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

[efex101]

that we are even freaking discussing this is unf+++cking real. is an LPN the same as an NP? DNP that is what you are basically trying to compare.

---

Members don't see this ad.

 

[W19]

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.

It's not even apples to oranges... It's apples to rabbits...

 

[winkleweizen]

Rn, bsn, LPN, NP, dnp. The more initials behind your name, the more worthless you are to me.

 

[Fox800]

this is actually pretty shocking

Nothing shocks me any more when it comes to noctors.

 

[W19]

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.

First year med school anatomy and neuroscience... Unbelievable what these people are able to get away with!

 

[W19]

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.

It's not MLP... It's mostly NP that are clueless. Most PA are great from what many physicians told me.

 

[deuist]

I once had a NP who worked in a cardiology clinic tell me he didn't know what WPW is. I'm really not sure what the NP students are learning, but patient care isn't it.

 

[Boatswain2PA]

I once had a NP who worked in a cardiology clinic tell me he didn't know what WPW is. I'm really not sure what the NP students are learning, but patient care isn't it.

Another great example of the difference between PA education and NP/DNP education. PA education is standardized by the NCCPA, so every single PA receives rigorous cardiology courses. Then we all take the same certification exam, which has significant cardiology questions on it (including WPW). Then we all take the same re-certification exam, which also has cardiology on it. This means that while I wouldn't expect the PA who has worked in orthopedic surgery for the past 15 years to be able to explain how blocking the AV node in a WPW a-fibber will cause V-fib, that PA does know what WPW is. I would expect them to be able to identify the irregularly irregular, variable QRS, short PR, and delta wave as WPW and say "waiiiiiiittttt a minute....let's call someone" And that is the same expectation you would have with an orthopedic surgeon or other non-EM or non-cards specialist.

If a "Cardiology NP" doesn't know about WPW, then shame on that NP and the cardiologist they work for. Like I said before, there are some terrific NPs out there who overcome their lack of medical education by self-study. Likewise, the cardiologist this NP worked for must put up with their medical ignorance. The cardiologist likely just uses the NP as a "professional rounder"; doing the admission H&Ps and documenting inpatient rounding.

 

[exsanguination]

I would expect them to be able to identify the irregularly irregular, variable QRS, short PR, and delta wave as WPW and say "waiiiiiiittttt a minute....let's call someone" And that is the same expectation you would have with an orthopedic surgeon or other non-EM or non-cards specialist.

I think you have unreasonably high expectations my friend

This is perhaps the reason you're so on top of your game and probably have the knowledge base of a physician in many respects. I've seen your posts, and you're the very small minority of MLPs.

 

[Boatswain2PA]

exang - unreasonably high expectation of non EM or Cards specialist doing basic EKG readings? Yeah, probably so because physicians are lucky in that they don't have to take standardized tests for recertification where we do.

I don't think I'm at the top of the game. There are LOTS of PAs who can school me day in and day out. And I learn from Docs on every single shift.

 

[VisionaryTics]

exang - unreasonably high expectation of non EM or Cards specialist doing basic EKG readings? Yeah, probably so because physicians are lucky in that they don't have to take standardized tests for recertification where we do.

We do, we just take tests focused on our specialty.

 

[Mad Jack]

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.

Let's flip the analogy a bit:

"You nurses believe your training makes you superior to the cleaning staff. I guarantee if you didn't have environmental services, you'd change your attitudes real quick."

Your statement is bull**** because it doesn't elevate nursing's training in any way. We have different skill sets and we can't survive without one another. Nurses are the ones with hubris, believing that they can, more often than not, do everything a doctor can do and that doctors are unnecessary. We never claim to not need nurses, but simply that they should stick to their own jobs, just as the people that clean the floors shouldn't be giving your meds, because they lack the training and competence.

 

[Boatswain2PA]

We do, we just take tests focused on our specialty.

Of course. My brain said "generalized", but fingers typed "standardized". PAs are following the MD path and changing from 6 year recertification to your 10 year recertification.

This is another place where NP/DNPs lack education. I believe once they pass their test, the have NO additional recertification tests...just CME. PAs on the other hand are following the historical model for MDs. We began with a standardized general medicine test, and we have recently added Certificate of Additional Qualification (CAQ) for specialists. While today's PAs still take the standardized general medicine PANCE/PANRE, I think in 10-15 years we will follow the MD field and strictly test and recertify in our specialty.

