nurses-masquerading-as-doctors

[wine is good]

Tempest in a teapot. . .

After her name she writes Nurse Practitioner.


Don't underestimate all of the general public. As a RN, I've encouraged people that have asked me about certain conditions to make sure they see a physician. I recently advised one on this after the NP danced around a problem that has gone on for> 2 weeks, where she, wouldn't even as much as get a urine culture C & S or order an ultrasound for one pt. Now don't get me wrong. I've seen GP's do this as well. And I understand that there are insurance issues to consider, but I felt this NP was blowing things off, and the pt needed to not play around with her anymore--or perhaps needed a referral to a specialist. Any number of serious things could be going on with this woman. She was getting the run around and her pain and other symptoms were increasing not decreasing.

But people are getting more educated about not being blown off, whether it be by NPs or primary care physicians. If the individual patients don't become their own advocates, they may find themselves in trouble.

Personally, I think NP from the link should have clarified what her doctorate is in from the beginning of announcing herself.

Nonetheless, this "NP fear" is overstated, and most of the general public isn't going to buy taking serious health concerns and having them primarily managed by NPs. And hopefully they won't buy being brushed aside or ignored by any practitioner.

Sometimes pts have to leave some practices, b/c they are not getting a reasonable amount of attention to things. This happens more than some want to admit. And I know darn well patients can be extremely demanding at times or even non-compliant, but then they come back and still whine to the physicians. I totally get that. But we have to take patients as they are. Only if they aren't willing to do their own part, then, sometimes the physicians have to let them go. I will say that if physicians are too pizzy and not as understanding with pt/clts as they could be, there could be, sometime in the future, more of a move to NPs that are willing to listen and follow-through with them. People want to know that you genuinely give a damn about their care. If people miss this truth, they are missing an awful lot.


Bottom line though is this is not representative of most NPs, etc. What's more, as this NP advertises herself this way, she may be putting her license and livelihood and even "secure" funds in greater risk.

Let some major lawsuits come up for some of these yahoos. It won't be an issue. As I said, the biggest boon to them will come in academic settings, period.

Stop worrying about something that isn't a real issue, and focus on those issues in healthcare that truly are. Don't fixate on the few bouys here and there, when the ship is about ready to be torn by a Titanic sized iceberg.

Whether most NP are representative of this or not is beside the issue. What's important is what will happen 10-15 yrs down the line. Cultural change happens slowly then becomes the norm. If the goal of the NP leaders is to make DNP as equivalent, and as evidence presented on this forum, it appears they are, I see this as an example of this attempt and it bothers me. Now, as a surgeon, I will not feel the heat much. My field is secure, for now. But, my primary care colleagues will. It's a matter of principal I see these residents who have worked hard in school and residency and about to graduate or actually are attendings, I think it's very unfair for them to have to face this issue.

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[jl lin]

Whether most NP are representative of this or not is beside the issue. What's important is what will happen 10-15 yrs down the line. Cultural change happens slowly then becomes the norm. If the goal of the NP leaders is to make DNP as equivalent, and as evidence presented on this forum, it appears they are, I see this as an example of this attempt and it bothers me. Now, as a surgeon, I will not feel the heat much. My field is secure, for now. But, my primary care colleagues will. It's a matter of principal I see these residents who have worked hard in school and residency and about to graduate or actually are attendings, I think it's very unfair for them to have to face this issue.

Again as far as I can see there are only two possible concerns for physicians.

1. Areas where no one wants to go.
2. NP's demonstrating more concern for the patients--listening better--building better repoires, etc.

Even then, all the lobbying in the world is no force for the long-held power of physicians and physician organizations in this country.

What you might have to worry about is if advanced practice people bring more revenue in, but since these privileges are essentially none-existent for "midlevels," I can't see pragmatically where the big concern will be.

I will yield somewhat to the exception of the anesthesiologist and hospitals putting CRNAs in to save money while they have the ologists supervising more and more of them. I think this is a dangerous practice. You spread them too thin, there is going to be trouble. But I don't even think CRNAs are going to be practicing in a big way independent of ologist supervision.

I'm an experience critical care nurse that has worked in many busy, high acuity centers. Guess what? No CRNA unsupervised would be running a case where my kid is being operated on, period. I have indeed interviewed the ologists and the CRNAs that would be on my children's cases when they had surgery. There's too much potential for problems. So, I want to know how many cases beyond my child's they are having to supervise, and how often them will be in to check on how the case is running. Thank God, at least in the places I've been, the ologists pretty much stay with the kids cases.

Now if I am like that, and I have built a certain level of confidence in what various practitioners can understand and do in certain areas, how much more will those without this experience be insistent on ologists running their children's cases? Again, people are getting more educated. In America, patients want the best available people to be in charge of their care and tx. In fact, many patients and families get downright pissy about this kind of thing.

If you want to be concerned, be concerned with those in the GP that don't know any better. What physicians need to do is make them more aware and keep them on their side.

Trust me, if the consumer-pts clamour enough about it, at least as long as there is some free-enterprise and choice and competition in healthcare going on, hospitals will give them what they want. Business wise, it would simply work against them.

The key is in education. When the tone is clear and things are well-established, everyone will come to accept their respective places.


But I truly believe there are much bigger issues before medicine right now.

 

[jl lin]

Yes, Yes, just ignore it... That's the best thing to do when problems are brewing. Best wait until they get full practice rights and become integrated in the system to worry about this.

Ever heard of nipping of problem in the bud?

What proof do you have that "midlevels" are on the verge of this massive physician takeover? Where are you seeing any significant trends where this is occuring or will be in the next five or ten years?

Please read this WHOLE article to see why pragmatically it would be quite hard, if not impossible for the fear to come to frution:

http://getbetterhealth.com/primary-care-the-doctors-exit-nurses-enter-movement/2010.04.21

It says a lot in terms of what I have been alluding to in terms of some pragmatics.

 

[JeffLebowski]

What proof do you have that "midlevels" are on the verge of this massive physician takeover? Where are seeing any significant trends where this occuring or will be in the next five or ten years?

This has been extensively discussed on this forum. It's a big issue and we're not taking it lightly.

 

[jl lin]

This has been extensively discussed on this forum. It's a big issue and we're not taking it lightly.

Jeff,

Again, read this in full:


http://getbetterhealth.com/primary-care-the-doctors-exit-nurses-enter-movement/2010.04.21




It's a matter of simple pragmatics.


