers because it's inefficient and wasteful.

If you don't want to be a nurse, don't go to nursing school.
 
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Hello everyone,

I am in nursing school and work as an ER tech. I have also posted this in a nursing forum, just wanted to get a different view. I am just curious to know a little bit about the scope of practice of NPs in the ER. I know some of the courses in NP school, depending on the program, can teach some pretty invasive procedures (intubation, central line, chest tubes). If they learn these procedures, why do they/are they not allowed to perform them in ED's? It just kind of seems like a waste of learning them if those cases just get handed over to the MD. I know flight nurses can perform these procedures, even without having a master's degree (unless they are flying with a resident, for the most part). I don't know, the question just kind of stumped me.

Thanks to all who answer!

degrees don't make a doctor. this is a concept that nurses seem to have trouble with but continue on with your alphabet soup name tags

anyone can learn how to do the technique. but do you know the indication? the pros and cons? what happens if you don't do the procedure? what the procedure is actually for? what are potentially harmful things can happen to the patient if you make a mistake? what signs and symptoms to look for if one of these events actually happens? what interventions are indicated to fix possible sequelae? it's much more than just putting a tube in someone's vasculature, chest or throat. do you know how to handle laryngospasm? pneumothorax? arterial spasm? if the patient needs a medication, what is the indication? the dosage? the side effects? max dose? interval? time of onset? half life? context-sensitive half life?

the cases aren't "handed to the md". you just don't know what you don't know which is why such a simple question would stump you
 
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Okay, so - I work with a lot of MLPs, both NPs and PAs.

25-30% are great at doing what they do. The remainder.... I too often find myself being thankful that I intervened "in-time".

Here's the part that bothers me; there's so much focus by the MLP students (and early practitioners) on wanting to (intubate/central line/chest tube/be on the "Front Lines" whatever that means)... but the vast majority of them are lacking in basic and clinical science knowledge. I can't help but think that a lot of them see MLP school was a way to "be like a doctor", but avoid those pesky entrance exams and requirements, and the time investment necessary. I'm all for "training them up" and I spend a lot of time doing so, but when I do, I see little interest displayed by the student/MLP in the actual mastery of the topic... the necessary anatomy/physiology/biochemistry/etc. They all too often want to know "just what to do and that's enough, kthxbye".

To make a sports analogy (like I am wont to do)... I'd love to be a MLB second-baseman... but I can't hit even single-A pitching. I don't go about touting myself as a guy that could play AAA ball in a place that's a "tough market".

Before you go draining pericardial effusions out on your own, you'd better prove that you can read the EKG and truly understand it, and not just "read what the computer says on the top".
 
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Does sound like a waste of learning. Guess they should stop teaching it. You'll note EM physicians don't learn to do appendectomies in Residency and then complain about the surgeons getting handed the case...
 
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degrees don't make a doctor. this is a concept that nurses seem to have trouble with but continue on with your alphabet soup name tags

anyone can learn how to do the technique. but do you know the indication? the pros and cons? what happens if you don't do the procedure? what the procedure is actually for? what are potentially harmful things can happen to the patient if you make a mistake? what signs and symptoms to look for if one of these events actually happens? what interventions are indicated to fix possible sequelae? it's much more than just putting a tube in someone's vasculature, chest or throat. do you know how to handle laryngospasm? pneumothorax? arterial spasm? if the patient needs a medication, what is the indication? the dosage? the side effects? max dose? interval? time of onset? half life? context-sensitive half life?

the cases aren't "handed to the md". you just don't know what you don't know which is why such a simple question would stump you
I guarantee a NP or flight nurse could answer all of those questions without hesitation...quit acting like a big shot, and quit assuming that nurses don't know anything at all.
 
I can clean teeth. Why should I have to go to dental hygiene school to work in a dentist's office? #struggle

Wouldn't education be more streamlined and effective if everyone could just do whatever they wanted?

