Nursing School Vs Med School, no comparison.

[dyspareunia]

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The more docs claim they cannot or do not have time to do things, the more midlevels do for them. You're claiming a doctor can't function properly without midlevels at two to three times the cost, while midlevels claim they can do everything a doc can do and more (because they'll do things docs are unwilling to do) for less. Is it any wonder doctors are losing the PR war?

I don't disagree with you there. I don't believe that midlevels can do everything a doc can do, but I believe that someone with a cold goes to see an NP, gets a Z-pack, feels better in a week, and now believes that an NP is just as capable as an MD/DO. I'm sure that happens everyday, but that doesn't mean midlevels should be given more autonomy.

Also, I'm not claiming that a doctor cannot function properly without midlevels. I'm claiming that midlevels provide services that improve patient care overall provided that the midlevel is functioning as a midlevel and not trying to do more than they are trained to do. Midlevels improve patient care, there's no denying that. The issue is that midlevels exist to do things doctors won't, shouldn't, or can't do for whatever reason. If a doctor has somehow mastered all the doctoring things and has time to learn a midlevel skill then that's great. By all means, learn anything and everything to improve patient care.

The reality though is that doctors spend their entire careers trying to master doctoring. Time spent learning how to work the vent and educate the patient on how the vent works is time lost learning about how to keep patients off (or get them off) vents.

It goes back to your point about niches. If everyone maximizes their ability within their niche then the team as a whole works better. When people start venturing out into other niches at the expense of their ability within their own niche that's when things fall apart.

 

[TooMuchResearch]

Knowing how to work the vent is something docs should know.

 

[Psai]

You should know how to do things. I know how to take a pulse and a blood pressure. Does that make it a good use of my time? No.

 

[Mad Jack]

You should know how to do things. I know how to take a pulse and a blood pressure. Does that make it a good use of my time? No.

But you should know it, and should be taught by people that are adept in it. If you choose to forget it or view it as "beneath you" later, then that's your perogative.

 

[mvenus929]

If one doc dared actually ask them whether they knew how to use an inhaler before prescribing it, a lot of them might have never become inpatients to begin with.

A lot of patients or patient families (in the case of children) are taught multiple times how to use an inhaler, and when to use it, but don't do it properly.

 

[username456789]

A lot of patients or patient families (in the case of children) are taught multiple times how to use an inhaler, and when to use it, but don't do it properly.

Bingo. Physicians do it all the time, but if patients are anything they're determined to forget as quickly as possible.

 

[Psai]

A lot of patients or patient families (in the case of children) are taught multiple times how to use an inhaler, and when to use it, but don't do it properly.

Dear Physician 15385,
It is now your fault if your patient has an exacerbation of their pre-existing condition and becomes hospitalized. We will take out a penalty from your paycheck for your negligence in the patient's care.
-Thanks,
Obama.

 

[Critical Mass REACHED]

There's some things doctors aren't very good at. Take mechanical ventilation- the reason Dean Hess teaches it and has so many funded papers published is that he knows more about it than most pulmonologists. A well-qualified nurse could probably better tell you how to teach your patients than 99% of physicians because their degree focuses much more strongly on teaching patients than the MD or DO degrees do. You're a fool if you aren't willing to look to others that are masters of their own domain for training. I'm not saying there's a lot of places midlevels and allied health professionals should be teaching physicians, but they certainly do have niches where they could contribute.

Don't agree with this at all, how can you say that when all we do is teach on rounds, teach each other, teach family, etc. All of us are capable of teaching patients or their families anything they would like to learn about.

I went to nursing school, and there was no lecture on or emphasis on "teaching." Not sure where you are getting this from? Do they teach patients how to use an inhaler? Sure they do, do they teach PTs how to use a incentive spirometer? Sure they do. That doesn't take a rocket science to do.

But to say that physicians lack teaching abilities is a HUGE lie. For god sakes we put presentations all day long for faculty and residents, to the point where it becomes like breathing. During nursing school we did "some" presentations, and I'll tell you it was HUGE project because most were not comfortable or used to teaching anything!

 

[@JackShephard]

This is the golden age for nursing.

They are just starting to get more independence in many fields, yet they don't have to handle the same malpractice. They train in 1/4 the time and effort but get 2/3rds the pay in some fields.

