Hey, why does everyone hate nurse practitioners?

[fab4fan]

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It depends on who you listen to. If you listent to the ANA or the nursing educators then yes they intend to replace the physicians. If you listen to the people actually working in the field then no they want a collaborative model working with physicians. In theory since there are many more NP's in practice this is the voice that should be heard. But the ANA controls the message so now you get "is your doctor an NP".

David Carpenter, PA-C

The ANA claims to be the "voice of nursing." Nothing could be further from the truth. There are millions of nurses here in the US, but membership in the ANA is paltry, at best. Why? Because when they aren't shooting themselves in the foot with yet another "position statement," they're alienating just about everyone involved in healthcare.

 

[fab4fan]

Meanwhile, most of the people being called "nurse" in hospitals and doctors' offices these days are actually nursing assistants or medical assistants...or people with no clinical training whatsoever. IMO, nursing is losing sight of its roots, and seems hell-bent on proving the Peter Principle.

Kudos to all of you who choose to be nurses, first and foremost. We need you.

Thanks. I'll try to remember that later today as I head off to that vortex of doom also known as the ED.

 

[core0]

The ANA claims to be the "voice of nursing." Nothing could be further from the truth. There are millions of nurses here in the US, but membership in the ANA is paltry, at best. Why? Because when they aren't shooting themselves in the foot with yet another "position statement," they're alienating just about everyone involved in healthcare.

In my opinion ANA uses NP's to advance their own political goals. This would be more pay (=more dollars for ANA) and more union membership (CNA and other organizations are unions in addition to their role representing nurses). It could be that they think that DNP will give them a seat at the table equal to MD's or it could be this is simply a bargaining point to get what they want (mandatory patient ratios seem to be the thing lately). So if they need to sacrifice the NP's to get 5:1 staffing ratios which way do you think things would go. Realistically NP's come from nursing but are not of nursing. They are closer to the medical model.

David Carpenter, PA-C

 

[Taurus]

Realistically NP's come from nursing but are not of nursing. They are closer to the medical model.

Of course, the NP's will deny this until they're blue in the face. They want to be known as practicing "advanced nursing", not medicine because they don't want to fall under the jurisdiction of the state Board of Medicine. When they go too far, it will unfortunately take court action to set them straight. 🙄

 

[lawguil]

The inference made was not such a grand leap, given the way midlevels are perceived on this board...
Though I reread the post, and it's clear that the TRAINER made the decision (about the one NP) after 3 missed diagnoses...Hopefully he won't "hate" on the remainder of NPs

Let's get real, however...This board is full of single anecdotal stories of "poor midlevel care" and then the inference is made by young, impressionable MS, who subsequently develop a chip toward midlevels, specifically NPs and CRNAs

Sounds like the clinic NP did terrible histories on 2 of these 3 pts, and just plain dropped the ball...

I have to admit that I do have a sour impression of NP's thus far. Anecdotal? Yes! As others have pointed out, my concern is not about what they now and do really well, but what they don’t know or do very well. Other vocations, based on my very limited experience and my knowledge of the NP educational model, are a less qualified practitioner.

I would add that the NP that I talked about did more than take poor histories. Although important, in orthopedics, a physical exam is quite often where you confirm your suspicions.

1st referral - Grade III AC sprain....FNP evaluated as an RC tear. Perhaps the tenderness of the AC Joint and elevated clavicle or piano key sign would be the dead giveaway.
2nd referral - ACL tear. FNP evaluated it as bursitis. - the joint effusion, quad shutdown and positive lachmans and anterior drawer test might help rule out the bursitis confirmation.
3rd referral - athlete who hit head and had post concussive symptoms. Evaluated by the FNP as unrelated to head trauma and felt that it might be related to a seizure disorder that she had recently read about in a journal. However, wrote a note returning the athlete to play. - bump your head followed by post concussion symptoms = concussion in the world of sports medicine.....even if the symptoms might be from something else!

Are other NP’s on this board comfortable with ortho/sports medicine related issues including evaluation, diagnosis and treatment?