 

[Mad Jack]

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.

To echo this sentiment for the op-

Our flight teams around here intubate fairly frequently, but we use RT/RN teams, and the RT does the intubation. I've never seen a patient a team actually put a chest tube in though, or a central line for that matter. Most of what flight teams do is transfers around here. Sure, they get called for a trauma every day or so, but on the timeline of a trauma pickup and drop off, doing a chest tube is just irresponsible and more likely to cause harm than good. They get trained to do emergency crics, needle decompressions, and chest tubes, amongst other things, but these are all skills that they pray they never have to use because it probably means something has gone way worse than expected and their patient is likely going to die in the meantime. A needle decompression here and there isn't a big deal, but you don't want to be doing an emergent pericardiocentesis that you've only done in a sim lab on a patient for the first time while you're flying in a tin box in the sky.

 

[deleted547339]

Another great example of the difference between PA education and NP/DNP education. PA education is standardized by the NCCPA, so every single PA receives rigorous cardiology courses. Then we all take the same certification exam, which has significant cardiology questions on it (including WPW). Then we all take the same re-certification exam, which also has cardiology on it. This means that while I wouldn't expect the PA who has worked in orthopedic surgery for the past 15 years to be able to explain how blocking the AV node in a WPW a-fibber will cause V-fib, that PA does know what WPW is. I would expect them to be able to identify the irregularly irregular, variable QRS, short PR, and delta wave as WPW and say "waiiiiiiittttt a minute....let's call someone" And that is the same expectation you would have with an orthopedic surgeon or other non-EM or non-cards specialist.

If a "Cardiology NP" doesn't know about WPW, then shame on that NP and the cardiologist they work for. Like I said before, there are some terrific NPs out there who overcome their lack of medical education by self-study. Likewise, the cardiologist this NP worked for must put up with their medical ignorance. The cardiologist likely just uses the NP as a "professional rounder"; doing the admission H&Ps and documenting inpatient rounding.

I LOVE my ortho buddies (my best friend is an orthopod), but if I asked him about a delta wave, he would assume it had to do with surfing...

 

[RustedFox]

I LOVE my ortho buddies (my best friend is an orthopod), but if I asked him about a delta wave, he would assume it had to do with surfing...

I caught a great delta wave last week, brahh.

 

[Boatswain2PA]

I caught a great delta wave last week, brahh.

Did it look like the wave in my profile pic? ;-)

 

[RustedFox]

Did it look like the wave in my profile pic? ;-)

No waaayy, brahh.

 

[Arcan57]

Keanu's blank visage is a mirror upon which anything can be projected. You could just replace the Rorschach with silenced video clips of his movie dialogue and I don't think you'd lose much accuracy. In other news, I'm superstoked they're making a John Wick 2.

 

[BoardingDoc]

No waaayy, brahh.

No, I have never fired my gun up in the air and gone AAAAAH!

 

[kenjixshadow]

@Mad Jack @RustedFox @Boatswain2PA had OP like

@Arcan57

 

[Birdstrike]

No waaayy, brahh.

Remember the part where he sky dived down from a plane and onto a wave? Didn't he do something as insanely bad ass as that, or am I thinking of something else?

Keaneu-"Yeah, braaaahhh---jkbrahhhhhhhh--ahhhh"

Swayze-"Yaa mon"

Point Break. Classic

 

[Birdstrike]

Here it is!

 

[TooMuchResearch]

Great. Movie.

 

[Birdstrike]

Great. Movie.

Lol yes! Ridiculous

 

[deleted547339]

RustedFox - you should be ashamed of what you've done to this threat, lol.

 

[Birdstrike]

RustedFox - you should be ashamed of what you've done to this threat, lol.

I like it better now. He should be given a medal.

 

[BoardingDoc]

I like it better now. He should be given a medal.

Oh wait, wrong website.

 

[HLxDrummer]

Just wanted to say thanks for this thread. Sadly I haven't laughed this much in a while (on my surgery rotation...).

 

[NursingStudent16]

Rn, bsn, LPN, NP, dnp. The more initials behind your name, the more worthless you are to me.

Just goes to show that you don't appreciate your nurses.