Why can't nurses place chest tubes when an MD is around? Because it's not their job. If everyone could flood whatever market they wanted at will, people would stop working hard to improve society. There has to be a reward at the end of medical school or it's not worth it. Why would I take on so much risk if I'm not guaranteed a job afterwards?

Society is not playing musical chairs with careers because it's inefficient and wasteful.

If you don't want to be a nurse, don't go to nursing school.
I didn't ****ing say I didn't want to be a nurse. Get out of here with that irrelevant crap.
 
Does sound like a waste of learning. Guess they should stop teaching it. You'll note EM physicians don't learn to do appendectomies in Residency and then complain about the surgeons getting handed the case...
I'm not complaining...I was just looking for a civil discussion. Which apparently can't happen on this website because MDs, residents, and med students always shun anything that has to do with nursing and say that they are not worthy of even breathing the same air as you. I guarantee if you didn't have nurses, you guys would change your attitudes real quick.
 
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I'm not complaining...I was just looking for a civil discussion. Which apparently can't happen on this website because MDs, residents, and med students always shun anything that has to do with nursing and say that they are not worthy of even breathing the same air as you. I guarantee if you didn't have nurses, you guys would change your attitudes real quick.

Try to have some insight here. I see this often when conversations between MDs and midlevels go this direction. They seem to follow the same path:

1) Mid-level/someone thinking about becoming a midlevel asks a question
2) MD responds, but mentions that the role of a midlevels, skillset and knowledge base are very different from that of a doctor
3) Mid-level/future midlevel accuses MD of being elitist and extends to level of hyperbole
4) Godwin's law takes effect

You're at level 3.

Some midlevels are great, some are terrible. Whether you like midlevels or not, our system is at the point where we can't get by without them. But just because we need midlevels to function doesn't mean that they have equal training to MDs. Anyone who think midlevels and MDs are equivalent lacks any basic understanding of medical training.
 
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I'm not complaining...I was just looking for a civil discussion. Which apparently can't happen on this website because MDs, residents, and med students always shun anything that has to do with nursing and say that they are not worthy of even breathing the same air as you. I guarantee if you didn't have nurses, you guys would change your attitudes real quick.

No one is shunning nursing. No one remotely questions the value of ancillary staff. You asked why NP's don't perform relatively rare and invasive procedures in the ED and you were given multiple accurate reasons. You seem to have come here with a chip on your shoulder...
 
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OP posted another thread and calling everyone here dinguses. :rofl::laugh::lol::corny:

http://forums.studentdoctor.net/thr...-med-students-dinguses.1133311/#post-16432801
 
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As someone who is applying this cycle, is teching in the ER, and was a prior infantry Corpsman, the answer is pretty simple.. its not their liscence they work under. Learning HOW to do a procedure is the easy part. Its learning/mastering the why and why not that is hard. Plus imo the person who put in the most work and time gets to make the decision. As for this:
because they did not go to medical school (but could have been completely capable to, if it weren't for financial, family, or other problems)
the difference isnt that they had these obstacles and MD's, residents, and med students did not. The difference is that MD's, residents, and med students did not allow the obstacles to become road blocks, they pushed through, and did not let anything deter them. Thats just my 2 cents.
 
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I guarantee a NP or flight nurse could answer all of those questions without hesitation...quit acting like a big shot, and quit assuming that nurses don't know anything at all.

I doubt it. Most of the nps I have met are of rather dubious quality and will not be able to answer the majority of these questions. They don't even have a good handle on much of the basics that any second year medical student should know. This is particularly apparent in the newer grads who have what they think is a more advanced degree. The only nurses that have impressed me are the icu nurses with decades of experience.

Explaining to you how much you don't know as an answer to your question is not acting like a big shot but simply answering your question. Then again it's obvious that you came here with an agenda and an attitude rather than a legitimate query which tends to be a common occurrence.

