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Nurse practitioners independent prescribing?

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Pharmohaulic

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I don't mean any offense to the nurse practitioners out there as there are some great ones, but have you looked at their curriculum?

It's pales definitely in comparison to medical school, but also PA school. Their classes are all theory and they only have like two assessment classes and one pharmacology class.

Yet they are getting the same rights to independently practice just like physicians without any supervision and essentially practice as a physician with a fraction of the training. What do you think?
 

Brahnold Bloodaxe

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We're all part of a team, you barbarian! The healthcare team. What are you, a Trump supporter? NPs do the jobs doctors just can't or won't do. Our healthcare would collapse without them! We'd have patients rotting in their hospital beds for lack of care, just like we have crops rotting in the fields for lack of illegal immigrant laborers.
 
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username456789

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How dare you knowledge shame the NPs. If they identify as competent prescribers, who are you (or any governing board) to tell them otherwise???

Check your privilege.
 
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Pharmohaulic

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How dare you knowledge shame the NPs. If they identify as competent prescribers, who are you (or any governing board) to tell them otherwise???

Check your privilege.

I didn't shame them, I was asking what you thought of their training lol
 
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We're all part of a team, you barbarian! The healthcare team. What are you, a Trump supporter? NPs do the jobs doctors just can't or won't do. Our healthcare would collapse without them! We'd have patients rotting in their hospital beds for lack of care, just like we have crops rotting in the fields for lack of illegal immigrant laborers.

Okay, so how does this rationalize credentialing for NPs to independently give Rx's?

Even a "benign" prescription for something like low-dose steroids can have really bad outcomes if you don't know what to look for in the Hx/PE.
 

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Okay, so how does this rationalize credentialing for NPs to independently give Rx's?

Even a "benign" prescription for something like low-dose steroids can have really bad outcomes if you don't know what to look for in the Hx/PE.


Did sarcasm suddenly become not a thing anymore?
 
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ProfMD

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What is it with people and APNs on this site? I feel like it is middle school, where you really like someone, but you can't admit it to your friends, so you feel like you need to make fun of them instead. Threads like this pop up fairly regularly. Then some people find a way to bash APNs in threads that have nothing to do with APNs.

I can speak from experience with my APN. I have been working with her for 5 years. She has been an APN for 10 years. She handles the floor work, freeing the resident up to operate - this is good for the resident. It would help me, the resident, and the patient if she could write for all medications, including narcotics. For the most part, these are meds that I ask her to write for or are recommended by a consulting service. With the limited scope of medications we use on my service, I can almost guarantee that she knows more about the dosing, indications, contraindications, and adverse reactions than the interns who started last week.

I realize this is heresy to most of you. If you feel the need to keep bashing APNs to make yourself feel superior, go right ahead. But realize that, for the most part, APNs are not the enemy. While you may not agree with what national nursing organizations are pushing for (I certainly don't agree with it all), there are individual APNs who are helpful in caring for patients as part of the team. As you progress in your career, you will probably even meet some.

The healthcare system would not collapse without them, but it would slow down. And, on surgical services like mine with limited resident resources, the residents would have to take time out of the OR to manage floor work, discharges, ED admits, etc.
 
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Pharmohaulic

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What is it with people and APNs on this site? I feel like it is middle school, where you really like someone, but you can't admit it to your friends, so you feel like you need to make fun of them instead. Threads like this pop up fairly regularly. Then some people find a way to bash APNs in threads that have nothing to do with APNs.

I can speak from experience with my APN. I have been working with her for 5 years. She has been an APN for 10 years. She handles the floor work, freeing the resident up to operate - this is good for the resident. It would help me, the resident, and the patient if she could write for all medications, including narcotics. For the most part, these are meds that I ask her to write for or are recommended by a consulting service. With the limited scope of medications we use on my service, I can almost guarantee that she knows more about the dosing, indications, contraindications, and adverse reactions than the interns who started last week.

I realize this is heresy to most of you. If you feel the need to keep bashing APNs to make yourself feel superior, go right ahead. But realize that, for the most part, APNs are not the enemy. While you may not agree with what national nursing organizations are pushing for (I certainly don't agree with it all), there are individual APNs who are helpful in caring for patients as part of the team. As you progress in your career, you will probably even meet some.

The healthcare system would not collapse without them, but it would slow down. And, on surgical services like mine with limited resident resources, the residents would have to take time out of the OR to manage floor work, discharges, ED admits, etc.

