N.P vs MD/DO ?

[medicinaid74]

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Sorry, I went through the first page and just couldn't get myself to skim through the next 8 pages to see if anyone asked my question.

Anyway, I talked to an Emergency Room PA and the only thing they don't "want" him to do is conscious sedation, but even then they are allowed because the physicians trust them. So, he can do everything... They can prescribe up to Schedule 2 medications which is the highest I believe unless you are an oncologist (Schedule 1 = Chemo cocktails). He works three days a week, has a pretty chill lifestyle, and went to PA school for two years.

Besides the more laid back lifestyle, the ability to start a family early, and the less amount of time in school, what are some other benefits of being a PA compared to being an MD/DO? It seems like he makes just as much as some primary care physicians without having to deal with the malpractice, etc.. Yes, I know he can't practice on his own, but I wouldn't mind anyway since I would work with a medical group or hospital.

I just a few of the pages in this forum after my wife told me about this site. She's an FNP and I'm a internal medicine resident who is currently in the Navy and I'm in my last and third year. I'm interested in the subspecialty of geriatrics. I had to sign up and write on the forums. Ok so here goes. I see that Taurus has a very biased perception of NPs. I'm not just backing up my wife here. I've worked with FNPs, ANP/GNPs, and one ACNP. They're all excellent providers. I must say something about Taurus, you need to get out of your bubble and see the real world. In your mind, a world of medicine may be spinning with medical doctors are the only ones doing the treatment/cure of diseases. In the real world in this age, things have changed dramatically since the 1970s. You seem to be the only one who absolutely will not work with, hire, or precept NP students. You know what? That's okay because you'll be singled out as a sad person who is resistant to the changing environment in the United States and also, the World. Everyone is moving forward. Where are you? Sure you can bring up links to sites. Like someone on this forum said, if NPs were performing terribly, wouldn't they be stopped? I agree with this one. In all my years in medical school, my colleagues who were RNs before and went to medical school, told me to be nice with everyone you work with. Majority of them were nurses and look, I'm married to a very beautiful Asian (Japanese/Korean/Haole(Caucasian)) nurse who is now an FNP. 😀 While working with some of them in my parts of my second year and lots during this third year so far, they've pretty much "got my back" in times I needed help.

Knowledge? You must look at the bigger picture. Nurses go through 4 years of undergraduate nursing school as well as many clinical hours during their BSN program. Thereafter, it's NP school for 2 years for a masters (Soon to be 2015 from what my wife said because of the "DNP" which I've heard they're scope of practice hasn't been increased such as to do independent OR surgeries). This is a total of 6 years of exposure to the health care field. Plus, they get off to work right off the bat and learn on the job. I went through 4 years for a undergraduate psychology degree while taking the required perquisite courses to get into medical school. No medical school work. Then it's 4 years of medical school which was pretty intense and yes, we may go more in dept in AP, Patho, esp neuro. Then residency, 3 years and I'm in my last year plus I want to do a Geriatric subspecialty fellowship. So far, 7 years. So don't give me this crap by saying nurses don't have as much education or skills as doctors. They are totally different fields of study. I saw what NPs do. It's amazing on what they're able to do although they didn't go to medical school. I can explain medical disease so specifically as I do with my other residents and attendings, that the NPs understand all of it. The outcome of patient care? Still great and no difference to a doc except for surgery. Do I regret going to medical school to become a physician? No. It was my choice. However, the only thing that bothers me is the money part. 😕 A few NPs made nearly as much, if not more than my attendings in IM. I guess Hawaii is a very expensive place to live eh? Surgery, anesthesiology, and radiology is a different story in terms of the dollars.

As for the poster above, if you want to become a doctor, then go to medical school. Learn to collaborate with other health care professionals. It's a dam team. Would you fight over titles in times of disasters and war? I dam hope not. If Taurus was the way he is on these forums during times like that, he would be kicked off the medical team and viewed as a sore loser who can't work with other providers such as NPs and only thinks about himself and his career. It's a damn job people, we all chose what we wanted to be. Therefore, do it, work as a team, don't bitch about why the NP/PA gets to do the same thing you do without going to medical school. In this time of age, theres not tolerance for that and you'd just be wasting other people's time. I've been told enough already from other providers, physicians, and nurses, that many people think we docs aren't nice to other providers. We need to change our image in a positive way by not trying to drown the profession of NPs. If we can collaborate to help the patient the best way possible, then that is worth something.

 

[zenman]

Majority of them were nurses and look, I'm married to a very beautiful Asian (Japanese/Korean/Haole(Caucasian)) nurse who is now an FNP. 😀

👍

Pic? Man, some Asian women are so pretty it's just sad you can't have 3-4 of them! I'm heading to Okinawa Naval Hospital for an internship late March. Hope it's a good experience. Tell me it will be. Let me ask you a question. Are IM guys/gals interested at all in menopause issues?

 

[The right Path]

So that's how you spell it. I've never seen it written before. In my mind it was something along the lines of "Howley"

My cousins are half Hawaiian, half "Howley"

 

[medicinaid74]

👍

Pic? Man, some Asian women are so pretty it's just sad you can't have 3-4 of them! I'm heading to Okinawa Naval Hospital for an internship late March. Hope it's a good experience. Tell me it will be. Let me ask you a question. Are IM guys/gals interested at all in menopause issues?

Now now...don't want to be selfish and take all the nice Asian women. How long are you going to be stationed in Okinawa? Let me tell you, Okinawa has many beautiful Asians but you can't just stop there to find the perfect one. Look also in Japan and Korea. I'm sure you'll have a good experience. No civilian counterpart would be able to travel so much like this in the world as we do. 😉 Why do you ask about the menopause issues? For me honestly, not really. 😛 Btw, are you a Lt. JG or Lt.? Just thought it'll be interesting to know.

 

[San_Juan_Sun]

I normally don't respond too much, but I couldn't resist.

I see that Taurus has a very biased perception of NPs... I must say something about Taurus, you need to get out of your bubble and see the real world.... In your mind, a world of medicine may be spinning with medical doctors are the only ones doing the treatment/cure of diseases.... I must say something about Taurus, you need to get out of your bubble and see the real world...

I think you're demonizing Taurus a bit here, and calling him (I think Taurus is a him) out unnecessarily. I believe that Taurus has always supported the collaborative midlevel model. In other words, midlevels extend physician practices and are overseen by the appropriate medicolegal bodies (i.e. state medical boards). He does not, as I do not, support independent midlevel practice. But that's a far cry from saying that only physicians can diagnose and treat disease.