 

[zenman]

Are other NP’s on this board comfortable with ortho/sports medicine related issues including evaluation, diagnosis and treatment?

Since ortho and sports medicine are specialities, I wouldn't think any practitioner, MD/DO/PA/NP, would be comfortable unless they had experience in that area. FYI, there is an ortho book written by an NP.

 

[lawguil]

Since ortho and sports medicine are specialities, I wouldn't think any practitioner, MD/DO/PA/NP, would be comfortable unless they had experience in that area. FYI, there is an ortho book written by an NP.

I don't agree with you entirely! These are basic primary care, urgent care and emergency care issues. If you think that family practitioners, pediatricians and urgent care facilities shouldn't be aware of how to handle the basics of sports medicine and orthopedics.....I whole heartedly disagree.

I think that some folks might agree that a grade III AC sprain (quite simply a shoulder with deformity) might be worthy of an x-ray especially if the practitioner doesn't know how to evaluate it. A patient who can't bear weight comfortably, has obvious joint effusion of the knee, and hurt it playing sports might be worthy of some studies and/or referral, and a possible concussion might indicate some basic balance testing and simply picking one of the more than 20 different concussion management guielines. Never in my 15 years as an ATC have I seen a patient with post concussion symptoms bring back a note from a practitioner returning them to play.

Based on your response and knowing you are an NP, you on some level have implied that you wouldn't feel comfortable with these basic cases. I have worked in sports medicine nearly all my career both in the classroom and as an ATC and have referred hundreds of athletes to emergency rooms and family/pediatric docs and PA's and have never seen such poor healthcare delivery.

This is only my second experience with an NP......Sorry third; my wife was seen by one when she was pregnant.

 

[zenman]

Based on your response and knowing you are an NP, you on some level have implied that you wouldn't feel comfortable with these basic cases.

I'm an NP student..although I sometimes wonder why. I'm basically comfortable with sports injuries...as a bodyworker and nurse in a country of round football fanatics hell bent on tearing themselves apart.

 

[alpha62]

Oh come it's not the complicated.

Everybody hates the NP's because they usually remind them so much of their ex-wife !

 

[deleted6669]

I don't agree with you entirely! These are basic primary care, urgent care and emergency care issues. If you think that family practitioners, pediatricians and urgent care facilities shouldn't be aware of how to handle the basics of sports medicine and orthopedics.....I whole heartedly disagree.

I think that some folks might agree that a grade III AC sprain (quite simply a shoulder with deformity) might be worthy of an x-ray especially if the practitioner doesn't know how to evaluate it. A patient who can't bear weight comfortably, has obvious joint effusion of the knee, and hurt it playing sports might be worthy of some studies and/or referral, and a possible concussion might indicate some basic balance testing and simply picking one of the more than 20 different concussion management guielines. Never in my 15 years as an ATC have I seen a patient with post concussion symptoms bring back a note from a practitioner returning them to play.

Based on your response and knowing you are an NP, you on some level have implied that you wouldn't feel comfortable with these basic cases. I have worked in sports medicine nearly all my career both in the classroom and as an ATC and have referred hundreds of athletes to emergency rooms and family/pediatric docs and PA's and have never seen such poor healthcare delivery.

This is only my second experience with an NP......Sorry third; my wife was seen by one when she was pregnant.

agree-this is very basic stuff that does not require a specialty evaluation initially, maybe down the line but not day 1.
same day ortho consults should be for emergent orthopedic surgical problems......( open fxs needing o.r.i.f., serious infections in joints, etc)
diito the concussion issues....no brainer.....

 

[horsenurse25]

Well, I got kicked very badly by two different horses, both were brown.

Therefore ALL brown horses kick.

Despite the fact that many people like brown horses and never had any problems themselves, all brown horses should be turned into dog food BECAUSE I HAVE SPOKEN...

And we all know that Med students are smarter and more clairvoyant than everyone else.

so there

 

[schutzhund]

Sometimes generalizations are accurate (in general😉 ).