I'm not bashing them as I clearly stated, in fact I said some of them are fantastic. What I did say was I questioned their training. There seems to be a big incongruence. Some programs seem extensive while others seem like online diploma Mills.
 
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ProfMD

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I'm not bashing them as I clearly stated, in fact I said some of them are fantastic. What I did say was I questioned their training. There seems to be a big incongruence. Some programs seem extensive while others seem like online diploma Mills.

This is a topic that is covered ad nauseum on this site. There are countless threads about exactly this question.

Yes, there is a wide variety of clinical training. Yes, some of them on online, which, in my opinion, is a travesty. However, APNs do require clinical exposure as part of their training. But, there is poor oversight and these experiences can be of variable quality, which is also unacceptable to me.

As far as individual practice rights, this varies state-by-state. In some states, there is no independent practice. In some states, there is full practice right after graduation (which is dangerous, I feel). In other states, the APN is required to work in a supervised setting for several years prior to applying for independent privileges. I happen to feel that the latter is a good compromise for covering underserved areas. I have discussed this previously, you can look at my post history if you want, and this is why @coffee-doc felt the need to call me out.

I understand that you are not intending to bash them, but you did start yet another thread which will serve that purpose.

Now, cue the APN haters ...
 
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Psai

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What is it with people and APNs on this site? I feel like it is middle school, where you really like someone, but you can't admit it to your friends, so you feel like you need to make fun of them instead. Threads like this pop up fairly regularly. Then some people find a way to bash APNs in threads that have nothing to do with APNs.

I can speak from experience with my APN. I have been working with her for 5 years. She has been an APN for 10 years. She handles the floor work, freeing the resident up to operate - this is good for the resident. It would help me, the resident, and the patient if she could write for all medications, including narcotics. For the most part, these are meds that I ask her to write for or are recommended by a consulting service. With the limited scope of medications we use on my service, I can almost guarantee that she knows more about the dosing, indications, contraindications, and adverse reactions than the interns who started last week.

I realize this is heresy to most of you. If you feel the need to keep bashing APNs to make yourself feel superior, go right ahead. But realize that, for the most part, APNs are not the enemy. While you may not agree with what national nursing organizations are pushing for (I certainly don't agree with it all), there are individual APNs who are helpful in caring for patients as part of the team. As you progress in your career, you will probably even meet some.

The healthcare system would not collapse without them, but it would slow down. And, on surgical services like mine with limited resident resources, the residents would have to take time out of the OR to manage floor work, discharges, ED admits, etc.

Because you're using an np the right way. Most nps push for more and more scope of practice. In the ED, they get mad if they're not seeing complicated patients. In anesthesia, they're demanding to do lines, epidurals, blocks, etc. which they shouldn't be doing. They are claiming equivalence between their education and yours. And yet surgery is different from medicine. Midlevels are not clamoring to do surgery yet. But I've read rumors about nps gearing up to do routine operations in the uk although I'm not sure about the veracity. Can you imagine having to fix a patient after they were mismanaged by a surgical np operating in the OR? This kind of thing happens on a regular basis in the ED where someone was sent home by a midlevel who didn't recognize what was going on and they come in with the pathology much farther along the course.

I don't want to take responsibility for someone else's actions unless I choose to do so like an academic attending does for a resident. With greater production pressures, there will be less oversight and more autonomy, and yet the physician will be required to use their license to shield the midlevel. So the midlevels get to play doctor and risk very little while the physician's name is on the chart. You can get through more patients and earn a little more money but is it worth the risk? Not if the extra money is going into the pockets of the administrators.

Also I've heard nps on the surgical team refuse to take a consult from a medical student in an academic institution. First of all, the patient needs a surgeon, not an np and the medical student wasn't consulting them. Second, it's a freaking academic institution where the goal is to teach, not to belittle trainees. That soured me greatly on their presence in academic institutions.
 
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Pharmohaulic

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Because you're using an np the right way. Most nps push for more and more scope of practice. In the ED, they get mad if they're not seeing complicated patients. In anesthesia, they're demanding to do lines, epidurals, blocks, etc. which they shouldn't be doing. They are claiming equivalence between their education and yours. And yet surgery is different from medicine. Midlevels are not clamoring to do surgery yet. But I've read rumors about nps gearing up to do routine operations in the uk although I'm not sure about the veracity. Can you imagine having to fix a patient after they were mismanaged by a surgical np operating in the OR? This kind of thing happens on a regular basis in the ED where someone was sent home by a midlevel who didn't recognize what was going on and they come in with the pathology much farther along the course.