Also, saying that nurses are not doctors is not the same as looking down on them or diminishing their important role. But if you want to be a real doctor, you're free to apply to medical school like the rest of us
 
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Everyone STOP!!!

I have to get some popcorn...

Ok, proceed :)
 
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Nursing *In General* (and I rarely speak in generalizations) is a mixture of undereducated (associate degree), underprepared (LPN), average to mediocre providers (RN, BSN) who have degraded their own specialty. Nurses in prior generations were relied upon by physicians to use judgement, clinical decision-making, and thought to carry out their orders, and involve them when needed. Today, nurses are being minted by the thousands as protocol-driven masters of paperwork, hellbent on data-keeping, compliance, and box-checking to make the government and their hospitals happy. This is not to say there are a few very sharp, efficient, thought-oriented people who choose to practice nursing instead of clocking in, clocking out, taking lunch, and charting what is required. Nurses are undereducated for the practice of medicine, but today overeducated for the practice of healthcare.

Doctors *In General* are over achievers, type-A driven personalities who excelled in school, outcompeted their peers, spent the majority of their younger adult years in training, and have entered the health care market and hospital world run by the nurses described above. Despite our vast education and training focusing on medical knowledge and patient care, we are ill-prepared and poorly understand just how different doctoring and nursing is. While we can calculate an anion gap, we at times have a hard time understanding how those with "lesser knowledge than us" can "get in the way of" our care. To that point, we are undereducated for the "practice" of "healthcare" and overeducated for the practice of medicine.

See what I did there - the practice of medicine, and the practice of healthcare are two totally different things, and the lines dividing the two are becoming sharper than ever. If this were a Venn Diagram, these would be two circles on opposite sides of the page.

The role of Midlevel providers, especially nurse practitioners, is still being molded by changes in the delivery of healthcare, and the practice of medicine. Clearly, the education of a nurse practitioner cannot compare to the rigors of medical school. Two years online test-taking with minimal hands-on training qualifies any nurse for an advanced degree. Lately, when discussion of nurse practitioners take place, there are two issues to debate: 1) what is the role of a nurse practitioner, and 2) should NP's be permitted to practice independently, without physician oversight. The latter seems to be the emotional debate amongst physicians, but often we lose focus of the former.

As physicians, I believe it is our duty to mold the midlevels who are entering our healthcare system and define what their role will be. This is the last bastion of medicine that we have the ability to control. We will need their help, just as they will need ours. I also believe that any nurse who gets two years of training and believes they are on par with a physician's level of training and skill probably needs to go back to school, or pursue a doctorate of medicine to really see the difference. There is serendipity in not knowing what you don't know.
 
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Nursing *In General* (and I rarely speak in generalizations) is a mixture of undereducated (associate degree), underprepared (LPN), average to mediocre providers (RN, BSN) who have degraded their own specialty. Nurses in prior generations were relied upon by physicians to use judgement, clinical decision-making, and thought to carry out their orders, and involve them when needed. Today, nurses are being minted by the thousands as protocol-driven masters of paperwork, hellbent on data-keeping, compliance, and box-checking to make the government and their hospitals happy. This is not to say there are a few very sharp, efficient, thought-oriented people who choose to practice nursing instead of clocking in, clocking out, taking lunch, and charting what is required. Nurses are undereducated for the practice of medicine, but today overeducated for the practice of healthcare.

Doctors *In General* are over achievers, type-A driven personalities who excelled in school, outcompeted their peers, spent the majority of their younger adult years in training, and have entered the health care market and hospital world run by the nurses described above. Despite our vast education and training focusing on medical knowledge and patient care, we are ill-prepared and poorly understand just how different doctoring and nursing is. While we can calculate an anion gap, we at times have a hard time understanding how those with "lesser knowledge than us" can "get in the way of" our care. To that point, we are undereducated for the "practice" of "healthcare" and overeducated for the practice of medicine.

