How do we stop nurse practitioners?

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This is exactly why people claiming anesthesiologists will go the way of the dinosaur are completely wrong- without anesthesiologists as a buffer against hospital litigation, hospitals would lose millions in malpractice claims. Comparatively, anesthesiologists running supervision function as a relatively cheap form of insurance.
Imagine how the job market would be if there were no CRNAs... It might not go the way of the dinosaur, but they will bring down wages considerablely...

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Imagine how the job market would be if there were no CRNAs... It might not go the way of the dinosaur, but they will bring down wages considerablely...
It remains to be seen. Perhaps, perhaps not. They've been saying anesthesiologist wages would decline for two decades now, that there'd be no jobs, etc.
 
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"...they don't have to go through an algorithm or to consult someone else to figure out what to do. A physician knows the right thing to do, they know when to do it, and they know how to do it efficiently, effectively, and safely."
 
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Why are doctor's from other specialties commenting on how great cRNa's are when it's out of their scope of practice and they don't even know anything about anesthesia?
 
Nope. Those are pathophysiology, pharmacology, etc.

Not all NP online schools are this lax.


I wonder at this whole idea about "all online" NP online programs. I can't think of any programs in my area that are all online NP and do not require the procurement of practicum hours.

It's just not true that clinical/practicums are not required. I think the difference is that some programs leave it to the NP to procure the necessarily clinical/practicums--the students must find them and have them appropriately evaluated, while other and in my view, better programs/schools provide them completely within their programs.

No accredited program or board of licensing will allow for no clinical/practicum hours.
I am not saying the clinical/practicum hours are nearly enough. What I am saying is that clinical hours are required, and doing core, coursework online would not be enough to meet the requirements for licensure as an NP.
 
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The "worthwhile" money comes from going after the organization or hospital.
So, even if CRNAs get more independence in practice, the experts running the lawsuits will try to go after the bigger money. If these organizations, clinics, and hospitals want to take the risk of not having adequate supervision of CRNAS--that is, by board certified anesthesiologists, that will only put them at higher risk.

When there are enough unsupervised "mishaps," hospitals and organizations will say, "It's not worth having unsupervised CRNAs." At that point, it will be tougher for CRNAs to get jobs--add to that the glut of SRNA to CRNAs being pushed out of the academic assembly lines.
I don't see anesthesiology being tossed aside. I think the field is relatively secure; although salaries may well go down in the future; but I can't see them going down too far.
 
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@jin lin but it's only 500-1000 hrs of preceptorship


Doesn't include the clinical practicums in programs necessarily, and it varies by states. Furthermore, some boards require a certain amount of clinical hours as a RN before acceptance into the program.

As I said, IMHO, it's no where near enough required, evaluated hours. I will say, however, that I know of some exceptions based on their years and levels of experience.
But what we are seeing more and more of today are limitations on this.

You used to see nurses going for advanced practiced education and certification, etc, AFTER many years of acute or critical care experience. Just about anyone with a 3.0 GPA can get in--w/ the exception of a few programs that say, if you are under 3.2, you have to get a certain score on the GRE.

I don't know of any CRNA programs that do not require clinical experience and a certain GRE before acceptance.

Places like University of Pennsylvania have some solid programs, but I still say these programs should require vey specific and more lengthy clinical experience and of course more graduate education hours under supervision.

If I were to consider an advanced practice program it would only be like one of the above.
And especially for something like CRNA, I would not want to practice without anesthesiology oversight. I don't think it is fair to the patients.

Sorry CRNAs. I just can't sign off on no BC anesthesiologist supervision.
 
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And the preceptorship quality varies DRASTICALLY from program to program. I knew some NP students that had to find their own preceptors, it was ridiculous.

Right. Plus, how well can you, all alone, fully vet your preceptor/s? I mean maybe, to some degree, but the advantage of programs like U of P is they are hooked up with good sources/in-house/network systems.

Yes, I hate to say it, but w/ education, sometime it is about getting what you pay for.
 
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@jl lin you also have to consider that hours of general RN training or on the floor are not the same as these are in a vastly different role that that of the medical decision maker. While critical care RNs certainly have some role in this, comparing the hrs of clinical training while obtaining an RN or MSN (not NP) to medical school is no more reasonable than counting hrs as an EMT or some other health profession towards training as an MD.

Basically NPs who have bypassed the critical care experience requirement have roughly 1k hrs of potentially questionable clinical training as the decision maker and are out independently practicing, this is less than a 3rd year med student. Can anyone explain how this makes sense?
 