I don't want to take responsibility for someone else's actions unless I choose to do so like an academic attending does for a resident. With greater production pressures, there will be less oversight and more autonomy, and yet the physician will be required to use their license to shield the midlevel. So the midlevels get to play doctor and risk very little while the physician's name is on the chart. You can get through more patients and earn a little more money but is it worth the risk? Not if the extra money is going into the pockets of the administrators.

Also I've heard nps on the surgical team refuse to take a consult from a medical student in an academic institution. First of all, the patient needs a surgeon, not an np and the medical student wasn't consulting them. Second, it's a freaking academic institution where the goal is to teach, not to belittle trainees. That soured me greatly on their presence in academic institutions.

I wonder what the scope of practice is for NP's in other weatern countries like Canada and the UK and if they have the extent of independent practice like here in the states.
 

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This is a topic that is covered ad nauseum on this site. There are countless threads about exactly this question.

Yes, there is a wide variety of clinical training. Yes, some of them on online, which, in my opinion, is a travesty. However, APNs do require clinical exposure as part of their training. But, there is poor oversight and these experiences can be of variable quality, which is also unacceptable to me.

As far as individual practice rights, this varies state-by-state. In some states, there is no independent practice. In some states, there is full practice right after graduation (which is dangerous, I feel). In other states, the APN is required to work in a supervised setting for several years prior to applying for independent privileges. I happen to feel that the latter is a good compromise for covering underserved areas. I have discussed this previously, you can look at my post history if you want, and this is why @coffee-doc felt the need to call me out.

I understand that you are not intending to bash them, but you did start yet another thread which will serve that purpose.

Now, cue the APN haters ...

How many NPs would actually go to work in an underserved area? My guess is not many. That is why some on the board have a fear of losing business (to someone likely less qualified) I can see why it wouldn't matter to a surgeon who doesn't want to do floor work, but for some doctors that is their actual job.
 
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ProfMD

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How many NPs would actually go to work in an underserved area? My guess is not many. That is why some on the board have a fear of losing business (to someone likely less qualified) I can see why it wouldn't matter to a surgeon who doesn't want to do floor work, but for some doctors that is their actual job.

Been through this argument before. I believe you were part of it. Not going to rehash it now.

If you want my answer to this question, then you can check my post history.
 
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sliceofbread136

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Been through this argument before. I believe you were part of it. Not going to rehash it now.

If you want my answer to this question, then you can check my post history.

I don't recall that, neither do I care nearly enough to do what you suggested.

I don't feel particularly strong about the issue, I was merely suggesting the reasoning behind SDNs view
 
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lymphocyte

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Yet they are getting the same rights to independently practice just like physicians without any supervision and essentially practice as a physician with a fraction of the training. What do you think?

paging @ProfMD and @lymphocyte to come yell at you

. But I've read rumors about nps gearing up to do routine operations in the uk although I'm not sure about the veracity.

I don't want to yell at anybody. I don't think @ProfMD does either. He's an attending surgeon and some of his first few posts were about helping a resident with financial issues, where a student should submit a review article, and suicide among physicians. He's one of the good guys. Look through my post history and draw your own conclusions about me. Both of us care deeply about our colleagues. Even the ones we might disagree with.

No rational doctor thinks that APNs should be given full practice rights compared to physicians. But many APNs are well-suited for a limited scope of practice. Within a limited scope of practice, they play an important role in providing care to the underserved (there's a moral argument), 2) they can handle routine, boring stuff for physicans (there's a practical argument), and 3) if they want full scope, they can pay for it and watch licensed physicians salivate at thought of providing expert testimony against them (there's a malpractice argument). And just to reiterate, increasing scope of practice for APNs has had no net negative impact on FM specialist income. To the contrary, FM specialists have seen their income rise dramatically.

Also, what's in your circle of control friend? What can you actually change, and why worry about what you can't? When I saw your post, I started looking through the National Practitioner Databank to examine malpractice claims against APNs in states with full-scope practice laws, I searched on PubMed, I pulled up an interesting RAND paper on the topic--but what's the point? This argument has been hashed over and over again on SDN, and it usually ends up with piles of data and actual attendings on one side, and hyperbole, "I've heard"s, and frank insecurity on the other.

