Nurse Practioners encroaching upon Physician territory?

[bakanoisha]

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"if they[Osteopaths] want to be recognized as physicians by our medical community, then they can attend the medical colleges put in place by our medical community." -Sen. Tasker Oddie 1930-

great stuff man... keep up the good work...

You truly are short a few screws. Osteopaths of yesteryear were very different from what they have become today. They have conformed to all current medical college standards and simply retain some of the osteopathic stuff, like OMM.

And, why in the hell do you insist on putting nurses on the same level as physicians? They have different educations and they fill different roles in healthcare.

 

[Freezer]

You officially win the "off by a long shot" award. Your comparisons are not only way off, but completely inappropriate.

👎thumbdown👎thumbdown👎thumbdown

long shot? really? what do any of you hope to accomplish with this bulletin... we have 10 people on one side who wont budge on the issue... and 10 on the other just as closed minded... this isnt a discussion or an argument or a debate anymore... it is futile nonsense... no shades of gray... just black and white...

please, to make this a more constructive discussion, why dont we talk about what rights and practices an NP should be afforded and limited as a health professional IF their role in medicine were to be further expanded through new legislation... for example, should NPs be allowed to prescribe schedule 1 medications? should NPs be allowed to discuss hospice and paliative care options with patients? because quite honestly, no one cares what classes someone takes in college... they can still suck as a health professional...

 

[Perrotfish]

And, why in the hell do you insist on putting nurses on the same level as physicians? They have different educations and they fill different roles in healthcare.

The argument here, being made by NPs who want to be MDs, is that a nurses education is sufficient to do a physicians job. It's not that the nurse's education is equivalent to the physicians, but just that the physician is overtrained (in some specialties) and therefore anurses can be trainined to meet the need in less time, in greater numbers, and for less expense. It's not that a someone with a doctorate in the janatorial sciences isn't very well trainined in what he does, but rather that the guy with the middle school diploma is equally well qualified to mop the floors and you're going to go ahead and hire him because he's cheaper.


This is an area where I break with SDN/physician orthodoxy., because to be honest, I see their point. When drug companies try to sell a high priced drug with unclear benifits compared to a cheaper generic, physicans tend to call them greedy and unethical (which I agree with) and demand congressional legislation to protect their poor patients from being gouged. However at the suggestion that physicians should evaluate their own training for cost-effectiveness those same docs look at you like you've got something unmentionable hanging off of your forehead. The basic philosophy of the medical community is that the absolute minimum amount of training a physician should have is the absolute maximum amount of training that any doctor has ever recieved for that job at any time or place in the US. Which is one of the reasons why medical schools are taking even older students and adding research years, while residncies are getting longer and longer while become more and more specialized. Heck, we are one of the only nations in the world that forces our future physicians to go through a near endless and extremely expensive 'premedical' phase where, as the name implies, they learn nothing about medicine, and even that huge expense absolutely no one is willing to get rid of.

If it were up to me I would try to put together a good old fashioned trial. Bring in some NPs and PAs, as well as some FPs, to each work independently in some area. Have the patients sign off on it the same way they would with a drug trial. Then test outcomes and see if an FP is really better. Same goes for CRNAs, midwives, chiros, whatever. If they fail the blind trial they're back to being subordinates, if they don't they should be able to practice on their own. Nothing too complicated.

 

[bakanoisha]

long shot? really?

You were comparing people those of us who don't want to give NP's an MD's job to "good ol boys" who are keeping black people down and out, solely for racist reasons.

Tell me how that isn't off by along shot, totally ridiculous, and uncalled for?

hey if any of you cant think of any more bs talking points to sling at each other... please refer to some AMA reports from the early 1900s and replace "DO" with "NP"... should give you some more ammunition... for those of you radical fascists types out there... refer to a 1950s New York Times and replace "african american" with "NP" and "good ole boy country club" with... well i guess you can keep the "good ole boy country club" part in... should do nicely with what you are trying to say...

 

[Instatewaiter]

So another that really equals 6 years + 6 months, not just 6 months.

I also did nearly 2500 hrs in two years of undergrad. But again, you don't count this anywhere in your calculations. I guess that when you advance from BSN to NP and NP to DNP, your past clinical time counts for nil?


I though med students started clinical rotations in the 3rd year (sorry if I am wrong) If you had 3000 hours by your third year, then you were working 80+/week for 12 months. Residents don't even do that.

1000 DNP hours, plus the two years of NP clinical + the two years of BSN clinical = way more than 1000hrs. Again, simple math.


See, its easy to skew the facts if you really want to. Call any DNP admissions department and ask them. You cant get a DNP in 6 months alone and over the sum of all the nursing education required to get a DNP, way more than 1000 clinical hours are amassed.

You completely misinterpreted what I was saying (with the 6 months). I will spell it out again. Going from BSN to NP vs BSN straight to DNP is only 6 months worth of extra course work. So starting from a BSN, you can go straight to a DNP by only having to do 6 more months of work over an BSN--> NP. Notice many (most) programs offer BSN straight to DNP. So credits to get an NP from a BSN are only around 15-20 less than to get a DNP. No where else in the world is the difference between a masters and a doctorate in the same field only 6 months difference.

So these DNP programs DO NOT REQUIRE the clinical hours of the NP- just the 1000 hours.

Your "clinical experience" during your undergraduate nursing is not the same as during DNP. You did not learn medical assessment nor diagnosis during your BSN. While sure you did pick up some valuable experience in the hospital it did not involve the same kind of thinking as you need to diagnose and treat. These hours, while valuable are not the same. It still stands that most DNP programs only require 1000 hours. I am glad you did more. You will likely be ahead of your peers.