See what I did there - the practice of medicine, and the practice of healthcare are two totally different things, and the lines dividing the two are becoming sharper than ever. If this were a Venn Diagram, these would be two circles on opposite sides of the page.

The role of Midlevel providers, especially nurse practitioners, is still being molded by changes in the delivery of healthcare, and the practice of medicine. Clearly, the education of a nurse practitioner cannot compare to the rigors of medical school. Two years online test-taking with minimal hands-on training qualifies any nurse for an advanced degree. Lately, when discussion of nurse practitioners take place, there are two issues to debate: 1) what is the role of a nurse practitioner, and 2) should NP's be permitted to practice independently, without physician oversight. The latter seems to be the emotional debate amongst physicians, but often we lose focus of the former.

As physicians, I believe it is our duty to mold the midlevels who are entering our healthcare system and define what their role will be. This is the last bastion of medicine that we have the ability to control. We will need their help, just as they will need ours. I also believe that any nurse who gets two years of training and believes they are on par with a physician's level of training and skill probably needs to go back to school, or pursue a doctorate of medicine to really see the difference. There is serendipity in not knowing what you don't know.
What happened to your Burt & Ernie avatar?
 
This is classic Dunning-Kruger effect. Nursing students who haven't even put in a dozen IV's think that doctors are idiots and that they should be the ones putting in chest tubes and managing crashing patients. Funny how seasoned midlevels who actually work at busy ED's and know their stuff aren't spewing this garbage.
 
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You'll note that while there is a huge rush to build new, online DNP programs, all of which promote doctorate level education, nobody is publishing any test-based comparisons between DNPs and MD/DOs. You'd think those schools would want to show equivalency or non-inferiority, if they could.
 
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You'll note that while there is a huge rush to build new, online DNP programs, all of which promote doctorate level education, nobody is publishing any test-based comparisons between DNPs and MD/DOs. You'd think those schools would want to show equivalency or non-inferiority, if they could.
It's almost like they remember that watered down step3 the nps took at columbia and don't want to repeat the results or something like that
 
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When are physicians going to get together and define what "practicing medicine" entails, and what it does not entail? Why is it "practicing medicine" (and thus falling under purview of the Board of Medicine) if you or I intubate or put in a chest tube, but "practicing advanced nursing" (and thus falling under the purview of the Board of Nursing) if a NP does it? The NPs have successfully taken over, at least politically, much of your jobs simply by having the Boards of Nursing say "This is now within our scope of practice."
 
Found this NCLEX practice question site. Anyone who says nursing has as much scientific knowledge as medicine is crazy.


Which task must be performed by the registered nurse?

A. Hanging a bag of total parenteral nutrition solution

B. Inserting an indwelling urinary catheter

C. Administering a vaginal suppository

D. Checking the weights used with skeletal traction

The sooner people realize they are comparing apples to oranges but both are fruits the better.
 
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I guarantee a NP or flight nurse could answer all of those questions without hesitation...quit acting like a big shot, and quit assuming that nurses don't know anything at all.

OP, not sure if you are still monitoring this thread, but let me share some insight with you as one who has been part of the educational process on both fronts.

First off, generally speaking, no they couldn't. That is not to say that there are 0 NPs out there that could answer those questions, but they would be the exception, not the rule.

I was in a DNP (Doctorate of Nursing Practice program [one that is often regarded as the top in the country]) and left because I was not satisfied with what my potential scope of practice would be. I am currently finishing my M1 year in an MD program.

Now for the comparison:
The depth of knowledge required in the past year of medical school is so far beyond what was required in nursing that they really cannot be compared on the same scale without offending (I cannot say 1/10 for nursing and 15/10 for medicine because I would be sounding like a "big shot"). I did not even need to buy books in nursing school and I was still the top of my class. I spent MAYBE 4-5 hours per week studying in total while attending full time (and this during the master's portion, so not just entry level nursing classes). I currently spend 30-40 hours per week studying in medical school, and I am still not learning everything.