As an aside, based on what I've seen as a healthcare consultant and now as a MS4 that's worked with APNs, I'm confident in the skills I'm developing, I feel optimistic about the future, and I feel great about the profession. It gets better and better every year. Just since starting medical school, I've watched doctors effectively cure most genotypes of Hep C, seen the advancement of endovascular therapy for certain ischemic strokes (think about what PCI did for AMIs), and witnessed a sea-change in the evidence-based toward "routine" things like BP management with the SPRINT trial (if you want to bring things back to the primary care world). Do you really feel like APNs are a threat here? You're spending 7-8 years+ learning how to skillfully cope with the future. APNs spend their time learning how to deal with what's already been done and dusted by others. Where's the self-confidence?

Take a deep breath. It's really going to be okay. And I'm going to keep thinking so, until somebody shows me actual evidence to the contrary.
 
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neusu

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Because you're using an np the right way. Most nps push for more and more scope of practice. In the ED, they get mad if they're not seeing complicated patients. In anesthesia, they're demanding to do lines, epidurals, blocks, etc. which they shouldn't be doing. They are claiming equivalence between their education and yours. And yet surgery is different from medicine. Midlevels are not clamoring to do surgery yet. But I've read rumors about nps gearing up to do routine operations in the uk although I'm not sure about the veracity. Can you imagine having to fix a patient after they were mismanaged by a surgical np operating in the OR? This kind of thing happens on a regular basis in the ED where someone was sent home by a midlevel who didn't recognize what was going on and they come in with the pathology much farther along the course.

I don't want to take responsibility for someone else's actions unless I choose to do so like an academic attending does for a resident. With greater production pressures, there will be less oversight and more autonomy, and yet the physician will be required to use their license to shield the midlevel. So the midlevels get to play doctor and risk very little while the physician's name is on the chart. You can get through more patients and earn a little more money but is it worth the risk? Not if the extra money is going into the pockets of the administrators.

Also I've heard nps on the surgical team refuse to take a consult from a medical student in an academic institution. First of all, the patient needs a surgeon, not an np and the medical student wasn't consulting them. Second, it's a freaking academic institution where the goal is to teach, not to belittle trainees. That soured me greatly on their presence in academic institutions.

Depending on the practice, PAs or surgical assists do operate. The PA may harvest the saphenous vein while the attending is cracking the chest. It will be quite some time, however, before a midlevel does the anastamosis on a CABG.
 
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Psai

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Depending on the practice, PAs or surgical assists do operate. The PA may harvest the saphenous vein while the attending is cracking the chest. It will be quite some time, however, before a midlevel does the anastamosis on a CABG.

That's true, I've seen it on peds and cardiac surgery and they did a fine job. But when I said operate I meant as the primary surgeon doing all the thinking and decision making, not as the first assist. It's not happening and won't anytime soon but you never know what people will push for in the name of access and holistic care as proxies for increasing their own salary.

I see the frantic rhetoric spammed by nurses on any news article that's even tangentially related to medicine or nursing, especially in my own field. It concerns me and it needs to be nipped in the bud before it becomes a bigger issue.
 
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lymphocyte

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That's true, I've seen it on peds and cardiac surgery and they did a fine job. But when I said operate I meant as the primary surgeon doing all the thinking and decision making, not as the first assist. It's not happening and won't anytime soon but you never know what people will push for in the name of access and holistic care as proxies for increasing their own salary.

I see the frantic rhetoric spammed by nurses on any news article that's even tangentially related to medicine or nursing, especially in my own field. It concerns me and it needs to be nipped in the bud before it becomes a bigger issue.

Tell me more about this frantic rhetoric...
 
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<L>

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Wow. What an original thread topic for Allo.
 
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Slack3r

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What is it with people and APNs on this site? I feel like it is middle school, where you really like someone, but you can't admit it to your friends, so you feel like you need to make fun of them instead. Threads like this pop up fairly regularly. Then some people find a way to bash APNs in threads that have nothing to do with APNs.

I can speak from experience with my APN. I have been working with her for 5 years. She has been an APN for 10 years. She handles the floor work, freeing the resident up to operate - this is good for the resident. It would help me, the resident, and the patient if she could write for all medications, including narcotics. For the most part, these are meds that I ask her to write for or are recommended by a consulting service. With the limited scope of medications we use on my service, I can almost guarantee that she knows more about the dosing, indications, contraindications, and adverse reactions than the interns who started last week.