Please adjust energies on to tort reform and enhancing delivery without us having to become utterly dependent on daddy gov't.

These are the real issues right now. . . not midlevels.


It's as simple as this. "Midlevels" by far are not educated and prepared enough to take on the daunting task of carrying primary care, or other kinds of expanded healthcare needs, period.

 

[Slack3r]

It's as simple as this. "Midlevels" by far are not educated and prepared enough to take on the daunting task of carrying primary care, or other kinds of expanded healthcare needs, period.

But that certainly isn't going to stop them from trying, now is it?

 

[jl lin]

But that certainly isn't going to stop them from trying, now is it?

And Britany Spears may want to try to run for president.

So what is the likelihood?

Come on already.

 

[mooshika]

Tempest in a teapot. . .

After her name she writes Nurse Practitioner.


Don't underestimate all of the general public. As a RN, I've encouraged people that have asked me about certain conditions to make sure they see a physician. I recently advised one on this after the NP danced around a problem that has gone on for> 2 weeks, where she, wouldn't even as much as get a urine culture C & S or order an ultrasound for one pt. Now don't get me wrong. I've seen GP's do this as well. And I understand that there are insurance issues to consider, but I felt this NP was blowing things off, and the pt needed to not play around with her anymore--or perhaps needed a referral to a specialist. Any number of serious things could be going on with this woman. She was getting the run around and her pain and other symptoms were increasing not decreasing.

But people are getting more educated about not being blown off, whether it be by NPs or primary care physicians. If the individual patients don't become their own advocates, they may find themselves in trouble.

Personally, I think NP from the link should have clarified what her doctorate is in from the beginning of announcing herself.

Nonetheless, this "NP fear" is overstated, and most of the general public isn't going to buy taking serious health concerns and having them primarily managed by NPs. And hopefully they won't buy being brushed aside or ignored by any practitioner.

Sometimes pts have to leave some practices, b/c they are not getting a reasonable amount of attention to things. This happens more than some want to admit. And I know darn well patients can be extremely demanding at times or even non-compliant, but then they come back and still whine to the physicians. I totally get that. But we have to take patients as they are. Only if they aren't willing to do their own part, then, sometimes the physicians have to let them go. I will say that if physicians are too pizzy and not as understanding with pt/clts as they could be, there could be, sometime in the future, more of a move to NPs that are willing to listen and follow-through with them. People want to know that you genuinely give a damn about their care. If people miss this truth, they are missing an awful lot.


Bottom line though is this is not representative of most NPs, etc. What's more, as this NP advertises herself this way, she may be putting her license and livelihood and even "secure" funds in greater risk.

Let some major lawsuits come up for some of these yahoos. It won't be an issue. As I said, the biggest boon to them will come in academic settings, period.

Stop worrying about something that isn't a real issue, and focus on those issues in healthcare that truly are. Don't fixate on the few bouys here and there, when the ship is about ready to be torn by a Titanic sized iceberg.

I've said this before but Ill say it again, jl lin you are a great patient advocate. I have seen too many times new, young doctors who after hearing a couple of symptoms and reading one set of labs jump to a diagnosis or a conclusion, or doodle around and not take the time to see the patient and listen to them, or not respectfully listen to the nurse who just spent 20 minutes with the patient and is trying to inform them about quirks and qualms of a patient that will potentially effect their response to treatment.

I have also seen crappy NP's do the same thing. You can't generalize, but I have seen more young docs do this for some reason, and have a chip on their shoulder to boot.

Here is a recent study regarding NP, PA and MD.

http://www.medscape.com/viewarticle/720540?src=mp&spon=24&uac=140116DG

 

[jbz24]

I've said this before but Ill say it again, jl lin you are a great patient advocate. I have seen too many times new, young doctors who after hearing a couple of symptoms and reading one set of labs jump to a diagnosis or a conclusion, or doodle around and not take the time to see the patient and listen to them, or listen to the nurse who is trying to inform them about quirks and qualms of a patient that will potentially effect their response to treatment.

I have also seen crappy NP's do the same thing. You can't generalize, but I have seen more young docs do this for some reason, and have a chip on their shoulder to boot.

Here is a recent study regarding NP, PA and MD.

Please remove your link. There's a possibility you just un-anonymized yourself to the world.

 

[mooshika]

Jeff,

Again, read this in full:


http://getbetterhealth.com/primary-care-the-doctors-exit-nurses-enter-movement/2010.04.21




It's a matter of simple pragmatics.


Please adjust energies on to tort reform and enhancing delivery without us having to become utterly dependent on daddy gov't.

These are the real issues right now. . . not midlevels.


It's as simple as this. "Midlevels" by far are not educated and prepared enough to take on the daunting task of carrying primary care, or other kinds of expanded healthcare needs, period.

There are real issues facing primary care such as moving to limit reimbursement for visits from medicare/aide to something like $28, which is less than it was in 1985, so how long do you think an MD can spend with a patient - especially these are OLDER people who have oodles of Hx, toms of meds and generally take more time to deal with due to the many issues they face like hearing loss, vision impairment and cognitive difficulties.

If you want to blame the NP's, ask yourselves are you really focusing on the right issue?

What I have been reading on SDN is a lot of focus and hysteria based on the symptoms and not the CAUSE of this perceived problem, which is ironically one of the reasons patient's have more positive experiences with NP's. Is the issue really what how someone introduces themselves - that is going to happen and already is - WHY things are happening this way...

The truth is, I will very likely NOT be able to practice primary care or any specialty that allows regular patient contact because of reasons other than some fictitious army of crazed, costumed, NP's whose sole purpose is to ruin doctors and kill patients.

 

[mooshika]

Please remove your link. There's a possibility you just un-anonymized yourself to the world.

