IOM supports removing scope of practice restrictions from Nurses

[Denatured]

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Doctor shortage looming? Use nurses, US report says

By Maggie Fox, Health and Science Editor

WASHINGTON, Oct 5 (Reuters) - Nurses can handle much of the strain that healthcare reform will place on doctors and should be given both the education and the authority to take on more medical duties, the U.S. Institute of Medicine said on Tuesday.

A report from the institute calls for an overhaul in the responsibility and training of nurses and says doing so is key to improving the fragmented and expensive U.S. healthcare system -- President Barack Obama's signature political initiative.

"We are re-creating nursing in America," Dr. Risa Lavizzo-Mourey, president and CEO of the nonprofit Robert Wood Johnson Foundation, said at a news conference.

"We believe that this report and the implementation of its findings is vital to the strength of healthcare in this nation," she said.

The foundation, which promotes healthcare reform and funds research on the issue, worked with the Institute of Medicine on the report.

Nurses already often deliver babies, counsel patients with heart disease or diabetes and care for dying cancer patients -- and these roles should be expanded nationally and paid for by both public and private insurers, the report says.

"Nurses have to be full partners with doctors," said Donna Shalala, a former Health and Human Services secretary who helped write the report. She said it should "usher in golden age of nursing" by allowing nurses to practice "to the full extent of their education and training."

DOCTOR SHORTAGE ANTICIPATED

The U.S. healthcare reform law passed in March is expected to add 32 million Americans to health insurance company rolls. Several groups, including the Institute of Medicine, have forecast shortages of doctors to provide care.

Last month, the Association of American Medical Colleges released new estimates that showed 63,000 more doctors would be needed in 2015 than would be available. [ID:nN30276233]

"We evaluated the evidence which has been accumulating now for decades as to the capability of nurses to bridge that gap," said Dr. John Rowe of the Columbia University Mailman School of Public Health, one of the report's authors.

"There have been concerns in the past that nurses could provide the quality and safety for some areas of primary care. The committee concluded that it was very clear from the evidence that nurses can very effectively and safely ... deliver those primary care services."

The United States has more than 3 million nurses, making them the single-largest segment of the healthcare workforce, said the non-partisan institute, which advises the federal government on medical matters.

It said states, federal agencies and healthcare organizations should remove so-called "scope of practice" barriers that limit what nurses may do.

The U.S. government and non-profit organizations should fund grants and scholarships to allow nurses to further their educations so they can take on bigger responsibilities.

"We really need to use nurses to their full potential," Shalala said.

By 2020, 80 percent of nurses should have a bachelor's degree at least and 10 percent of them should go on to get a doctorate degree, the report recommends. Many nurses now practice with a two-year certificate.

 

[Denatured]

The Future of Nursing: Leading Change, Advancing Health
Released:
October 5, 2010
Type:
Consensus Report
Topics:
Health Care Workforce, Quality and Patient Safety, Health Services, Coverage, and Access
Activity:
Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine
Board:
Studies under the IOM Executive Office
With more than 3 million members, the nursing profession is the largest segment of the nation’s health care workforce. Working on the front lines of patient care, nurses can play a vital role in helping realize the objectives set forth in the 2010 Affordable Care Act, legislation that represents the broadest health care overhaul since the 1965 creation of the Medicare and Medicaid programs. A number of barriers prevent nurses from being able to respond effectively to rapidly changing health care settings and an evolving health care system. These barriers need to be overcome to ensure that nurses are well- positioned to lead change and advance health.

In 2008, The Robert Wood Johnson Foundation (RWJF) and the IOM launched a two-year initiative to respond to the need to assess and transform the nursing profession. The IOM appointed the Committee on the RWJF Initiative on the Future of Nursing, at the IOM, with the purpose of producing a report that would make recommendations for an action-oriented blueprint for the future of nursing. Through its deliberations, the committee developed four key messages:

Nurses should practice to the full extent of their education and training.
Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States.
Effective workforce planning and policy making require better data collection and information infrastructure.
The United States has the opportunity to transform its health care system, and nurses can and should play a fundamental role in this transformation. However, the power to improve the current regulatory, business, and organizational conditions does not rest solely with nurses; government, businesses, health care organizations, professional associations, and the insurance industry all must play a role. Working together, these many diverse parties can help ensure that the health care system provides seamless, affordable, quality care that is accessible to all and leads to improved health outcomes.