I realize this is heresy to most of you. If you feel the need to keep bashing APNs to make yourself feel superior, go right ahead. But realize that, for the most part, APNs are not the enemy. While you may not agree with what national nursing organizations are pushing for (I certainly don't agree with it all), there are individual APNs who are helpful in caring for patients as part of the team. As you progress in your career, you will probably even meet some.

The healthcare system would not collapse without them, but it would slow down. And, on surgical services like mine with limited resident resources, the residents would have to take time out of the OR to manage floor work, discharges, ED admits, etc.

You are again, as you've done countless times before, arguing two separate issues. Using a supervised NP for more rote tasks (i.e. Post op checks) while freeing you up for more intensive activities (operating) is NOT the same as granting independent practice rights to NPs in fields like primary care, etc. The fact that you have yet to grasp this argument is bewildering, to say the least.
 
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ProfMD

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You are again, as you've done countless times before, arguing two separate issues. Using a supervised NP for more rote tasks (i.e. Post op checks) while freeing you up for more intensive activities (operating) is NOT the same as granting independent practice rights to NPs in fields like primary care, etc. The fact that you have yet to grasp this argument is bewildering, to say the least.

What argument do I fail to grasp? I have always argued two issues:
1) Supervised APN roles in speciality care with expanded prescription rites.
2) Independent practice APNs in primary care in underserved areas. I would propose following the same lead some states are using and require a period of supervised practice for several years prior to granting independent license. I would also propose that APNs with independent practice rites only be granted those rites to practice in an underserved area.

I feel that #1 is entirely reasonable and should be done now. I concede that #2 is a harder sell to both physicians (because it grants too much autonomy) and to nursing groups (because it grants not enough autonomy).

If you look through my post history, which I know you won't, you will see that this is consistent with my previous posts. I am quite aware that these are two separate situations.

Are you less bewildered now?
 
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Slack3r

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What argument do I fail to grasp? I have always argued two issues:
1) Supervised APN roles in speciality care with expanded prescription rites.
2) Independent practice APNs in primary care in underserved areas. I would propose following the same lead some states are using and require a period of supervised practice for several years prior to granting independent license. I would also propose that APNs with independent practice rites only be granted those rites to practice in an underserved area.

I feel that #1 is entirely reasonable and should be done now. I concede that #2 is a harder sell to both physicians (because it grants too much autonomy) and to nursing groups (because it grants not enough autonomy).

If you look through my post history, which I know you won't, you will see that this is consistent with my previous posts. I am quite aware that these are two separate situations.

Are you less bewildered now?

I'm well aware of your post history. You're the guy arguing that supervised NPs are important pieces of the healthcare team anytime someone suggests they not be granted independent practicing rights. Which I always find curious, since they're two separate issues. The former most do support and the latter no one should.
 
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ProfMD

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I'm well aware of your post history. You're the guy arguing that supervised NPs are important pieces of the healthcare team anytime someone suggests they not be granted independent practicing rights. Which I always find curious, since they're two separate issues. The former most do support and the latter no one should.

I am the guy who says supervised APNs are an important part of the healthcare team. However, I say this mostly in regards to expanded prescription rights, not independent practice.

The independent practice part comes when I look around my rural state and see large swaths with no ready access to primary care, or people whose primary care provider is an APN whose supervising physician works elsewhere and cannot refer the patient for something straightforward like PT.

I know what I posted. I dare say, I know my opinions better than you know my opinions. These are two separate issues, I get that. Hence the previous post where they were broken down by #1 and #2. #1 is one issue (dealing mostly with prescription rights), #2 is a separate issue (dealing with the delivery of primary care). They are related only in that they both involve APNs.

Please stop trying to misconstrue my arguments. I am not sure how I can make them much simpler than bullet pointing them out for you.
 
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Psai

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We've had nps for how many years now and your rural areas still have no primary care nps lining up to practice there? Man I'm shocked
 
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Promethean

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I didn't shame them, I was asking what you thought of their training lol

I think so little of their training that even though it would have been far cheaper and more convenient for me to turn my RN into an NP, I put in the extra couple of years effort to finish my pre-reqs, take the MCAT, and apply to medical schools.

There are great NP programs. And there are some where a poster presentation based on a literature review fulfills the "clinical experience" obligation. I'm not exaggerating. Several of my colleagues opened up to me about how disappointed they were with the quality of their NP programs, that they didn't feel that there was any significant clinical training component, because it was assumed that basic clinical skills would have been acquired in the basic RN program, and honed through on-the-job experiences. Instead, much of the curriculum was focused toward theory and administration, but not nearly as much practice as one would hope in a program geared toward producing future practitioners.