 

[diphenyl]

Jane Smith, RN, ASN, BSN, FNP, DNP, CPR, ACLS, BLS, LMFAO, PhD, ROTFL

 

[Druggernaut]

Just goes to show that you don't appreciate your nurses.

That's not true. Emergency medicine is probably one of the specialties that appreciates its nurses most, since they're some of the best in the hospital and we work so closely with them.

The alphabet soup, however, smacks of insecurity and compensation. Much like your posts.

 

[Boatswain2PA]

Just goes to show that you don't appreciate your nurses.

You don't understand the difference between association and causation, and therefore you are (once again) getting butt-hurt when there was no disrespect given.

It is not the letters behind the nurses' name that makes the nurse useless, but rather it is the nurses who use (and rely on) their titles that are most likely to be useless.

 

[RustedFox]

GUYS GUYS GUYS: FOUND THE OP!

Nursing Student Sues University after Failing Class Twice

DALLAS, Pa. (AP) — A nursing student who says anxiety and depression made it difficult for her to concentrate has sued a northeastern Pennsylvania university after twice failing a required course.

Jennifer Burbella claims her Misericordia University professor didn’t do enough to help her pass a class on adult health patterns.

She said the professor gave her a distraction-free environment and extra time for her final exam when she took the class a second time but didn’t respond to telephoned questions as promised, creating even more stress.

Burbella says the lack of help caused her to break down crying.

She says the Catholic university near Wilkes-Barre gave another disabled student better accommodations and that her treatment violated a federal disability discrimination law.

The Citizens’ Voice reports the Stroudsburg woman is seeking more than $75,000 in damages.

A Misericordia spokesman told the newspaper it doesn’t comment on pending litigation.

Burbella entered the university’s nursing program in 2010 and struggled toward a bachelor’s degree in nursing because of her conditions, the lawsuit says, and experienced great anxiety from social and academic challenges and family medical issues.

After failing the first time, Burbella says the university forced her to re-take the class in a summer session beginning four days later, causing “great trepidation.”

Misericordia has an undergraduate enrollment of about 3,200 students.

 

[Psai]

GUYS GUYS GUYS: FOUND THE OP!

Nursing Student Sues University after Failing Class Twice

DALLAS, Pa. (AP) — A nursing student who says anxiety and depression made it difficult for her to concentrate has sued a northeastern Pennsylvania university after twice failing a required course.

Jennifer Burbella claims her Misericordia University professor didn’t do enough to help her pass a class on adult health patterns.

She said the professor gave her a distraction-free environment and extra time for her final exam when she took the class a second time but didn’t respond to telephoned questions as promised, creating even more stress.

Burbella says the lack of help caused her to break down crying.

She says the Catholic university near Wilkes-Barre gave another disabled student better accommodations and that her treatment violated a federal disability discrimination law.

The Citizens’ Voice reports the Stroudsburg woman is seeking more than $75,000 in damages.

A Misericordia spokesman told the newspaper it doesn’t comment on pending litigation.

Burbella entered the university’s nursing program in 2010 and struggled toward a bachelor’s degree in nursing because of her conditions, the lawsuit says, and experienced great anxiety from social and academic challenges and family medical issues.

After failing the first time, Burbella says the university forced her to re-take the class in a summer session beginning four days later, causing “great trepidation.”

Misericordia has an undergraduate enrollment of about 3,200 students.

With a school name like that, no wonder. Girl needs to get over it though, if you have anxiety and depression from class how will you handle real patients

 

[Birdstrike]

Can we get back talking about iconic, low budget movies from the late '80s and early '90s, please?

"Nobody puts baby in a corner" -Patrick Swayze

(Good part at 00:20)

 

[RustedFox]

Swayze was freaking awesome. I'm bummed that he died of pancreatic CA. Believe it or not, I PubMed'ed "pancreatic cancer prevention" the other day (hey, the ghost of Johnny Castle must have come to me or something), and I found a rather interesting article about chemoprevention with some pretty common oral drugs/neutraceuticals.

http://www.ncbi.nlm.nih.gov/pubmed/23404329

 

[Birdstrike]

Swayze was freaking awesome. I'm bummed that he died of pancreatic CA. Believe it or not, I PubMed'ed "pancreatic cancer prevention" the other day (hey, the ghost of Johnny Castle must have come to me or something), and I found a rather interesting article about chemoprevention with some pretty common oral drugs/neutraceuticals.

http://www.ncbi.nlm.nih.gov/pubmed/23404329

More classic Swayze (notice Charlie Tiger Blood in back. Lol)

 

[chtdrmn]

I know that I am late to the party on this, but I felt that I should, as a nurse, clarify certain things to the "nurses" who have posted on this thread. As nurses, we don't know jack ****. Plain and simple. Yes we gain experience that increases our level of understanding, but we don't know medicine no matter how "certified" we are.