As they are scrutinized more with more freedom in practice, they will soon have more stringent standards of care.

It will be this cycle in many of the fields that nurses become prominent (eg anesthesia, psych, etc):

The next few decades in medicine...
- Nurses gain more independent rights
- Nurses pay increases as they are acting like many doctors
- Physician pay decreases due to nursing competition
- Saturation point is reached and nurses begin to make publicized errors
- Nurse pay decreases lower than where they started due to physician competition at lower rates

This is a huge scheme by the government to lower healthcare expenditures. It will start in the VA and government healthcare organizations, then it will spread to the private market via legislation. In the end everyone loses, except the government, big business, pharma and insurance companies.

 

[dyspareunia]

This is the golden age for nursing.

They are just starting to get more independence in many fields, yet they don't have to handle the same malpractice. They train in 1/4 the time and effort but get 2/3rds the pay in some fields.

As they are scrutinized more with more freedom in practice, they will soon have more stringent standards of care.

It will be this cycle in many of the fields that nurses become prominent (eg anesthesia, psych, etc):

- Nurses gain more independent rights
- Nurses pay increases as they are acting like many doctors
- Physician pay decreases due to nursing competition
- Saturation point is reached and nurses begin to make publicized errors
- Nurse pay decreases lower than where they started due to physician competition at lower rates

This is a huge scheme by the government to lower healthcare expenditures. It will start in the VA and government healthcare organizations, then it will spread to the private market via legislation. In the end everyone loses, except the government, big business, pharma and insurance companies.

Oh man, you really had me going.. Until you went all conspiracy theory.

 

[@JackShephard]

Oh man, you really had me going.. Until you went all conspiracy theory.

Well, don't think of it as a conspiracy theory. Think of it as politicians sitting in a budget office, asking how can we lower healthcare costs? One guy says, "let's give nurse practioners (noctors) independent practice rights in primary care and psychiatry." And so it begins...

 

[music2doc]

I'd rather be trained by a doctor. I'm not going to medical school to learn from a midlevel.

I have no idea where you are in your med school training (your statement makes me think first year but maybe I'm wrong), but I know if you said this in front of one of the physician faculty members I have close relationships with, you'd probably be shot on sight. I realize you probably did not mean for it to come off so strongly, but to think just because someone is of a lower level of training than you (newsflash: as of right now, they're not; heck, I'd estimate you're almost below the ER Techs until at least a couple of rotations into your 3rd year). Even an attending would be wise to learn from his/her "midlevels" just as a good nurse learns from his/her techs or a good manager learns from his/her employees. Everyone has something to learn and something to teach. The sooner you and I learn that, the better off everyone will be.

If I wanted to learn how to think like a midlevel I would have gone to a school for midlevels.

Sure they can teach you things, but as it has already said ITT, they don't know what they don't know so they may be missing something important and therefore relaying incomplete information to you.

If I only know the alphabet through "m" I can teach you "a-m" but you would never have known about "n-z".

And you don't think physicians are blind to what they don't know? At this point in our educations, I don't think we really have any right to refuse to learn from anyone in the hospital. Even the valet guy outside or the triage registrar in the ED probably has learned a few useful tips and tricks that you could learn from them when it comes to different aspects of patient care. I'm no saint when it comes to this, so I say it as much to remind myself as anything, but we can all learn from anyone. I think it's best to keep our eyes and ears wide open during medical school instead of shutting out people we deem somehow "less than ourselves."

 

[bakedbeans18]

There are a few nurses in my class, and when people get to talking about getting Senior AOA and honoring all of their clerkships, I think "uhh, get in line behind those nurses....they've already gotten their feet wet." Then again, I could be wrong, I didn't go to nursing school or anything like that, I'm just a run of the mill MD student 🙂

 

[beckster_01RN]

Here's hoping I don't regret jumping into this conversation, but here goes nothing.

I am a RN working in the MICU, and the misconceptions flying around about the nursing profession are unbelievable.

For one thing, Critical Mass, you don't let us forget that you attended nursing school, but yours was much different than mine. I will be the first to admit that nursing school had a lot of BS. However if I took one thing out of school it is that a nurse functions as a patient advocate. You may think that patient education is going into a room and giving a patient detailed rhetoric about their disease process, which is great and important. But the nurse is the one that follows you into the room, interprets the data that you presented, and makes sure that the patient really understands what it means when you leave the room. And fwiw learning how to provide patient education was a major focus in nursing school, and incorporated into every facet of my education.