Having seen both sides, I can tell you that it does not surprise me one bit that they missed these injuries. The education is simply not there. Those diagnoses require baseline knowledge of anatomy that is lacking at most (every?) NP program. From my personal experience, the NP curriculum requires about the same level of anatomy as you get at a AP A&P class in HS, or what you can get a community college (like for nurses, EMTs, barbers, etc). You cannot diagnose an AC separation if you don't know what the AC joint is. You cannot accurately diagnose neuro injuries if you have essentially no knowledge of the brain.

This is the problem that I have with NPs and autonomous practice. The education is not even close to what a physician gets. I cannot begin to illustrate this enough. Imagine only taking one semester total of your 1st and 2nd year followed by one semester of your 3rd and 4th and then being allowed to see patients by yourself and write prescriptions with essentially no oversight. Think I'm exaggerating?

Again, I think there is a place for NPs. I think NPs can eventually learn a niche area of medicine, excuse me "advanced practice nursing", pretty well (i.e. ortho). They can be useful in routine tasks and in patient education. The problem is they do not have close to the same level of baseline education to be making independent clinical decisions.

Argue away but until you've done both you argument is all conjecture. Every midlevel I know that later went to medical school will tell you they are amazed and frightened about how little they knew and how much they thought they did.

(BTW, I do not feel this way about most PAs and I have no real problem with the pods or most other fields)

 

[Taurus]

So does anyone here think that the new DNP programs will address these deficits in NP knowledge? Or will we have a situation of NP's who don't know what they're doing but who walk around calling themselves "doctor" anyways?

 

[deleted6669]

So does anyone here think that the new DNP programs will address these deficits in NP knowledge? Or will we have a situation of NP's who don't know what they're doing but who walk around calling themselves "doctor" anyways?

The dnp programs I have seen add around 1000 hrs of clinical time to the 500-800 already in place so a dnp should be a better clinician than an np right out of an ms level np program. this brings np programs closer to the avg clinical time of every pa program(avg 2200 hrs).

 

[zenman]

Well, I got kicked very badly by two different horses, both were brown.

Therefore ALL brown horses kick.

Despite the fact that many people like brown horses and never had any problems themselves, all brown horses should be turned into dog food BECAUSE I HAVE SPOKEN...

And we all know that Med students are smarter and more clairvoyant than everyone else.

so there

Sounds like you got kicked off the hind tit

 

[helpfuldoc2b]

to the o.p.- fyi-
p.a.'s in most states CAN own clinics and hire physicians to do whatever their states require in terms of supervision. in some states it might mean they hire a doc to be there all the time while the pa sees pts, in other states it might mean 10% chart review within 1 month(no onsite md presence at all), while in other states it might mean a documented meeting every 6 months for 30 min to discuss the practice(no chart review or on site md presence at all).
I have several friends who are pa's who own their own clinics in rural, inner city, and suburban locations so I can assure you it is done more often than you think.
the real advantage of pa over np is the ability to change specialty without going back to school.
the real advantage of np over pa is practicing completely independently in the 9 or so states that allow this. many states do require a "collaborating" physician so these np's are truly not independent. other states require a collaborating md if the np desires to write for controlled substances.
it is only 9 or states in which an np can hang their own shingle and work completely independently of an md and have full rx rights.( correct me if I am off on the # here if someone knows the exact # of fully independent np states).

I am just curious, if your so pro-PA and PA Master Defender and think its the greatest field in the world and you can own your own clinic, make tons of money and hire docs under you, why did you give up the profession and go to medical school?! No offense, pure curiousity.

 

[FoughtFyr]

I am just curious, if your so pro-PA and PA Master Defender and think its the greatest field in the world and you can own your own clinic, make tons of money and hire docs under you, why did you give up the profession and go to medical school?! No offense, pure curiousity.

He didn't. Emedpa is still an active PA to the best of my knowledge.

- H

 

[alpha62]

Hillary is going to get elected, because the american public wants us converted to their own personal civil servant serf class.

fighting over who is smarter, better, than the other guy is starting to sound like the last conversation held in the shower room at Auschwitz

 

[Bandit]

I am the one who went to med school after PA school and I feel it gives me a perspective many of you do not.