Like some DO schools?
Actually, even at LECOM, they come from predetermined sites, though those sites can be scattered all over the country:

http://forums.studentdoctor.net/threads/wvsom-vs-lecom-b.1169754/#post-17131154

"I am a current 3rd year at LECOM-B on rotations. My experience is people confuse shaky clinicals with a lot of freedom. There are year long sites available if you want to go to a particular location for an entire year. Sites are available in Florida (Orlando, Miami, St. Pete, Brandon, Pensacola), New York, Erie Pennsylvania. There is also a list of spots available for students if they would like to rotate month to month around the country. That list includes physicians from almost every state. If you want to set up your own, you are free to do that but you need to keep in contact with the school about what you are doing."

Would love to know of any where you just have to find preceptors though.
 
(Exactly! This is what i am concerned about. And this is one of major reasons of me not going toward primary care. I dont want others with pathetic background thinking that they can do as good as i do)



The Np is here to stay. It's a matter of economics and big business. No matter what amount of lobbying you do with fellow professionals things won't change. They meet the economic needs of rural communities, and sadly whittle away at the job market in the large cities.

There is but one solution, you have to change.

I faced a similar situation as a maintenance electrician. Studied hard, obtained all my licenses, worked in Aerospace. The building manager refused to have electricians on the night shift, he gave that work to the Air Conditioning mechanic. Crossing union lines of work is a no-no. Everyone know it, but it happens. I looked at the situation and I change. I went back to school to get extra-high voltage training.

This is work that puts the fear of God into every A/C mechanic ( and quite a few electricians)

However, I earn more money, work less, and never have to worry about another craft doing my job.

Perhaps this will point you into the right direction.



F14
 
@jl lin you also have to consider that hours of general RN training or on the floor are not the same as these are in a vastly different role that that of the medical decision maker. While critical care RNs certainly have some role in this, comparing the hrs of clinical training while obtaining an RN or MSN (not NP) to medical school is no more reasonable than counting hrs as an EMT or some other health profession towards training as an MD.

Basically NPs who have bypassed the critical care experience requirement have roughly 1k hrs of potentially questionable clinical training as the decision maker and are out independently practicing, this is less than a 3rd year med student. Can anyone explain how this makes sense?

Well, if you read, I am not exactly disagreeing with you. But it is not as simple as taking some glorified online correspondence courses either. LOL.

I mean actually what you have stated is one of my HUGE beefs w/ just about all of these kinds of programs.

At least in GME, even if there is some amount of subjectivity, you are being guided, supervised over a long period of time and have rigid standards to meet.

I had actually thought about CRNA b/c of my CCRN experience and even though I was sick when I took the exam, I enjoyed taking the CCRN, b/c it was challenging in it's own right. I like looking at studies and learning more than the basics. But I have worked long enough and have enough sense to know that I would be a fool to work as a total independent CRNA w/o the back-up of reputable, BC anesthesiologists. It's unsafe, and I just wouldn't do it, period. In fact, honestly, you couldn't pay me twice the normal about that CRNAs get to work independently. I would be scared ****less at the more complicated cases. I have worked long enough to know that Murphy's Law is very real. When crap hits the fan, the more and better quality support, guidance, and help, the better.

PS @TwinsFan , it doesn't make sense. It's idiotic.
 
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Interesting. So when people say they have to "set up their own rotations" for 3rd year, that's coming off a list the school already has, and has preumably vetted to some degree? That makes me feel better.

This is the case.
 
Is that the case for your school where you are setting up core 3rd year rotations from their list of affiliates?

Yes. You can add to the list, but it must be approved and vetted by the school. Normally (~99.9% of the time) you just use something from the pre-approved list.
 
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Yes. You can add to the list, but it must be approved and vetted by the school. Normally (~99.9% of the time) you just use something from the pre-approved list.

Would you have to set it up yourself even if it were from the pre-approved list?
 
Would you have to set it up yourself even if it were from the pre-approved list?

Except for core rotations which are set up by the school.

Otherwise yes. It's pretty straightforward. Unless you pick one that no one has used in a while it's a matter of emailing the rotation site to secure a spot and then they let the school know. You get a confirmation email and that's that.

I like it because it lets me essentially "audition" at places I'd like to do a residency at. Also it lets me see what it's like at various hospitals and if I'd even consider a residency there.
 