 

[deleted87716]

However, the power to improve the current regulatory, business, and organizational conditions does not rest solely with nurses

Really? Gee, thanks for clearing that up. 🙄

 

[PharmBound2011]

"Nurses have to be full partners with doctors," said Donna Shalala


When did nurses and doctors become FULL partners?

 

[Denatured]

"Nurses have to be full partners with doctors," said Donna Shalala


When did nurses and doctors become FULL partners?

They aren't. That's what the Institute of Medicine is trying to change. The article takes it out of context. It says full partners in the reshaping of the health care system, not clinically. It's only advocating the removal of barriers to practice.

 

[drift]

I find it quite odd that PA's were completely excluded from the "600 page comprehensive study." They are better trained for primary care then any NP and still I only hear of Nurse Practitioners pushing for more power. Why would an NP get "full extent of their license" (fluffy way to say independent practice), while a PA, who is higher trained, still have supervisory requirements?

Why would an NP be reimbursed 100% of a Physician while a PA only gets reimbursed 85% ?!

Personally, I think this is just bizarre. If you want more primary care doctors, then increase residency slots and produce more physicians, not more Nurses.

Give nurses more training, then give them a bigger scope of practice. Walk before you run.

 

[deleted87716]

Despite all of the criticism heaped on the AMA in recent years, they're starting to sound like the only sane people around.

http://www.ama-assn.org/ama/pub/news/news/nursing-future-workforce.shtml

AMA Responds to IOM Report on Future of Nursing

Physician-led team approach to care helps ensure high quality patient care and value for health care spending

For immediate release:
Oct. 5, 2010

Statement attributable to:
Rebecca J. Patchin, MD
Board Member, American Medical Association

“With a shortage of both physicians and nurses and millions more insured Americans, health care professionals will need to continue working together to meet the surge in demand for health care. A physician-led team approach to care—with each member of the team playing the role they are educated and trained to play—helps ensure patients get high quality care and value for their health care spending.

“Nurses are critical to the health care team, but there is no substitute for education and training. Physicians have*seven or more years of postgraduate education and more than 10,000 hours of clinical experience, most nurse practitioners have just*two-to-three years of postgraduate education and less clinical experience than is obtained in the first year of a three year medical residency. These additional years of physician education and training are*vital to optimal patient care, especially in the event of a complication or medical emergency, and patients agree. A*new study shows that 80 percent of patients expect to see a physician when they come to the emergency department, with*more than half*of those surveyed willing to wait two more hours to be cared for by a physician.

“The AMA is committed to expanding the health care workforce so patients have access to the care they need when they need it. With a shortage of both nurses and physicians, increasing the responsibility of nurses is not the answer to the physician shortage. Research shows that in states where nurses can practice independently, physicians and nurses continue to work in the same urban areas, so increasing the independent practice of nurses has not helped solve shortage issues in rural areas. Efforts to get health care professionals in areas where shortages loom must continue in order to increase access to care for all patients.”

 

[drift]

Despite all of the criticism heaped on the AMA in recent years, they're starting to sound like the only sane people around.

http://www.ama-assn.org/ama/pub/news/news/nursing-future-workforce.shtml

👍

 

[Denatured]

You didn't read the study because they are mentioned (I know because I read all 506 pages), but this study was on nursing as a whole. But they do make references to physician assistants. The article also calls for more postgraduate residencies, so again I see you did not read it.