Yes med students start rotations 3rd year. Perhaps I was unclear. I had 3000 hours during my third year (probably more). I averaged ~60h per week and had 3 weeks off. So, 60 hours per week, for 49 weeks makes 2940 hours. 80 hours a week year round would have made almost 4200 hours. For the record, there were weeks where I worked well over 100 hours in the hospital (not including study time at home). Residents do this all the time. Like residents our hours need to average to no more than 80 hours in a 4 week period. So 1 week I could do 100 hours, the next 90, the next 80. The last week would need to be only 50 so that I averaged 80 hours over 4 weeks.

 

[bakanoisha]

Yes med students start rotations 3rd year. Perhaps I was unclear. I had 3000 hours during my third year (probably more). I averaged ~60h per week and had 3 weeks off. So, 60 hours per week, for 49 weeks makes 2940 hours. 80 hours a week year round would have made almost 4200 hours. For the record, there were weeks where I worked well over 100 hours in the hospital (not including study time at home). Residents do this all the time. Like residents our hours need to average to no more than 80 hours in a 4 week period. So 1 week I could do 100 hours, the next 90, the next 80. The last week would need to be only 50 so that I averaged 80 hours over 4 weeks.

You sound ridiculously busy during those years... when did you do your homework!?

 

[Freezer]

You truly are short a few screws. Osteopaths of yesteryear were very different from what they have become today. They have conformed to all current medical college standards and simply retain some of the osteopathic stuff, like OMM.

And, why in the hell do you insist on putting nurses on the same level as physicians? They have different educations and they fill different roles in healthcare.

sure, osteopaths are very different today than what they were in 1910... and then from 1920-1940 they evolved into the physicians we know and love today... oh now lets see what could have happened during those years to make them want to change their practice... oh thats right, it was all that state legislation that was discussed compromised and written! i knew it had to be something... it wasnt "no DO vs pro DO"... it was "what do DOs have to do to be recognized in the legal medical community"...

nurses do fill a wide variety of necessary roles in healthcare... all i would argue is if an NP, which recieves much more education than the average RN, is trained to do a task... then why not let them? what roles can we let them safely fill today? i see NPs running urgent care units... establishing family care... its not like we are saying, "here, go be a neurosurgeon"... but i think there are a lot of tasks physicians routinely do that can be safely passed to an NP if policy were to be rewritten...

 

[bakanoisha]

sure, osteopaths are very different today than what they were in 1910... and then from 1920-1940 they evolved into the physicians we know and love today... oh now lets see what could have happened during those years to make them want to change their practice... oh thats right, it was all that state legislation that was discussed compromised and written! i knew it had to be something... it wasnt "no DO vs pro DO"... it was "what do DOs have to do to be recognized in the legal medical community"...

Did it ever cross your mind that there were legitimate reasons for not including the DO's of the time in the legal medical community?

nurses do fill a wide variety of necessary roles in healthcare... all i would argue is if an NP, which recieves much more education than the average RN, is trained to do a task... then why not let them? what roles can we let them safely fill today? i see NPs running urgent care units... establishing family care... its not like we are saying, "here, go be a neurosurgeon"... but i think their are a lot of tasks physicians routinely do that can be safely passed to an NP if policy were to be rewritten...

And they can do many of the routine tasks... that's precisely why they work semi-autonomously under a physician. Being that they aren't as well trained as physicians for diagnosis, their scope of practice should be limited to a scope that is smaller than that of a physicians.

 

[RogueUnicorn]

Dude, you really ought to go check with your own org about this. The DNP is an academic degree. It's not about patient care. "Theory" is the politics and procedures side. It has nothing to do with patients.

hmm? you're mistaken. there's PhD in Nursing for that.

 

[RogueUnicorn]

But like I asked previously, how much does clinical time as a nurse really help in the practice of medicine? You're taught to think like a nurse in nursing school (at least that's what I'm assuming based on nursing theory courses being required) while you are taught to think as a doctor in medical school. Sure, all those clinical hours might help a bit, but I feel like it's not as helpful as the nursing community seems to make it out to be.

Also, there are several direct-entry NP programs where you can become an NP in about 3 years with no prior healthcare experience. That's kinda scary if someone with no prior experience in a clinical setting is going to take classes that involve a significant amount of fluff, as Instatewaiter pointed out, and then are allowed to practice independently.

I don't think it's fair to say that clinical time spent as a nurse equals clinical time spent practicing medicine. They're not the same thing, so how can you count the number of years a person was a nurse prior to an NP/DNP as valid clinical hours practicing medicine? Just like I can't say that my volunteer hours count as time spent practicing nursing/medicine, I don't understand how you can say time spent being a nurse = time spent practicing medicine. Seriously, if I'm wrong about it, please provide evidence that years spent as a nurse is equivalent to what a med student does during M3/M4 and what a resident does during residency. But if you can't provide the evidence, you can't say they're equal either.

And can't you earn an NP/DNP part-time? So you can get paid during the time you're earning the degree. Where are you getting the 3000-4000 clinical hours from? I can't see in the NP/DNP curricula anything much more than about a 1000 hours. As for the prior years of nursing experience, please read the earlier bits in my post where I argue that they're not the same as practicing medicine.

to say the BSN education has no bearing on DNP is laughably ridiculous. i can understand why the confusion may come into play, because the RN education has been deliberately separated from medical education. but really, any ******* nurse can diagnose a wide variety of conditions from the get-go. it's just that they're not technically allowed to.

also, considering that most nurses on hospital floors run circles around first and second year residents, i'm rather confident that years spent nursing >>>ms3/4 in clinical terms.

 

[Freezer]

Did it ever cross your mind that there were legitimate reasons for not including the DO's of the time in the legal medical community?

And they can do many of the routine tasks... that's precisely why they work semi-autonomously under a physician. Being that they aren't as well trained as physicians for diagnosis, their scope of practice should be limited to a scope that is smaller than that of a physicians.

i like this... lets expand on this... so lets say hypothetically, nursing schools create a sort of NP residency program... maybe even expand on their curriculum in nursing school... in your opinion, what conditions in this residency would have to apply in order for an NP to be given more autonomy? instead of turning them into MDs or DOs, what would they have to do in order to be a new type of advanced healthcare professional? what voids or problem areas are left in healthcare that an NP could fill? what would that NP have to do to fill those areas? an MD curriculum creates an MD... a DO curriculum creates a DO... how should we create the new NP to best suit tomorrows healthcare needs?