As a nurse, I know how to carry out orders prescribed by the physician. I know the signs and symptoms of very basic "red flags" that need to be relayed to them so that they can come in behind us to assess the patient and modify treatment. Just because I know lab values and the difference between normal/abnormal findings doesn't mean I understand medicine. It means that I'm the eyes and ears for the physician, but I'm not the brain so-to-speak.

Nursing school is a joke. It's laughable. Good lord, I can't even say it's worthy of an undergraduate degree. You spend an entire semester learning how to bathe patients, make beds, and hold hands. I passed nursing school just by reading Wikipedia 30 minutes prior to the exam. I never went to class, and I sure as hell didn't buy any books. Male and female reproductive anatomy have more in common than nursing does to medicine. Nursing is important, but don't even begin to pretend that you can compare it to medicine.

Currently, I'm a flight nurse/paramedic. I have a ton more autonomy than any other nurse related field except possibly CRNAs. With that said, I don't start slamming tubes or lines in patients without radioing the doc and saying look we've tried everything else and the patient will die if we don't do it. The doc respects our assessment, verifies that it's a last resort, then we proceed. I've done needle decompressions often, chest tubes every now and then, I've trached more patients than I care to, but I have only done 1 central line placement. She was a burn patient with zero peripheral access and it was a last resort to initiate fluid resuscitation.

All I do is stabilize patients and hand them over to a higher level of care, which guess what, is an ER physician or trauma surgeon because I don't know **** about medicine. I know skills and competencies, I can assess, I can stabilize, and I can treat via protocol that were set forth by MDs, but I cannot diagnose because, once again, I don't know medicine.

MSN level providers are vastly a joke especially now that many of them don't require any expertise. CRNAs are excluded simply because they are highly specialized in the nursing profession. All the other practitioner programs are just evidenced based practice nursing that is so simple every child understands. To prevent hospital acquired infections you must wash your hands. No ****? Really?

I digress. I love my job as a nurse, and I support nursing. I also have common sense and respect, so I understand why MDs get paid more and do more, same with PAs. I just can't stand people thinking they deserve more without working for more. Much respect to the MDs and PAs who practice medicine. I practice nursing, and other nurses need to realize the difference. As a nurse, it's embarrassing to be associated with nurses who are holier and mightier than thou.

 

[docdragon]

Swayze was freaking awesome. I'm bummed that he died of pancreatic CA. Believe it or not, I PubMed'ed "pancreatic cancer prevention" the other day (hey, the ghost of Johnny Castle must have come to me or something), and I found a rather interesting article about chemoprevention with some pretty common oral drugs/neutraceuticals.

http://www.ncbi.nlm.nih.gov/pubmed/23404329

That is GREAT. So if I chew willow bark, eat turmeric, and nosh broccoli then life is good!

chtdrmn -- common sense, good communication and a team approach make a gold platinum diamond star nurse. i heart. oh, and a sense of humor and a spoonful of sugar!

 

[kmb1908]

I know that I am late to the party on this, but I felt that I should, as a nurse, clarify certain things to the "nurses" who have posted on this thread. As nurses, we don't know jack ****. Plain and simple. Yes we gain experience that increases our level of understanding, but we don't know medicine no matter how "certified" we are.

As a nurse, I know how to carry out orders prescribed by the physician. I know the signs and symptoms of very basic "red flags" that need to be relayed to them so that they can come in behind us to assess the patient and modify treatment. Just because I know lab values and the difference between normal/abnormal findings doesn't mean I understand medicine. It means that I'm the eyes and ears for the physician, but I'm not the brain so-to-speak.