I find it quite odd that PA's were completely excluded from the "600 page comprehensive study." They are better trained for primary care then any NP and still I only hear of Nurse Practitioners pushing for more power. Why would an NP get "full extent of their license" (fluffy way to say independent practice), while a PA, who is higher trained, still have supervisory requirements?

Why would an NP be reimbursed 100% of a Physician while a PA only gets reimbursed 85% ?!

Personally, I think this is just bizarre. If you want more primary care doctors, then increase residency slots and produce more physicians, not more Nurses.

Give nurses more training, then give them a bigger scope of practice. Walk before you run.

 

[tkim]

You didn't read the study because they are mentioned (I know because I read all 506 pages), but this study was on nursing as a whole. But they do make references to physician assistants. The article also calls for more postgraduate residencies, so again I see you did not read it.

Curious you said you read it but it's 587 pages - not 506.

 

[Denatured]

Curious you said you read it but it's 587 pages - not 506.

Ok, ok, you got me. I skipped the section on international nursing. I care little about the state of nursing in the phillipines.

 

[tkim]

Ok, ok, you got me. I skipped the section on international nursing. I care little about the state of nursing in the phillipines.

It was an important section, and the importation of international nurses to the US will have an impact.

 

[maceo]

the healthcare field is so disgustingly against physicians. in one breath, they add on extra years to residency saying x amount of years is not enough to practice said field competently. ...this happened in a number of residencies. and then they say.. well nps can practice independently making medical decisions.. i repeat medical decisions.. without even attending medical school, without even taking the required science classes (as undergrads, thats as basic as you get) to understand truly what they are doing. And the people (PAs) who can truly step up to the plate to fill in the gap they leave out of the equation entirely. WTF? how can anyone look at the health care industry and take it seriously when this is what is going on.. NOt to mention the huge nursing shortages that is going on.. If nurses wanted to be doctors,... they should go to medical school..

 

[altap]

I agree with drift, they should increase the number of residency slot in primary care and if I may add, teaching hospitals should start providing observerships (paid or not) to foreign born FMGs who want to go into primary care. Let's face it, not too many american med grads and US born FMGs would go into primary care because of school debt. What do you do if there is a physician shortage? Churn out more physicians.

 

[drift]

You didn't read the study because they are mentioned (I know because I read all 506 pages), but this study was on nursing as a whole. But they do make references to physician assistants. The article also calls for more postgraduate residencies, so again I see you did not read it.

You can't go to nursing school and somehow do a "medical residency" and call yourself a physician. You would just be a nurse, who did a residency to increase her nursing skills.

Medical School + Residency = Physician

NP + Residency = Residency trained...NP

 

[drift]

http://allnurses.com/nurse-practitioners-np/md-do-np-65769.html

^
This shows their intent. They're discussing who should be called a "Physician" and some nurses are actually very convinced that they themselves are PHYSICIANS!!!!

Holy F*CK ?!?!!?!


If anything even close to what is proposed goes through anywhere, I absolutely cannot imagine how degrading it would feel for the highly qualified IM/FM/PEDS primary care physician being told up by a NP who claims to have the "knowledge of a physician with the additional knowledge of a nursing professional"

 

[Denatured]

I agree with drift, they should increase the number of residency slot in primary care and if I may add, teaching hospitals should start providing observerships (paid or not) to foreign born FMGs who want to go into primary care. Let's face it, not too many american med grads and US born FMGs would go into primary care because of school debt. What do you do if there is a physician shortage? Churn out more physicians.

Do you know how many slots go unfilled in family practice? You open more slots and there will just be more empty seats. What needs to happen is make medical school cheaper for every med student, and doubly cheaper for those who go into primary care.

You can't go to nursing school and somehow do a "medical residency" and call yourself a physician. You would just be a nurse, who did a residency to increase her nursing skills.

Medical School + Residency = Physician

NP + Residency = Residency trained...NP

I agree with that statement, and no one said that np plus pg-residency equalled a physician.