I also teach and precept PA/NP/MD/DO students clinically at the facility I still work at as a PA.

Helpfuldoc2b--Did you have questions regarding this subject? Or did you simlpy throw a bomb Emeds way?

 

[lawguil]

I am the one who went to med school after PA school and I feel it gives me a perspective many of you do not.

I also teach and precept PA/NP/MD/DO students clinically at the facility I still work at as a PA.

FoughtFyr--Did you have questions regarding this subject? Or did you simlpy throw a bomb Emeds way?

Bandit,

I would love to hear your perspectives on the differences of MD/DO v. PA.
Is the education drastically different?
In your judgement, is PA education inadequate?
Are you happy with your decision to go to med school?

Also, as a preceptor for PA and NP students, do you have any comments about the differences b/t the two?

L.

 

[FoughtFyr]

FoughtFyr--Did you have questions regarding this subject? Or did you simlpy throw a bomb Emeds way?

No bomb. Helpfuldoc2b questioned why emedpa (a member I respect very much) had left being a PA in favor of being an MD. I merely replied that he hadn't (to the best of my knowledge). I also wanted to make it clear that this thread has moderators' eyes on it as the language is getting a bit personal and the discussion degenerating.

- H

 

[deleted6669]

He didn't. Emedpa is still an active PA to the best of my knowledge.

- H

yup, EM PA 18-20 shifts/month.
have thought about medschool but never applied.
probably won't unless a shortened bridge program comes into being.

 

[Bandit]

My apologies Fought FYR--I meant to direct my question to helpfuldoc2b!

I will edit the OP but here is the explaination!!

 

[corpsmanUP]

I am a couple of years ahead of Bandit, having a similar background. I was a PA before I was a doctor, and I can comment on the educational differences in the 2 professions. The major difference is the depth of pathophysiology, the depth of physiology, and the ton of self study required for many of the Shelf exams, and board exams. That is of course in addition to the internal exams for the particular courses. Clinicals were only slightly different. Residents don't let med students out of as much as they let PA students out of, even if it is unconscious. Overall there were just dozens more hurdles to jump over than there were in PA school. PA school has no real hurdle of any kind, with the PANCE exam being easier than some of the Monday morning exams I took covering 3 days of lectures! PA education is undoubtedly very similar to medical school.

 

[zenman]

Hillary is going to get elected, because the american public wants us converted to their own personal civil servant serf class.

I don't know why Hillary wants to run...she already ran the country for two terms!

 

[Faebinder]

I am a couple of years ahead of Bandit, having a similar background. I was a PA before I was a doctor, and I can comment on the educational differences in the 2 professions. The major difference is the depth of pathophysiology, the depth of physiology, and the ton of self study required for many of the Shelf exams, and board exams. That is of course in addition to the internal exams for the particular courses. Clinicals were only slightly different. Residents don't let med students out of as much as they let PA students out of, even if it is unconscious. Overall there were just dozens more hurdles to jump over than there were in PA school. PA school has no real hurdle of any kind, with the PANCE exam being easier than some of the Monday morning exams I took covering 3 days of lectures! PA education is undoubtedly very similar to medical school.

Immunology? Neuroscience? Parasitology? Genetics? Curious now as to how you see those differences.

 

[corpsmanUP]

Immunology? Neuroscience? Parasitology? Genetics? Curious now as to how you see those differences.

My neuro course in PA school was as intense as my med school neuro course. Immunology at most med schools is no longer a course, and the "systems based" format has taken over. You really cannot separate immunology out of pathophysiology and gen physio. We had a course called cell science that incorporated biochem/immuno/embryo, and it was pretty intense. Parasitology?? You must be thinking undergrad. Micro is generally included in pathophys. Just pull out a copy of Robbins Path and see how every one of these topics is incorporated into Path. Same goes for genetics.

 

[prairiedog]

Sometimes generalizations are accurate (in general😉 ).