I have been clear from the start that I want to do primary care. A great many people have asked me why on Earth I would go to medical school for that at this point, when the NP was such low hanging fruit for me. It is because I didn't want to gamble on whether the program I picked would be adequate to give me the skills I need to be fully competent in clinic.

NP is a valid path toward providing advanced nursing care... under the supervision of a fully trained and licensed physician. That doesn't come from a position of nurse hate. Indeed, if NP programs were to standardize, offering more robust clinical training, so that their graduates were capable of passing competency exams on the level of the USMLE or COMLEX, then they should absolutely have full independent practice rights, and why ever not? But as long as graduates of good programs are indistinguishable from graduates of subpar programs, granting unsupervised practice rights (including full independent prescribing) endangers patients.
 
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I don't want to yell at anybody. I don't think @ProfMD does either. He's an attending surgeon and some of his first few posts were about helping a resident with financial issues, where a student should submit a review article, and suicide among physicians. He's one of the good guys. Look through my post history and draw your own conclusions about me. Both of us care deeply about our colleagues. Even the ones we might disagree with.

No rational doctor thinks that APNs should be given full practice rights compared to physicians. But many APNs are well-suited for a limited scope of practice. Within a limited scope of practice, they play an important role in providing care to the underserved (there's a moral argument), 2) they can handle routine, boring stuff for physicans (there's a practical argument), and 3) if they want full scope, they can pay for it and watch licensed physicians salivate at thought of providing expert testimony against them (there's a malpractice argument). And just to reiterate, increasing scope of practice for APNs has had no net negative impact on FM specialist income. To the contrary, FM specialists have seen their income rise dramatically.

Also, what's in your circle of control friend? What can you actually change, and why worry about what you can't? When I saw your post, I started looking through the National Practitioner Databank to examine malpractice claims against APNs in states with full-scope practice laws, I searched on PubMed, I pulled up an interesting RAND paper on the topic--but what's the point? This argument has been hashed over and over again on SDN, and it usually ends up with piles of data and actual attendings on one side, and hyperbole, "I've heard"s, and frank insecurity on the other.

As an aside, based on what I've seen as a healthcare consultant and now as a MS4 that's worked with APNs, I'm confident in the skills I'm developing, I feel optimistic about the future, and I feel great about the profession. It gets better and better every year. Just since starting medical school, I've watched doctors effectively cure most genotypes of Hep C, seen the advancement of endovascular therapy for certain ischemic strokes (think about what PCI did for AMIs), and witnessed a sea-change in the evidence-based toward "routine" things like BP management with the SPRINT trial (if you want to bring things back to the primary care world). Do you really feel like APNs are a threat here? You're spending 7-8 years+ learning how to skillfully cope with the future. APNs spend their time learning how to deal with what's already been done and dusted by others. Where's the self-confidence?

Take a deep breath. It's really going to be okay. And I'm going to keep thinking so, until somebody shows me actual evidence to the contrary.

:clap:

I probably should have read the whole thread before I made my post above. If I'd seen this first, I wouldn't have felt compelled to join in.
 
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NYCGuy86

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There are great NP programs. And there are some where a poster presentation based on a literature review fulfills the "clinical experience" obligation. I'm not exaggerating.

Which school is that???
 

Psai

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I think so little of their training that even though it would have been far cheaper and more convenient for me to turn my RN into an NP, I put in the extra couple of years effort to finish my pre-reqs, take the MCAT, and apply to medical schools.

There are great NP programs. And there are some where a poster presentation based on a literature review fulfills the "clinical experience" obligation. I'm not exaggerating. Several of my colleagues opened up to me about how disappointed they were with the quality of their NP programs, that they didn't feel that there was any significant clinical training component, because it was assumed that basic clinical skills would have been acquired in the basic RN program, and honed through on-the-job experiences. Instead, much of the curriculum was focused toward theory and administration, but not nearly as much practice as one would hope in a program geared toward producing future practitioners.

I have been clear from the start that I want to do primary care. A great many people have asked me why on Earth I would go to medical school for that at this point, when the NP was such low hanging fruit for me. It is because I didn't want to gamble on whether the program I picked would be adequate to give me the skills I need to be fully competent in clinic.