With nursing school, there are X amount of facts to learn, and the time to learn them is VERY manageable. In medical school there are X amount of facts, X amount of concepts, and X amount of connections between the two to learn, and when you think you know them all, you realize there is a whole level of understanding yet to achieve. THIS is why it is the physicians call, THIS is why the MLPs should not do things that require deeper understanding of the issue at hand, THIS is why it is silly to try to compare expertise or understanding. They just aren't even on the same scale. Constantly in nursing I heard about how it is "a profession" -- that is it has its own set of unique knowledge required to practice -- why then, when there is a separation between that knowledge and that which is required to practice medicine, is it suddenly elitism?

Nursing is a fantastic field. It is a hard job, and it takes a certain drive and focus to be good at it, I am not here to downplay that. I am simply saying, don't act like it is or should be something that it isn't.
 
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......... THIS is why the NURSES should not do things that require deeper understanding of the issue at hand, THIS is why it is silly to try to compare expertise or understanding. They just aren't even on the same scale....

There, fixed that for you. Not all "MLP's" are created equal. The weakest PA program is much, much, much more intense than the strongest of DNP programs. Not insinuating PA education is equal to MD/DO education (it's obviously not), but it teaches medicine.
 
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Stop the pissing match against mid-levels. It's unbecoming. No real doctor fears mid-level encroachment. If you fear midlevel encroachment, you probably should. Be confident in your skills as a doctor and don't show insecurity by getting in p***ing matches with nurses and PAs. Nobody respects a doctor that sh*ts on nurses and PAs.
 
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Stop the pissing match against mid-levels. It's unbecoming. No real doctor fears mid-level encroachment. If you fear midlevel encroachment, you probably should. Be confident in your skills as a doctor and don't show insecurity by getting in p***ing matches with nurses and PAs. Nobody respects a doctor that sh*ts on nurses and PAs.
But you are in a specialty they aren't getting independent full coverage in yet.....a few specialties aren't so fortunate
 
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These threads are so funny. Guess what? I work in a trauma center (level 3 or 4). Guess how many chest tubes I've put in this month? Yup. Zip. So far this year? Yup. Zip. While central lines and intubations are more common, they're not exactly multiple times a week occurrences. I can't remember the last time I had two tubes in a single shift. That's community EM. Now, if I'm doing them that rarely, why in the world would I need a mid-level to help do those procedures?

Are there midlevels doing this stuff? Sure. On rare occasions mostly in very remote locations. But if your goal in life is to do as many central lines and intubations as possible, go into anesthesia and work at a big tertiary care center where there aren't any residents. Don't do EM because that's not what EM is. It's belly pain and chest pain and anxiety. Sometimes all three in the same patient. What are my midlevels doing? Dental pain. Back pain. Lacerations. Peds fevers. If you don't want to do that, go to medical school so you can see the anxiety patients who also have chest pain.

And any flight nurse who tells you he/she is doing chest tubes, intubations and central lines all the time is lying, especially in mid-air. I'd buy an occasional IO line and maybe even a needle decompression and a rare intubation though.
 
Whitecoat - Agree with everything you said, except I think flight nurses in remote locations intubate fairly frequently. Local EMS in very remote areas are often volunteer, so it's the flight nurse/medic who provides the advanced prehospital care like intubation. I've never known of a flight nurse/medic doing a CVL or chest tube.

Back to the OP: I had a DNP student with me for a bit, she graduates in 2 weeks. Had her work up a head trauma patient. When we pulled up the head CT, her first question to me was "which side is left and right?" She said she had never looked at a CT in her entire DNP program.

She graduates as a FNP DNP in 2 weeks, and she has never looked at a CT.
 