Maceo, who has increased the years of residency outside of medicine's own organization? Not saying your wrong I've just never seen anything dictated by an outside organization that residency had to be longer. Also, there are multiple articles on the importance of PAs. This article was based on the future of nursing, which the IOM decided it should fill the doctor shortage. Perhaps there should be a similar research study on the future of PAs?

Besides, the AMA could easily decide to give them more freedom and it would go virtually unopposed. It would be almost as simple as a snap of their fingers. But they won't even let them change their name to physician associate. So while it would be simpler and more practical to give PAs more freedom, the fact remains they are under the AMA so it's just more likely that NPs will become more autonomous. It is what it is.

 

[fab4fan]

Did the IOM ever consider that there are plenty of nurses out there who are content not to be full partners with doctors and don't necessarily want more responsibilities than they already have?

I don't want more responsibility. It would ruin my slacker image.

 

[zenman]

It was an important section, and the importation of international nurses to the US will have an impact.

I agree it's important, especially since I've had a problem with every nurse from that certain island...except for one.

 

[pianoman511]

It would seem like all of this is just a round-about way to increase access to medical care. It is pretty much the way things work in american politics. Why not work to decrease the cost of medical education, increase incentives for primary care, and institute insurance reform. Nope....instead we won't concentrate on the doctors, we'll give NPs equivalent practice rights and reimbursement. That way, more nurses will see the benefits of becoming a nurse practitioner and go back to school.

Not that it's a bad thing, but then we'll have less nurses (and less experienced nurses for that matter) working on the floors and have to import more nurses. Where are we left ? Less doctors, less nurses, more NPs. It's a wonderful paradox. The nursing lobby wants to increase access to care but instead they are simultaneously decreasing access to experienced nurses and creating competition between NPs and physicians (because let's face it, that is what is going to happen eventually - likely sooner rather than later).

 

[deleted87716]

Besides, the AMA could easily decide to give them more freedom and it would go virtually unopposed. It would be almost as simple as a snap of their fingers. But they won't even let them change their name to physician associate. So while it would be simpler and more practical to give PAs more freedom, the fact remains they are under the AMA so it's just more likely that NPs will become more autonomous. It is what it is.

You don't know much about the AMA. The AMA is merely a lobbying organization. They have no authority whatsoever.

Nobody involved in healthcare can do anything "with a snap of their fingers."

 

[deleted87716]

It would seem like all of this is just a round-about way to increase access to medical care.

NP independence hasn't solved access problems in any of the states where it's currently legal.

 

[pianoman511]

NP independence hasn't solved access problems in any of the states where it's currently legal.

I definitely agree, I meant to say that it's what the nursing lobby maintains is their reasoning behind this push and even what the IOM report claims.

 

[BLKPA2MD]

And the people (PAs) who can truly step up to the plate to fill in the gap they leave out of the equation entirely. WTF?

....Not surprise at all.

 

[Denatured]

You don't know much about the AMA. The AMA is merely a lobbying organization. They have no authority whatsoever.

Nobody involved in healthcare can do anything "with a snap of their fingers."

You'd be surprised how much I know.

I know they don't actually control the board of medicine, but if the AMA lobbied for PA independence then it would change in a matter of a few years.

 

[deleted87716]

You'd be surprised how much I know.

At this point, yes, I'd have to be.

 

[Denatured]

At this point, yes, I'd have to be.

OOOOOoohhh snap! No you di-int!
🙄

 

[altap]

By offering observership in primary care (PC) to foreign born FMGs who would like to go into PC, residency programs would not only provide the much needed US clinical experience to the foreign born FMG, but also would be able to compare the gen. medical knowledge and clinical acumen of a foreign born FMG to a US med grad and a US born FMG. If I'm not mistaken UCLA is offering observership in PC to foreign born FMGs.

 

[deleted6669]

By offering observership in primary care (PC) to foreign born FMGs who would like to go into PC, residency programs would not only provide the much needed US clinical experience to the foreign born FMG, but also would be able to compare the gen. medical knowledge and clinical acumen of a foreign born FMG to a US med grad and a US born FMG. If I'm not mistaken UCLA is offering observership in PC to foreign born FMGs.