Having seen both sides, I can tell you that it does not surprise me one bit that they missed these injuries. The education is simply not there. Those diagnoses require baseline knowledge of anatomy that is lacking at most (every?) NP program. From my personal experience, the NP curriculum requires about the same level of anatomy as you get at a AP A&P class in HS, or what you can get a community college (like for nurses, EMTs, barbers, etc). You cannot diagnose an AC separation if you don't know what the AC joint is. You cannot accurately diagnose neuro injuries if you have essentially no knowledge of the brain.

This is the problem that I have with NPs and autonomous practice. The education is not even close to what a physician gets. I cannot begin to illustrate this enough. Imagine only taking one semester total of your 1st and 2nd year followed by one semester of your 3rd and 4th and then being allowed to see patients by yourself and write prescriptions with essentially no oversight. Think I'm exaggerating?

Again, I think there is a place for NPs. I think NPs can eventually learn a niche area of medicine, excuse me "advanced practice nursing", pretty well (i.e. ortho). They can be useful in routine tasks and in patient education. The problem is they do not have close to the same level of baseline education to be making independent clinical decisions.

Argue away but until you've done both you argument is all conjecture. Every midlevel I know that later went to medical school will tell you they are amazed and frightened about how little they knew and how much they thought they did.

(BTW, I do not feel this way about most PAs and I have no real problem with the pods or most other fields)

How would you explain the MD missing these things? Or are you suggesting a MD would never miss these "things"?

 

[horsenurse25]

Sounds like you got kicked off the hind tit

Horses don't have 'hind tits'. They only have two teats. 🙄

 

[lawguil]

How would you explain the MD missing these things? Or are you suggesting a MD would never miss these "things"?

In my 15 years of experience as an athletic trainer/teacher - physicians have never missed a suspicious or possible ACL tear (I have seen them suspect an ACL tear and then it be something less) never miss-diagnosed an AC separation and never miss diagnosed a concussion. It's not because they are perfect. It's because the cases mentioned above are easy and straight forward.
Just my experience, L.

 

[horsenurse25]

Of course, since this is anonymous board and no one is required to produce the burden of proof... there is a real possibility that you have various insecurities about mid-levels and made the entire situation up.

(Just throwing that out there to see who bites...😛 )

 

[prairiedog]

In my 15 years of experience as an athletic trainer/teacher - physicians have never missed a suspicious or possible ACL tear (I have seen them suspect an ACL tear and then it be something less) never miss-diagnosed an AC separation and never miss diagnosed a concussion. It's not because they are perfect. It's because the cases mentioned above are easy and straight forward.
Just my experience, L.

You have made my point. I didn't think it would be that easy! Thanks

 

[lawguil]

Of course, since this is anonymous board and no one is required to produce the burden of proof... there is a real possibility that you have various insecurities about mid-levels and made the entire situation up.

(Just throwing that out there to see who bites...😛 )

horsenurse25,

I think my record on this board stands for itself - good or bad. Please feel free to review any and all of my previous posts, many of which express my support for PA's. I have had very limited exposure to NP's (about 3 experiences). Two bad and the other was when my wife was pregnant. We switched practitioners because the women kept trying to be our buddy and acted so motherly....It was uncomfortable. The other two were just absolutely disturbing. One FNP didn't even know what Hodgkin’s disease was and the other was an indirect experience exposing the incompetence of an NP in the area primary care orthopedics and sports medicine.

My experience with PA's has been great. As I have said before, I admit that I do have a sour impression of NP's thus far. Anecdotal? Yes! As others have pointed out, my concern is not about what they now and do really well, but what they don’t know or do very well. Based on my very limited experience and my knowledge of the NP educational model, they are the least qualified practitioner.

I’m not removed from the fact that practitioners are often wrong and make mistakes. But I think I could ask any family physician/PA in the world what Hodgkin’s disease was and they could respond on the spot with a detailed answer that is right. I think we could ask any physician/PA in the world where the AC joint is and they could provide the right answer. I think we could ask any family physician/PA in existence what some of the red flag signs are that would cause them to suspect an ACL tear. And I’m also quite positive that we could expect that any physician/PA in this country could identify, do an appropriate neurological evaluation, and follow at least some basic protocol or guidelines about return to sport.