Thank you for that! Anyway.. long version of abstract:

Veterans’ Perceptions of Care by Nurse Practitioners, Physician Assistants, and Physicians: A Comparison From Satisfaction Surveys

Budzi D, Lurie S, Singh K, Hooker R
J Am Acad Nurse Pract. 2010;22:170-176
Study Summary

The Veteran's Health Administration (VHA) is the largest healthcare system and the single largest employer of nurse practitioners (NPs) and physician assistants (PAs) in the United States. In the VHA system, these providers increase patient access to healthcare. The VHA measures patient satisfaction with all providers on a regular basis to monitor health outcomes and to make organizational adjustments to care. Previous research suggests that quality of care improves when standards of care are measured consistently.
The VHA developed 13 standards of care to measure and improve customer service. Evaluating and responding to patients' perceptions of care, as a measure of healthcare quality, is one of the VHA's essential nonclinical endeavors.
Purpose. This study was undertaken to examine the differences in patient satisfaction with care provided by NPs, PAs, and physicians in the VHA system.
Data source. A standardized survey was mailed to a random sample of patients who received primary care in the VHA system. Secondary data were obtained from the VHA's Survey of Healthcare Experience of Patients (SHEP), a monthly survey designed to measure patient satisfaction. Descriptive statistics were calculated, and categorical variables were summarized with frequency counts. The numbers of NP, PA, and physician providers were analyzed to determine whether a correlation with satisfaction scores was evident.
Conclusions. Of the 2,164,559 surveys mailed to veterans, 1,601,828 were returned (response rate 74%). Of these, 74% were satisfied with care, 26% were dissatisfied with care, and the rest concluded that some of the questions were not appropriate. The study found that satisfaction scores increased by 5% when more NPs provided care, and 1.8% when more physicians provided care. Satisfaction scores were slightly increased or remained the same when more PAs provided care. Respondents were more satisfied with services provided by NPs because they paid attention to the patient's educational needs, met those needs, individualized care, and listened actively. Male respondents reported higher levels of satisfaction than female respondents. More patients reported a preference to see an NP than to see a PA or a physician.
Implications for practice. This study shows that most primary care clinic patients would rather see NPs than PAs or physicians. Besides clinical care, NPs focus on health promotion, disease prevention, health education, attentiveness, and counseling. These findings have implications for the hiring of more NPs in the VHA system.
Viewpoint

Although these findings are not unique, it is refreshing to see large sample sizes used in comparative research. It is also helpful to know the characteristics about NP care that patients identify as contributing to their preferences to receive care from NPs. This type of research should reinforce the teaching of NPs to ensure continuity of the services shown to be important to patients. One concern is that as a result of the nursing faculty shortage, NPs will no longer value and practice the "caring" behaviors that are critical in meeting the needs of patients, particularly in a large VHA setting.
Abstract

 

[jbz24]

There are real issues facing primary care such as moving to limit reimbursement for visits from medicare/aide to something like $28, which is less than it was in 1985, so how long do you think an MD can spend with a patient - especially these are OLDER people who have oodles of Hx, toms of meds and generally take more time to deal with due to the many issues they face like hearing loss, vision impairment and cognitive difficulties.

If you want to blame the NP's, ask yourselves are you really focusing on the right issue?

What I have been reading on SDN is a lot of focus and hysteria based on the symptoms and not the CAUSE of this perceived problem, which is ironically one of the reasons patient's have more positive experiences with NP's. Is the issue really what how someone introduces themselves - that is going to happen and already is - WHY things are happening this way...

The truth is, I will very likely NOT be able to practice primary care or any specialty that allows regular patient contact because of reasons other than some fictitious army of crazed, costumed, NP's whose sole purpose is to ruin doctors and kill patients.

No one is saying the NP issue is the sole problem for primary care doctors or even the primary issue at the moment. However, it is a threat, and with the powerful nursing union, it can easily become a bigger threat. Public opinion is easily swayed by politicians, and even when the president believes nurses are more important for health care than doctors, it is an issue.

 

[smq123]

Sometimes pts have to leave some practices, b/c they are not getting a reasonable amount of attention to things. This happens more than some want to admit. And I know darn well patients can be extremely demanding at times or even non-compliant, but then they come back and still whine to the physicians. I totally get that. But we have to take patients as they are. Only if they aren't willing to do their own part, then, sometimes the physicians have to let them go. I will say that if physicians are too pizzy and not as understanding with pt/clts as they could be, there could be, sometime in the future, more of a move to NPs that are willing to listen and follow-through with them.

The thing is, NPs are not, by nature, more patient or more willing to listen than an MD/DO is.

They see patients who aren't as sick, with fewer chronic problems. From the NPs I've seen, they see about the same number of patients as a resident does....which is significantly fewer than an attending sees. And, since they don't practice independently, they don't get sued as much.

If NPs started seeing really sick patients, with a lot of chronic problems, and started increasing their patient volume, and had a bigger threat of lawsuits, then patients would see the same level of "customer service" from an NP as they would from an overworked MD/DO. So they can pat themselves on the back for "superior customer service" all they want, but until they start seeing more and higher acuity patients, it's kind of meaningless.

 

[Dr Oops]

There are real issues facing primary care such as moving to limit reimbursement for visits from medicare/aide to something like $28, which is less than it was in 1985, so how long do you think an MD can spend with a patient - especially these are OLDER people who have oodles of Hx, toms of meds and generally take more time to deal with due to the many issues they face like hearing loss, vision impairment and cognitive difficulties.

If you want to blame the NP's, ask yourselves are you really focusing on the right issue?

What I have been reading on SDN is a lot of focus and hysteria based on the symptoms and not the CAUSE of this perceived problem, which is ironically one of the reasons patient's have more positive experiences with NP's. Is the issue really what how someone introduces themselves - that is going to happen and already is - WHY things are happening this way...

The truth is, I will very likely NOT be able to practice primary care or any specialty that allows regular patient contact because of reasons other than some fictitious army of crazed, costumed, NP's whose sole purpose is to ruin doctors and kill patients.

Who cares if the nurse will come hold your hand when they cant manage your tons of medication and morbidities. You bring up a good point. The population is getting older and they will have LOTS of simultaneous problems, which will require the years of training afforded to physicians. NPs will basically just be a middle man, taking their pay and referring out these patients.

I read the study you posted (or at least what I think you were trying to post). Basically it said a bunch of old men liked the attention they got from the nurses. Gee shocker. It had nothing to do with actual quality of care.