Now that I have that off my chest, I understand your frustration with the "nurse takeover." I have met the occasional "Dr. Nurse" that insisted on the title. In one respect I get it, a PhD or a DNP are both hard-earned titles, and in the professional/educational arena I don't think it is entirely inappropriate to want to be referred to as such. Egotistical and petty? Maybe, but I also have not pursued that level of education so who am I to judge. I also agree that it is inappropriate in the clinical setting, but only because it can cause patient confusion.

I have worked closely with many, many NPs and PAs, and have never met the "militant" that is described here as representing the majority of the profession. I have not once met an NP who felt they should practice independently. Med school is an entirely different ball game and nurses know that. Honestly, if I could design a nursing program then I would put more in-depth science courses in it then I would, but the fact is that nursing is not just the easier alternative to being a doctor, it is a completely different job. A nurse isn't there to simply follow doctors orders. They are there to help guide the patient through a confusing medical system, pointing them towards the various services they need. I think that background lends itself well to being an NP. An NP is going to be better at coordinating care than an MD because that is where their training was focused. I think a critical care nurse makes a great CRNA because they spend their entire shift analyzing every single change in heart rate, blood pressure, and UOP to determine its significance. We are experts at managing sedation (trust me...). We are constantly thinking steps ahead and developing "what if" scenarios in our head so that we are on top of the game should that patient tank. The only reason that nurses don't get sued is because that is not where the money is, but technically a nurse is the last line of defense. If I administer an unsafe medication that was ordered by the doctor and there is a poor outcome, according to nursing standards of care I am equally responsible for harm done to the patient.

One more point of contention and I am done. Early on in this thread it was pointed out that nurses appear angry with life, they are looking for fights, they are insecure in their profession, etc. That is often true, but to understand why then take one look at perception of nurses by the layperson which is only perpetuated by the media. We have been fighting an uphill battle to be recognized as more than a doctors servant, a sex symbol, or a background figure in healthcare. Every time a family member calls themselves a nurse because they have been taking care of their grandma at home, not because they went to school, a small part of me becomes a little more bitter. Reading through this thread where I saw more unprofessional comments directed towards nurses than I have ever seen in my life, I became a little angrier. If you want to be taken seriously as med students then you'd better start taking nurses seriously too, because we obviously aren't going anywhere. I think that your attempt at raising hell on the nursing board only made the nurses there look more professional, especially in contrast to some of the hateful and crude comments on this thread.

 

[Nasrudin]

Here's hoping I don't regret jumping into this conversation, but here goes nothing.

I am a RN working in the MICU, and the misconceptions flying around about the nursing profession are unbelievable.

For one thing, Critical Mass, you don't let us forget that you attended nursing school, but yours was much different than mine. I will be the first to admit that nursing school had a lot of BS. However if I took one thing out of school it is that a nurse functions as a patient advocate. You may think that patient education is going into a room and giving a patient detailed rhetoric about their disease process, which is great and important. But the nurse is the one that follows you into the room, interprets the data that you presented, and makes sure that the patient really understands what it means when you leave the room. And fwiw learning how to provide patient education was a major focus in nursing school, and incorporated into every facet of my education.

Now that I have that off my chest, I understand your frustration with the "nurse takeover." I have met the occasional "Dr. Nurse" that insisted on the title. In one respect I get it, a PhD or a DNP are both hard-earned titles, and in the professional/educational arena I don't think it is entirely inappropriate to want to be referred to as such. Egotistical and petty? Maybe, but I also have not pursued that level of education so who am I to judge. I also agree that it is inappropriate in the clinical setting, but only because it can cause patient confusion.