Are these folks who have passed usmle but couldn't match or fmg's who couldn't pass usmle?
florida used to allow any fmg to take a state specific exam to practice as pa's in florida. the vast majority( > 95%) of these folks failed a watered down version of the national pa boards. I would hate to see similar folks let loose on primary care. if we are talking folks who have passed usmle then that's a little more palatable...

 

[mig26x]

NP independence hasn't solved access problems in any of the states where it's currently legal.

excellent point!!

 

[Taurus]

If I were an NP, I wouldn't exactly be standing and cheering for this report.

In the past I had mentioned this and I think that this is what will happen if we continue down this road. If NP reimbursements are the same for physicians, the NP's have the same privileges as physicians, and residency is required, what do you have? A physician or someone who will have the same level of training as one.

NP's can expect longer and harder training. Having to do residencies. They will have to take recertification tests like physicians. Etc, etc. It wouldn't be hard to convince politicians by the AMA that if NP's want all the rewards and privileges as physicians that NP's should then have to go through the same hurdles as physicians.

To the NP's, say goodbye to being able to complete your training in 2 years. Say goodbye to online degrees. You're going down the same road that medicine did a long time ago.

Furthermore, I think that many of the suggestions in the report will be very difficult to implement, such as increasing reimbursement levels, changing the scope of practice, etc. when you have 1) a healthcare system that is going bankrupt 2) states historically will fight tooth and nail before giving up power to the federal govt 3) Republicans likely making significant gains in Congress for the rest of Obama's administration.

 

[Therapist4Chnge]

In the past I had mentioned this and I think that this is what will happen if we continue down this road. If NP reimbursements are the same for physicians, the NP's have the same privileges as physicians, and residency is required, what do you have? A physician or someone who will have the same level of training as one.

To the NP's, say goodbye to being able to complete your training in 2 years. Say goodbye to online degrees. You're going down the same road that medicine did a long time ago.

The nursing lobby would push to have their cake and eat it too. They want the same privileges, BUT within the "nursing" profession so they can set their own standards. The training wouldn't change, it'd still be available online, but they make more money.

 

[drift]

in the past it used to be just the MD as the "doctor." Then came the DO (they deserved the title, because they implemented equal medical training). And now in the future, when one thinks of a "doctor", it will be the MD/DO (but who wants to go to over 11 years of full-time schooling for that stupid degree?) and the NP, which you can get online in about 6-7 years of part-time study.

If the line between NPs and MD/DOs is narrowed any further, several capable students who would've been great physicians will be directed towards nursing. If many physicians knew this could be the future, they could have certainly chosen to go to nursing and saved the hassle of pre-med, mcat, med school, match, residency and condensed it all into a bachelors in nursing and then a part-time 2 years of study.

This will kill medicine.

For people who think this can't happen, think again!. CRNAs are now independent in 15 states, 2 states just successfully opted for independent practice this year. In several states, CRNAs have REPLACED Anesthesiologists successfully. The nursing lobby is now just targeting the primary care market, essentially wanting to do YOUR (the doctor's) job.

What can we do to stop this?

 

[Paseo Del Norte]

Did the IOM ever consider that there are plenty of nurses out there who are content not to be full partners with doctors and don't necessarily want more responsibilities than they already have?

I don't want more responsibility. It would ruin my slacker image.

Word. I don't really care about physicians in that sense. I want to go to work and make my money with the least amount of mucking about and worrying about rather inane concepts such as full nurse partnership.

This whole nurses gone wild thing is cramping my style.

 

[Denatured]

I think you have few options left after this IOM report (with support from physicians) and their meeting in the next few weeks to decide how to implement the report. I see 3 ways (in order of difficulty) out, but there are possibly more. 1) infiltrate nursing by getting an RN degree and work your way up as high as you can to disrupt from within. 2) infiltrate the IOM, which will be hard since they only admit 65 per year and 25% of those have to be a profession outside of healthcare, you haveto be nominated from within, and have some outstanding achievement 3) produce an unbiased/statistically sound study that shows NPs and CRNAs are not safe and/or cost effective and have it published in a respectable, peer reviewed journal like Health Affairs.