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I personally have a few issues with NPs, however I do still think they are useful. I do think in the current state they will be hurting more then helping long term.

I understand their original purpose is to help cover the physician shortage, and aid physicians however now it is being used as a political move.
First of all, I have heard of NPs referring to themselves in a healthcare environment, that is not good. It is not ethical. It is like a PA calling themselves a doctor, they are not, just like NPs are not. The NPs I have encountered in some states are god awful, others are good. I think in states with "restricted access" should be the primary model. It is ridiculous for someone with half the training of the doctor to have all the responsibilities of one. I have seen NPs used in a proper capacity(such as the NP rounds, diagnoses minor conditions, as does the PA, basically does more basic stuff the doctor does not want or feel the need to do, the NP then reports to the MD what she did and the MD can decide what cases he wants to take a second look at, and gives him a lot more freedom to take more complicated cases). That is the proper capacity, however NPs are vying to be equal to MDs, in fact DNPs think they should be called doctors which is ridiculous. Being a doctor is the highest position in a field. MD is the doctorate for the field of medicine, and considering NPs are practicing medicine, saying their midlevel degree is a doctorate would be an awful thing to say imo.
 
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This is from a NP...

"Aside from surgery and a few other specific areas NP work in the same capacity as physicians"

Are these people delusional?
 
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why stop ? just do your thing
 
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This is from a NP...

"Aside from surgery and a few other specific areas NP work in the same capacity as physicians"

Are these people delusional?
Yes.

"He who knows not and knows not that he knows not is a fool...shun him."

The Dunning–Kruger effect is a cognitive bias in which relatively unskilled individuals suffer from illusory superiority, mistakenly assessing their ability to be much higher than it really is. Dunning and Kruger attributed this bias to a metacognitive inability of the unskilled to recognize their own ineptitude and evaluate their own ability accurately.
 
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I personally have a few issues with NPs, however I do still think they are useful. I do think in the current state they will be hurting more then helping long term.

I understand their original purpose is to help cover the physician shortage, and aid physicians however now it is being used as a political move.
First of all, I have heard of NPs referring to themselves in a healthcare environment, that is not good. It is not ethical. It is like a PA calling themselves a doctor, they are not, just like NPs are not.

You are mistaken my friend. Now you can earn an illustrious Doctorate of Nursing Practice (or Nurse Practitioner'ing or whatever it's called) degree and voila! You're a doctor.
 
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Just happened to stumble upon this thread and as a pharmacist, this makes me happy :).

Sent from my ONE A2005 using Tapatalk

Lol you guys are like the only people who are excellent at your job, actually do useful things that people appreciate and don't try to put on airs about being a "doctor"
 
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Yes.

"He who knows not and knows not that he knows not is a fool...shun him."

The Dunning–Kruger effect is a cognitive bias in which relatively unskilled individuals suffer from illusory superiority, mistakenly assessing their ability to be much higher than it really is. Dunning and Kruger attributed this bias to a metacognitive inability of the unskilled to recognize their own ineptitude and evaluate their own ability accurately.
I feel like this could be a reason why less bright/talented people can go really far in business and other pursuits that require a charm/charisma/artistry vs some sort of concrete knowledge. They don't know their limits and/or the mediocrity of their work, so they're not as afraid to put their work out there. More chances you take (or the more products you push), the greater your chances of success. Impostor syndrome probably hits the exceptionally talented and gifted people a lot harder, resulting in greater self doubt and overanalyzing. That's a shame.
 
Lol you guys are like the only people who are excellent at your job, actually do useful things that people appreciate and don't try to put on airs about being a "doctor"

It's an issue of acknowledgement and respect. We're the experts in our (admittedly narrow and specialized) slice of healthcare. Just as we defer to physicians in directing patient care, it's appreciated when you guys are willing to defer to us on issues of pharmacotherapy. That's worth more to me (and most pharmacists I know) than a title.