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Not trying to pile on NPs here, but another recent story. DNP student working with me again in the ED. 55 yo comes in code blue. Per family may have taken too many potassium pills. Asked DNP student what we should do for possible K+, she said Kayexelate. I told her Ca+, asked her what she wanted to give, Ca gluc or CaCl. She didn't know anything about the difference between them, instead she thought they had "different bioavailability". She simply couldn't comprehend why it would take 3X as much CaGlu as CaCl to get the same amount of Ca. Mechanism of Ca on the heart muscle? She didn't have a clue.

This is just one example of her lack of understanding of ANYTHING medical in this code. There were several others, but you get the point.

She graduates as DNP in 2 weeks.....

I love nurses (I'm married to one), and I know many terrific NPs. But NP/DNP education is a joke.
 
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My favorite (as a radiologist) is calling the ED NPs for a finding and them having no idea what I'm talking about and having to repeat myself in layman's terms.

Me: "Hey Joe Smith in the waiting room has thrombus in his right MCA"
Them: *scoffs* "ok....what does that mean?"
Me: "He is having a stroke."

Me: "Hey it looks like little Sandy Mckiddo might have malrotation, sucks right?"
Them: "What"
Me: "Call surgery."

I wasn't really one to get too upset about MLPs before residency but my experiences the last few years have really opened my eyes.
 
Whitecoat - Agree with everything you said, except I think flight nurses in remote locations intubate fairly frequently. Local EMS in very remote areas are often volunteer, so it's the flight nurse/medic who provides the advanced prehospital care like intubation. I've never known of a flight nurse/medic doing a CVL or chest tube.

Back to the OP: I had a DNP student with me yesterday for a bit, she graduates in 2 weeks. Had her work up a head trauma patient. When we pulled up the head CT, her first question to me was "which side is left and right?" She said she had never looked at a CT in her entire DNP program.

She graduates as a FNP DNP in 2 weeks, and she has never looked at a CT.

Well, DNP programs don't necessarily teach that much clinical information; I believe that it is aimed more towards research, ethics, and other things like that from the curriculums of DNP programs that I have seen . The clinical information would come more with the NP programs, and not necessarily with FNP as much, but more with ACNP because they are more equip to handle the acute injuries and acute diagnostic tests that need to be implemented and analyzed for them. ACNP are more along the lines of PA's than FNP are, in my opinion. Even if they don't have the same exact classes that a PA has had, the classes are very similar, just based on the nursing model rather than the medical model. But if this was your student, I don't believe she should be graduating if she doesn't even know that question. I know that answer and I am not even finished with my BSN yet. But you can't group all students in the category of "stupid" just because you have had a few students who can't answer the simple questions.
 
"DNP programs don't necessarily teach that much clinical information" - Correct, and that is the problem.

"...aimed more towards research, ethics, and other things" - Correct, and again, that is the problem. Most "research" in academia is done solely for the purpose of doing research. I was just forced to read a "nursing research" systematic review on the use of Doula's during L&D to reduce c-sections. Sounds great...but what about outcomes for the child being born? Isn't THAT why we do C-sections?

"The clinical information would come more with the NP programs"- No, it doesn't. She is in a DNP program...as in she entered as a RN and will be coming out a DNP. This isn't a NP to DNP program.

"Even if they don't have the same exact classes that a PA has had, the classes are very similar..." --- No, not even close. PA education is medicine. We learn how the Ca+ increases the threshhold potential of the myocytes. We have taken Chem (not "Chem for nursing"), and oftentimes Organic and Biochem, so we understand why CaCl is 1/3 the SIZE of Calcium Gluconate. While PAs are learning this, NPs (and DNPs) are learning about the social barriers for transexual latino children born to a three parent family in Milwauukee. While we are learning to read CT scans, DNP students are taking online "leadership" classes about how to advocate for the profession at the state legislatures.

And lastly, I never called her stupid. She isn't. She is a very bright young lady. However she doesn't know squat about MEDICINE.
 
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"DNP programs don't necessarily teach that much clinical information" - Correct, and that is the problem.