The fact is, the NP’s I’ve experienced don’t even know! How do you miss a GRADE III AC seperation (grade one-maybe) How do you diagnose a knee that is twice the size the contra-lateral side as bursitis, how do you take an athlete who hit their head playing sport, was experiencing post-concussion symptoms and return them to sport thinking it was something else? As a primary care provider, on the front lines of health care, not know what Hodgkin’s disease is?

Surely, this is Anecdotal. Do any NP’s want to talk about their didactic and clinical education in orthopedics and oncology?

 

[lawguil]

You have made my point. I didn't think it would be that easy! Thanks

I respect what you're saying, but I'm not sure that I understand what you're saying.

Despite the fact that I've clearly taken a position, I'm more than willing to entertain (and hope) that I am wrong. Please tell me about your education in orthopedics and oncology that represent the entry-level standard in nursing, RN or NP.

Could you find the AC joint? Would you recognize what a grade III AC separations looks like (you can almost diagnose it with a persons shirt on!)? Would you recognize a description of the right mechanisms that cause ACL tears, an effused knee, quad shutdown, painful weight bearing? Could you perform the basic knee tests during a physical evaluation? The family docs/PA's that I have dealt with the last 15 years can! Could you recognize the red flags of lymphoma?

 

[zenman]

Could you find the AC joint? Would you recognize what a grade III AC separations looks like (you can almost diagnose it with a persons shirt on!)?

Can you, without any history from a fully clothed patient, run your hands above their body and ID problems?

I swear medical education is lacking

I see you're in New England. I was just in Lenox, MA a few weeks ago. How close are you? I might be there again in the future.

 

[horsenurse25]

I respect what you're saying, but I'm not sure that I understand what you’re saying.

Despite the fact that I've clearly taken a position, I'm more than willing to entertain (and hope) that I am wrong. Please tell me about your education in orthopedics and oncology that represent the entry-level standard in nursing, RN or NP.

Could you find the AC joint? Would you recognize what a grade III AC separations looks like (you can almost diagnose it with a persons shirt on!)? Would you recognize a description of the right mechanisms that cause ACL tears, an effused knee, quad shutdown, painful weight bearing? Could you perform the basic knee tests during a physical evaluation? The family docs/PA's that I have dealt with the last 15 years can! Could you recognize the red flags of lymphoma?

Whatever. 🙄 🙄

My 11 year old son is doing basic anatomy for his 5th grade class and knows what the AC joint is. Maybe I should send him over to your clinic to help you out??? 😛

You don't like NP's. That is fine. But you had better get used to them because they are taking over a clinic near you!!!😱 😱

There, that might send him into a blind panic. 😀

Perhaps you have seen a couple crappy NP's. But it is funny that such an incompetent bunch of numbskulls are such a growing segment of the health care system. Maybe they are only good for really confident, non-threatened physicians.

I am a NP, and a darn good one. But I also work closely with an excellent MD and we confer constantly with each other. I for one do not think that NP's should be independent, they are mid-level after all. But we do great work, save the system money and save the MD wear and tear on their time and energy.

You should try one...!
Some of us are Damn Good Lookin'

 

[corpsmanUP]

Whatever. 🙄 🙄



You don't like NP's. That is fine. But you had better get used to them because they are taking over a clinic near you!!!😱 😱
Some of us are Damn Good Lookin'

Couple of points:
Just because you invade the chiropractors turf (coming to a strip center near you) doesn't mean you are coming anywhere near taking over medicine. As long as women are getting UTI's and OCD people need their weekend Keflex to "prevent their cold", you will have a job. And you can have that crap, because you can't mess it up, and we don't want it.

Next, there are some damn good looking Philipino transexuals!!