I'm not just backing up my wife here.

Highly debatable. After all, she's the one that got you to post.

I've worked with FNPs, ANP/GNPs, and one ACNP. They're all excellent providers.

All of them? Then you haven't critically reviewed their work. They range from crummy to superb, just as physicians do. You paint with far too broad a brush.

You seem to be the only one who absolutely will not work with, hire, or precept NP students. You know what? That's okay because you'll be singled out as a sad person who is resistant to the changing environment in the United States and also, the World.

He's not the only one. I'm very reluctant to train those who would presume to replace me. Like the anesthesia folks have. I will however train/hire/collaborate with PAs, because as a body they respect the collaborative arrangement. Unlike the NPs/CRNAs and their lobbying bodies always pushing towards independent practice. It isn't personal against NPs, it's a policy choice. (I work with a few NPs, who I really like, FWIW.)

Like someone on this forum said, if NPs were performing terribly, wouldn't they be stopped?

Not necessarily. By claiming to offer cheaper care (not substantiated by any evidence I've ever seen) they offer hospitals and care systems incentive to restrict physician practices in order to save money.

Furthermore, if NPs/DNPs can convince states that their practice of medicine should actually be governed under a Board of Nursing, they skip important mechanisms that ensure public safety. I have little faith in this partisan era, that a state Board of Nursing offers the expertise or lack of partisanship needed to protect the public good.

I agree with this one. In all my years in medical school, my colleagues who were RNs before and went to medical school, told me to be nice with everyone you work with.

I agree with them. But "being nice" doesn't qualify NPs to practice independent medicine.

While working with some of them in my parts of my second year and lots during this third year so far, they've pretty much "got my back" in times I needed help.

We all depend on each other in medicine. From my personal perspective, our OR/PACU/ICU nurses are worth their weight in gold. I highly value their opinions. But that doesn't qualify them to act as a physician.

Knowledge? You must look at the bigger picture.

We've counted the credit hours and years in training so many times on SDN, but I can't let the following pass...

Nurses go through 4 years of undergraduate nursing school as well as many clinical hours during their BSN program. Thereafter, it's NP school for 2 years for a masters (Soon to be 2015 from what my wife said because of the "DNP" which I've heard they're scope of practice hasn't been increased such as to do independent OR surgeries). This is a total of 6 years of exposure to the health care field. Plus, they get off to work right off the bat and learn on the job. I went through 4 years for a undergraduate psychology degree while taking the required perquisite courses to get into medical school. No medical school work. Then it's 4 years of medical school which was pretty intense and yes, we may go more in dept in AP, Patho, esp neuro. Then residency, 3 years and I'm in my last year plus I want to do a Geriatric subspecialty fellowship. So far, 7 years.

First, you include a NPs undergrad years into their total training years (6 by your count), but you fail to do so with physicians. If you applied the same standard to the docs, 4 undergrad + 4 med school + 3 residency = 11 years minimum.

Secondly, you cannot use prerequisites into total training time. They are simply a foundation preliminary to training. My year of high school Spanish doesn't give me any functional fluency. And fluency in patient care is what we're after, not the medical equivalent of knowing the how to ask for the bathroom in Espanol.

So don't give me this crap by saying nurses don't have as much education or skills as doctors.

They don't, certainly not by any measurable standard. NPs do not go through the most rigorous standardized metric of knowledge and skills, namely residency. I feel bad for you that you value your residency so poorly, since it has apparently profited you nothing in terms of "education and skills" as the nurses.

They are totally different fields of study.

You seem to imply over and over again that medicine can be safely practiced by both the physician and the physician extender. How then are they different fields of study? If they are truly so different, how am I deficient to the "knowledge and skills" of an NP?

I can explain medical disease so specifically as I do with my other residents and attendings, that the NPs understand all of it.

It sounds like you have a talent for teaching. I think that would translate well to midlevels extending your practice. But it certainly doesn't make NPs fit for independent medicine.

The outcome of patient care? Still great and no difference to a doc except for surgery.

Evidence?

And by the way, it won't be long before we surgeons start to see significant lobbying by the nursing groups for surgical privilieges. Maybe not all surgeries, but certainly that which is lucrative and relatively easy. (One example being PICC lines. I'm already told by the PICC team that I'm not qualified to put in a PICC line. 🙂 ).

Anyways, sorry for the tangent. Again, I need some good evidence that the outcome of patient care is the same. (And spare me the few propaganda studies that we've already torn to shreds on SDN years ago. Do a search.)

However, the only thing that bothers me is the money part. 😕 A few NPs made nearly as much, if not more than my attendings in IM.

I wonder how bothered you'll be when those you've trained/hired attempt to swipe the more lucrative parts of your practice. Those student loans won't pay themselves, ya know?

As for the poster above, if you want to become a doctor, then go to medical school.

I totally agree with you.

Learn to collaborate with other health care professionals.

Amen. Taurus and I salute you.

Would you fight over titles in times of disasters and war?

That's a bit of hyperbole there. This isn't a war in any sense that doesn't trivialize a real war.

And it's not about titles per se, it's about public safety.

If Taurus was the way he is on these forums during times like that, he would be kicked off the medical team and viewed as a sore loser who can't work with other providers such as NPs and only thinks about himself and his career.

Again, no need to call out Taurus. No need to get personal... until you're losing the debate of ideas.

I've been told enough already from other providers, physicians, and nurses, that many people think we docs aren't nice to other providers. We need to change our image in a positive way...

Hallelujah.

...by not trying to drown the profession of NPs. If we can collaborate to help the patient the best way possible, then that is worth something.

If NPs are willing to collaborate, that's awesome. If their profession intends to expand to independent practice, I'll do my best to oppose it. Again, it's about policy, not about people. I hope that as you begin to see that distinction, you can put aside who you're married and demand more rigorous evidence from the nursing lobby.

Once again, a big thanks to the awesome nurses who make modern medicine possible.

 

[DO2Be2013]

Knowledge? You must look at the bigger picture. Nurses go through 4 years of undergraduate nursing school as well as many clinical hours during their BSN program. Thereafter, it's NP school for 2 years for a masters (Soon to be 2015 from what my wife said because of the "DNP" which I've heard they're scope of practice hasn't been increased such as to do independent OR surgeries). This is a total of 6 years of exposure to the health care field. Plus, they get off to work right off the bat and learn on the job. I went through 4 years for a undergraduate psychology degree while taking the required perquisite courses to get into medical school. No medical school work. Then it's 4 years of medical school which was pretty intense and yes, we may go more in dept in AP, Patho, esp neuro. Then residency, 3 years and I'm in my last year plus I want to do a Geriatric subspecialty fellowship. So far, 7 years. So don't give me this crap by saying nurses don't have as much education or skills as doctors.