Also APNs are terrible at returning pages. /rant
 
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The problem is when midlevels want to become terminal providers who work independently (i.e. not "mid" anything)

I'm all for work-life balance. Most people going down the PA/NP care more about lifestyle than advancing their knowledge or becoming excellent providers. Unfortunately, many doctors and doctors in training today have drifted towards that mentality as well. This is how we help close the gap between the value we provide and that of midlevels.
Most people going down the PA/NP route may have hopes of transforming their lifestyle, however, there are many who truly want to create change in healthcare. While you say this is the case with NP/PA's, I'm very positive we've all seen the same with physicians too. There are some that don't give a rat's a$$ either because they were expected to become a physician, and it wasn't all what it was cracked up to be, or they've become disenchanted because the medical care services arena has changed. We are now serving a broken system that doesn't know what to do to fix itself. Companies/Hospitals are running nurses and support staff into the ground amidst staff shortages, while demanding patient turnover rates from physicians. Who WOULDN'T be angry and defensive at this point?! Physicians feel stifled by foolish, greedy demands made by corporate idiots. No wonder half of the people on this forum are angry regarding the influx of midlevel's and questioning their career choice, or threatening "sexual harassment" as a way to get rid of NP's? (I chuckled at that one, since nurses get sexually harassed by patients numerous times a day).

At the same time, nurses feel stifled for similar reasons and experience similar existential crises. The amount of physical, emotional, and mental labor that goes into nursing is absolutely ridiculous--nobody wants to do it! Most nurses came into the field with the hope that they could make a difference in someone's life, when in reality,---they are treated with disrespect by both the employer and the people they serve. I have become a legal drug dealer/waitress/teacher/janitor/babysitter/body guard/paper shuffler/court reporter with mounds of repetitive documentation, etc. Sometimes I never eat lunch. Sometimes I hold my urine for 12 hours and completely forget about it because I was busy monitoring multiple patient statuses, and their needs were more important than mine. --While I would like to get away from this lifestyle, I also have the ridiculous idea that I can help renovate health care into something it should have been all along: holistic, personal, and preventative. Suddenly, I am reminded of the harsh reality that nobody will ever pay for that because it makes too much sense. Then there are other days I feel that health care will NEVER change as long as we keep the current systems in place, and if I "can't beat 'em,---JOIN 'em" in their greed. However, that's not me. That's not why I became a nurse and that's NOT why I'm becoming a nurse practitioner. Yes, the money may be a little better than a travel-nurse job---MAYBE.... BUT, I want to really help influence how care is delivered. I want to take my bedside experience and use it far beyond traditional medicine. I want to use it to help empower and educate patients besides throwing prescriptions/pills at them. Many of my physician coworkers have supported this and encouraged me to make this step for years. It's sad to come to a forum where nurses/np's/pa's are not welcome. I came to crash the party and remind you all that you're very valuable and we need you just as much as you need us, obviously. :)

As far as value goes? Yeah, I challenge you to do that---for the sake of your patients. If NP's/PA's challenge you to do that, then I hope you always have someone to inspire/anger/empower you to do better than you did yesterday. Because while there are some really good physicians, there are also some really awful ones we have to put up with and vice versa. So, let's agree in saying that not all physicians are alike. Because they aren't. There are some physicians and surgeons that I wouldn't let touch me with a 50 foot pole after seeing their patient outcomes--(yes, nurses notice that stuff). Same goes with NP's/PA's. Some patients would rather see a physician, while some of them would rather see the PA/NP. Some of them couldn't care less. It's a balance--and that's why you'll always have your job.

But, here's an idea: Imagine a sick population that is continually growing (because it is). Now imagine the immense stress and strain of having to see all of those patients with wait times up to 6 months? Some of them are critically ill. Would you rather them have to wait that long? Is that fair healthcare? Yes, you could hire another physician, but that's a lot of money--plus training and startup, and STILL won't reduce the wait-time by much. OR, you could hire several very qualified, top-notch NP's/PA's, etc.,--resulting in less money spent, plus--------the workload gets divided. You save money and increase your revenue as well. As a consequence, patients are happy/happier because they've been seen/and/or treated, and you don't have to refer them to someone else instead. There's also value in that. Think about it.
 
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a family member emailed me the other day about how she didn't understand why her "psychiatrist" wanted to change her medication. I looked the person up - it's an NP. my family member doesn't work in healthcare and had no idea that she was seeing someone who is not a doctor because this NP markets herself as a psychiatrist to patients who don't know any better

I realize this post was from several years ago, but let's be honest here: most patients don't know any better, anyway. No offense to your family member, but this is an observation of the general public. I'm absolutely positive that the NP did not mean to NOT specify that they were an NP. I personally would have told the patient that I was an NP, however, this should CLEARLY be apparent on a business card or on the outside of the building, ORRRRRR somewhere else. Maybe she didn't think she HAD to specify because of designations listed (as mentioned before). Here's the catch: did she blatantly say "I'm Dr. Such-n-Such?" perhaps because she's a DNP? Or did she address herself on a first name basis, as most NP/PA's do? I think midlevel's assume that everyone knows they are a "midlevel" when they introduce themselves on a first name basis. I also believe that it's the patient's responsibility to look at the corresponding credentials on the card to see who they are dealing with while waiting to be seen, especially in a climate where physicians are not the only providers these days. Again, that's probably asking too much of the general public. You can barely ask people to turn off their cellphones these days without them getting offended or without having to offer an explanation of "WHY."
 