 

[jbz24]

Thank you for that! Anyway.. long version of abstract:

Veterans' Perceptions of Care by Nurse Practitioners, Physician Assistants, and Physicians: A Comparison From Satisfaction Surveys

Budzi D, Lurie S, Singh K, Hooker R
J Am Acad Nurse Pract. 2010;22:170-176
Study Summary

The Veteran's Health Administration (VHA) is the largest healthcare system and the single largest employer of nurse practitioners (NPs) and physician assistants (PAs) in the United States. In the VHA system, these providers increase patient access to healthcare. The VHA measures patient satisfaction with all providers on a regular basis to monitor health outcomes and to make organizational adjustments to care. Previous research suggests that quality of care improves when standards of care are measured consistently.
The VHA developed 13 standards of care to measure and improve customer service. Evaluating and responding to patients' perceptions of care, as a measure of healthcare quality, is one of the VHA's essential nonclinical endeavors.
Purpose. This study was undertaken to examine the differences in patient satisfaction with care provided by NPs, PAs, and physicians in the VHA system.
Data source. A standardized survey was mailed to a random sample of patients who received primary care in the VHA system. Secondary data were obtained from the VHA's Survey of Healthcare Experience of Patients (SHEP), a monthly survey designed to measure patient satisfaction. Descriptive statistics were calculated, and categorical variables were summarized with frequency counts. The numbers of NP, PA, and physician providers were analyzed to determine whether a correlation with satisfaction scores was evident.
Conclusions. Of the 2,164,559 surveys mailed to veterans, 1,601,828 were returned (response rate 74%). Of these, 74% were satisfied with care, 26% were dissatisfied with care, and the rest concluded that some of the questions were not appropriate. The study found that satisfaction scores increased by 5% when more NPs provided care, and 1.8% when more physicians provided care. Satisfaction scores were slightly increased or remained the same when more PAs provided care. Respondents were more satisfied with services provided by NPs because they paid attention to the patient's educational needs, met those needs, individualized care, and listened actively. Male respondents reported higher levels of satisfaction than female respondents. More patients reported a preference to see an NP than to see a PA or a physician.
Implications for practice. This study shows that most primary care clinic patients would rather see NPs than PAs or physicians. Besides clinical care, NPs focus on health promotion, disease prevention, health education, attentiveness, and counseling. These findings have implications for the hiring of more NPs in the VHA system.
Viewpoint

Although these findings are not unique, it is refreshing to see large sample sizes used in comparative research. It is also helpful to know the characteristics about NP care that patients identify as contributing to their preferences to receive care from NPs. This type of research should reinforce the teaching of NPs to ensure continuity of the services shown to be important to patients. One concern is that as a result of the nursing faculty shortage, NPs will no longer value and practice the "caring" behaviors that are critical in meeting the needs of patients, particularly in a large VHA setting.
Abstract

Wow this is one terrible article to post. I pulled up the full text and look at some of the things in the body of the article.

"NPs and PAs provide health care that is indistinguishable in quality from care provided by physicians. NP preparation includes a practical emphasis on attention to patient education, individualization of care, active listening, and more (Hoffman & Mercer, 2008; International Council of Nurses International Nurse Practitioner/Advance Practice Nursing Network, 2006). PA education is more of a generalist approach focusing on health care, and may include research, administration, and educational activities (American Academy of Physician Assistants [AAPA], 2006). The urgent need for NPs and PAs reflects factors such as the push for cost containment, fast expansion in the healthcare industry, and an aging baby-boomer population in the nation. As the number of veterans returning from war continues to increase, there is more need for more providers such as NPs and PAs in the VHA system."

Some REAL problems with this article:
- Patient satisfaction as an end point? Seriously? How about adverse effects, death, etc.?
- Biased authors
- 64% response rate might be enough, but I don't see any statistics proving that
- There are 1/3 as many PAs as NPs in this study. Isn't it a shock that more patients perceived NPs better than PAs?
- There are ZERO statistics used in this study. They quote a bunch of percentages but in no way show if this is even statistically significant. What a joke of a paper.

 

[jl lin]

The thing is, NPs are not, by nature, more patient or more willing to listen than an MD/DO is.

They see patients who aren't as sick, with fewer chronic problems. From the NPs I've seen, they see about the same number of patients as a resident does....which is significantly fewer than an attending sees. And, since they don't practice independently, they don't get sued as much.

If NPs started seeing really sick patients, with a lot of chronic problems, and started increasing their patient volume, and had a bigger threat of lawsuits, then patients would see the same level of "customer service" from an NP as they would from an overworked MD/DO. So they can pat themselves on the back for "superior customer service" all they want, but until they start seeing more and higher acuity patients, it's kind of meaningless.

Agreed and point taken.

My position is that this so called takeover isn't about to happen anytime soon, and for the reasons you alluded to above.

But it may in fact be worthy of consideration that some decent percentage of NPs that worked as RNs for a while have evolved more holistically speaking, and this may give them an edge in dealing and relating with patients.

I've seen how strong holistic skills make a difference. In peds for example, you are dealing with the parent as much as the child. But the docs that dismiss the parent or primary caregiver out of hand don't realize they are working at a great disadvantage. Often no one knows that child and the nuances of the child's body, responses, behaviors, etc, more than the parent. It's a mistake to take the position that "I'm the Dr., blah, blah, blah. . ." and not REALLY listen and give humble and honest consideration to what the parent or primary caregiver is sharing about the child.

Same thing with couples. Very close couples, elderly or not, know each other. But when you are "raised" in either nursing or medicine to bypass the holistic model, you very well can miss some important things. Still, overall, for the last several decades, nurses have been educated in the holistic model. Whether the individual takes the model to heart in practice may also be another thing as well.

I'm just saying it is something to consider.



But I stand by the practical reality that NPs, PAs ,or DNPS are NOT going to be taking over medicine any time soon. It's just NOT realistic all the way around.

Yet some folks keep harping on it like it is this huge and imminently dangerous crisis. It may be something to keep an eye on, but it is not the big "iceberg" for Medicine's Titanic right now.


Some of the stirring up, I wonder at times, has to do with some latent issues of insecurity with some folks. For how can they miss the overall power and influence medicine has and continues to have--nursing unions or not.

Listen, again I say this. So much in nursing sadly is that it is a house divided against itself. I've been inside the house for some time. Medicine is in no imminent danger.


The exception I may make is with anesthesiologist, and the infusion of AAs and CRNAs (and AAs are just as much a potential threat as CRNAs, don't be misled by that), and the fact that they are spreading the ologists too thin many times in having to supervise all these CRNAs during cases. Personally, I think it is as scary as hell.

My kids were only op'd in places where the ologist was right up close, and not pulled into all these other rooms. And they knew I meant business. The potential for danger is just too great. If the center wasn't on the ball with this, regardless of how much I liked the surgeon, it wasn't going to happen there.