 

[prairiedog]

Couple of points:
Just because you invade the chiropractors turf (coming to a strip center near you) doesn't mean you are coming anywhere near taking over medicine. As long as women are getting UTI's and OCD people need their weekend Keflex to "prevent their cold", you will have a job. And you can have that crap, because you can't mess it up, and we don't want it.

Next, there are some damn good looking Philipino transexuals!!

Corpsman were you as frustrated as a PA as you are now? What is the real reason you hate NPs? Job security? rejection? Your arguments are clouded by your hostility. Have you read the book “ The secret”, positive thoughts may enable you to articulate your position with less bias.

 

[Taurus]

Corpsman were you as frustrated as a PA as you are now? What is the real reason you hate NPs? Job security? rejection? Your arguments are clouded by your hostility. Have you read the book “ The secret”, positive thoughts may enable you to articulate your position with less bias.

I can assure you that corpsmanUP is not the only one who doesn't like autonomous NP's and DNP's. PCP's are poorly organized and have done little to push back. As soon as the NP's start to try to invade the medical specialties, I can assure you that you will see a much stronger response. We have watched and learned the modus operandi of NP's and CRNA's. I am proud to say that I have been actively involved in raising awareness in one specialty where there is a nascent midlevel group.

 

[zenman]

Next, there are some damn good looking Philipino transexuals!!

I guess you haven't dated any of the Thai ones, then😀

 

[chimichanga]

...Just because you invade the chiropractors turf (coming to a strip center near you)...

My last two PCPs (physicians) were in strip centers, one next to the Safeway, and the other next to a barbershop...what's youir point, ALL chiros are less than worthy because they are in a strip center?

 

[alpha62]

I workin a rural health clinic that treated pts in the front, and ran a lumber mill in the back.

You could hear the buzz saw radiating from the floor to the table to the pt with every heart exam.

I treated some pts after hours in a my hut in the ville in Korea. A thriving whorehouse operating 24/7 in the room next to me

It can always be worse, and they can always hurt you more.

My last two PCPs (physicians) were in strip centers, one next to the Safeway, and the other next to a barbershop...what's youir point, ALL chiros are less than worthy because they are in a strip center?

 

[horsenurse25]

Couple of points:
Just because you invade the chiropractors turf (coming to a strip center near you) doesn't mean you are coming anywhere near taking over medicine. As long as women are getting UTI's and OCD people need their weekend Keflex to "prevent their cold", you will have a job. And you can have that crap, because you can't mess it up, and we don't want it.

Hmm. I thought MDs are supposed to care for all infirm people, regardless of how much any individual affliction excites you or not.

Silly me. I guess medicine is all about you.

Further, real doctors - you know the ones who are actually MDs, not wanna-bes - appreciate the mid-levels and realize their worth. In fact, even on the SDN doctor interviews, the 3 doctors that work with them (the fourth doesn't work in that capacity) express positivie views.

Next, there are some damn good looking Philipino transexuals!! .

Oooohhhh. So THAT is the way you swing then.

 

[MedicineFoundMe]

I respect what you're saying, but I'm not sure that I understand what you’re saying.

Despite the fact that I've clearly taken a position, I'm more than willing to entertain (and hope) that I am wrong. Please tell me about your education in orthopedics and oncology that represent the entry-level standard in nursing, RN or NP.

Could you find the AC joint? Would you recognize what a grade III AC separations looks like (you can almost diagnose it with a persons shirt on!)? Would you recognize a description of the right mechanisms that cause ACL tears, an effused knee, quad shutdown, painful weight bearing? Could you perform the basic knee tests during a physical evaluation? The family docs/PA's that I have dealt with the last 15 years can! Could you recognize the red flags of lymphoma?

I am a NP. I can absolutely do all those things, but not because of my training. NPs have to learn this stuff on their owns which in my opinion makes it harder to be than a MD or PA. At least you have a structured formal education to teach you this. I had to write papers for two years then teach myself. Luckily, I am extremely smrt.

I have worked with NPs that don't understand this, and those are the ones that could **** up a wet dream. That MS stuff is easy... you just have to be exposed to it a few times.