 

[fab4fan]

word. I don't really care about physicians in that sense. I want to go to work and make my money with the least amount of mucking about and worrying about rather inane concepts such as full nurse partnership.

This whole nurses gone wild thing is cramping my style.

+1

 

[Boatswain2PA]

I think you have few options left after this IOM report (with support from physicians) and their meeting in the next few weeks to decide how to implement the report. I see 3 ways (in order of difficulty) out, but there are possibly more. 1) infiltrate nursing by getting an RN degree and work your way up as high as you can to disrupt from within. 2) infiltrate the IOM, which will be hard since they only admit 65 per year and 25% of those have to be a profession outside of healthcare, you haveto be nominated from within, and have some outstanding achievement 3) produce an unbiased/statistically sound study that shows NPs and CRNAs are not safe and/or cost effective and have it published in a respectable, peer reviewed journal like Health Affairs.

I think you missed one. The state BOM (or equivalent organization) supervises Doctors, while in most states the board of nursing supervises nurses. If the state BOMs start defining what practicing "medicine" is, and then defends those definitions in court, the encroachment of nursing into medicine will stop.

Think about it. Why is putting in a chest tube a nursing task if completed by a nurse, but a medical task if performed by a Doctor or PA?

If the state BOMs decide to get on track with this then the NP/DNP could be reduced to what it should be - a vitallly important DEPENDENT practitioner who works under the supervision of a (real) Doctor.

 

[Denatured]

The report actual touches on that. Doctors have an unlimited scope, so therefor everything technically falls under medicine. And since there are other disciplines (PT, pharmacy, OT, DC, etc) that share scope with doctors, it would be unreasonable to presume that certain aspects of scope could be shared and others could not.

Though I could see your point as in the case of electromyography placed out of scope for PAs in New Jersey and pain management outside of CRNA scope in Louisiana.

But you still will need sound studies if you want complete victory in that arena because you'll be fighting the nursing lobby who has studies on their safety, precedent in many states of independent practice, and now the support of the IOM who we know influences policy.

I think you missed one. The state BOM (or equivalent organization) supervises Doctors, while in most states the board of nursing supervises nurses. If the state BOMs start defining what practicing "medicine" is, and then defends those definitions in court, the encroachment of nursing into medicine will stop.

Think about it. Why is putting in a chest tube a nursing task if completed by a nurse, but a medical task if performed by a Doctor or PA?

If the state BOMs decide to get on track with this then the NP/DNP could be reduced to what it should be - a vitallly important DEPENDENT practitioner who works under the supervision of a (real) Doctor.

 

[Paseo Del Norte]

I think you have few options left after this IOM report (with support from physicians) and their meeting in the next few weeks to decide how to implement the report. I see 3 ways (in order of difficulty) out, but there are possibly more. 1) infiltrate nursing by getting an RN degree and work your way up as high as you can to disrupt from within. 2) infiltrate the IOM, which will be hard since they only admit 65 per year and 25% of those have to be a profession outside of healthcare, you haveto be nominated from within, and have some outstanding achievement 3) produce an unbiased/statistically sound study that shows NPs and CRNAs are not safe and/or cost effective and have it published in a respectable, peer reviewed journal like Health Affairs.

Really? Incognito, ninja, spy, infiltration nursing is a viable option?

 

[altap]

During the 1950's, 1960's and 1970's (if I'm not mistaken), when the US was in dire need of physicians, the US sponsored foreign born FMGs to come to the US to train and to practice medicine. These foreign born FMGs passed the FLEX (?), had their residency training and went on to practice medicine all over the US (sadly, most of these physicians are retiring or are retired now). Thus, a healthcare catastrophe was averted. IMHO, the US should do this again (recruit and hire the best and the brightest from all over the world) so that this recurring problem of primary care physician shortage will be solved.