But I do understand that the costs of having all ologists run the cases would be outrageous; b/c honestly, they do charge an incredible amount.

Medicine is in a jam, and part of it has to do with the continuous elevation of charges over time. They didn't stay in balance. And the educational system is to blame for this as well.

So you have these folks now coming into medicine, and the burden of unsustainable costs is, one way or another, thrust on to them.

It's an overwhelming situation for which there are absolutely no easy answers.

 

[Speculatrix]

But it may in fact be worthy of consideration that some decent percentage of NPs that worked as RNs for a while have evolved more holistically speaking, and this may give them an edge in dealing and relating with patients.

I've seen how strong holistic skills make a difference. In peds for example, you are dealing with the parent as much as the child. But the docs that dismiss the parent or primary caregiver out of hand don't realize they are working at a great disadvantage. Often no one knows that child and the nuances of the child's body, responses, behaviors, etc, more than the parent. It's a mistake to take the position that "I'm the Dr., blah, blah, blah. . ." and not REALLY listen and give humble and honest consideration to what the parent or primary caregiver is sharing about the child.

A no-brainer? I hated pediatrics because I hated dealing with the parents, and any good pediatrician (and all pediatrics books I've read) would advocate holistically interacting with the parents. Some of my pediatrics preceptors were people who've had tenure for 40+ years, and they were the ones who advocated for being hyper-vigilant whenever the parent described the kid as "irritable".

On another note, I've seen patients who were much happier with their NP than MD because the NP ordered every test possible... RAST's for every possible allergy, even though that might not have been clinically indicated then. Maybe (false) patient perceptions have some impact on midlevel creep?

 

[jl lin]

A no-brainer? I hated pediatrics because I hated dealing with the parents, and any good pediatrician (and all pediatrics books I've read) would advocate holistically interacting with the parents. Some of my pediatrics preceptors were people who've had tenure for 40+ years, and they were the ones who advocated for being hyper-vigilant whenever the parent described the kid as "irritable".

On another note, I've seen patients who were much happier with their NP than MD because the NP ordered every test possible... RAST's for every possible allergy, even though that might not have been clinically indicated then. Maybe (false) patient perceptions have some impact on midlevel creep?

Some are more holistic, while others are not--especially in sub-specialization. Depends.

As an example, however, family-centered care wouldn't have moved as far ahead as it has if it were not for nursing and those that are more holistic in approach. There is still a fair amount in lack of buy-in for family-centered care. And I know docs and nurses that would bust a gut in having mom and dad present during a code and whilst we cracked open a kid's chest. But I can tell you that it IS done in a number of places. As long as the family can handle it and they don't interfer w/ effective tx, it doesn't both me to have them there.


And there is a difference in reading about doing something versus having overriding principles permeate just about every aspect of care and tx. So there is more of this in nursing education than in medical education I think, although there has been more of a move toward it in more recent years. But quite a number of educators and leaders in medicine still scoff at it--even if they don't in mixed company, so to speak.

If you don't get good education on the holistic models, you may not get a buy-in on it.

Now it may be more of a force in osteopathic medical school. I'm not sure.

I say it is good to appreciate the models and to learn to respect that human beings are multi-dimensional. But again, in an age where the end all and be all is primarily evidence based practice, well, it can easily be pushed aside.

It's funny how human disciplines tend to run in extremes rather than working to incorporate the best of all worlds. It's shouldn't be an either/or kind of thing.

Oh well. Another topic for another time.

 

[smq123]

If you don't get good education on the holistic models, you may not get a buy-in on it.

Now it may be more of a force in osteopathic medical school. I'm not sure.

It is an out-dated, and frankly insulting, myth that allopathic schools don't teach you how to treat the "whole" patient. As an allopathic grad, I can tell you that is not true now (if it ever was true to begin with). I have had attendings that are MDs and DOs, and I couldn't tell which was which until I looked at their ID badge - it's not like they treated patients in a completely different manner or anything.

 

[jl lin]

It is an out-dated, and frankly insulting, myth that allopathic schools don't teach you how to treat the "whole" patient. As an allopathic grad, I can tell you that is not true now (if it ever was true to begin with). I have had attendings that are MDs and DOs, and I couldn't tell which was which until I looked at their ID badge - it's not like they treated patients in a completely different manner or anything.

Good to know.

 

[mooshika]

Who cares if the nurse will come hold your hand when they cant manage your tons of medication and morbidities. You bring up a good point. The population is getting older and they will have LOTS of simultaneous problems, which will require the years of training afforded to physicians. NPs will basically just be a middle man, taking their pay and referring out these patients.

I read the study you posted (or at least what I think you were trying to post). Basically it said a bunch of old men liked the attention they got from the nurses. Gee shocker. It had nothing to do with actual quality of care.

Oh, so I must have missed the part about how all the NP's were female HOTTIES and the MD's were all male, ugly old geezers, so the outcome was biased... I missed that part. So we are back to the nurse-***** argument again are we? That is clearly an assessment made by a fine scientific mind - the kind trained in medicine as opposed to the fallacious science presented in nursing. Also, your assumption that the NP's in the study were FEMALE. Also a scientific assessment in your part, not a biased assumption at all.

It is a summary, first of all, not the entire study. It is not meant to put an end to an argument, just some information, and of course it matters not since it was a study showing results that you do not like, it must be that the study is flawed.

I think what bothers some of you is that you have figured out that you actually don't need all the training you are given in medical school to do what the NP's are doing excellently on a daily basis on less then half the credit hours. That must really rub.

 

[mooshika]

Wow this is one terrible article to post. I pulled up the full text and look at some of the things in the body of the article.

"NPs and PAs provide health care that is indistinguishable in quality from care provided by physicians. NP preparation includes a practical emphasis on attention to patient education, individualization of care, active listening, and more (Hoffman & Mercer, 2008; International Council of Nurses International Nurse Practitioner/Advance Practice Nursing Network, 2006). PA education is more of a generalist approach focusing on health care, and may include research, administration, and educational activities (American Academy of Physician Assistants [AAPA], 2006). The urgent need for NPs and PAs reflects factors such as the push for cost containment, fast expansion in the healthcare industry, and an aging baby-boomer population in the nation. As the number of veterans returning from war continues to increase, there is more need for more providers such as NPs and PAs in the VHA system."