 

[RogueUnicorn]

i like this... lets expand on this... so lets say hypothetically, nursing schools create a sort of NP residency program... maybe even expand on their curriculum in nursing school... in your opinion, what conditions in this residency would have to apply in order for an NP to be given more autonomy? instead of turning them into MDs or DOs, what would they have to do in order to be a new type of advanced healthcare professional? what voids or problem areas are left in healthcare that an NP could fill? what would that NP have to do to fill those areas? an MD curriculum creates an MD... a DO curriculum creates a DO... how should we create the new NP to best suit tomorrows healthcare needs?

stop with this reasoned search for an acceptable compromise!!!!

 

[VassarLiberal]

I had heard anecdotal evidence of NPs prescribing unnecessary pharmaceuticals at higher rates than physicians, and doing some review of the literature, it seems that they do. Lots of the research that I found, however, doesn't differentiate between NPs and PAs, but I would venture to guess that due to increased MD/DO supervision of PAs and the emphasis on medicine and basic sciences provided by PA education, PAs have lower prescribing rates than NPs. Nevertheless, more research is necessary here.

-Practitioner Prescribing Habits for Pharyngitis:
Implications for Evaluation and Management

Patients with pharyngitis but negative cultures were treated with antibiotics at higher rates (57% versus 38%) by NPs/PAs versus physicians (MD/DO)

- Differences in antibiotic prescribing among physicians, residents, and nonphysician clinicians
This is just the abstract, as I'm not able to access the full article myself, but, nevertheless, NPs/PAs prescribed antibiotics more often than physicians overall, and more often even when antibiotics are "rarely indicated."


In regards to training, it appears that NPs have less pharmacology training than physician assistants (PA), dentists (DDS/DMD), and physicians (MD/DO, and quite possibly DPM).

Evidence of that dentists and physicians receive more pharmacology training than NPs is provided here: (just an abstract here, you can find the full article elsewhere, I believe) http://www.eric.ed.gov:80/ERICWebPo...&ERICExtSearch_SearchType_0=no&accno=ED301661

PAs average 78 hours of in-classroom hours of instruction in pharmacology (http://www.aapa.org/images/stories/Advocacy-issue-briefs/controlledrx.pdf)

The pharmacology training of nurse practitioners seems to be less in hours of instruction than that of their medically-trained equivalent, the PA. I selected the University of Pennsylvania's adult NP program to examine. This program, ranked as the number one adult NP program by US News, a biased and weak ranking, but, still, a ranking, offers one course in pharmacology –*"NURS508 - Applied Pharmacology in Nursing Practice."
In terms of hours, let's look at another program. Emory's adult NP program offers 3 credit hours in "Advanced Pharmacology" (http://www.nursing.emory.edu/nursing/admissions/msn/amsb.shtml). One semester is roughly 14 weeks. 3 credit hours refers to 3 hours of class per week, so this is approximately 42 hours of actual instructional time in pharmacology.

On the other hand, nurses have been demonstrated to be better managers of some chronic conditions. Quite a bit of research demonstrates this for diabetes management. (Example: http://care.diabetesjournals.org/content/26/8/2281.full Still, in this study, a physician did supervise the nurses managing the cases.)

 

[bakanoisha]

i like this... lets expand on this... so lets say hypothetically, nursing schools create a sort of NP residency program... maybe even expand on their curriculum in nursing school... in your opinion, what conditions in this residency would have to apply in order for an NP to be given more autonomy? instead of turning them into MDs or DOs, what would they have to do in order to be a new type of advanced healthcare professional? what voids or problem areas are left in healthcare that an NP could fill? what would that NP have to do to fill those areas? an MD curriculum creates an MD... a DO curriculum creates a DO... how should we create the new NP to best suit tomorrows healthcare needs?

Well... if NP's want to become an MD/DO equivalent to suit the needs of tomorrows healthcare needs, they can follow the route of the DO and put their NP's through medical school and a full residency. Simple, right?

 

[Charles_Carmichael]

to say the BSN education has no bearing on DNP is laughably ridiculous. i can understand why the confusion may come into play, because the RN education has been deliberately separated from medical education. but really, any ******* nurse can diagnose a wide variety of conditions from the get-go. it's just that they're not technically allowed to.

also, considering that most nurses on hospital floors run circles around first and second year residents, i'm rather confident that years spent nursing >>>ms3/4 in clinical terms.

BSN education doesn't really have a bearing on DNP education. How is that laughably ridiculous? BSN education is designed to put out nurses that practice nursing. A DNP is trying to put out DNPs that practice medicine. When you decide to pursue an NP/DNP after being a nurse, you don't get a huge advantage because you have learn how to think in a medical manner rather than in a nursing manner. Completely different philosophies, ways of thinking, etc. How does this not make sense?

And it's hard to believe that most nurses run circles around 2nd year residents. I call BS on that and ask that you provide evidence of that, not anecdotes. I can see a long-time nurse in a particular department knowing more/etc. than a newly minted intern, but after a few months, I don't think you can say that floor nurses are running circles around them. Medical students graduate with a lot of knowledge; they're just not that great at applying it just yet. Or at least that's the sense I'm getting. But give them a month or so with the steep learning curve that exists in residency, and I highly doubt that nurses are running circles around them. If you're comparing a nurse that has been in a particular department for decades compared to a rotating intern in their first months of residency, okay, maybe I can understand that. But to say that nurses run circles around 2nd year residents is a bit of a stretch.

And may I ask how you are "confident that years spent nursing >>>ms3/4 in clinical terms?"