And just so you know... a grade III AC sep doesn't need surgery, unless you just want it to look pretty again. GASP!!!! "This is what I'm talking about, you NPs Blah blah blah blah". It came from the ortho MD I referred him to. So there.

 

[chimichanga]

... NPs have to learn this stuff on their owns which in my opinion makes it harder to be than a MD or PA. At least you have a structured formal education to teach you this. I had to write papers for two years then teach myself. Luckily, I am extremely smrt...

ahh yes...sitting back waiting for the flaming to begin...should be good for at least 2 more pages of responses...

 

[YupGypsy]

I am a NP. I can absolutely do all those things, but not because of my training. NPs have to learn this stuff on their owns which in my opinion makes it harder to be than a MD or PA. At least you have a structured formal education to teach you this. I had to write papers for two years then teach myself. Luckily, I am extremely smrt.

You can sure make an effective argument.

 

[YupGypsy]

To the OP: I would go where your heart is. A NP is vastly different from a MD. Different philosophy, different training. A NP deals more in prevention and holistic care, a MD fixes things (or tries to). A NP usually has more time and interest in the whole patient. A MD is more interested in the hole in the patient.

Wow, that is so deep.

Wait, where did I hear this before? Oh, that's right, it's the EXACT SAME dogma that family practitioners preached in the 60's. If you hadn't noticed, everyone's promulgating "holistic care" so much now that it has lost its worth. Hardly groundbreaking.

You guys are better hand-holders, though, I'll give you that.

 

[lawguil]

I am a NP. I can absolutely do all those things, but not because of my training. NPs have to learn this stuff on their owns which in my opinion makes it harder to be than a MD or PA. At least you have a structured formal education to teach you this. I had to write papers for two years then teach myself. Luckily, I am extremely smrt.

I have worked with NPs that don't understand this, and those are the ones that could **** up a wet dream. That MS stuff is easy... you just have to be exposed to it a few times.

And just so you know... a grade III AC sep doesn't need surgery, unless you just want it to look pretty again. GASP!!!! "This is what I'm talking about, you NPs Blah blah blah blah". It came from the ortho MD I referred him to. So there.

Thanks for your honest response! I also agree that most grade III AC sprains don't need surgery except for cosmetic reasons. TF Schlegel MD published a paper in the AJSM (2001) and found that 4 out of 20 conservatively treated Grade III AC sprains felt that their long term outcome was less than optimal and only 1 out of the 20 wished they had persued surgery.

 

[brightness]

I've been following along. It really is disappointing to read that a field I had so much interest in (nursing) is not as promising as I once thought. I don't like the idea of needing to "teach myself"...and although I am not sure if medicine is enough of a passion to go to medical school, I am still entertaining that possibility.
I've had reservations about being an NP- actually, I wanted to go into nurse midwifery, because I am very interested in holistic care and I felt that being a CNM would reach that goal. I still do feel that way- but, I want to be competent and good at what I do. Although I feel that PAs and even doctors are less holistic than I prefer, I am more comfortable with their knowledge base and scope of practice.

 

[SupergreenMnM]

I am a NP. I can absolutely do all those things, but not because of my training. NPs have to learn this stuff on their owns which in my opinion makes it harder to be than a MD or PA. At least you have a structured formal education to teach you this. I had to write papers for two years then teach myself. Luckily, I am extremely smrt.

I have worked with NPs that don't understand this, and those are the ones that could **** up a wet dream. That MS stuff is easy... you just have to be exposed to it a few times.

And just so you know... a grade III AC sep doesn't need surgery, unless you just want it to look pretty again. GASP!!!! "This is what I'm talking about, you NPs Blah blah blah blah". It came from the ortho MD I referred him to. So there.

Sorry, but from my perspective this is exactly what makes NPs so scarey to me! I bet there are good ones, like you seem to be, that do learn on their own...but would you be so willing to accept, say, the next airline pilot you travel with if he said 'they taught me how to fly a single engine, I'm teaching myself how to fly this 747!' ?