I think this paragraph is really stretching it, perhaps beyond all bounds of credibility. First of all, a BSN does not represent four years of "exposure to the health care field." That's a claim I've seen a lot of nurses make when comparing NPs to MD's- that they have six years of "healthcare" education and doctors just have seven- and it holds no water. Like every other bachelor's degree out there, a BSN is composed of roughly 60 credits of general education requirements (the literature and math and arts credits that the university requires all students to take), and the rest is pre-requisite courses for the major and the major content courses themselves. In terms of academic credits, a BSN is at best two or maybe two and a half years' worth of nursing education. Whether undergrad RN education is really relevent anyway when considering the training required to diagnose and treat (the kinds of skills taught to medical students and midlevel providers in their graduate training) is a whole other debate as well. I'm sure you know you didn't earn 120 psychology credits in your psych BA, but yet you imply that nurses spend all four years of the undergraduate education on "healthcare." Anyway, now we're talking four years of true nursing education for the MSN-prepared NP, not six.

Also, you should consider the glut of direct-entry MSN programs out there who accept students with a non-healthcare bachelor's and put them through a one-year accelerated BSN followed immediately by a two-year master's, graduating NPs with zero nursing work experience and 36-39 months of healthcare education (not six years).

Finally, I dispute the premise that you can compare years of education between physicians and NPs like it's an apples to apples scenario in the first place. Comparing continuous measurements is only meaningful when they are expressed in equivalent units. It's misleading to call the 30-32 credits a typical undergraduate BSN student will complete in two semesters a "year" while also counting as a "year" the roughly 60 credits of coursework done in a typical M1 or M2 schedule. Or, even worse, counting the roughly 4000-5000 annual training hours typical of a residency program as a "year" compared to the online courseload and/or 500 clinical hours required in a "year" of most MSN programs. If you properly adjusted the didactic portions of nursing and medicine to scale for credit hours, and adjusted the hours in the clinical phases of NP education to the M3/M4 and residency hours, you'd find a much greater discrepency than just six years for NPs to seven for physicians.

 

[zenman]

Now now...don't want to be selfish and take all the nice Asian women. How long are you going to be stationed in Okinawa? Let me tell you, Okinawa has many beautiful Asians but you can't just stop there to find the perfect one. Look also in Japan and Korea. I'm sure you'll have a good experience. No civilian counterpart would be able to travel so much like this in the world as we do. 😉 Why do you ask about the menopause issues? For me honestly, not really. 😛 Btw, are you a Lt. JG or Lt.? Just thought it'll be interesting to know.

I'm ex-military (ARMY). I live in Bangkok (where there are a few pretty women other than my wife) but I can only look at them. I just picked Okinawa for a preceptor site for psych NP. I'll be there 6 months.

 

[ChillyRN]

A few years ago, there was a problem with the AC compressor. The whole unit was 90*, but they needed a part that wouldn't be in for 24h. It was uncomfortable, he!! yes, but it was hardly the Superdome. My patient was in w/ COPD, the heat was especially uncomfortable for her, but there was absolutely nothing anyone could do. She was pis***. Her doc, our most senior and respected attending physician, rounded and I guess she gave him whatfor about the a/c. So he got pis***, at me (?) and wrote an order in huge print that took up an entire page: "Nurse to fix go**amn airconditioning, STAT." I was more than a little annoyed by this at the time, but I just ignored him and the order and got over it. I'm sure he got a proper @#$%! out from the utilization review people when they saw that order, lol. If I only told you the a/c story, you might roll your eyes, laugh a little and think yup, that doc is a jerk.

Last week, I walked into a patient room to find this same doc feeding a patient. He did not get up and hand me the spoon either, just smiled at me over his shoulder and kept talking to her and spooning in the pureed whatever that was. I have seen him on is knees praying with patients and families, and I have known him to stay up all night holding hands, wiping browns and fetching coffee, blankets, etc. Perhaps his empathy, compassion and dedication are exactly what make him so respected, though it helps that he is a gifted diagnostician and clinician! But he isn't perfect, and I don't expect him to be. If he were prompted, he might recall the time that I let him know, in no uncertain terms, that he was not to call me "sweetie" ever again. I don't know if he remembers what I b!tch I was about that, and how unprofessionally I handled that situtation. I do know he's never done it again. He's a great doctor. And if I don't say so myself, I'm a great nurse. We respect, and genuinely like each other, and I have lots of stories like this.

Sometimes, people really are just jerks. I worked in a place that was home to a c-thoracic surgeon who did not allow nurses and other staff to speak to him until they were spoken to, and no one was allowed to ride the elevator with him, ever. This individual was, by all accounts, a fantastic surgeon so the hospital kissed his butt and capitulated to his every demand, eventually building him his own private elevator. That he had some phobia and/or personality disorder seems unrelated to his professional status, but I suspect had I needed by chest cracked back then, I'd have wanted him to do it. He had great stats, and probably few friends. To my knowledge, he never did an honorable thing in his miserable life, and probably tortured small animals in his free time. However, he's the excepetion, not the rule, which is why he makes a good anecdote, lol; it is the only extreme example I have from almost 20 years in health care.

My experience has never mirrored the acrimony I sometimes see here and at all nurses, and I think doG for that!


There was a big big big turf fight in our hosp b/w ED RNs and the CRNAs (we don't actually have an anesthesiologist. There is one on paper at the mothership in the chain, but never on our campus) about conscious sedation, originally specifically targeted at shoulder reductions. The CRNAs "won," and RNs are not allowed to administer any conscious sedation in the ED. The ED docs didn't care until it was over, b/c they decided after the fact that the CRNAs were making some comment about their ability to supervise safe administration of con.sedation and maintain an airway. So since then, there has been a large uptick in the number of patients for whom the docs decide c.sedation is necessary, and the CRNAs get paged and they have to come in every time. Per their own shortsighted policy, they have to stay and recover the patient themselves too. And to add insult to injury, we now have a guy in town who deliberately throws his shoulder out so he can get pain meds, and he does it 3-4 times a week since Thanksgiving. I like all the CRNAs, and all the ED docs and nurses, and I don't have a dog in that fight, but I find it amusing just the same. There is probably a patient advocate out there who would be up in arms about the extra expense to the patient for anesthesia services, and someone else who will point out how much safer they are during their shoulder reduction.

