Bill for Independent Nurse Practice in Mental Health

[sunlioness]

and...OMG, dramatic much?

Perhaps. But then again, I'm not the one dealing in personal insults to anonymous people on the Internet based only on a few lines of text with which I find fault. This seems a clear case of the pot calling the kettle black.

Might I suggest that if we continue to discuss such a highly charged topic that we back up our assertions with data? There's a lot of research out there looking these questions. But most of us here (myself included) seem to be arguing based on emotion and unsupported assumptions/opinions. It might be far less unpleasant if we looked to some of that data.

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[Indodo]

Might I suggest that if we continue to discuss such a highly charged topic that we back up our assertions with data? There's a lot of research out there looking these questions. But most of us here (myself included) seem to be arguing based on emotion and unsupported assumptions/opinions. It might be far less unpleasant if we looked to some of that data.

Okay go! Start here.

...the most competent, humble, conservative, and effective clinicians...I hope we hire more.

And board certification doesn't have any more of a psychotherapy component than asking some multiple choice questions about it...I think psychologists and even masters level counsellors get more exposure and on the job practice doing it than we do.

 

[PistolPete]

I get so tired every time I read these kinds of bills in congress... if these people wanted to be doctors, why didn't they go to medical school?

 

[Armadillos]

I feel conflicted about the NP situation. On one hand it completely makes sense to me that there should be a path for a nurse with 15 years working experience to transition to a more physician like role w/o going through the entirety of medschool/residency.

But on the other hand it seems absolutely insane to have a NP system where people pretty much go straight through from the beginning with the intention of getting a NP asap

 

[OldPsychDoc]

I get so tired every time I read these kinds of bills in congress... if these people wanted to be doctors, why didn't they go to medical school?

Maybe they didn't want to be doctors.
Maybe they wanted to be an advanced practice nurse and work at the fullest extent of that role.
Maybe they're good at it.
Maybe we should focus on being good at our role, too.

 

[sunlioness]

I feel conflicted about the NP situation. On one hand it completely makes sense to me that there should be a path for a nurse with 15 years working experience to transition to a more physician like role w/o going through the entirety of medschool/residency.

But on the other hand it seems absolutely insane to have a NP system where people pretty much go straight through from the beginning with the intention of getting a NP asap

I was talking with one of our NP's about this this week. I brought it up with her because I was dismayed by some of the attitudes expressed here and wanted to know if these were attitudes she'd commonly run into. I was there for the next 5-10 minutes listening to a litany of her and her colleagues negative experiences dealing with physician attitudes to the point of downright exploitation in some cases. She told the other NP that I had asked her about it and he cornered me in the hallway and said, "Believe me, Dr Lioness. You have no idea." And that right after I had dinner with a PA friend of mine. He had recently changed jobs and I asked him why. Apparently, his doc insisted that my friend take his hospital call. Something for which he was neither qualified nor credentialed.

Anyway the NP I originally talked to supports independent practice with reservations. She believes they need a residency program first. She then added, "Honestly, if so many docs weren't complete jerks to midlevels, independent practice probably wouldn't even be a thing."

 

[hamstergang]

Anyway the NP I originally talked to supports independent practice with reservations. She believes they need a residency program first. She then added, "Honestly, if so many docs weren't complete jerks to midlevels, independent practice probably wouldn't even be a thing."

So is this more like the NP saying:
a) "Those docs were jerks to me, so I want to practice independent of them just so I don't have to deal with them."
or
b) "Those docs were jerks to me, so I want to take over their job and practice independently even though I don't feel qualified to do so."

 

[sunlioness]

I don't believe that's what she said at all, no.

 

[hamstergang]

I don't believe that's what she said at all, no.

So then how should I interpret that line?

 

[Nasrudin]

I never understood the presumed link between interpersonal demeanor and workforce politics. The fact that I don't think NP's, of the current iteration and level of training, belong anywhere near the independent clinical market, doesn't mean I go kick them in the shins at my earliest opportunity. For many reasons, not the least of which, is weaponized use of being offended that has been inculcated into their camps and codependently supported by ours.

 

[Indodo]

I never understood the presumed link between interpersonal demeanor and workforce politics. The fact that I don't think NP's, of the current iteration and level of training, belong anywhere near the independent clinical market, doesn't mean I go kick them in the shins at my earliest opportunity. For many reasons, not the least of which, is weaponized use of being offended that has been inculcated into their camps and codependently supported by ours.

Perfect.

 

[Zenman1]

Maybe they didn't want to be doctors.
Maybe they wanted to be an advanced practice nurse and work at the fullest extent of that role.
Maybe they're good at it.
Maybe we should focus on being good at our role, too.

Pretty much describes my life…at least the part I can talk about.

 

[heyjack70]

I think there are a number of difficulties when challenging ARNPs on scope of practice, regardless of how appropriate the challenge may be. One, they are likely the most ambitious of all RNs pursuing ARNP training, or else they would just stay as RNs. I think they tend towards very strong, type-A personalities and this makes for a very charged debate if their point of view is challenged. Two, most RNs are women, and most ARNPs are women, and a man arguing against a woman about what she can do is almost inherently assumed to be sexist in the present day. Three, from a political standpoint, it's not just MD/DOs vs ARNPs, it's MD/DOs vs ARNP's plus every other type of nurse out there...which is a ton of support on the non-MD/DO side. For example, if there is a bill for independent practice rights and a legislator gets 100 letters from physicians, they might get 1000 letters from various types of Nurses, from Nursing assistants up through RNs and ARNP/CRNAs. So the deck is really stacked in the nurse's favor. Anyone have any ideas on preventing independent practice.

I still support zip code or county restrictions for independent practice to move the NPs into the high need areas they are intended to help cover. It makes no sense to have a practice of 20 NP's in downtown Manhattan while other areas have no psychiatric providers at all.

 

[Therapist4Chnge]

Initially conceived, the NP made sense....before independant practice...and DEFINITELY before direct-entry programs that strip out all practical "on the job" experience that was such a large part of the initial proposal.

 

[Indodo]

Maybe they didn't want to be doctors.
Maybe they wanted to be an advanced practice nurse and work at the fullest extent of that role.
Maybe they're good at it.
Maybe we should focus on being good at our role, too.

Since independently practicing NPs want to essentially have our scope, this is pointless.
Unless you are implying that psychiatry residency programs don't serve a purpose in their current form. In that case perhaps this may come down to where someone trained. While their are inferior programs out there I don't think even the best NP training approximates it but I can't be sure. I know that no NP could get the training I got as a psychiatrist, not even close.