 

[VassarLiberal]

but really, any ******* parent can diagnose a wide variety of conditions from the get-go.

Fixed it for you.

 

[bakanoisha]

Fixed it for you.

Hahahahaha... so true! 👍

 

[Charles_Carmichael]

I had heard anecdotal evidence of NPs prescribing unnecessary pharmaceuticals at higher rates than physicians, and doing some review of the literature, it seems that they do. Lots of the research that I found, however, doesn't differentiate between NPs and PAs, but I would venture to guess that due to increased MD/DO supervision of PAs and the emphasis on medicine and basic sciences provided by PA education, PAs have lower prescribing rates than NPs. Nevertheless, more research is necessary here.

-Practitioner Prescribing Habits for Pharyngitis:
Implications for Evaluation and Management

Patients with pharyngitis but negative cultures were treated with antibiotics at higher rates (57% versus 38%) by NPs/PAs versus physicians (MD/DO)

- Differences in antibiotic prescribing among physicians, residents, and nonphysician clinicians
This is just the abstract, as I'm not able to access the full article myself, but, nevertheless, NPs/PAs prescribed antibiotics more often than physicians overall, and more often even when antibiotics are "rarely indicated."


In regards to training, it appears that NPs have less pharmacology training than physician assistants (PA), dentists (DDS/DMD), and physicians (MD/DO, and quite possibly DPM).

Evidence of that dentists and physicians receive more pharmacology training than NPs is provided here: (just an abstract here, you can find the full article elsewhere, I believe) http://www.eric.ed.gov:80/ERICWebPo...&ERICExtSearch_SearchType_0=no&accno=ED301661

PAs average 78 hours of in-classroom hours of instruction in pharmacology (http://www.aapa.org/images/stories/Advocacy-issue-briefs/controlledrx.pdf)

The pharmacology training of nurse practitioners seems to be less in hours of instruction than that of their medically-trained equivalent, the PA. I selected the University of Pennsylvania's adult NP program to examine. This program, ranked as the number one adult NP program by US News, a biased and weak ranking, but, still, a ranking, offers one course in pharmacology –*"NURS508 - Applied Pharmacology in Nursing Practice."
In terms of hours, let's look at another program. Emory's adult NP program offers 3 credit hours in "Advanced Pharmacology" (http://www.nursing.emory.edu/nursing/admissions/msn/amsb.shtml). One semester is roughly 14 weeks. 3 credit hours refers to 3 hours of class per week, so this is approximately 42 hours of actual instructional time in pharmacology.

On the other hand, nurses have been demonstrated to be better managers of some chronic conditions. Quite a bit of research demonstrates this for diabetes management. (Example: http://care.diabetesjournals.org/content/26/8/2281.full Still, in this study, a physician did supervise the nurses managing the cases.)

I have no problem with PAs. Their training is much closer to the training of physicians (compared to NP/DNP training) and they're not trying to equate themselves with physicians. They're also regulated by the BOM, unlike the NP/DNP. I still don't understand how they are regulated by the BON when they're practicing medicine.

 

[SoFreakedOut]

I say, give a backhand right across the face to the next b****-a** nurse who thinks she can come and treat a patient over you (a physician). That'd teach her (or him) to stay in her (or his) place.

Wow, there's a lot of room for you to grow up. I know with the long application to medical school and all the things that are required of us (shadowing, volunteering, excellent grades, great recs, etc.) we tend to put being a doctor on a pedestal. But guess what, you can't handle patients single-handedly. You're going to have to deal with medical assistants, receptionists, nurses...a whole lot of other people. So try to lose the elitist attitude already.

I see this debate paralleling the concerns people have for illegal immigrant workers. They make them out to seem like evil creatures who are encroaching on the jobs citizens could otherwise have and what's more, they might even want normal wages! How dare they?! The reality is this country needs them because we don't have enough people willing to do what they do for the amount they get paid (don't get me wrong, regulating illegal and legal status is fine, that's just a separate issue than whether they're actually "taking our jobs").

Same goes for NPs. They're not taking over primary care doctors' jobs, there are simply not enough primary care doctors to take care of patients. It is more lucrative to specialize and this has caused a huge shortage in primary care doctors. As a result, many NPs are helping fill in the gaps and they're doing it for lower wages. I definitely wouldn't put them as the bad guys. Of course they'd want to get paid more for doing the same work as some doctors. The real issue is that salary needs to be raised at a national level for primary care doctors to lure more medical students into the field. The boundaries would then work themselves out. The last person I'd be upset at is the NP for doing your work for less. Sure doctors amass a lot of knowledge, but so do NPs and once you see similar cases every day, every single fact you learned throughout med school won't be as pertinent.

 

[RogueUnicorn]

BSN education doesn't really have a bearing on DNP education. How is that laughably ridiculous? BSN education is designed to put out nurses that practice nursing. A DNP is trying to put out DNPs that practice medicine. When you decide to pursue an NP/DNP after being a nurse, you don't get a huge advantage because you have learn how to think in a medical manner rather than in a nursing manner. Completely different philosophies, ways of thinking, etc. How does this not make sense?

And it's hard to believe that most nurses run circles around 2nd year residents. I call BS on that and ask that you provide evidence of that, not anecdotes. I can see a long-time nurse in a particular department knowing more/etc. than a newly minted intern, but after a few months, I don't think you can say that floor nurses are running circles around them. Medical students graduate with a lot of knowledge; they're just not that great at applying it just yet. Or at least that's the sense I'm getting. But give them a month or so with the steep learning curve that exists in residency, and I highly doubt that nurses are running circles around them. If you're comparing a nurse that has been in a particular department for decades compared to a rotating intern in their first months of residency, okay, maybe I can understand that. But to say that nurses run circles around 2nd year residents is a bit of a stretch.

