Not hiring NP's

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And near me is a rural facility that only uses NP's, because of them not needing a physician to cosign. And ER's here are roughly 50/50. It varies.

An ER won't resort to midlevel provider coverage unless they absolutely have to. Thank goodness for air ambulances.

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In emergency medicine, PA's outnumber NP's by about 2-1 nationwide.
 
We all know that not all NP's come out as new providers with a deep background in ER or ICU as a nurse, but plenty do. I'd be more comfortable with my ED charge nurse that became an NP reading my EKG's vs the typical new grad PA. Same goes for doing spot reads of an image. Are there new grad RNs out there going to NP school and coming out without much exposure to patient care? Yeah. Where I work, experienced nurses are going to NP school left and right to get away from the bedside. These are competent folks.
 
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Would it surprise you to find out that a lot of nurses know how to read EKG's? Some don't, but a lot of us do.

Beyond reading the computer printout on top?

I haven't met a nurse yet that had a clue about Sgarbossa criteria, WPW, Brugada, right heart strain/PE, etc.

Not a single one.

The one's who do think they know EKGs are the ones who are all worried about ST elevation in a big, wide LBBB on a non-toxic patient.
 
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There is no physician co-signature required. If the facility is under that impression then they are not operating with the most current knowledge.
sometimes it's a billing issue. many NPs who work at hospitals in "independent" states still get their notes cosigned because the hospital policy supersedes the state law.
 
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Beyond reading the computer printout on top?

I haven't met a nurse yet that had a clue about Sgarbossa criteria, WPW, Brugada, right heart strain/PE, etc.

Not a single one.

The one's who do think they know EKGs are the ones who are all worried about ST elevation in a big, wide LBBB on a non-toxic patient.

Lol... that's true to a large extent, so I'll give you that. Ill also give you that an RN isn't in any position to act on anything fancy, even if they happened to be versed on the exotic stuff, but I didn't say they were. But they do have a level of familiarity with the process that is helpful to build off of. I hear what you are saying about being uncomfortable with the lack of a standardized push for benchmarks you feel important. NP's will definitely suffer if they have a vast landscape of quality.

If you feel comfortable diving into an EKG and calling out those features, then more power to you. But your average fast track newby PA is going to tread lightly and punt or consult with the doc well before things get hot. Those of you guys in the boonies that can hold down the fort are a cut above the rest of the PA's coming out because you gained experience along the way.

Time will tell whether NP's are making the cut. There are tons of anecdote to pass around here, but I'm waiting for the juicy expose on poor quality NP's ruining lives left and right. The evidence just isn't there. A lot of you will say its the lobby. But if this were widespread, lawyers would be ALL OVER IT. NP's aren't big enough fat cats for a ambulance chaser to bother rolling? Well their employers are. But its not happening because its not happening.

I don't have a beef with PA's. I love them and work closely with them. I find that working with them is more refreshing than a lot of NP's because there isn't a "supernurse" mentality that some NP's have. I would be willing to be a PA if the role wasn't wedded to the notion that one provider needs to have a symbiotic relationship with a superior provider. I think its a disservice to everyone to have PAs be like the medical community's dental hygienist. To me that's an outmoded relationship.
 
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Subtle but important different. At no point did I suggest an PA 12-18 month residency is the same as an MD/DO 3-4 year residency. I wondered if the skillset of a PA with a residency + CAQ + years of experience might be equivalent to that of an EMT physician. It was a question, not an assertion.

Well, as a common consultant to the ED, I have experience with both fresh and seasoned PAs and fresh and seasoned attending EM attendings. The skillset isn't even close. While I don't always agree with the decisions of the EM attendings, the skillset the bring is head and shoulders above every PA. This is not all that surprising when you consider that even with a PA residency they still have tens of thousands more hours of clinical training and a much broader and deeper fund of knowledge.

With regard to the NP and PA argument- I think it is dependent on the individual and the practice location- inpatient vs outpatient and between different specialties. I have worked with a few exceptional NPs and one exceptional PA (NPs are more common in my hospital). I have also worked with a bunch of terrible NPs and only one bad PA (who was fresh out of school). In my experience the PAs are less confident in their skills and ask for more help, however they seem equally capable. On the other hand, NPs often do not ask for help and get into trouble because they have no idea what they don't know. For a physician who is in a state or hospital where they are responsible, if you have one of these NPs you may get screwed. Know the capabilities of those beneath you.
 
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A physician told me that they like employing NPs in their group because as nurses, they are more comfortable calling a doc for guidance from their time as RNs, and do so appropriately. Thats one opinion, but not really a flattering one for folks that tout NPs being independent.

Overall, what I've found is that it's rare that physicians are in any way preoccupied with the PA or NP profession in the slightest... to the extent that most don't really differentiate. If the market where they are at is PA friendly, they will hire from that labor pool. Med students seem to be up in arms in a few threads about how bad they think NPs will suck based on deductive reasoning rather than any firsthand knowledge, but there you go. Once they are out in the industry counting the cash coming in, the parts of their brains that are now breathlessly consumed with concern over what group to put down will instead be reallocated to figuring out how to retire to the quickest. Because then its like deep down, a large part of the appeal of medicine is the money, but that's not as good an answer as "doing it for the people" or "the challenge". When you sacrifice your 20s and part of your 30s for your career before you see a big payday, that payday might prove to be small compensation given the amount of effort. Then you are left with "desire to serve humanity", but that can be hard to muster after a parade of addicts try to manipulate you all day at work.

That could be why you sometimes hear physicians telling people that they wouldn't encourage folks to get into medicine. The money is good eventually, but a job still feels like a job, and people work to get paid, even the docs.
 
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In PA school the answer of "consult with the physician" is regularly the right answer on the test. PAs are taught that we are not the be-all-and-end-all of medical knowledge and are a member of the team where we need to continually learn and never be afraid to ask for help.

NPs, however, are taught to be silos and don't know what they don't know. This is why they are dangerous.

What evidence is there that NPs are "taught to be silos" and not to consult others?
 
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So you cannot back up your claim. Thank you.
 
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