Nursing school is a joke. It's laughable. Good lord, I can't even say it's worthy of an undergraduate degree. You spend an entire semester learning how to bathe patients, make beds, and hold hands. I passed nursing school just by reading Wikipedia 30 minutes prior to the exam. I never went to class, and I sure as hell didn't buy any books. Male and female reproductive anatomy have more in common than nursing does to medicine. Nursing is important, but don't even begin to pretend that you can compare it to medicine.

Currently, I'm a flight nurse/paramedic. I have a ton more autonomy than any other nurse related field except possibly CRNAs. With that said, I don't start slamming tubes or lines in patients without radioing the doc and saying look we've tried everything else and the patient will die if we don't do it. The doc respects our assessment, verifies that it's a last resort, then we proceed. I've done needle decompressions often, chest tubes every now and then, I've trached more patients than I care to, but I have only done 1 central line placement. She was a burn patient with zero peripheral access and it was a last resort to initiate fluid resuscitation.

All I do is stabilize patients and hand them over to a higher level of care, which guess what, is an ER physician or trauma surgeon because I don't know **** about medicine. I know skills and competencies, I can assess, I can stabilize, and I can treat via protocol that were set forth by MDs, but I cannot diagnose because, once again, I don't know medicine.

MSN level providers are vastly a joke especially now that many of them don't require any expertise. CRNAs are excluded simply because they are highly specialized in the nursing profession. All the other practitioner programs are just evidenced based practice nursing that is so simple every child understands. To prevent hospital acquired infections you must wash your hands. No ****? Really?

I digress. I love my job as a nurse, and I support nursing. I also have common sense and respect, so I understand why MDs get paid more and do more, same with PAs. I just can't stand people thinking they deserve more without working for more. Much respect to the MDs and PAs who practice medicine. I practice nursing, and other nurses need to realize the difference. As a nurse, it's embarrassing to be associated with nurses who are holier and mightier than thou.

This. ALL of this.

 

[RustedFox]

That is GREAT. So if I chew willow bark, eat turmeric, and nosh broccoli then life is good!

I take turmeric as an adjunctive therapy for inflammatory bowel disease (NOT "irritable bowel disease). There is a clear and noticeable improvement in all of my symptoms. No joke.

 

[Angry Birds]

The very first day of my residency we had a patient that required intubation. I was shaking in my boots, but my attending told me, "Don't sweat intubation. Even a monkey can learn how to intubate. Whether you can do mechanical skills or not is a very minor part of being a good doctor."

What he was alluding to was that it is the mental part that makes a good doctor. Someone who knows what to do and when to do it. So, even if a NP learned how to intubate, so what? I can teach someone off the street how to intubate. Does that make them an ER doctor? It's the mental aspect--the years and years of education--that makes a doctor. It's the rigors of an at least 3-4 year residency that makes a doctor. There is no way to fast track that.

I respect and like the nurses I work with. They are vital to the work I do, and I thank them for that. But, this doesn't mean that they could do my job, nor would I be particularly good at theirs. We work in two completely different roles.

Imagine if LPN's were claiming that they were just as, or almost as, qualified as RN's, and that they could do all the same things an RN could do. Would RN's be upset or not? So why the surprise when doctors get upset at the encroachment by NP's? What occupation is NOT upset when another less qualified person encroaches on their livelihood?

 

[Psai]

The very first day of my residency we had a patient that required intubation. I was shaking in my boots, but my attending told me, "Don't sweat intubation. Even a monkey can learn how to intubate. Whether you can do mechanical skills or not is a very minor part of being a good doctor."

What he was alluding to was that it is the mental part that makes a good doctor. Someone who knows what to do and when to do it. So, even if a NP learned how to intubate, so what? I can teach someone off the street how to intubate. Does that make them an ER doctor? It's the mental aspect--the years and years of education--that makes a doctor. It's the rigors of an at least 3-4 year residency that makes a doctor. There is no way to fast track that.

I respect and like the nurses I work with. They are vital to the work I do, and I thank them for that. But, this doesn't mean that they could do my job, nor would I be particularly good at theirs. We work in two completely different roles.

Imagine if LPN's were claiming that they were just as, or almost as, qualified as RN's, and that they could do all the same things an RN could do. Would RN's be upset or not? So why the surprise when doctors get upset at the encroachment by NP's? What occupation is NOT upset when another less qualified person encroaches on their livelihood?

It's funny how CRNAs get all upset about AAs when they're much more similar to one another than they are to anesthesiologists