Some REAL problems with this article:
- Patient satisfaction as an end point? Seriously? How about adverse effects, death, etc.?
- Biased authors
- 64% response rate might be enough, but I don't see any statistics proving that
- There are 1/3 as many PAs as NPs in this study. Isn't it a shock that more patients perceived NPs better than PAs?
- There are ZERO statistics used in this study. They quote a bunch of percentages but in no way show if this is even statistically significant. What a joke of a paper.

Maybe you had better get over there and straighten those idiots out, being that you are such an expert. Make sure you humiliate them in front of the patients too, and remind them that you are a REAL DOCTOR after you do that, so they can change their minds about who they, the patients, would rather spend time with in the exam room.

 

[daveyjwin]

Oh, so I must have missed the part about how all the NP's were female HOTTIES and the MD's were all male, ugly old geezers, so the outcome was biased... I missed that part. So we are back to the nurse-***** argument again are we? That is clearly an assessment made by a fine scientific mind - the kind trained in medicine as opposed to the fallacious science presented in nursing. Also, your assumption that the NP's in the study were FEMALE. Also a scientific assessment in your part, not a biased assumption at all.

I'm going to bed shortly, but I'd like to point out that only 5.8% of nurses are males, implying that a similar percent are likely to be NPs, and 69% of FP and IM Physicians are males. Just saying that it backs up the theory posited above, especially with the marginally superior outcomes in patients satisfaction of NPs vs PAs, who are 94% vs 56% females respectively, who are catering and caring for an overwhelmingly male population (in the VA system, ~16% of veterans are female). Common sense dictates it's likely that old military dudes like being cared for by women over men, and to argue against this point would be absurd, and I think the numbers are in favor of this argument.

The p0oint is, the study sucks, and there hasn't been any adequetely blinded controlled study comparing outcomes between Physicians and NPs and PAs, mainly because of the legal risks and liability involved. No research board is going to approve randomly assigning STEMIs to unsupervised NPs/PAs anytime soon... and why do we think that is? Would you volunteer your mother or father to the care of an unsupervised NP/PA over a board certified physician in a life threatening emergency? Didn't think so...

 

[smq123]

Oh, so I must have missed the part about how all the NP's were female HOTTIES and the MD's were all male, ugly old geezers, so the outcome was biased... I missed that part. So we are back to the nurse-***** argument again are we?

You really need to calm down. No one is calling nurses "******," which you'd realize if you read the whole post carefully and rationally.

 

[VA Hopeful Dr]

Maybe you had better get over there and straighten those idiots out, being that you are such an expert. Make sure you humiliate them in front of the patients too, and remind them that you are a REAL DOCTOR after you do that, so they can change their minds about who they, the patients, would rather spend time with in the exam room.

The last point that the poster you quoted made was valuable. If a study doesn't show that the results it obtains are statistically significant, then we aren't going to think too much of it.

Please drop the attitude. You're making me even more distrustful of NPs. I'd like a rational discussion, but not if you're going to act this way.

 

[benjee]

actually, nothing that we can do to stop it when government legalizing these dangerous practices. In third world countries , it is pretty common ppl ( with no medical knowledge )self dx and self treated . when a country is running out of money , something needs to be sacrificed.

 

[thedrjojo]

If you don't get good education on the holistic models, you may not get a buy-in on it.

Now it may be more of a force in osteopathic medical school. I'm not sure.

My medical school (MD in inner city Newark, NJ) has a humanism center (which is directed by a transplant surgen/PD of surgical residency)... we have a course taught simultaneously with Internal Medicine called Health Beliefs and Behaviors, our first 2 years, the most weighed class as far as GPA is concerned is Physicians Core, which along with History taking and Physical Diagnosis, has modules on Ethics, Cultural Competency, and Evidence Based Medicine. Each year students recognize residents with Humanism Awards for those that set a great example. I have personally signed patients up to Pathmark's pharmacy plan so they can go across the street and get cheap meds, etc. While this is not indicitive all of nurses everywhere, the favorite phrase out of nurses in this hospital is "they aren't my patient". (not sure how many are RN's, not many if any are NP's)

 

[NYRN]

I have personally signed patients up to Pathmark's pharmacy plan so they can go across the street and get cheap meds, etc. QUOTE]

This is a wonderful thing you are doing, and these are types of things that patients will love about you. Believe me, they will tell everyone they know that they have the best doctor because he works with them to make sure they can get their meds/treatments instead of just handing them a script and saying see you in a month. If all providers take into consideration the situation of the patient, we will see more compliance with care in many cases. Writing RX's for things the patient can't afford if there are alternatives available will help. Its sad when you see many elderly people on a fixed income skipping meds because they can't afford all of their RX's.

This type of situation is where an MD/NP partnership can be beneficial for all involved and especially for the patient. The MD decides the main plan of care, while the NP working with him/her arranges for services such as ordering supplies for that patient, home care, making follow up calls, etc.

 

[JaggerPlate]

The last point that the poster you quoted made was valuable. If a study doesn't show that the results it obtains are statistically significant, then we aren't going to think too much of it.

Please drop the attitude. You're making me even more distrustful of NPs. I'd like a rational discussion, but not if you're going to act this way.

That study is an absolute joke.

 

[cyclohexanol]

Maybe you had better get over there and straighten those idiots out, being that you are such an expert. Make sure you humiliate them in front of the patients too, and remind them that you are a REAL DOCTOR after you do that, so they can change their minds about who they, the patients, would rather spend time with in the exam room.

Maybe before posting a "study", you should read the actual study as opposed to just the summary. Everything regarding the analysis by jbz24 (biased authors, zero statistical analysis, etc.) was absolutely correct. No conclusions whatsoever can be drawn from the "study".

kthx

 

[Maybeknot]

So apparently the nurses have found my website (which most likely have been an SDNer or a lurker because this is the only place I posted the link; although I guess a google crawler might have somehow found it too).

http://allnurses.com/nurse-practitioners-np/http-www-no-478213.html

I've been getting inundated with, um, friendly suggestions. I was going to post a selection of the responses, but doing so would have been demeaning-by-association for the majority of nurses.

 

[NYRN]

So apparently the nurses have found my website (which most likely have been an SDNer or a lurker because this is the only place I posted the link; although I guess a google crawler might have somehow found it too).

http://allnurses.com/nurse-practitioners-np/http-www-no-478213.html

I've been getting inundated with, um, friendly suggestions. I was going to post a selection of the responses, but doing so would have been demeaning-by-association for the majority of nurses.