I don't know why I told you all of that, just can't sleep and felt like it I guess.

 

[The right Path]

A few years ago, there was a problem with the AC compressor. The whole unit was 90*, but they needed a part that wouldn't be in for 24h. It was uncomfortable, he!! yes, but it was hardly the Superdome. My patient was in w/ COPD, the heat was especially uncomfortable for her, but there was absolutely nothing anyone could do. She was pis***. Her doc, our most senior and respected attending physician, rounded and I guess she gave him whatfor about the a/c. So he got pis***, at me (?) and wrote an order in huge print that took up an entire page: "Nurse to fix go**amn airconditioning, STAT." I was more than a little annoyed by this at the time, but I just ignored him and the order and got over it. I'm sure he got a proper @#$%! out from the utilization review people when they saw that order, lol. If I only told you the a/c story, you might roll your eyes, laugh a little and think yup, that doc is a jerk.

Last week, I walked into a patient room to find this same doc feeding a patient. He did not get up and hand me the spoon either, just smiled at me over his shoulder and kept talking to her and spooning in the pureed whatever that was. I have seen him on is knees praying with patients and families, and I have known him to stay up all night holding hands, wiping browns and fetching coffee, blankets, etc. Perhaps his empathy, compassion and dedication are exactly what make him so respected, though it helps that he is a gifted diagnostician and clinician! But he isn't perfect, and I don't expect him to be. If he were prompted, he might recall the time that I let him know, in no uncertain terms, that he was not to call me "sweetie" ever again. I don't know if he remembers what I b!tch I was about that, and how unprofessionally I handled that situtation. I do know he's never done it again. He's a great doctor. And if I don't say so myself, I'm a great nurse. We respect, and genuinely like each other, and I have lots of stories like this.

Sometimes, people really are just jerks. I worked in a place that was home to a c-thoracic surgeon who did not allow nurses and other staff to speak to him until they were spoken to, and no one was allowed to ride the elevator with him, ever. This individual was, by all accounts, a fantastic surgeon so the hospital kissed his butt and capitulated to his every demand, eventually building him his own private elevator. That he had some phobia and/or personality disorder seems unrelated to his professional status, but I suspect had I needed by chest cracked back then, I'd have wanted him to do it. He had great stats, and probably few friends. To my knowledge, he never did an honorable thing in his miserable life, and probably tortured small animals in his free time. However, he's the excepetion, not the rule, which is why he makes a good anecdote, lol; it is the only extreme example I have from almost 20 years in health care.

My experience has never mirrored the acrimony I sometimes see here and at all nurses, and I think doG for that!


There was a big big big turf fight in our hosp b/w ED RNs and the CRNAs (we don't actually have an anesthesiologist. There is one on paper at the mothership in the chain, but never on our campus) about conscious sedation, originally specifically targeted at shoulder reductions. The CRNAs "won," and RNs are not allowed to administer any conscious sedation in the ED. The ED docs didn't care until it was over, b/c they decided after the fact that the CRNAs were making some comment about their ability to supervise safe administration of con.sedation and maintain an airway. So since then, there has been a large uptick in the number of patients for whom the docs decide c.sedation is necessary, and the CRNAs get paged and they have to come in every time. Per their own shortsighted policy, they have to stay and recover the patient themselves too. And to add insult to injury, we now have a guy in town who deliberately throws his shoulder out so he can get pain meds, and he does it 3-4 times a week since Thanksgiving. I like all the CRNAs, and all the ED docs and nurses, and I don't have a dog in that fight, but I find it amusing just the same. There is probably a patient advocate out there who would be up in arms about the extra expense to the patient for anesthesia services, and someone else who will point out how much safer they are during their shoulder reduction.

I don't know why I told you all of that, just can't sleep and felt like it I guess.

What planet is this on?

 

[zenman]

What planet is this on?

Planet Hospital, a very lonely and desolate planet.

 

[DNPDoctor]

Planet Hospital full of female co-workers, a backstabbing and gossiping planet.

Fixed that for you 😉

 

[ChillyRN]

That docs behavior is not really unusual. It doesn't happen every day, but every physician on our staff has gone the extra mile for us (nursing staff) at one time or another -both personally and in the work place. My last child was born at home, we were attended by a midwife. This was a very controversial move around here, lol. No one had ever heard of such a thing and they were skeptical (too polite to tell me I was stupid or crazy, lol). I delivered at 6am, and my friend who was here called and told everyone at the hosp that mother and babe were doing beautifully. Word got around the place, and at lunch time one of the other docs on staff, a family practice guy whom I didn't really know well dropped by my house (he just lives on the next block, we knew him from the neighborhood too). Ostensibly he was here to deliver a fruit and muffin basket, but I think he was worried about us and really wanted to look us over, lol. Very conveniently, 😉 he had all his equipment with him in a gym bag, and since he was here anyway felt he might as well give ds a well newborn exam, and did I want him to check my fundus, ya know, since he was here?

My parents are getting older and have had a few problems. My mom had a serious fall, my dad has had a MI and frontal lobe dementia. I know I can call any of the docs on staff, on call or not, 24/7 and they would bend over backwards to help me with one of my parents or children if I needed something. One of my sons friends had a bike accident on our property and seriously damaged his eye. Rather than have the child transferred an hour away, the (general) surgeon called an opthamologist and a plastics guy he knew, and they came here, as a favor to him. He called in favors on my behalf, for a kid hat wasn't even mine, lol. The kids mother was giving me a really hard time, blaming me for the accident (long story). Overhearing all this in the ED, he felt bad for me and made these calls to give her less to b!tch about, so she' get off my case. He even made a pont of telling her that if it were not for me, they wouldn't be seeing her son locally. Now that wasn't really true, but he thought he was helping.

Have all your experiences really been devoid of such kindnesses? this is a general query, not directed at anyone in particular.

I have worked in the eastern and midwestern parts of the country in medium to extremely large medical centers, and I have never encountered the unhappiness, competitiveness or backstabbing I read about on the internet. Caveat: among nurses, yes- to some degree, but inter-professional, no, not ever, not anywhere. Not at U of FL (Shands) not at U of NC, Duke, U of Michigan or Henry Ford MC. I guess all the *****holes are in California or something, 😛 Sure there have been less than gregarious people along the way, people I didn't invite to dinner, lol. Other than the crazed cardio-thoracic surgeon, I've largely forgotten them. He was a real gem, and one in a million. Other examples of people behaving badly are merely examples of people having bad days, not nurses or doctors being jerks. At least, since I see people as individuals and not their role, that is how I've always looked at it.