 

[Denatured]

Really? Incognito, ninja, spy, infiltration nursing is a viable option?

Oh that would be a sure fire way to win. Problem is you would have to become a nurse and actually advance it is some way to make it high enough where you could denounce independent practice and people listen.

Hey, if republicans think Obama did it...

During the 1950's, 1960's and 1970's (if I'm not mistaken), when the US was in dire need of physicians, the US sponsored foreign born FMGs to come to the US to train and to practice medicine. These foreign born FMGs passed the FLEX (?), had their residency training and went on to practice medicine all over the US (sadly, most of these physicians are retiring or are retired now). Thus, a healthcare catastrophe was averted. IMHO, the US should do this again (recruit and hire the best and the brightest from all over the world) so that this recurring problem of primary care physician shortage will be solved.

Why not just give PAs more autonomy? Their training is based on the same med school model as done during WWII. Worked then so I bet it could work now.

 

[deleted87716]

Why not just give PAs more autonomy?

For the same reason that NPs shouldn't be given more autonomy. Both groups are already practicing "to the full extent of their education and training." Medical practice should be based on competency, not politics.

Lowering the bar for the independent practice of medicine would accomplish nothing (aside from endangering the public) without payment reform for primary care services. If primary care is unattractive to physicians, it will be equally unattractive to anyone else.

 

[Denatured]

If primary care is unattractive to physicians, it will be equally unattractive to anyone else.

Thanks for making my point. Same reason FMGs won't solve the problem.

 

[fab4fan]

Really? Incognito, ninja, spy, infiltration nursing is a viable option?

If you look anything like your avatar, I think you're going to have a hard time pulling off the incognito bit. 😉

 

[deleted87716]

This whole nurses gone wild thing is cramping my style.

+1

So, do you guys speak up within your specialty organizations? The Mundinger groupies would have us believe that all of nursing is marching in lockstep to their drumbeat for increased scope. My experience, and I suspect yours, is different.

So, why is a vocal minority deciding the future of nursing?

 

[danielmd06]

The primary care shortage can only be reasonably ameliorated by recruiting or incentivizing more medical students into becoming primary care physicians. Nurses cannot adequately correct this problem, no matter how much Kool-Aid you drink.

It's unlikely that reimbursements will go up (as a political concept). Ergo, we should provide more slots for students in medical school, and place restrictions and/or caps on the number of specialty residency positions. How many dermatologists do we need? The remaining students will have to choose between a separate career altogether and going into primary care.

Also, we should continue observerships/transitions for FMG's as primary care physicians.

Slapping a band-aid on this problem by flooding the system with nurses who have not completed full medical residency training and yet demand equal pay (fee for service!) does not save any money for the system and indeed only endangers patients.

 

[Charles_Carmichael]

So, do you guys speak up within your specialty organizations? The Mundinger groupies would have us believe that all of nursing is marching in lockstep to their drumbeat for increased scope. My experience, and I suspect yours, is different.

So, why is a vocal minority deciding the future of nursing?

Thank you! This is the same question I've asked multiple times in different threads on these forums and others as well.

The only "majority" I ever have heard is the supposedly "vocal minority." I have absolutely never seen nurses, other than on anonymous forums, go against what the "minority" is saying.

No offense to Fab and Paseo. I always enjoy reading their posts and, for all I know, they might be really active in their organizations against this encroachment. I just never hear the "majority" do anything publicly.

 

[Paseo Del Norte]

So, do you guys speak up within your specialty organizations? The Mundinger groupies would have us believe that all of nursing is marching in lockstep to their drumbeat for increased scope. My experience, and I suspect yours, is different.

So, why is a vocal minority deciding the future of nursing?

Thank you! This is the same question I've asked multiple times in different threads on these forums and others as well.

The only "majority" I ever have heard is the supposedly "vocal minority." I have absolutely never seen nurses, other than on anonymous forums, go against what the "minority" is saying.