On an earlier post, you asked me to review your website and I made suggestions to you for improvement. I don't think any of the suggestions I made were anit-NP or anti-MD. You have the right to develop any website you want, I don't have a problem with that, as long as all the info included is factual.

 

[Maybeknot]

On an earlier post, you asked me to review your website and I made suggestions to you for improvement. I don't think any of the suggestions I made were anit-NP or anti-MD. You have the right to develop any website you want, I don't have a problem with that, as long as all the info included is factual.

NYRN, yes. I saved your suggestions and was planning on modifying it in a few weeks when my schedule relaxed a bit. Of course, starting Monday I started getting several dozen angry comments (that was automatically emailed to me by the server.)

I appreciate your help and I certainly will follow through with your suggestions; I just haven't had a chance to do it yet.

 

[JaggerPlate]

So apparently the nurses have found my website (which most likely have been an SDNer or a lurker because this is the only place I posted the link; although I guess a google crawler might have somehow found it too).

http://allnurses.com/nurse-practitioners-np/http-www-no-478213.html

I've been getting inundated with, um, friendly suggestions. I was going to post a selection of the responses, but doing so would have been demeaning-by-association for the majority of nurses.

Hahahah that's awesome. I like how they tried to use an alexa rating as defense too. Keep it up!

 

[Bombesin]

http://www.newswise.com/articles/co...ealth-care-truth-and-transparency-act-of-2010

 

[NYRN]

http://www.newswise.com/articles/co...ealth-care-truth-and-transparency-act-of-2010

EVERY health professional should stand behind this. Anyone who would be against this is part of the problem.

Edited to add that there was only one thing that I disturbed me when it came to the bill.

I'm editing to add one thing from the ANA website that concerned me:

The Healthcare Truth and Transparency Act is also inconsistent in its approach to the issue of false representation. The legislation fails to address the actions and representations of MDs and DOs that fall outside of their education, skills, and clinical training. In addition, this bill fails to address the potential for non-licensed providers to portray themselves as something that they are not.

I think this issue needs to be addressed or else we will all be in trouble. The fact that unlicensed providers are not addressed in this bill leaves open the possibility for some school somewhere to create some sort of technician or assistant that would sidestep licensing requirement for nursing and medical care and not fall under this bill. How about something like a Healthcare Technologist? Who knows what they will be allowed to do since they will not fall under the control of nursing or medicine. I'm sure they won't be doing surgery, but there are still a ton of other things they will try to do that could kill a patient.

I am also all for there being restrictions on doctors performing procedures and practicing medicine outside of their training if there is potential harm to the patient. Patients undergoing surgery by someone who does not have formal training should be made aware of that when signing consent. It doesnt take an IR to insert a mediport, but there are just some things that should be restricted to MD's with specialized training.

The ANA is taking the position that this would further restrict or eliminate the NP role altogether. I can't really comment on that because I have to read the actual bill in entirety before I believe that its actually trying to do this, or if this is exaggeration.

 

[VA Hopeful Dr]

This is a wonderful thing you are doing, and these are types of things that patients will love about you. Believe me, they will tell everyone they know that they have the best doctor because he works with them to make sure they can get their meds/treatments instead of just handing them a script and saying see you in a month. If all providers take into consideration the situation of the patient, we will see more compliance with care in many cases. Writing RX's for things the patient can't afford if there are alternatives available will help. Its sad when you see many elderly people on a fixed income skipping meds because they can't afford all of their RX's.

This type of situation is where an MD/NP partnership can be beneficial for all involved and especially for the patient. The MD decides the main plan of care, while the NP working with him/her arranges for services such as ordering supplies for that patient, home care, making follow up calls, etc.

I don't think any of us are against this type of model.

 

[VA Hopeful Dr]

That study is an absolute joke.

That was kinda my point

 

[JaggerPlate]

That was kinda my point

Yup

 

[mooshika]

You really need to calm down. No one is calling nurses "******," which you'd realize if you read the whole post carefully and rationally.

You are absolutely right. The poster I referred to did not say "nurses are ******." That would be outrageous. They said that it was the nurse's sexual attractiveness that accounted for the veteran's preference for them over an MD.

I really should be more careful when I make conclusions. NP's would have to offer sexy hotness to the patients since this is the only thing that could possibly explain why a veteran would prefer their care over an MD. And offering sexy hotness in exchange for insurance reimbursement would not be called prostitution, so you are right, no one here ever suggested the "nurse's are ******" argument.

Thanks for helping me with that!

 

[Dr Oops]

You are absolutely right. The poster I referred to did not say "nurses are ******." That would be outrageous. They said that it was the nurse's sexual attractiveness that accounted for the veteran's preference for them over an MD.

I really should be more careful when I make conclusions. NP's would have to offer sexy hotness to the patients since this is the only thing that could possibly explain why a veteran would prefer their care over an MD. And offering sexy hotness in exchange for insurance reimbursement would not be called prostitution, so you are right, no one here ever suggested the "nurse's are ******" argument.

Thanks for helping me with that!

not a bad idea, maybe then id see some NPs

 

[jl lin]

Sadly I see that this whole "us versus them" mentality is still going on. It gets people no where.

Respect needs to go both ways. I don't see the necessity or value in getting all adversarial about things. Besides, it takes away from the credibility of people's positions.

 

[Apollyon]

You are absolutely right. The poster I referred to did not say "nurses are ******." That would be outrageous. They said that it was the nurse's sexual attractiveness that accounted for the veteran's preference for them over an MD.

I really should be more careful when I make conclusions. NP's would have to offer sexy hotness to the patients since this is the only thing that could possibly explain why a veteran would prefer their care over an MD. And offering sexy hotness in exchange for insurance reimbursement would not be called prostitution, so you are right, no one here ever suggested the "nurse's are ******" argument.

Thanks for helping me with that!

Where I am now, there are two NPs that work the walk-in clinic (both female). One is average looking and outstanding as a mid-level. She knows what she doesn't know, and knows when to ask for help. Her patients don't bounce back.

The other? She's hot. I have to stop there, because there's nothing else good to say.

 

[Dr Oops]

Sadly I see that this whole "us versus them" mentality is still going on. It gets people no where.

Respect needs to go both ways. I don't see the necessity or value in getting all adversarial about things. Besides, it takes away from the creditability of people's positions.