And may I ask how you are "confident that years spent nursing >>>ms3/4 in clinical terms?"

hard to refute that, as i don't have full free online article access anymore and research on this is doubtful to exist to start with. nurses with 5+ years of experience (most of them, at least on most of the floors i've ever been on) have incredible amounts of knowledge. it may be confined to their particular specialty, but it is extremely high, at least in big university hospitals that i've been in.

"running circles" perhaps puts the dynamic in an adversarial manner which is not the case, and if i portrayed it that way it was a mistake. there is no competition between the nurses and the residents to see who can do better. but i've personally seen surgical residents take advice from the more senior floor nurses (i.e. nurse told them what the course of action was) and there was great mutual trust. most nurses put in lots of drug orders that they knew should be coming anyway. never once was this a problem and almost always the resident was grateful. just saying, it's not fair to bash all nurses as a bunch of half-trained buttwiping monkeys.

finally, as a general point, almost no well esteemed graduate nursing program regularly accepts nurses with less than a few years of experience, and even then the students usually take some time off to go work, as the lack of clinical experience serves as a severe demerit in the job search.

 

[Charles_Carmichael]

hard to refute that, as i don't have full free online article access anymore and research on this is doubtful to exist to start with. nurses with 5+ years of experience (most of them, at least on most of the floors i've ever been on) have incredible amounts of knowledge. it may be confined to their particular specialty, but it is extremely high, at least in big university hospitals that i've been in.

"running circles" perhaps puts the dynamic in an adversarial manner which is not the case, and if i portrayed it that way it was a mistake. there is no competition between the nurses and the residents to see who can do better. but i've personally seen surgical residents take advice from the more senior floor nurses (i.e. nurse told them what the course of action was) and there was great mutual trust. most nurses put in lots of drug orders that they knew should be coming anyway. never once was this a problem and almost always the resident was grateful. just saying, it's not fair to bash all nurses as a bunch of half-trained buttwiping monkeys.

finally, as a general point, almost no well esteemed graduate nursing program regularly accepts nurses with less than a few years of experience, and even then the students usually take some time off to go work, as the lack of clinical experience serves as a severe demerit in the job search.

I don't think anyone is arguing that nurses are dumb or anything of that sort. I definitely am not. And I completely understand that a nurse that has years and years of experience in a particular department will initially know more about what to do in clinical situations than a new med school graduate. That resident will be forced to adapt to residency and find his bearings; in my opinion, he/she will likely surpass what the nurse knows within the first year. However, I do acknowledge that I have no hard evidence to back this up other than what the residents/attendings I've spoken to have told me. And what they say does make sense; what you learn in medical school regarding physiology/pathophys/etc. is far superior to what nurses learn. From what I understand, residency is about applying what you have learned in medical school in a clinical setting (any med students/residents/attendings can correct me if my assumption is completely wrong).

What we're arguing is that the level of NP/DNP training that's provided is not adequate to practice independently without any physician supervision. As I've mentioned repeatedly, the most vocal group of NPs and DNPs are actively pushing towards being called a doctor in a clinical setting, being equivalent to physicians, and being reimbursed in an equivalent manner to physicians. It's a slap in the face to physicians to say that you are equal to them with about half their training. The way to become a physician is not through becoming a nurse. If that's the case, we're all idiots for wanting to take the longer and harder path towards practicing medicine. There are no shortcuts to learning to practice medicine; there's a reason that physicians have to have a minimum of 7 years of medical (not nursing) training before they're allowed to practice independently.

Would you be willing to let a 4th year med student practice independently? No. Even though they've had more basic science education and clinical hours than NPs and DNPs. Don't think what I'm saying is due to hate of nurses or anything of that sort. I realize how important nurses are and I also realize that midlevels are important in the current system. What scares me are the midlevels wanting to practice without any physician supervision and insist they're equivalent to physicians when they do not have the same level of training.

 

[VassarLiberal]

I still don't understand how they [NPs] are regulated by the BON when they're practicing medicine.

That's the beauty of it, from the legal reasoning standpoint, I think. They practice medicine under the guise of nursing. Since the legal scope of nursing practice is fairly broad, and there is a grey area between nursing and medical care, state legislators etc. have allowed NPs to practice in this legal grey area. The states define advanced practice nursing as they wish (http://books.google.com/books?hl=en...SDjqXNRL-Ot4IYuvwMT1Txjg#v=onepage&q=&f=false has some insight and lists of state laws). Or so it seems to this non-attorney/non-physician.

The DEA lets them prescribe under the same authority as PAs, and federal law seems to largely let the states do what they will.

 

[demayette]

I have no problem with PAs. Their training is much closer to the training of physicians (compared to NP/DNP training) and they're not trying to equate themselves with physicians. They're also regulated by the BOM, unlike the NP/DNP. I still don't understand how they are regulated by the BON when they're practicing medicine.

I do not think NP should have been allowed to diagnose and prescribe in the first place (This NP stuff is b.....s... and USA in the only country in the American Continent that has the mid level practitioners cr...p (ie NP/PA)..I can understand the PA model because it is regulated by the BOM and the classroom curriculum is somewhat similar to MD/DO (residency is another story);however, I feel like PAs are qualified to handle less complicated medical cases.
I do not think NPs/DNP should be allowed to practice medicine when they do not have no knowledge in CHEMISTRY, BIOCHEMISTRY etc... And that DNP cr...p is a way for nurses to try to equate themselves with MD/DO...
If AMA allows these things to go on, in a few years Physical Therapist will try to become PCPs too just because they have knoweledge in anatomy.
If somebody wanna practice medicine, do yourself a favor and go to medical school.......And believe or not, I am a nurse

 

[VassarLiberal]

USA in the only country in the American Continent that has the mid level practitioners cr...p (ie NP/PA)

Canada's military has PAs, and they're making inroads into civilian practice. Also, Canadian advanced care paramedics can perform more procedures than US EMT-Ps, including suturing.