I have worked closely with many, many NPs and PAs, and have never met the "militant" that is described here as representing the majority of the profession. I have not once met an NP who felt they should practice independently. Med school is an entirely different ball game and nurses know that. Honestly, if I could design a nursing program then I would put more in-depth science courses in it then I would, but the fact is that nursing is not just the easier alternative to being a doctor, it is a completely different job. A nurse isn't there to simply follow doctors orders. They are there to help guide the patient through a confusing medical system, pointing them towards the various services they need. I think that background lends itself well to being an NP. An NP is going to be better at coordinating care than an MD because that is where their training was focused. I think a critical care nurse makes a great CRNA because they spend their entire shift analyzing every single change in heart rate, blood pressure, and UOP to determine its significance. We are experts at managing sedation (trust me...). We are constantly thinking steps ahead and developing "what if" scenarios in our head so that we are on top of the game should that patient tank. The only reason that nurses don't get sued is because that is not where the money is, but technically a nurse is the last line of defense. If I administer an unsafe medication that was ordered by the doctor and there is a poor outcome, according to nursing standards of care I am equally responsible for harm done to the patient.

One more point of contention and I am done. Early on in this thread it was pointed out that nurses appear angry with life, they are looking for fights, they are insecure in their profession, etc. That is often true, but to understand why then take one look at perception of nurses by the layperson which is only perpetuated by the media. We have been fighting an uphill battle to be recognized as more than a doctors servant, a sex symbol, or a background figure in healthcare. Every time a family member calls themselves a nurse because they have been taking care of their grandma at home, not because they went to school, a small part of me becomes a little more bitter. Reading through this thread where I saw more unprofessional comments directed towards nurses than I have ever seen in my life, I became a little angrier. If you want to be taken seriously as med students then you'd better start taking nurses seriously too, because we obviously aren't going anywhere. I think that your attempt at raising hell on the nursing board only made the nurses there look more professional, especially in contrast to some of the hateful and crude comments on this thread.

Some good points. But a bit dramatic. C'mon be real. The break room on your unit could easily fill a thousand of these threads some more aggressive and defamatory, some not.

There will always be antagonism between our fields. It's just that one on one we most often make the best of it because we depend on each other to get through each shift. And who wants to fight just to get the job done.

You are mistaken about what constitutes Machiavellian principle though by looking for an NP with a black beret and a raised fist. As someone who was taken for granted enough to observe your camp, without the artifice of deceit, I can attest--your feeble attempt at moral pagentry is hilarious.

We are at play constantly in the games of power. It is a fact of life. And we negotiate our livelihoods by how good we are at it. It's just the fight you describe that nurses have had to fight to get a basic level of respect has made you all far more devious at it than we, as a profession.

This is simply our break room. And we need to come to terms with how your profession has been kicking our @sses. While managing the type of sheepish naïveté you portray in ways as beguiling as they are masterful. Made all the more effective by the vast majority of you being unconscious vessels of this moral propaganda.

 

[beckster_01RN]

Not much more dramatic than you, but it's all good in the hood. I agree that many nurses don't do much for the profession, but the worst doctor-bashing I see online is "the mean old doctor yelled at me 🙁 :'( ." But I also tend to avoid any threads on allnurses with too many exclamation points. I don't see how anything I said was deceitful or beguiling, but I'm not going to spend time arguing about it. As you said this is your breakroom, and you have just as much right to vent as nurses. But if would hate to think that I'm actually reading opinions of the doctors that are standing next to me at my workplace. A little bit of respect goes a loooong way.

 

[mvenus929]

But if would hate to think that I'm actually reading opinions of the doctors that are standing next to me at my workplace. A little bit of respect goes a loooong way.

Outside of SDN, I feel the opinion of nurses among med students is generally good. After all, the nurs can make or break us as students or residents. There have been a handful of times when I've had a bad experience with an RN, but by and large, they are great and helpful and friendly.

There is plenty of worry about the NP situation, because it kind of affects how we choose our profession. If NPs are going to get paid as much and function as independently as a primary care physician, what incentive is there to go into primary care with the debt loads that we face?

 

[Nasrudin]

Not much more dramatic than you, but it's all good in the hood. I agree that many nurses don't do much for the profession, but the worst doctor-bashing I see online is "the mean old doctor yelled at me 🙁 :'( ." But I also tend to avoid any threads on allnurses with too many exclamation points. I don't see how anything I said was deceitful or beguiling, but I'm not going to spend time arguing about it. As you said this is your breakroom, and you have just as much right to vent as nurses. But if would hate to think that I'm actually reading opinions of the doctors that are standing next to me at my workplace. A little bit of respect goes a loooong way.

I haven't read this whole thread but please give an example of something that hurts your feelings or something that's beyond the pale, b/c I'm sorry....I've seen so much dirty politics and bullying on your side of the fence that your poor lil self struggling to imagine the contents of this thread is a bit funny to me.