Now, you want to talk about badly behaved patients, and that is another story! I am convinced that I have taken care of the worst scum society has to offer, and I'm not talking about the inmates we used to get from Central Prison. Thankfully, I have also had enough really special people to keep my in the biz! In summary, when it comes to whom I hold responsible for the headaches and disapointments I've had in nursing, docs get .10% of the blame, other nurses .15%, and administrators .75%. Patients and their families have been responsible for 99% of my headaches, and they have pretty much been the same on every planet I've inhabited.

This, however, is a low paying planet. I took a huge paycut to work here. Fortunately, I am not the breadwinner or we'd be in trouble, but sometimes I still cry a little when I see my deposit slip.

 

[ChillyRN]

And since the thread was originally about MD and DNP issues, I wanted to mention something about that. I am a FNP/DNP student. Now I don't know what all of their political opinions are on the subject, but all of the med staff have been extremely supportive of my cont ed. A few have offered to precept me, but I have declined. The reason is, I don't think it is appropriate to mix roles in the same place. Here, in this system, with these patients, I am a RN. Doing FNP clinicals here might be confusing, so I am opting to drive 2 hours away. I also think it is not to my advantage as a student learner to be precepted by people who are my friends/coworkers. I think strangers will be more objective in helping me evaluate my strengths and weaknesses. They seem disappointed, but they are still supportive and have mentioned that they know people to recommend to work with or to stay away from, when the time comes.

One doc was asking me about the program, and he jokingly said to me "Well, I'm not going to call you doctor." I said "Joe, just don't forget to call me for the BBQ (an annual bash he and his wife throw) and we'll be good." He was subtle, but I think I got his point, lol. I'm not the least bit bothered by it. I'm going after the best ed I can get, and right now, this seems to be it. One of the surgeons was looking at my pathophys textbook, and rather emphatically declared it to be inferior. He said with some disgust "This is a nursing book." Someone else might have chosen to take offense, I just shrugged. It is the textbook my prof wanted, who am I to argue with either of them? The next time I saw him, about a month later, he said, "Oh good, your here. Wait a minute (where was I going to go, lol?), and he disappeared. 30 minutes later he returned with the newest edition of a pathophys book he found acceptable (a med students book I presume). He took the time to look for and order me a textbook. How nice was that? If he never endorses the DNP idea, what do I care? He supports me. I hope he'll help me learn to suture, b/c his patients have beautiful suture lines! There is one ED doc who has been pretty outspoken about his opposition to the DNP, but he still comes to the unit (the CCU is right next door to the ED, we share a coffeepot) to get me to look at really good ear infections, cornea ulcerations and interesting xrays, etc. He always asks "What are you learning now?" and tries to show me things that apply and might be helpful or interesting. I appreciate his help and his candor, but mostly his respect.

You know who has been more critical, less supportive? Nurses, lol. They are always telling me how crazy I am to want to go back to school now at my age, yada yada yada. "Who wants the responsibility?" "Why? You won't make much more money, your hours won't be much better." (I have the best shift in the hosp: Tu, Wed, Thurs, no w/e or holidays anymore). But even those people are rare. Mostly people say "Good for you, good luck, let me know if I can't help."

 

[blue shift]

Also, you should consider the glut of direct-entry MSN programs out there who accept students with a non-healthcare bachelor's and put them through a one-year accelerated BSN followed immediately by a two-year master's, graduating NPs with zero nursing work experience and 36-39 months of healthcare education (not six years).

So...what do you support?

On one hand, med students and residents (not necessarily the doctors, or they wouldn't be hiring NPs and PAs in droves) deny that nursing clinicals and nursing work experience count as NP training. On the other hand, they also hate the thought of entry-level NP programs.

So which is it?

Either nursing experience counts or there is nothing wrong with entry-level MSN programs.

 

[zenman]

And since the thread was originally about MD and DNP issues, I wanted to mention something about that. I am a FNP/DNP student. Now I don't know what all of their political opinions are on the subject, but all of the med staff have been extremely supportive of my cont ed.

FYI, I'm taking a DNP course for an elective, Understanding Financial and Business Concepts, and even with my MBA I'm spending more time than I want to on the course. My instructor also seems to be very knowledgeable.

One of the surgeons was looking at my pathophys textbook, and rather emphatically declared it to be inferior. He said with some disgust "This is a nursing book." Someone else might have chosen to take offense, I just shrugged. It is the textbook my prof wanted, who am I to argue with either of them? The next time I saw him, about a month later, he said, "Oh good, your here. Wait a minute (where was I going to go, lol?), and he disappeared. 30 minutes later he returned with the newest edition of a pathophys book he found acceptable (a med students book I presume).

That's interesting. Does his book have different or bigger words because pathophys is pretty cut and dried? Dumb as I am I was actually able to understand Guyton. So what difference do you see between the two books? The only pathophys book I have on my shelf is the one by McCance and Huether, both nurses. It's deep enough for me, lol! I'm currently taking a physical assessment course and using a book written by physicians and nurses. I have another one written just by a physician. They both have the same info. God knows I'd hate to miss anything!

 

[ChillyRN]

FYI, I'm taking a DNP course for an elective, Understanding Financial and Business Concepts, and even with my MBA I'm spending more time than I want to on the course. My instructor also seems to be very knowledgeable.

My matriculation plan has 92 credit hours and I'm only 11 in. I'm a long way from D level classes. I'll get back to you in 3-4 years.

That's interesting. Does his book have different or bigger words because pathophys is pretty cut and dried? Dumb as I am I was actually able to understand Guyton. So what difference do you see between the two books? The only pathophys book I have on my shelf is the one by McCance and Huether, both nurses. It's deep enough for me, lol! I'm currently taking a physical assessment course and using a book written by physicians and nurses. I have another one written just by a physician. They both have the same info. God knows I'd hate to miss anything!

My book is McCance and Huether, lol. The one he gave me is Robbins Pathologi Basis of Disease. I don't know if it is better, but it is certainly heavier. 😉 It seems to have much more clinical information in it, so in that sense it is certainly ahead of my present level. I think 2 years from now, it will be very valuable. Right now, since I have to complete the workbook that accompanies McCance and write (hypothetical) comprehensive health assessments and physical assessment write-ups based on the "clinical commentaries," I haven't used this new one much.