 

[Charles_Carmichael]

That's the beauty of it, from the legal reasoning standpoint, I think. They practice medicine under the guise of nursing. Since the legal scope of nursing practice is fairly broad, and there is a grey area between nursing and medical care, state legislators etc. have allowed NPs to practice in this legal grey area. The states define advanced practice nursing as they wish (http://books.google.com/books?hl=en...SDjqXNRL-Ot4IYuvwMT1Txjg#v=onepage&q=&f=false has some insight and lists of state laws). Or so it seems to this non-attorney/non-physician.

The DEA lets them prescribe under the same authority as PAs, and federal law seems to largely let the states do what they will.

I have to hand it to the NPs/DNPs though. They're really sneaky/brilliant about the way they're practicing medicine without BOM oversight.

 

[VassarLiberal]

I have to hand it to the NPs/DNPs though. They're really sneaky/brilliant about the way they're practicing medicine without BOM oversight.

It's mo-f****n' genius.

The overlap between the practice of medicine
and the practice of nursing – American Association of Nurse Anesthetists

"Where does the practice of nursing end and the practice of medicine begin? The answer, as so clearly stated by the Missouri Supreme Court, is that there is no defining line between the professions. There are numerous overlapping areas and activities which constitute the practice of nursing when performed by nurses and the practice of medicine when performed by physicians."

Interesting, no? I imagine a creative malpractice lawyer could have a field day suing a CRNA or NP who harms a patient (maybe have rulings overturned?).

 

[Hoody]

I have no problem with PAs. Their training is much closer to the training of physicians (compared to NP/DNP training) and they're not trying to equate themselves with physicians. They're also regulated by the BOM, unlike the NP/DNP. I still don't understand how they are regulated by the BON when they're practicing medicine.

Maybe advance practice nurses should be under the BOM. But seriously, you can't compare PA school to NP/DNP school when you don't know what either truly consists of. This is like comparing apples to oranges when all you really know is limes.

I don't think anyone is arguing that nurses are dumb or anything of that sort. I definitely am not.

I hear you, but your words seem to speak otherwise...

However, I do acknowledge that I have no hard evidence to back this up other than what the residents/attendings I've spoken to have told me. And what they say does make sense; what you learn in medical school regarding physiology/pathophys/etc. is far superior to what nurses learn.

Let me repeat myself one more time. I had several phys and pahophys classes while in undergrad school. I may not have studied at the depth or pace as a MD/DO, but I was required to take general phys and pathophys before applying and then spent another two years taking upper division phys and pathophys classes (w/ labs) as part of the core curriculum. Furthermore, some of the courses were cross listed with graduate level courses, such as medical microbiology, a 5 credit class that has two full labs a week. That has to account for something no?

What we're arguing is that the level of NP/DNP training that's provided is not adequate to practice independently without any physician supervision.

I think we all agree on this. What we don't agree on it what you're saying NPs/DNPs do or do not do to get their degrees.

Don't think what I'm saying is due to hate of nurses or anything of that sort.

I think your saying this because your ill-informed. My only other advice to you at this point is to call a DNP program and ask them how many clinical hours you would need to get a DNP degree and what the lecture courses truly entail. Clearly you are never going to believe what we tell you here. Make sure to ask about each different track that leads to the DNP as the numbers will all be slightly different, but still significantly more, than what you are willing to give credit for.

I realize how important nurses are and I also realize that midlevels are important in the current system. What scares me are the midlevels wanting to practice without any physician supervision and insist they're equivalent to physicians when they do not have the same level of training.

They are already practicing w/out physician supervision and have been doing so for quite some time. I suppose it if were as unsafe and as disastrous as most here make it seem then it would have been stopped.

 

[LuciusVorenus]

hey if any of you cant think of any more bs talking points to sling at each other... please refer to some AMA reports from the early 1900s and replace "DO" with "NP"... should give you some more ammunition... for those of you radical fascists types out there... refer to a 1950s New York Times and replace "african american" with "NP" and "good ole boy country club" with... well i guess you can keep the "good ole boy country club" part in... should do nicely with what you are trying to say...

Oh yeahhhh
I totally remember the days when NPs were forced to use different public facilities, were lynched, beaten for congregating, etc.
Me not trusting an NP with my families health care needs does not equal racism.
I'm sick of everyone comparing themselves to African Americans.
Am I the only person who thought that was ridiculous?

 

[Hoody]

I'm sick of everyone comparing themselves to African Americans. Am I the only person who thought that was ridiculous?

No. I thought it was a bit ridiculous too...but not enough for you to start another thread/poll about it. And other posters are making just as ridiculous statements regarding things they think they know about NP/SNP training, so it goes both ways and everyone should be held to the same standards.

Me not trusting an NP with my families health care needs does not equal racism.

Not everyone trusts NPs. Not everyone has too. For some strange reason, some Patients actually prefer NPs and will only see NPs. It's too bad more research isn't done on Patient outcomes regarding Patients who see only MDs/DOs, Patients who only see NPs, and for Patients who see a mix of both. Maybe this would help alleviate some of the concern that NPs are so incredibly undertrained and unprepared that their Patients have drastically worse outcomes.

It seems strange (at least to me) that when we are discussing NPs and MDs, specifically FP physicians, everyone has got the back of the MD saying that its too tough of a job for an NP to do, etc. However, when discussing MDs, FP/PCPs and other MD specialties, the FP physician gets little to no respect and/or true understanding of the specialty from their fellow colleagues. It's like FP/PCPs are too good to be nurses yet not good enough to be considered of adequate knowledge/effort as other MDs. It would be kick arse if everyone was this supportive of FP/PCPs all the time. 👍

 

[LuciusVorenus]

No. I thought it was a bit ridiculous too...but not enough for you to start another thread/poll about it. And other posters are making just as ridiculous statements regarding things they think they know about NP/SNP training, so it goes both ways and everyone should be held to the same standards.