And I'm not saying you yourself are being deceitful. I'm saying your presumption of moral authority, of being mother Teresa like, en masse, allows you to play Machiavellian games while seeming sweet and innocent, playing very adroitly at public sympathy.

Like NP's wanting independence to help the down trodden get basic health care. Without the slightest cognition of your profession's actual duplicity. That's a masterful mindf@ck on a grand scale. Know this....everyone wants power. You seek independence for no other reason than power. And if you think NP's who get trained to competence at full pay thanks to us, don't eventually resent their loss of wages "for doing the same job," then your understanding of human motivation is deficient.

 

[Critical Mass REACHED]

Bekster RN: did you really just say you are the experts in sedation ?

Comments like that drive me to say snarky comments but I won't, because you came off as nice. But, that statement is a down right lie. Anesthesiologist practically spend months and months working in the ICU's, and manage the sickest patients in the OR. They "Anesthesiologist" are the experts, not the nurses in the ICU. Yes, you can read some basic EKG's, and can recognize patterns of what we typically order when you see X Y Z, but don't confuse that as superior knowledge.

 

[dyspareunia]

And you don't think physicians are blind to what they don't know? At this point in our educations, I don't think we really have any right to refuse to learn from anyone in the hospital. Even the valet guy outside or the triage registrar in the ED probably has learned a few useful tips and tricks that you could learn from them when it comes to different aspects of patient care. I'm no saint when it comes to this, so I say it as much to remind myself as anything, but we can all learn from anyone. I think it's best to keep our eyes and ears wide open during medical school instead of shutting out people we deem somehow "less than ourselves."

I didn't mean to imply that physicians should refuse to learn from nurses or anyone else. I meant that it can be dangerous for a med student to learn from a nurse if they don't keep in mind that the nurse's knowledge is more limited than that of a resident, attending, or fellow.

It's like being an MS1 and not understanding something from lecture. Yes, you can go ask an MS2 who probably knows it kind of well, but your best bet is to go straight to the professor and have them explain it to you.

 

[Critical Mass REACHED]

Long thread, seems to be some confusion. No one is saying the nurse practitioner can't teach, what is being implied is you can't expect a NP/Nurse to teach pathophysiology to a resident or intern, or a medical student.

Another confusion floating around here is PhD's teaching. No one said PhD's shouldn't teach! Most of them are experts in their area (anatomy, pathophysiology, genetics, etc) they are basically producing the chapters we read.

PhD in nursing is not something we can't learn from, but it's not a topic we well heavily dive into. A Doctor in Nursing, is just that. An expert at nursing. If they have something to say, everyone will listen when it's in regard to their field. But to say they are they are the experts in vents, teaching, genetics, and so fourth is a lie. PhD in (nursing) are expert nurses.

 

[allojay]

Long thread, seems to be some confusion. No one is saying the nurse practitioner can't teach, what is being implied is you can't expect a NP/Nurse to teach pathophysiology to a resident or intern, or a medical student.

Another confusion floating around here is PhD's teaching. No one said PhD's shouldn't teach! Most of them are experts in their area (anatomy, pathophysiology, genetics, etc) they are basically producing the chapters we read.

PhD in nursing is not something we can't learn from, but it's not a topic we well heavily dive into. A Doctor in Nursing, is just that. An expert at nursing. If they have something to say, everyone will listen when it's in regard to their field. But to say they are they are the experts in vents, teaching, genetics, and so fourth is a lie. PhD in (nursing) are expert nurses.

I'm not going to lie, this thread has been going on for too long. But in response to what you said, I have to say that I disagree slightly. I've personally met a handful of nurses and NP's that understand the pathophysiology of various conditions better than some docs. Does that mean they can teach it in an academic medical school setting? Probably Not. But I'll say this. There's a medical school in NY where a DNP teaches Patho to medical students in the lecture and clinical setting. Having shadowed her, I know for a fact that she knows a lot more than most if the docs I know. She's probably one out of a very few nurses that is apt enough to teach patho in a med school.

I'm not knocking Nursing or Medicine. I just think each one has it's focus and aims to solve the same problem. It's very funny how this stuff still goes on today. Can't we just get along? Or agree to disagree?