He also gave me one of his anatomy books. I had Grey's, but he gave me one by Netter, and I think it has better photos. After the $900 I laid out for books this semester, I'm now hoping he keeps up this trend of getting me books he thinks I should have! He's a good guy all around. I am blessed with wonderful friends and colleagues.

 

[Charles_Carmichael]

That's interesting. Does his book have different or bigger words because pathophys is pretty cut and dried? Dumb as I am I was actually able to understand Guyton. So what difference do you see between the two books? The only pathophys book I have on my shelf is the one by McCance and Huether, both nurses. It's deep enough for me, lol! I'm currently taking a physical assessment course and using a book written by physicians and nurses. I have another one written just by a physician. They both have the same info. God knows I'd hate to miss anything!

You know, there can actually be a pretty big difference between two textbooks on the same exact subject. For example, a human physiology textbook I used for an intro to physiology course sophomore year was absolutely terrible; it didn't present concepts well, there were barely any equations, it was more of a memorization type of book (which is strange for physio). But when I took an upper level physio course with the med school professor, and I used Costanzo's textbook (with occasional reference to Boron's ginormous medical physiology textbook), I noticed an immediate difference. There were lots of equations (thank god!), it presented material in a very conceptual manner, the pictures (graphs) were amazing. It basically blew that old textbook of mine out of the water; the difference was night and day!

It was probably because my first textbook was not designed to provide the comprehensive level of info that a med student needs, but rather, was intended to provide one with a basic, general understanding of physio. Similarly, I can understand that a "nursing" textbook (ie. a book aimed for nurses) might not have all the info/details as one designed for med students/pathologists.

 

[zenman]

You know, there can actually be a pretty big difference between two textbooks on the same exact subject.

True. Now that ChillyRN has McCance and Robbins we expect a comparision! I know an author who has written Louisiana history books and she said it's amazing about the crap and inaccurate books that are published in her area.

 

[medicinaid74]

I think you're demonizing Taurus a bit here, and calling him (I think Taurus is a him) out unnecessarily. I believe that Taurus has always supported the collaborative midlevel model. In other words, midlevels extend physician practices and are overseen by the appropriate medicolegal bodies (i.e. state medical boards). He does not, as I do not, support independent midlevel practice. But that's a far cry from saying that only physicians can diagnose and treat disease.

My apologies to Taurus! I also apologize for what I said about Taurus being kicked off the medical team. 🙂 You know what though, as a resident, I love what I do in IM...up to 80 hours a week of work, sleep overs at medical centers, and making equal to $12/hr. I agree that NPs should not be doing surgery. However, I do believe NPs should be able to be independent in primary health care but in a way, slightly limited in scope. Just my 2cents. Not to sound like I'm whooped, but my wife had to lecture me about DNPs. 🙁 As a good husband, I listened well. I read some posts and it sounded demeaning by a few posters about NPs. I am actually a supporter of NPs in primary care and also psych (@Zenman).

 

[blue shift]

My apologies to Taurus! I also apologize for what I said about Taurus being kicked off the medical team. 🙂 You know what though, as a resident, I love what I do in IM...up to 80 hours a week of work, sleep overs at medical centers, and making equal to $12/hr. I agree that NPs should not be doing surgery. However, I do believe NPs should be able to be independent in primary health care but in a way, slightly limited in scope. Just my 2cents. Not to sound like I'm whooped, but my wife had to lecture me about DNPs. 🙁 As a good husband, I listened well. I read some posts and it sounded demeaning by a few posters about NPs. I am actually a supporter of NPs in primary care and also psych (@Zenman).

A large number of docs are supportive of NPs as well, as evidenced by the fact that they employ them and work alongside them. And many of those that aren't supportive would be if NPs were to disappear from the landscape...because MD workloads would skyrocket in an instant. Both primary care MDs and ED docs, as those who couldn't find a doctor to take care of them would continue to flock to the ED.

 

[deleted87716]

And many of those that aren't supportive would be if NPs were to disappear from the landscape...because MD workloads would skyrocket in an instant.

Sorry, but that makes no sense.

Theoretically, patients might have more of an access problem if there were no mid-levels, but that wouldn't affect my workload in the slightest.

 

[DO2Be2013]

So...what do you support?

On one hand, med students and residents (not necessarily the doctors, or they wouldn't be hiring NPs and PAs in droves) deny that nursing clinicals and nursing work experience count as NP training. On the other hand, they also hate the thought of entry-level NP programs.

So which is it?

Either nursing experience counts or there is nothing wrong with entry-level MSN programs.

I don't hate the thought of entry-level nursing programs. I don't take a position on them either way, in terms of which path is more or less likely to produce competent mid-level providers.

Taken in context, my comment was simply a response to the claim that all NPs have at least six years of healthcare education. That claim is untrue.

I think you'll find, by the way, a more nuanced opinion of NPs/PAs exists among medical students like myself as well as the physicians who hire them. It's not a dichotomic thing like you're making it out to be. Most of us have no problem collaborating with NPs, and I believe that's been expressed repeatedly around here. I can even see myself "hiring" one, as you put it. Most of us, including a good number of doctors who currently employ and/or work with NPs, also happen to believe they should practice within a mid-level, supervised scope. Claims of parity or near-parity with physician education and training, especially those supported with exaggerated and demonstrably false assertions, are a separate concern. Such claims are all that I addressed in my post.

 

[JeffLebowski]

My apologies to Taurus! I also apologize for what I said about Taurus being kicked off the medical team. 🙂 You know what though, as a resident, I love what I do in IM...up to 80 hours a week of work, sleep overs at medical centers, and making equal to $12/hr. I agree that NPs should not be doing surgery. However, I do believe NPs should be able to be independent in primary health care but in a way, slightly limited in scope. Just my 2cents. Not to sound like I'm whooped, but my wife had to lecture me about DNPs. 🙁 As a good husband, I listened well. I read some posts and it sounded demeaning by a few posters about NPs. I am actually a supporter of NPs in primary care and also psych (@Zenman).

In general, the medical field is not against NP's, they're against NP's saying they're everything a doctor is and more. NP's are valuable in an appropriate role.

By the way, you do sound whipped. Or at least myopic.

 

[foreverLaur]

My apologies to Taurus! I also apologize for what I said about Taurus being kicked off the medical team. 🙂 You know what though, as a resident, I love what I do in IM...up to 80 hours a week of work, sleep overs at medical centers, and making equal to $12/hr. I agree that NPs should not be doing surgery. However, I do believe NPs should be able to be independent in primary health care but in a way, slightly limited in scope. Just my 2cents. Not to sound like I'm whooped, but my wife had to lecture me about DNPs. 🙁 As a good husband, I listened well. I read some posts and it sounded demeaning by a few posters about NPs. I am actually a supporter of NPs in primary care and also psych (@Zenman).

