sendwich

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what are some things NP are responsible for? are they the more "medical" aspects of nursing? how so? what do they do that is different from RNs? thanks
 

md03

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Im a NP who is now in medical school. I went to a NP program that didnt' requrie a BSN first, so we did a little bit of RN stuff (just barely enough to qualify to take the NCLEX)

Yes, in a way NP takes care of more medical stuff. Most probably work in clinic/office setting, but there are increasing opportunities in more specialized settings. Take, for example, a family practice office. If you were to watch the activities of the NP and the MD working there, you would be unable to tell the difference. The NP sees the patient, takes a history, does an exam, makes a diagnoses and prescribes treatment, including writing prescriptions for meds. (whereas the RN in the office would take the vitals, put the pt in the room and give injections)

Differences..NP aren't trained to handle the scope of diseases that MD are. Generally NP must be "supervised" in some way by MD...what this means in acutal practice varies from state to state. The charts often must be cosigned by the MD. And one minor, but very annoying, aspect is that any tests, xrays, you order or referals you make go out under the MD's name (so in some ways the NP doesn't seem to exist)

Generally, NP aren't expected to do traditional things that RN do working on a hospital floor (IV, give meds, etc) However, you must be careful becuase in some settings the view is that a NP is like having a nurse and a doctor in one for a very cheap price, like a job I had in a rural setting. I never had a nurse in my clinic (run by a hosptial) and was expected to do all the nursing stuff as well as manage the medical issues.

However, where I go to medical school, NP's work in very specialized settings. THere are several that work in the trauma area, for example. They see some very sick patients (like some with spleen, liver or kidney lacerations). They can initally evaluate these patients, order tests, read the xray/CT, and decide to admit if necessary as well as write admission orders. The RNs carry out the NP orders just like they do the MD orders. What the NP don't do is work in the shock trauma area (this is the full "trauma, life in the ER type area). They work in the same area with a 2nd year surgery resident, but, unlike the resident, they don't go over to the shock trauma area when those patients come in. The basic premise is that they stay in the trauma assessment area and help keep if from getting too backed up.

What made me go to med school after being a NP for several years is that I want to be the one that the buck stops at. I prefer dealing with the sicker, more complicated patients, which, generally NP's don't. I like doing procecures and NP gereally get a lot of flack for trying to do procedures. And NP is NEVER the person who the buck stops at. And now that I've been in medical school, I've decided to do general surgery. NP's can't do operations.

But, in general, yes, being a NP is very much like being a MD and patients really can't tell the difference.
 

Rad 1

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Just one small correction to the above post. NP's DO NOT/ CANNOT read the x-rays/CT's. Radiology residencies exist specifically to teach MD's/DO's how to do this. I don't mean to be abrupt, but after working in the field of Radiology for a few years, I have seen too many non-physicians and even some non-Radiologist physicians falsely credit themselves w/ being able to interpret various diagnostic studies. If there are NP's doing this, then they are definitely practicing out of their field and creating danger for the patients.

Rad 1
 

md03

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you are right that the radiologst has the final word on interpretation of films. Reality is, however, that radiologists are not always available in every hospital 24/7 (thought with tele-radiology, some can read films from home). This means that many health care providers must interpret films without and treat the patient without direct, immediate input from a radiologist. Most of the time, things that need urgent/emergent attention are not missed by non-radiologist providers who have a decent amount of experience. Every hospital without 24/7 radiology coverage has a policy/protocol for followup if the radiolgist reading does not agree with the provider who saw the patinet at the time. Most common this happens with chest films or extremity films looking for possible fractures. The vast majority of the time, if the provider missed something, it was a subtle finding that didn't impact the immediate care (eg a tiny fracture that the provider missed, but splinted the patient anyway, when the treatment even knowing about the fracture would have been to splint and provide a follow-up appointment)

At my medical school, the surgeons interpret CT scans as well in the trauma center. The volume is too high to wait for a radiology report on everything. In the wee hours of the morning, there is no radiology attending. The surgeon may be a 5th year resident, and the radiology resident may be a 2nd year. The surgeons are always careful to ask the radiology resident's opinion regarding CT they are not sure of.

I have seen providers miss xray findings as well. I have also correctly interpreted films when working as NP that the MD covering the ER incorrectly interpreted.

I believe that all providers who routinely order imaging studies should be able to do basic interpretation, rather than rely soley on the radiolgist report. It is much more valuable to view the films yourself. One should never pretend to be a radiolgist when one isn't. To say, however, that no one but a radiologist can correctly interpret xrays is similar to saying that only internal medicine doctors can diagnose hypertension, or that only a surgeon can diagnose an inguinal hernia. There are some basic things which all providers should be able to do. The fact that board exams which ALL medical students take requires some basic x-ray interpretation says that we are all expected to be able to achive a certain level of compentence in that area.
 
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