NP is a valid path toward providing advanced nursing care... under the supervision of a fully trained and licensed physician. That doesn't come from a position of nurse hate. Indeed, if NP programs were to standardize, offering more robust clinical training, so that their graduates were capable of passing competency exams on the level of the USMLE or COMLEX, then they should absolutely have full independent practice rights, and why ever not? But as long as graduates of good programs are indistinguishable from graduates of subpar programs, granting unsupervised practice rights (including full independent prescribing) endangers patients.

Passing board exams is required but not sufficient. Even if they could pass the same exams I wouldn't treat them as equals
 

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Im a PA-C and to be honest I am not thrilled that APRNs can practice independently. I have read many quotes online from APRNs stating that the level of care they provide to patients is equal if not better than the care provided by the MD.. I have been practicing for eleven years and I have a great collaborative relationship with the MDs and APRNs that I work with. But I have seen many mistakes made by the APRNs at my practice example # 1 A young patient comes in with chest pain and the APRN sends her to the ED STAT, normal vitals, in no apparent distress, and no EKG done in office. example # 2 A patient with seizure disorder comes in with a rash on his body x 2 months in and out of the ED rxd zantac benadryl and seen by a fellow APRN in the office and given Atarax, I saw the patient who clearly had a drug reaction type of rash; looked at his med list saw he was on Tegretol diagnosed him with DRESS syndrome stopped the medication LFTs and Eosinophils started to trend back to normal. And these are APRNs that have been in practice for several years. I think the AAPA and AMA need to unite to stop the independent practice of APRNs and to stop their egos. The level of education that an APRN does not compare at all to the MD's level of rigorous training. 1000 clinical hours in a doctoral NP program does not make you an equal to an MD. Also APRNs don't have to take a recertification exam like MDs and PAs. I believe they recertify every five years logging CME and having a set of clinical hours. I will be writing letters to the state legislation.
 
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Pharmohaulic

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Im a PA-C and to be honest I am not thrilled that APRNs can practice independently. I have read many quotes online from APRNs stating that the level of care they provide to patients is equal if not better than the care provided by the MD.. I have been practicing for eleven years and I have a great collaborative relationship with the MDs and APRNs that I work with. But I have seen many mistakes made by the APRNs at my practice example # 1 A young patient comes in with chest pain and the APRN sends her to the ED STAT, normal vitals, in no apparent distress, and no EKG done in office. example # 2 A patient with seizure disorder comes in with a rash on his body x 2 months in and out of the ED rxd zantac benadryl and seen by a fellow APRN in the office and given Atarax, I saw the patient who clearly had a drug reaction type of rash; looked at his med list saw he was on Tegretol diagnosed him with DRESS syndrome stopped the medication LFTs and Eosinophils started to trend back to normal. And these are APRNs that have been in practice for several years. I think the AAPA and AMA need to unite to stop the independent practice of APRNs and to stop their egos. The level of education that an APRN does not compare at all to the MD's level of rigorous training. 1000 clinical hours in a doctoral NP program does not make you an equal to an MD. Also APRNs don't have to take a recertification exam like MDs and PAs. I believe they recertify every five years logging CME and having a set of clinical hours. I will be writing letters to the state legislation.

How did they get such liberal privileges to begin with?
 

VA Hopeful Dr

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We've had nps for how many years now and your rural areas still have no primary care nps lining up to practice there? Man I'm shocked
Nor is the primary care shortage getting any better (CVS minute clinics notwithstanding). NPs have learned the same lessons that medical students have: it pays to go into cardiology/gastroenterology/orthopedics.
 
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Ho0v-man

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Im a PA-C and to be honest I am not thrilled that APRNs can practice independently. I have read many quotes online from APRNs stating that the level of care they provide to patients is equal if not better than the care provided by the MD.. I have been practicing for eleven years and I have a great collaborative relationship with the MDs and APRNs that I work with. But I have seen many mistakes made by the APRNs at my practice example # 1 A young patient comes in with chest pain and the APRN sends her to the ED STAT, normal vitals, in no apparent distress, and no EKG done in office. example # 2 A patient with seizure disorder comes in with a rash on his body x 2 months in and out of the ED rxd zantac benadryl and seen by a fellow APRN in the office and given Atarax, I saw the patient who clearly had a drug reaction type of rash; looked at his med list saw he was on Tegretol diagnosed him with DRESS syndrome stopped the medication LFTs and Eosinophils started to trend back to normal. And these are APRNs that have been in practice for several years. I think the AAPA and AMA need to unite to stop the independent practice of APRNs and to stop their egos. The level of education that an APRN does not compare at all to the MD's level of rigorous training. 1000 clinical hours in a doctoral NP program does not make you an equal to an MD. Also APRNs don't have to take a recertification exam like MDs and PAs. I believe they recertify every five years logging CME and having a set of clinical hours. I will be writing letters to the state legislation.