What about PAs doing the same? They have more didactic education and triple the clinical hours as NPs and most have substantial health care experience before starting PA school.

 

[DNPDoctor]

What about PAs doing the same? They have more didactic education and triple the clinical hours as NPs and most have substantial health care experience before starting PA school.

I disagree. While there are some PA schools requiring health care experience for entrance admission, there are many that do not.

On the other hand, while there are a few direct entry NP programs, majority of the NP programs require the RNs to have thousands of hours in clinical experiences before becoming eligible to apply.

Also, NP focus all of their clinical hours in a specific specialized area, while PA splits the hours into several specialized area.

In the end, both become competent mid level providers.

 

[foreverLaur]

I disagree. While there are some PA schools requiring health care experience for entrance admission, there are many that do not.

On the other hand, while there are a few direct entry NP programs, majority of the NP programs require the RNs to have thousands of hours in clinical experiences before becoming eligible to apply.

Also, NP focus all of their clinical hours in a specific specialized area, while PA splits the hours into several specialized area.

In the end, both become competent mid level providers.

However, the FNP programs require zero experience as a RN. To my knowledge, only NNP and ACNP programs require RN experience and then it is only 1-2 years. All PA programs used to require experience, but that is slowly going away as there are becoming more and more direct entry NP programs as well.

Yes, PAs receive a broader medical education. However, between those plus elective hours, is it more than feasible to get more than the 600 hours NPs get in a specific specialty area. Students at Cornell, for example, get 800 elective hours alone. So it would be feasible to get up to 1,000 clinical hours in a specialty hour of choice which could be almost double that a NP gets.

 

[DNPDoctor]

However, the FNP programs require zero experience as a RN. To my knowledge, only NNP and ACNP programs require RN experience and then it is only 1-2 years. All PA programs used to require experience, but that is slowly going away as there are becoming more and more direct entry NP programs as well.

Yes, PAs receive a broader medical education. However, between those plus elective hours, is it more than feasible to get more than the 600 hours NPs get in a specific specialty area. Students at Cornell, for example, get 800 elective hours alone. So it would be feasible to get up to 1,000 clinical hours in a specialty hour of choice which could be almost double that a NP gets.

Most NP programs, including FNP programs, require experience as a RN.

There are some exceptions to this (no experience as RN programs), but those exceptions account for a very small percentage of the program.

There are not "more and more" direct entry NP programs opening up.

Out of 2,000 hours in PA program, if they receive 800 hours in a single program, 1200/6 = 200 hours is spent for each of the other programs?

There are some NP programs with 600-800 hours in a single specialty, but there are also others with > 800 and 1000 hours.

Where do you get your information from foreverlaur? Taurus?

 

[foreverLaur]

Most NP programs, including FNP programs, require experience as a RN.

There are some exceptions to this (no experience as RN programs), but those exceptions account for a very small percentage of the program.

There are not "more and more" direct entry NP programs opening up.

Out of 2,000 hours in PA program, if they receive 800 hours in a single program, 1200/6 = 200 hours is spent for each of the other programs?

There are some NP programs with 600-800 hours in a single specialty, but there are also others with > 800 and 1000 hours.

Where do you get your information from foreverlaur? Taurus?

Cornell is my top choice program and they have 15 four week rotations. Assuming 40 hours a week (which we all know that a lot of clinical require more than 40 hours a week), that is 2,400 clinical hours. 800 of those hours are purely elective hours. So you could do your 8 weeks of general surgery and then do another 20 weeks of whatever surgical specialty you were interested in. Or you could do your 8 weeks of IM and then do your 800 elective hours in cardiology. Or technically, you have 12 weeks of "acute care" rotations plus 20 weeks of electives that you could focus in acute care. That would give you approximately 1,280 clinical hours in acute care. More than a NP would get!!

Case Western Nursing:

The admission requirements for BSN graduates to enter the MSN Program are as follows:

• Three professional recommendations
• RN licensure in Ohio
• Satisfactory scores on the Miller Analogies Test (MAT) or the Graduate Record Examination (GRE).
• Completion of an accredited first professional degree program in nursing.
• Some majors and sub-specialties (such as ACNP, NNP, Flight, Cardiac, and Anesthesia) require specific work experience and/or interviews.

Yes, well all know that acute care, neonatal, and CRNA require work experience - need it to get licensed. However, FNP, PNP, etc do not require any. The direct entry programs allow you to become a FNP, for example, in 3 continuous years.

 

[DNPDoctor]

40 hours a week is an assumption.

I have MD friends from American accredited Carribean med schools who did 35 hours per week during their clerkship.

At the end of the day, assuming the best for PA and worst for NP, it's only 200-300 hours difference (1-2 months) in experience in a particular area that they will be working in. That's before discounting the fact that the most NP already had thousands of hours working in the acute setting as a RN, while PA might not have had previous experience in health care and had to take baby steps in the hospital setting when dealing with the patients and making proper health assessments.

Now assuming that PAs decide not to work in the area where they've had 800 hour of training in their elective rotation. 2400 hr / 15 (clinical rotations) = 160 hours of experience for elsewhere.

 

[foreverLaur]

So we can agree that a PA and NP are relatively identical if they work in their chosen specialty. If either one opts to change, additional learning is necessary.

I don't agree with the PAs who enter school without patient care experience. I also don't agree with the NP programs that don't require RN experience.

That's why I am pursuing a nursing degree before applying to PA school and intend to have 2-3 years before starting PA school. I'm picking PA school because the area I am interested in is primarily dominated by PAs more than NPs.

However, I see no reason why a new grad FNP would be any better at providing primary care than a new grad PA, especially if they each had a similar background before attending graduate school... whether that be direct patient care experience or no experience.

 

[blue shift]

However, the FNP programs require zero experience as a RN. To my knowledge, only NNP and ACNP programs require RN experience and then it is only 1-2 years. All PA programs used to require experience, but that is slowly going away as there are becoming more and more direct entry NP programs as well.

Yes, PAs receive a broader medical education. However, between those plus elective hours, is it more than feasible to get more than the 600 hours NPs get in a specific specialty area. Students at Cornell, for example, get 800 elective hours alone. So it would be feasible to get up to 1,000 clinical hours in a specialty hour of choice which could be almost double that a NP gets.

Quoting one program is NOT an indication of what "the FNP programs" require.