 

[Nasrudin]

I'm not going to lie, this thread has been going on for too long. But in response to what you said, I have to say that I disagree slightly. I've personally met a handful of nurses and NP's that understand the pathophysiology of various conditions better than some docs. Does that mean they can teach it in an academic medical school setting? Probably Not. But I'll say this. There's a medical school in NY where a DNP teaches Patho to medical students in the lecture and clinical setting. Having shadowed her, I know for a fact that she knows a lot more than most if the docs I know. She's probably one out of a very few nurses that is apt enough to teach patho in a med school.

I'm not knocking Nursing or Medicine. I just think each one has it's focus and aims to solve the same problem. It's very funny how this stuff still goes on today. Can't we just get along? Or agree to disagree?

This is the type of codependent, self-hating liberal crap that prevents from organizing properly as a profession. Everything is nursing dogma is so essentially self-edifying and justifying that they aren't even aware of it. And we're taught constantly by PC police to be on our constant P's and Q's about everyone else's self esteem.

And what have we gained from it.

 

[allojay]

This is the type of codependent, self-hating liberal crap that prevents from organizing properly as a profession. Everything is nursing dogma is so essentially self-edifying and justifying that they aren't even aware of it. And we're taught constantly by PC police to be on our constant P's and Q's about everyone else's self esteem.

And what have we gained from it.

Whoa! Someone seems upset...please elaborate on your solution to this problem..you apparently seem to have the answers.

 

[dyspareunia]

I've personally met a handful of nurses and NP's that understand the pathophysiology of various conditions better than some docs.

Lol pls go.

 

[Nasrudin]

Whoa! Someone seems upset...please elaborate on your solution to this problem..you apparently seem to have the answers.

I'm not upset at all. It's your whiny passive aggressive mind that sees disagreement as disagreeable.

 

[allojay]

Lol pls go.

If you find that hard to believe, then it speaks to your ignorance. Not all nurses and NP's are the same. Just like physicians, some know more than others and vice-versa. I'm not saying they have a medical education, but I'm saying they put the extra effort to be well versed and knowledgeable in the subject. You don't need a medical degree to be able to effectively understand and teach patho. I'm not sure about the nurses and NP's you've worked with personally, but I can tell you that I've met a good number of very knowledgeable nurses out there, more so in the critical care setting.

 

[allojay]

I'm not upset at all. It's your whiny passive aggressive mind that sees disagreement as disagreeable.

Ok. I see. My point is that this thread is too long and hasn't got anywhere. I wasn't being serious regarding the last sentence of my earlier post; it was more of being ironic.

 

[yappy]

Not much more dramatic than you, but it's all good in the hood. I agree that many nurses don't do much for the profession, but the worst doctor-bashing I see online is "the mean old doctor yelled at me 🙁 :'( ." But I also tend to avoid any threads on allnurses with too many exclamation points. I don't see how anything I said was deceitful or beguiling, but I'm not going to spend time arguing about it. As you said this is your breakroom, and you have just as much right to vent as nurses. But if would hate to think that I'm actually reading opinions of the doctors that are standing next to me at my workplace. A little bit of respect goes a loooong way.

This is crazy. The criticism of nursing stems from their aggressive intrusion into providing medical services that have historically required an undergraduate degree, MD / DO degree, and residency. Indeed, union-politician partnerships, lack of rigor in undergraduate & graduate nursing programs, and back-door scope of practice gains warrant harsh criticism. If Nursing recognised its role as "nurse" then there would be no disrespect.

Differences in training/education/outcomes need to be made in order to maintain the integrity of our healthcare system.

Physicians = educated.
Nurses = trained.

 

[Critical Mass REACHED]

If you find that hard to believe, then it speaks to your ignorance. Not all nurses and NP's are the same. Just like physicians, some know more than others and vice-versa. I'm not saying they have a medical education, but I'm saying they put the extra effort to be well versed and knowledgeable in the subject. You don't need a medical degree to be able to effectively understand and teach patho. I'm not sure about the nurses and NP's you've worked with personally, but I can tell you that I've met a good number of very knowledgeable nurses out there, more so in the critical care setting.

You can go ahead and get your "Pathophysiology" lectures from a nurse, I'll gladly go with our outstanding Pathologist to teach us. You have got to be lying to us, or yourself saying such a statement.