Well, if the med assistants started going on tv and saying that they were better than nurses and could do their jobs and do them better, how would you feel?

Its "us vs them" because of this DNP propaganda campaign. By having your lobbyists and tv reps say you are not only equal but better than us at OUR jobs, it can only be us vs them.

 

[Winged Scapula]

Attendings can also do their part. Many of you here are residents and students but if you have an attending with whom you work and feel able to talk to, you might wish to broach this subject. I have found that most attendings are totally unaware of the DNP "movement".

As of today, I have educated several of my colleagues. At the next Surgery Dept meeting in June, we are discussing changing the by-laws to include whom can call themselves Dr in the clinical setting. Sitting next to the Chief of Surgery in the OR lounge comes in handy.

 

[jl lin]

Well, if the med assistants started going on tv and saying that they were better than nurses and could do their jobs and do them better, how would you feel?

Its "us vs them" because of this DNP propaganda campaign. By having your lobbyists and tv reps say you are not only equal but better than us at OUR jobs, it can only be us vs them.

I am sorry but I do not see this so called "DNP movement" going anywhere. Hell nurses don't even buy into it.

The day the nursing profession and its organizations are stronger than the medical profession and its organizations is the day the world will stand still for 24 hours.

 

[Dr Oops]

I am sorry but I do not see this so called "DNP movement" going anywhere. Hell nurses don't even buy into it.

The day the nursing profession and its organizations are stronger than the medical profession and its organizations is the day the world will stand still for 24 hours.

R u kidding me?

The medical organizations wanted 2 things, fix SGR and tort reform, they got exactly zero of those. Nurses got equal reimbursement as ob/gyns and increased funding to help them take over primary care. Not to mention the president going on about how much more nurses care about patients. I would be proud of your lobbies they actually get things done.

 

[Rabbit Hole]

I am sorry but I do not see this so called "DNP movement" going anywhere. Hell nurses don't even buy into it.

The day the nursing profession and its organizations are stronger than the medical profession and its organizations is the day the world will stand still for 24 hours.

Read every article here and get back to us with an intelligent response. Have a nice day.


DNP Roadmap Task Force Report (AACN, October 2006) [80pgs]

Nurse Practitioner DNP Education, Certification and Titling: A Unified Statement (NP Roundtable, June 2008) [2pgs]

Doctor of Nursing Practice (DNP) Programs Frequently Asked Questions (AACN, Updated October 2009) [6pgs]

AMA Scope of Practice Data Series - Nurse Practitioners (AMA, October 2009) [142pgs]
- Response from Nurse Practitioner Organizations (December 2009) [1pg]

American College of Physicians - Nurse Practitioners in Primary Care (ACP, January 2009) [23pgs]

ACP Encouraged by Report on Primary Care Training; Notes Lack of Agreement on one Recommendation (ACP, March 2010) [2pgs]


AACN Position Statement on the Practice Doctorate in Nursing (AACN, October 2004) [20pgs]

The Essentials of Doctoral Education for Advanced Nursing Practice (AACN, October 2006) [28pgs]


Articles/documents/literature that were mentioned on this topic have been archived for reference. All material is public access and can otherwise be viewed by clicking on the links posted by members in the original threads. Individual files can be downloaded from this storage folder on the ifile.it website:

pol.i.tick.ing reading material [Nurse Practitioners are so hot right now]
-Note: Non-PDF material not included-

 

[jbz24]

Read every article here and get back to us with an intelligent response. Have a nice day.


DNP Roadmap Task Force Report (AACN, October 2006) [80pgs]

Nurse Practitioner DNP Education, Certification and Titling: A Unified Statement (NP Roundtable, June 2008) [2pgs]

Doctor of Nursing Practice (DNP) Programs Frequently Asked Questions (AACN, Updated October 2009) [6pgs]

AMA Scope of Practice Data Series - Nurse Practitioners (AMA, October 2009) [142pgs]
- Response from Nurse Practitioner Organizations (December 2009) [1pg]

American College of Physicians - Nurse Practitioners in Primary Care (ACP, January 2009) [23pgs]

ACP Encouraged by Report on Primary Care Training; Notes Lack of Agreement on one Recommendation (ACP, March 2010) [2pgs]


AACN Position Statement on the Practice Doctorate in Nursing (AACN, October 2004) [20pgs]

The Essentials of Doctoral Education for Advanced Nursing Practice (AACN, October 2006) [28pgs]


Articles/documents/literature that were mentioned on this topic have been archived for reference. All material is public access and can otherwise be viewed by clicking on the links posted by members in the original threads. Individual files can be downloaded from this storage folder on the ifile.it website:

pol.i.tick.ing reading material [Nurse Practitioners are so hot right now]
-Note: Non-PDF material not included-

Thanks for these links. Some of them are kind of scary. I wish some of our own organizations went a little further than they are.

 

[mooshika]

Read every article here and get back to us with an intelligent response. Have a nice day.


DNP Roadmap Task Force Report (AACN, October 2006) [80pgs]

Nurse Practitioner DNP Education, Certification and Titling: A Unified Statement (NP Roundtable, June 2008) [2pgs]

Doctor of Nursing Practice (DNP) Programs Frequently Asked Questions (AACN, Updated October 2009) [6pgs]

AMA Scope of Practice Data Series - Nurse Practitioners (AMA, October 2009) [142pgs]
- Response from Nurse Practitioner Organizations (December 2009) [1pg]

American College of Physicians - Nurse Practitioners in Primary Care (ACP, January 2009) [23pgs]

ACP Encouraged by Report on Primary Care Training; Notes Lack of Agreement on one Recommendation (ACP, March 2010) [2pgs]


AACN Position Statement on the Practice Doctorate in Nursing (AACN, October 2004) [20pgs]

The Essentials of Doctoral Education for Advanced Nursing Practice (AACN, October 2006) [28pgs]


Articles/documents/literature that were mentioned on this topic have been archived for reference. All material is public access and can otherwise be viewed by clicking on the links posted by members in the original threads. Individual files can be downloaded from this storage folder on the ifile.it website:

pol.i.tick.ing reading material [Nurse Practitioners are so hot right now]
-Note: Non-PDF material not included-

No one is going to take you seriously until you start treating other people/posters with respect. She did nothing to insult you. Get off your high horse and come back in eight years when you actually have a license to practice something and a little experience under your belt, and see just how far you get with your wise mouth.