I was talking about JUST the African American part, not really the whole NP vs PCP argument :/ I was just curious is why the poll :O

However, when discussing MDs, FP/PCPs and other MD specialties, the FP physician gets little to no respect and/or true understanding of the specialty from their fellow colleagues. It's like FP/PCPs are too good to be nurses yet not good enough to be considered of adequate knowledge/effort as other MDs. It would be kick arse if everyone was this supportive of FP/PCPs all the time. 👍

Hey! I love my PCP 🙁 My PCP diagnosed a disease for me that 3 other specialists missed. 😀

 

[adeline]

hmm? you're mistaken. there's PhD in Nursing for that.

so what category does a doctorate of nursing practice fall under if it's not acad? it certainly lacks applicability to the real world.

 

[Hoody]

so what category does a doctorate of nursing practice fall under if it's not acad?

Why don't you call the BON and ask them. Or better yet, search one of 598748913 posts regarding this subject. I'm sure you can find your answer there.

it certainly lacks applicability to the real world.

according to the almighty and all knowing adeline?

 

[RogueUnicorn]

so what category does a doctorate of nursing practice fall under if it's not acad? it certainly lacks applicability to the real world.

it's a practice degree. it's in the name.

 

[adeline]

it's a practice degree. it's in the name.

....except that dnp's don't practice, they do admin/politics.

according to the almighty and all knowing adeline?

dude, i appreciate the attention, but you could hide the boner a bit better.

 

[Hoody]

....except that dnp's don't practice, they do admin/politics.

😆😆😆😆


wait, let me breathe. okay....

😆😆😆😆

dude, i appreciate the attention, but you could hide the boner a bit better.

dude, I'm a girl 😉

 

[VassarLiberal]

....except that dnp's don't practice, they do admin/politics.

If DNPs stuck to politics, there wouldn't be a problem. When nurse practitioners try to represent themselves as physician-equivalents, then there's a serious issue.

Hey! I love my PCP

I love my weed more.

But in all seriousness...

The DNP is intended to be a practice degree. The DNP provides clinical doctoral training.

 

[RogueUnicorn]

....except that dnp's don't practice, they do admin/politics.


dude, i appreciate the attention, but you could hide the boner a bit better.

::

 

[VassarLiberal]

My only other advice to you at this point is to call a DNP program and ask them how many clinical hours you would need to get a DNP degree and what the lecture courses truly entail.

Seems to me that you can do a graduate-entry DNP program or a BSN/MSN that gives NP certification without having any clinical background other than that which you get in your nursing education, at least, according to Emory and Yale Schools of Nursing.

 

[RogueUnicorn]

Seems to me that you can do a graduate-entry DNP program or a BSN/MSN that gives NP certification without having any clinical background other than that which you get in your nursing education, at least, according to Emory and Yale Schools of Nursing.

refer to my post about what actually happens

 

[Web MD]

I realize this is anectodal, but just a thought regarding NP as PCPs. I've had to be seen by NPs twice while my PCP was on vacation, one time a week after I returned from a trip to South America and once when I was just feeling like crap. The first NP failed to notice a parasite I'd picked up on my trip, and prescribed ampicillin and told me to return in a month. When I was dying a week later, I went back in to my PCP who apologized for the misdiagnosis and immediately picked up on what was wrong. Second time, I was told by an NP I had bronchitis and just needed rest, and when I came back a few days later hacking my lungs up, the doc took a chest x ray and turns out it was pneumonia. Don't be so sure that midlevels can easily diagnose and take over the PCP roles. I for one, will never be seen or let family be seen by anyone without MD/DO behind their name after those exciting experiences.

 

[Instatewaiter]

You sound ridiculously busy during those years... when did you do your homework!?

You dont really have homework per se during 3rd year. You do have shelf exams which are major, national, standardized exams covering the material for that specific clerkship. So instead of homework, you have to study the material for say, OB/GYN.

also, considering that most nurses on hospital floors run circles around first and second year residents, i'm rather confident that years spent nursing >>>ms3/4 in clinical terms.

Nurses run circles around interns. I will give you that, no doubt. The new interns are transitioning not only to a new hosptial system that runs completely different than their home institution but also to a step up from 3rd/4th year. They have more responsibility as an intern. It takes months for them to get used to their new job. Necessarily they need to lean on people who know the system (and catch mistakes). Nurses in this instance are lifesavers. However, the skills sets of these interns and the nurses are no doubt different. This is obviously seen once these first 6 or so months are gone and the interns have their bearings. The nurses no longer run circles around the interns because the interns' clinical acumen has caught up to their academic knowledge.

Saying nurses run circles around PGY2s is utterly obsurd. I am not being hyperbolic either. The 2nd year internal medicine residents at my home institution run the teams. They have interns below them and they check in with the attending as needed. They already know the ropes and can perform as the actual leader of each medicine team with support (the attending) only when needed.

 

[RogueUnicorn]

You dont really have homework per se during 3rd year. You do have shelf exams which are major, national, standardized exams covering the material for that specific clerkship. So instead of homework, you have to study the material for say, OB/GYN.



Nurses run circles around interns. I will give you that, no doubt. The new interns are transitioning not only to a new hosptial system that runs completely different than their home institution but also to a step up from 3rd/4th year. They have more responsibility as an intern. It takes months for them to get used to their new job. Necessarily they need to lean on people who know the system (and catch mistakes). Nurses in this instance are lifesavers. However, the skills sets of these interns and the nurses are no doubt different. This is obviously seen once these first 6 or so months are gone and the interns have their bearings. The nurses no longer run circles around the interns because the interns' clinical acumen has caught up to their academic knowledge.

Saying nurses run circles around PGY2s is utterly obsurd. I am not being hyperbolic either. The 2nd year internal medicine residents at my home institution run the teams. They have interns below them and they check in with the attending as needed. They already know the ropes and can perform as the actual leader of each medicine team with support (the attending) only when needed.

at where i was the teams were run by PGY3

 

[Instatewaiter]

Maybe advance practice nurses should be under the BOM. But seriously, you can't compare PA school to NP/DNP school when you don't know what either truly consists of. This is like comparing apples to oranges when all you really know is limes.