 

[evilbooyaa]

I'm not knocking Nursing or Medicine. I just think each one has it's focus and aims to solve the same problem. It's very funny how this stuff still goes on today. Can't we just get along? Or agree to disagree?

This thought process is what is getting our ass kicked in the political arena. Physicians want to be PC, not stir up trouble, etc. etc. when the vocal minority of NPs are willing to do just that. Push to go from the nursing field into the medicine field. Physicians not holding their ground in the past has led to this issue in the first place (allowing NPs to exist and practice medicine put us on the slippery slope to NPs wanting independent practice and claiming equivalency).

At some point we have to hold our ground, or cede ALL of primary care to them (as equal reimbursement means FM/Peds/Outpatient IM gets downward pressure on reimbursement rather than NPs making more money). Then they'll start aiming for independent practice in specialties (which is limited at this time except for CRNAs and maybe Derm).

 

[dyspareunia]

If you find that hard to believe, then it speaks to your ignorance. Not all nurses and NP's are the same. Just like physicians, some know more than others and vice-versa. I'm not saying they have a medical education, but I'm saying they put the extra effort to be well versed and knowledgeable in the subject. You don't need a medical degree to be able to effectively understand and teach patho. I'm not sure about the nurses and NP's you've worked with personally, but I can tell you that I've met a good number of very knowledgeable nurses out there, more so in the critical care setting.

I too can show up on the wards spouting random minutiae that the docs don't know about. To someone with minimal medical knowledge, such as a lay person.. and apparently you if you think a nurse knows more pathophys than a doc, I will appear to know more than the doctor does.

Anyone with a decent understanding of the pathophys would know minutiae =/= understanding.

 

[allojay]

You can go ahead and get your "Pathophysiology" lectures from a nurse, I'll gladly go with our outstanding Pathologist to teach us. You have got to be lying to us, or yourself saying such a statement.

Listen, You're taking what i said to an extreme. No one ever said that verbatim. I said that a select few nurses have the knowledge base to be able to do so. Don't get me wrong, I'd rather get notes from a pathologist myself. But the truth is that, you can't say that All nurses in the world don't have the knowledge base to be able to teach a patho course. That's very narrow minded to even think that. I'm not here to go back and forth for hours, so that is all i'll say regarding that.

 

[allojay]

I too can show up on the wards spouting random minutiae that the docs don't know about. To someone with minimal medical knowledge, such as a lay person.. and apparently you if you think a nurse knows more pathophys than a doc, I will appear to know more than the doctor does.

Anyone with a decent understanding of the pathophys would know minutiae =/= understanding.

Again, you're taking what I said to an extreme. I never said ALL nurses know more than Physicians. That is completely absurd. Docs have longer training, more clinical experience, and so on. But I've encountered scenarios where the Nurse (mostly in the critical care setting) knows the patho better than the doc. That doesn't mean that the nurse is smarter or more competent, I'm just saying that the nurse in that scenario is more versed explaining the patho than the doc does. I'm not bashing physicians at all. I'm just trying to say that they're some overqualified nurses out there that do more than their training requires, and through that extra work, have developed become well versed. That is all.

 

[Critical Mass REACHED]

Listen, You're taking what i said to an extreme. No one ever said that verbatim. I said that a select few nurses have the knowledge base to be able to do so. Don't get me wrong, I'd rather get notes from a pathologist myself. But the truth is that, you can't say that All nurses in the world don't have the knowledge base to be able to teach a patho course. That's very narrow minded to even think that. I'm not here to go back and forth for hours, so that is all i'll say regarding that.

Sure there are some nurses practitioners "very rare" that continue to stay up to date with knowledge, and just maybe have equal amount of knowledge as a physician specialist.

I'll use the NFL as an example. Your example is about as common as a 5-6 NFL running back or wide receiver. Sure there have been some who were good enough to play the position "hall a famer" probably not, but able to play on the field. But that is a rare site.

 

[VisionaryTics]

But the truth is that, you can't say that All nurses in the world don't have the knowledge base to be able to teach a patho course. That's very narrow minded to even think that.

Okay. What does that mean? What does this "everyone is great" attitude contribute to the conversation? You can say things like "Stop being so close minded", "In my experience..", etc, but as above, this is just wishy washy bullcrap that doesn't address the question: what is a reasonable scope of practice for a nursing practitioner as a profession?