"...aimed more towards research, ethics, and other things" - Correct, and again, that is the problem. Most "research" in academia is done solely for the purpose of doing research. I was just forced to read a "nursing research" systematic review on the use of Doula's during L&D to reduce c-sections. Sounds great...but what about outcomes for the child being born? Isn't THAT why we do C-sections?

"The clinical information would come more with the NP programs"- No, it doesn't. She is in a DNP program...as in she entered as a RN and will be coming out a DNP. This isn't a NP to DNP program.

"Even if they don't have the same exact classes that a PA has had, the classes are very similar..." --- No, not even close. PA education is medicine. We learn how the Ca+ increases the threshhold potential of the myocytes. We have taken Chem (not "Chem for nursing"), and oftentimes Organic and Biochem, so we understand why CaCl is 1/3 the SIZE of Calcium Gluconate. While PAs are learning this, NPs (and DNPs) are learning about the social barriers for transexual latino children born to a three parent family in Milwauukee. While we are learning to read CT scans, DNP students are taking online "leadership" classes about how to advocate for the profession at the state legislatures.

And lastly, I never called her stupid. She isn't. She is a very bright young lady. However she doesn't know squat about MEDICINE.

You can really tell that a PA has the same mentality as anyone in medicine...arrogant and big headed. I mean, if you can't comment on my post without ridiculing EVERYTHING I have to say, just stay off.
 
He's not ridiculing you; he's offering valid and accurate criticizm. You should recognize that, but I guess they don't teach THAT in nursing school, either.
 
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I heart this thread for so many reasons. Just waiting for Boats' doula/c-section comment above to suck in some home birth zealots into the vortex of suck this thread so quickly became. The amount of Rumsfeldian "unknown unknowns" displayed in this one is a treat.
 
You can really tell that a PA has the same mentality as anyone in medicine...arrogant and big headed. I mean, if you can't comment on my post without ridiculing EVERYTHING I have to say, just stay off.

How did you know I have a big head? I would think with all of the intense psychosocial, organizational, cultural awareness, and advanced leadership courses you are taking you would know better than to make fun of someone's unusual physical attributes! I suggest you report yourself to your school's cultural counselor so they can arrange some additional sensitivity training for you!



And just for the record....THAT is ridiculing what you are saying.
 
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I believe Boats is just speaking the truth based on the reality he's seen, and it's being taken the wrong way.

Before residency I guess I just took PAs for granted, and it probably irks Boats to be placed on the same level as NPs, who universally have less in-depth understanding and (in some states) more independence than him/her.

I did rotations with PA students, but never recall an NP student. From what I understand, PA school is basically a practice-oriented abbreviated medical training minus residency, while NP school isn't medical training at all...
 
I'm not arguing that PAs are better than NPs. I have worked with some amazing NPs who overcame their lack of medical education provided in their NP program by constant studying. And I know some PAs who are terrible despite passing a standardized intensive PA program.

I am arguing that NP education (including DNP education) <<<<<<<< PA education <<<<<<<<MD education.
 
Not trying to pile on NPs here, but another recent story. DNP student working with me again in the ED. 55 yo comes in code blue. Per family may have taken too many potassium pills. Asked DNP student what we should do for possible K+, she said Kayexelate. I told her Ca+, asked her what she wanted to give, Ca gluc or CaCl. She didn't know anything about the difference between them, instead she thought they had "different bioavailability". She simply couldn't comprehend why it would take 3X as much CaGlu as CaCl to get the same amount of Ca. Mechanism of Ca on the heart muscle? She didn't have a clue.

This is just one example of her lack of understanding of ANYTHING medical in this code. There were several others, but you get the point.

She graduates as DNP in 2 weeks.....

I love nurses (I'm married to one), and I know many terrific NPs. But NP/DNP education is a joke.

this is actually pretty shocking
 
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I loved the original post.
 
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