Has anyone had any sort of intellectual contest with mid-levels who claim they have equal knowledge to physicians? Seems kind of petty, but after all this time of biting your tongue, you'd think someone would have said, "Okay, you say you can do it equally well or know just as much, so let's run through a bunch of scenarios and see how you do..."

You know, an intellectual, nerdy "3 pm by the swing set" scenario...
 
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Has anyone had any sort of intellectual contest with mid-levels who claim they have equal knowledge to physicians? Seems kind of petty, but after all this time of biting your tongue, you'd think someone would have said, "Okay, you say you can do it equally well or know just as much, so let's run through a bunch of scenarios and see how you do..."

You know, an intellectual, nerdy "3 pm by the swing set" scenario...

I believe that was done by having a group of NPs try to pass Step 3. The results were not inspiring. I'll try to find a source.
 
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Request Rejected

"Candidates must pass a certification exam for the degree of “Doctor of Nurse Practice.” However, this exam, while cribbed from the United States Medical Licensing Exam (USMLE) Step 3 exam that is required of physicians and only one component of physician licensure, is smaller in scope and uses discontinued questions. Only 50 percent of the first cohort to take the DNP exam earned a passing grade."

I'm trying to link to the PDF which can be found at www.aafp.org/dam/AAFP/documents/advocacy/workforce/gme/ES-FPvsDNP-110810.pdf
 
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Yes, it did. You just changed it...

Anyway, I was confused about your status.
Yes, I changed it but there must have been a delay in between the time it updated and you said "...why your 'status' says 'Resident [Any field]'?" I had literally just joined about an hour before, couldn't find an accurate status, then later went back in, scoured the list to find something close, changed it, and then you posted minutes later. But yeah, I can totally see how you were confused about my status!
 
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Yes, I changed it but there must have been a delay in between the time it updated and you said "...why your 'status' says 'Resident [Any field]'?" I had literally just joined about an hour before, couldn't find an accurate status, then later went back in, scoured the list to find something close, changed it, and then you posted minutes later. But yeah, I can totally see how you were confused about my status!

So, you are new around here. You might consider changing your avatar to something that doesn't identify you. SDN is best experienced in anonymity, the better to be able to have candid conversations about professional matters without having an employer or co-worker or admissions director or patient come upon something you said and take it out of context.
 
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So, you are new around here. You might consider changing your avatar to something that doesn't identify you. SDN is best experienced in anonymity, the better to be able to have candid conversations about professional matters without having an employer or co-worker or admissions director or patient come upon something you said and take it out of context.

Thanks for the suggestion. I was about to change that as well earlier after seeing one of the SDN policies.
 
Has anyone had any sort of intellectual contest with mid-levels who claim they have equal knowledge to physicians? Seems kind of petty, but after all this time of biting your tongue, you'd think someone would have said, "Okay, you say you can do it equally well or know just as much, so let's run through a bunch of scenarios and see how you do..."

You know, an intellectual, nerdy "3 pm by the swing set" scenario...
Well, I had one NP student who told me she is learning the same thing that physicians learn in 4 years. She just graduated about 2 weeks ago, and she posted a graduation pic in Facebook, and below that pic was: 'Congratulations to me'. I have never seen someone congratulate him/herself before. Maybe I don't live in the real world.
 
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I just refer to them as midlevels constantly because that is what they are. I feel like as physicians we are pressured to be "nice" and "team players" but we have gotten soft in doing so and now I see NPs and PAs not wanting to be referred as a midlevels and wanna be called some other nonsense to float their self esteem boat. You can't have your cake and eat it too. If you want good hours, minimal debt, and a good salary be an NP/PA recognizing you are a MIDLEVEL. If you want to be trained at the highest level and call the shots, pay your dues, go to med school, incur the ridiculous debt, go through the indentured servitude of residency, and then come out of it as TOPLEVEL.
 
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