Don't make me pull out the curricula of PA schools vs DNP. It is not pretty for you guys. PA schools have more clinical hours, have a stronger basic science foundation and dont have nearly as many fluff courses.

I know what both consist of because I have already done the research in the past. Don't make me show you up again or as the kids say "pwn you" (that's what they say right?).


- Old man instate

 

[adeline]

I know what both consist of because I have already done the research in the past. Don't make me show you up again or as the kids say "pwn you" (that's what they say right?).


- Old man instate

LOL I think that is the slang. IDK though. 😛

-old lady adeline

 

[Hoody]

I realize this is anecdotal, but just a thought regarding NP as PCPs. I've had to be seen by NPs twice while my PCP was on vacation, one time a week after I returned from a trip to South America and once when I was just feeling like crap. The first NP failed to notice a parasite I'd picked up on my trip, and prescribed ampicillin and told me to return in a month. When I was dying a week later, I went back in to my PCP who apologized for the misdiagnosis and immediately picked up on what was wrong. Second time, I was told by an NP I had bronchitis and just needed rest, and when I came back a few days later hacking my lungs up, the doc took a chest x ray and turns out it was pneumonia. Don't be so sure that midlevels can easily diagnose and take over the PCP roles. I for one, will never be seen or let family be seen by anyone without MD/DO behind their name after those exciting experiences.

I have an an anecdotal too....

Yesterday morning I triaged a patient who was in shock after taking Keflex. He was prescribed keflex by the Resident in the ER a week earlier, which was ultimately approved by the attending. Problem was, and is, he is allergic to cephs and Keflex belongs to the group. Duh.

Looks like TWO MDs effed up and overlooked the patients documented allergies eh? Whoops. Now if it were an NP who has made that mistake, you all would be calling for her head. 🙄

 

[Instatewaiter]

Let me repeat myself one more time. I had several phys and pahophys classes while in undergrad school.

A vignette:
Before med school I did essentially a masters in biochemistry. One of the courses I had to take was physiology. It was taken not only with the grad students but also with the NP students. For the NP students this was their weed out course. And they struggled.

None of them got an A. Granted it was a hard course but I did without having had phys or pathophys before. Clearly the nursing phys and pathophys are not the same level if I can get an A and none of them (~10-20) can. So let's not act like your undergrad phys can be counted along with your graduate level courses.

Another little anectdote: most med schools will not accept nursing bio or nursing chem as pre-recs. Ask yourself why.

Again, while your BSN probably helped you, it cannot be considered equivalent or even part of the graduate level education. In a similar tone, the clinical hours you have working as an RN are not the same you would have working as an NP during your clincal education. Let's not act like these are teh same either.

I think your saying this because your ill-informed. My only other advice to you at this point is to call a DNP program and ask them how many clinical hours you would need to get a DNP degree and what the lecture courses truly entail. Clearly you are never going to believe what we tell you here.

There is no need to do this. It is posted on their website as a requirement. 1000 hours clear as day.

 

[RogueUnicorn]

Another little anectdote: most med schools will not accept nursing bio or nursing chem as pre-recs. Ask yourself why.

there is absolutely no question that the "basic sciences" required of BSNs are completely worthless. i definitely agree with this.

also, i think this thread could have gone a very interesting and informative direction had we followed the lead of that one poster with the simpsons avatar... but oh well.

 

[Hoody]

A vignette:
Before med school I did essentially a masters in biochemistry. One of the courses I had to take was physiology. It was taken not only with the grad students but also with the NP students. For the NP students this was their weed out course. And they struggled.

None of them got an A. Granted it was a hard course but I did without having had phys or pathophys before. Clearly the nursing phys and pathophys are not the same level if I can get an A and none of them (~10-20) can.

I got an A. So lets not apply your situation to the mass.

So let's not act like your undergrad phys can be counted along with your graduate level courses.

Actually integrative physiology is a 4500 something level course that is cross listed with 5100 something (i.e. graduate level) integrative phys. And Im not arguing that intergrative phys should count for anything other than what they are, upper division science courses that you keep saying are "fluff" or watered down. Not true. You keep saying that BSNs have NO SCIENCE FOUNDATION. How can I have no science foundation when I had to take all these science classes?

Another little anectdote: most med schools will not accept nursing bio or nursing chem as pre-recs. Ask yourself why.

nursing bio/chem? not sure what that is but I took general biology I&II. The same bio that all bio majors and pre meds take. Same with chemistry. In fact, not one science class (bio, chem, math, stats, micro, medical micro, phys, patho phys, pharm) were nursing specific. They were the same exact science classes that all bio/chem/pre meds take.

Again, while your BSN probably helped you, it cannot be considered equivalent or even part of the graduate level education. In a similar tone, the clinical hours you have working as an RN are not the same you would have working as an NP during your clincal education. Let's not act like these are teh same either.

This is your opinion....based off your profound knowledge of what nursing entails and requires. The basic fact that you are arguing that nurses don't have a scientific background speaks volumes about what you truly know....nothing. Therefore your opinion is, well, simply that.

There is no need to do this. It is posted on their website as a requirement. 1000 hours clear as day.

Right. clear as day. Anyone can walk in with any degree, or no degree, complete 1000 clinical hours and a few "fluff" courses and walk away with a DNP degree. Thats why so many people are doing it. Its just that easy.


Keep trying though.... 😉

 

[SireSpanky]

so what category does a doctorate of nursing practice fall under if it's not acad? it certainly lacks applicability to the real world.

It's a professional degree, just like an MD, MBA, JD, etc.

Research degrees are your PhDs.

They are all academic though.

 

[Hoody]

All things aside, I can't wait to be a MD. woot.


and MD/JD would be sick as well. I'd fight for staff protection rights. 👍