No offense to Fab and Paseo. I always enjoy reading their posts and, for all I know, they might be really active in their organizations against this encroachment. I just never hear the "majority" do anything publicly.

Well, we must understand that nursing is much more fragmented than the groups that push for this craziness would have you believe. You have many nurses like my self who are essentially "blue collar" nurses with associate degrees that are basically only good at manual labour and menial nursing tasks. There exists a whole lot of pretentious attitude regarding the stratification of nurses based on a degree or lack there of when considering practical nurses. You do not often see people like my self at the front making and pushing policy. It is quite easy to write us off. Or simply look at my statements as the rambling of an associate degree nurse who has a hardon for nurses with more education.

In addition, many really do not care all that much. They are like me and simply want to work, make money and go home without all the other stuff. Nor do many feel any need to take time and energy out to fight against the status quo. Of course, I honestly have no idea how many nurses truly support this movement and how many oppose.

To answer the question, I am a member of only one nursing orgainasition, the ENA. The primary reason I signed up was to get a nice discount on the certified emergency nurse and certified flight registered nurse board examinations. Oh, and the ENA journals provide me with material to complete my weekly article review requirement in respiratory school. Rest assured, I have sent letters and have openly debated the issue with other nurses. I have also had blunt discussions with my respiratory classmates and instructors.

However, this is my honest opinion: Change will not come from nursing. No super secret nurse spy is going to topple the inertia of the current movement. This ninja, defeat from within stuff would not even pan out in Taurus' wettest dreams. (Sorry guy, I just had to say it, but hopefully you all get the point.) Physician groups need to mobilise, connect with the public, produce data, and ultimately push change through legislation.

Fab, you are pretty much correct, no super spy stuff for me...

 

[fab4fan]

So, do you guys speak up within your specialty organizations? The Mundinger groupies would have us believe that all of nursing is marching in lockstep to their drumbeat for increased scope. My experience, and I suspect yours, is different.

So, why is a vocal minority deciding the future of nursing?

I don't belong to the ANA, so I don't talk to them, nor their minions. I belong to the California Nurses' Association, and they are more concerned with bedside nursing issues than advanced practice. My specialty organization is the Oncology Nurses Society, and to be honest, I really haven't heard much agitating from them for independent practice. From what I've seen, their focus is on cancer issues (go figure).

 

[fab4fan]

Well, we must understand that nursing is much more fragmented than the groups that push for this craziness would have you believe. You have many nurses like my self who are essentially "blue collar" nurses with associate degrees that are basically only good at manual labour and menial nursing tasks. There exists a whole lot of pretentious attitude regarding the stratification of nurses based on a degree or lack there of when considering practical nurses. You do not often see people like my self at the front making and pushing policy. It is quite easy to write us off. Or simply look at my statements as the rambling of an associate degree nurse who has a hardon for nurses with more education.

In addition, many really do not care all that much. They are like me and simply want to work, make money and go home without all the other stuff. Nor do many feel any need to take time and energy out to fight against the status quo. Of course, I honestly have no idea how many nurses truly support this movement and how many oppose.

To answer the question, I am a member of only one nursing orgainasition, the ENA. The primary reason I signed up was to get a nice discount on the certified emergency nurse and certified flight registered nurse board examinations. Oh, and the ENA journals provide me with material to complete my weekly article review requirement in respiratory school. Rest assured, I have sent letters and have openly debated the issue with other nurses. I have also had blunt discussions with my respiratory classmates and instructors.

However, this is my honest opinion: Change will not come from nursing. No super secret nurse spy is going to topple the inertia of the current movement. This ninja, defeat from within stuff would not even pan out in Taurus' wettest dreams. (Sorry guy, I just had to say it, but hopefully you all get the point.) Physician groups need to mobilise, connect with the public, produce data, and ultimately push change through legislation.

Fab, you are pretty much correct, no super spy stuff for me...

What he said.