Yeah don't get why NP is even a thing when PA is so much more standardized and just more rigorous in every way. Despite the superior training PAs have, they, for the most part, aren't trying to kick docs out of medicine.




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Psai

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Yeah don't get why NP is even a thing when PA is so much more standardized and just more rigorous in every way. Despite the superior training PAs have, they, for the most part, aren't trying to kick docs out of medicine.




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You do see a lot of PA students talking big about their 4 years of med school into 2 years or whatever they like to believe but PAs in practice are very well aware of the difference.
 

Ho0v-man

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You do see a lot of PA students talking big about their 4 years of med school into 2 years or whatever they like to believe but PAs in practice are very well aware of the difference.

Agree 100%. NPs in practice seem to think the difference is only in title, despite not having near the training of a PA.


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cbrons

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Ho0v-man

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If you check my post hx, I literally said this was impossible like a month or two ago. Do most NP programs even have an anatomy course or is it just the one that's required for nursing school? They have zero background in this stuff.

Just this week alone I've been asked if you can see the scapula on a shoulder X-ray, had one order a c-spine film for "r/o tonsillitis", and another insist that they needed to ct a 18 month olds elbow to "r/o nurse maids"!

This is all NPs, not PAs btw.


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W19

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If you check my post hx, I literally said this was impossible like a month or two ago. Do most NP programs even have an anatomy course or is it just the one that's required for nursing school? They have zero background in this stuff.

Just this week alone I've been asked if you can see the scapula on a shoulder X-ray, had one order a c-spine film for "r/o tonsillitis", and another insist that they needed to ct a 18 month olds elbow to "r/o nurse maids"!

This is all NPs, not PAs btw.


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I was (am) a RN and I checked many NP programs in my state before deciding to go to med school and I don't remember seeing one that had advanced level anatomy and physio. But that was 6+ years ago. Things might change now.

Radiology is a 5-year (6-year de facto) residency and NP will be allowed to do what radiologists do with ZERO training... Great!
 
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Ho0v-man

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I was (am) a RN and I checked many NP programs in my state before deciding to go to med school and I don't remember seeing one that had a an advanced level anatomy and physio. But that was 6+ years ago. Things might change now.

If anything, the bar has probably lowered tbh.

When I read the first part of your post I anticipated a long lecture heading my way but I ended up pleasantly surprised.

It did make me realize that I come off as kind of anti nurse on these boards at times, though. I'd like to mention (to anyone that cares) that I'm pretty anti NP because of problems with the rigors of their educational model and I'm against the way nursing schools seem to tell their students that they're basically doctors despite not having anything close to the same education.

I have nothing against nurses though. I don't actually understand why there's this seemingly big push by national nursing leadership to stomp doctors into the ground. Nursing is a fine career on its own and one could surely be proud of being a nurse. If anything, the anti doctor mantra that seems to go on at nursing/NP schools kind of just screams "inferiority complex" and makes an otherwise respectable field look bad.


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I was (am) a RN and I checked many NP programs in my state before deciding to go to med school and I don't remember seeing one that had advanced level anatomy and physio. But that was 6+ years ago. Things might change now.

Radiology is a 5-year (6-year de facto) residency and NP will be allowed to do what radiologists do with ZERO training... Great!

They have basic physio but I haven't seen any with any significant anatomy. Standards are probably lower with the dnp than they use to be since there's a push by the leadership for nurses to obtain "doctorate degrees".
 

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After he can figure out a way to cash in on it first.

Hey man, didn't you read his post? He said it was to help the patient, you understand? The. PATIENT.
 
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Mansamusa

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I was (am) a RN and I checked many NP programs in my state before deciding to go to med school and I don't remember seeing one that had advanced level anatomy and physio. But that was 6+ years ago. Things might change now.

Radiology is a 5-year (6-year de facto) residency and NP will be allowed to do what radiologists do with ZERO training... Great!
It hasn't changed. My sister is a NP (recent) and one of the things she complained about was the fact that she never had a real anatomy course.
 
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