"Only" 1-2 years is about the same amount of time most PA programs require...and a good deal more than some of them require. 1-2 years of full time work is about 2000 (40 hours a week, 48 weeks a year) to 4000 hours of experience, which of course is on top of nursing clinicals learned during a BSN. The PA programs that require 2000 hours of patient experience are far fewer than those that require a minimum of 1000 or less. None of the PA programs in my state even require 1000 hours. And don't forget the programs that train you as a PA from your freshman year of college to the end of grad school.

I personally believe PAs receive a MUCH more rigorous training regimen, so don't get me wrong. I am in favor of tougher NP standards. But I don't discount current NPs and their nursing experience, either.

However, I see no reason why a new grad FNP would be any better at providing primary care than a new grad PA, especially if they each had a similar background before attending graduate school... whether that be direct patient care experience or no experience.

I make no claims to the accuracy of this, but I think people like NPs (with previous nursing experience) because as a nurse it's ALL about patient contact. I'm not saying all nurses are full of sunshine and happiness - bad nurses can make a patient's life a LIVING HELL - but as a general rule nurses are very familiar with the holistic needs of a patient. People like their primary care providers to spend time with them and get to know them. This doesn't make NPs better primary care providers, but it does mean that people who go to FNPs, even new grad FNPs, are getting someone who has spent many, many hours one-on-one with patients and their families directly and are comfortable in that environment. The average person really does enjoy that in their PCP. That is what the "nursing model" is all about, and it's sad that some NPs feel it's less valid than what doctors do and are constantly trying to compare, as if they can't be worthwhile without also being a doctor.

 

[DNPDoctor]

Quoting one program is NOT an indication of what "the FNP programs" require.

"Only" 1-2 years is about the same amount of time most PA programs require...and a good deal more than some of them require. 1-2 years of full time work is about 2000 (40 hours a week, 48 weeks a year) to 4000 hours of experience, which of course is on top of nursing clinicals learned during a BSN. The PA programs that require 2000 hours of patient experience are far fewer than those that require a minimum of 1000 or less. None of the PA programs in my state even require 1000 hours. And don't forget the programs that train you as a PA from your freshman year of college to the end of grad school.

I personally believe PAs receive a MUCH more rigorous training regimen, so don't get me wrong. I am in favor of tougher NP standards. But I don't discount current NPs and their nursing experience, either.

Yes, I agree.

The problem that I see here is that people do not do their own due dilligence.

They immediately pick up the biased information from the others, who have their own set of agenda, and believe it as a fact.

 

[DO2Be2013]

Well in the interest of due dilligence, since I mentioned direct entry programs, I did some googling and it wasn't too hard to find that there are 285 accredited FNP programs in the U.S., and that of those, 69 are for non-nurses with bachelors degrees in other fields (ie, "direct entry" programs).

That represents just shy of 25% of programs, or 1 in 4. I don't know, that seems like a pretty significant number to me.

Also, of the remaining 75% which require prior RN licensure, it's difficult to ascertain how many require actual RN work experience. I clicked on a few websites and found at least one which required a BSN and RN license, but never indicated that it required any work experience, which makes me assume that in theory someone could go right from a BSN and apply to their program. The odds of getting in, I don't know. And I'm not clicking on all 285 links to read all their rules. But I think it's fair to say that quite possibly more than 25% of programs are taking people with no real RN work experience.

 

[fab4fan]

Yes, I agree.

The problem that I see here is that people do not do their own due dilligence.

They immediately pick up the biased information from the others, who have their own set of agenda, and believe it as a fact.

FYI: laur is the queen of Google here. Real world experience, not so much.

 

[foreverLaur]

FYI: laur is the queen of Google here. Real world experience, not so much.

Right - because you've attended so many nursing schools that you have real experience with them. Most people have only attended 1-2 nursing schools in their lifetime. Last time I checked, nursing school websites don't lie.

I have nurses in my family (LPNs, RNs, and NP/CNS), life long family friends in medicine, a past roommate in medical school, a current roommate in nursing school, I'm a student at a nursing school (haven't started classes yet), and I've worked in the hospital based setting for almost 2 years.

So I may not have as much personal hand on experience as a lot of people in here, but the people I know wouldn't lie to me, nursing websites don't lie, and I've had some experience working in the hospital based setting on a variety of floors and I've asked a lot of questions while doing so.

I'm fully entitled to my opinions and people who post on these forums are trying to get a wide variety of opinions. Mine is just one of many. People are more than welcomed to do what they wish with my personal opinions and experiences. It doesn't make then good or bad. Just mine. Everyone has different experiences.

 

[fab4fan]

Right - because you've attended so many nursing schools that you have real experience with them. Most people have only attended 1-2 nursing schools in their lifetime. Last time I checked, nursing school websites don't lie.

I have nurses in my family (LPNs, RNs, and NP/CNS), life long family friends in medicine, a past roommate in medical school, a current roommate in nursing school, I'm a student at a nursing school (haven't started classes yet), and I've worked in the hospital based setting for almost 2 years.

So I may not have as much personal hand on experience as a lot of people in here, but the people I know wouldn't lie to me, nursing websites don't lie, and I've had some experience working in the hospital based setting on a variety of floors and I've asked a lot of questions while doing so.

I'm fully entitled to my opinions and people who post on these forums are trying to get a wide variety of opinions. Mine is just one of many. People are more than welcomed to do what they wish with my personal opinions and experiences. It doesn't make then good or bad. Just mine. Everyone has different experiences.

It's that you post as if you're an expert in the field of nursing (and PA), without having even completed a semester's worth of education that is so disconcerting.

Sure, you do have a right to your opinions. But you ought to be honest and say your opinion comes from no real experience and should be taken for what it's worth.

And while I may have only gone to one school for my RN and another while working on my BSN, I do work with many nurses from many different nursing programs, and am in touch with many others still through my professional organizations.

 

[foreverLaur]

And while I may have only gone to one school for my RN and another while working on my BSN, I do work with many nurses from many different nursing programs, and am in touch with many others still through my professional organizations.

So your people are better than my people? You can't totally discredit my opinions. They do come from a wide variety of sources and I have personally worked in the hospital setting for a while so I'm not entirely clueless.

 

[fab4fan]

So your people are better than my people? You can't totally discredit my opinions. They do come from a wide variety of sources and I have personally worked in the hospital setting for a while so I'm not entirely clueless.

You haven't worked as a nurse, so you really can't offer any opinions on what real world nursing is. Sorry. Get your license and some experience, and yes, your opinions will have more validity.