As someone said above, physicians have minded their Ps and Qs, played nice, didn't rock the boat, while nursing advocates have aggressively sought to define and expand their scope of practice. They don't want to "get along". They want my job. As someone dedicating my life to the competent care of my patients, I have a problem with that. It makes me upset that you don't.

 

[allojay]

This thought process is what is getting our ass kicked in the political arena. Physicians want to be PC, not stir up trouble, etc. etc. when the vocal minority of NPs are willing to do just that. Push to go from the nursing field into the medicine field. Physicians not holding their ground in the past has led to this issue in the first place (allowing NPs to exist and practice medicine put us on the slippery slope to NPs wanting independent practice and claiming equivalency).

At some point we have to hold our ground, or cede ALL of primary care to them (as equal reimbursement means FM/Peds/Outpatient IM gets downward pressure on reimbursement rather than NPs making more money). Then they'll start aiming for independent practice in specialties (which is limited at this time except for CRNAs and maybe Derm).

That highlighted sentence wasn't meant to be taken literally, because I knew that the fight/ disagreement between nursing and medicine will perpetuate. You have a valid point, and objectively speaking I think that the MD vs. NP mentality isn't beneficial. As much as I think that some NP's are competent, you can't compare the NP's education to that of a physician's. From the look of it, I think docs are losing the political battle because NP's are easier to utilize. With all due respect to NP's, NP's are cheap labor compared to docs and from a political standpoint appears to be financially preferable. Do i agree with that? Of course not. But it's sad that we'll start seeing the uprise of more NP's in practice that are not as experienced as docs out there.

 

[Nasrudin]

I think we should refocus our case to account for equity and justice. The issue is not just the competency of NP's but how they achieve it at our expense. And how they and the tax payers are willing to ride our backs to train a scab work force.

The fact is that with enough effort the training plateaus will meet. I think it's foolish to think otherwise. Eventually we tend to forget all the complexity we learn academically and they tend to pick up enough clinical judgment on the job that I don't believe 10 years or less down the road there is a measurable difference at least with our average lot. The top of each of our specialties will remain as such. But I think means and medians of groups in these discussions is far more important.

If nurses had to train LVN's to replace them fire and brimstone would break forth from the heavens and righteous anger would befall all the enemies of the Nursealites.

Why is it different with us? How did we learn to be such pansies?

 

[allojay]

Okay. What does that mean? What does this "everyone is great" attitude contribute to the conversation? You can say things like "Stop being so close minded", "In my experience..", etc, but as above, this is just wishy washy bullcrap that doesn't address the question: what is a reasonable scope of practice for a nursing practitioner as a profession?

As someone said above, physicians have minded their Ps and Qs, played nice, didn't rock the boat, while nursing advocates have aggressively sought to define and expand their scope of practice. They don't want to "get along". They want my job. As someone dedicating my life to the competent care of my patients, I have a problem with that. It makes me upset that you don't.

I completely understand what you're saying, but you can't disregard a whole field because of their aggressive advocates. I think that both nursing and medicine should cut the BS and work together to heal patients appropriately. Do docs need to be more aggressive in their pursuit to keep their jobs? Hell Yea! But at the same time, you have to realize that it's all about money nowadays. Would a practice rather pay a physician 100k annually or pay an NP 70/80K? I'm sure you know the answer to that. Do I agree with this? No. I think that the years that doc's put in, in addition to their experience, residencies, and so on..puts them in a prime position to take 'great' care of their patients. I don't know if i can say the same thing for your typical NP.

To answer the question..what is a reasonable scope of practice for a nursing practitioner as a profession? I really don't know. I'm not sure why the NP position was created, especially when you have PA's. But it's a very tough question to answer. The more I think of it, the NP position seems to be something created to give nursing a way to sort of compete with medicine and declare autonomy in healthcare. I'm disappointed that NP's with far less experience and education will have the same rights as an MD, but that won't make me go out and bash the field. The sad truth is that it all comes down to money, and NP's are cheaper. I'm upset that if this ends up being the case, that we'll see a decline in the quality of healthcare in the years to come.

 

[sobored]

Okay. What does that mean? What does this "everyone is great" attitude contribute to the conversation? You can say things like "Stop being so close minded", "In my experience..", etc, but as above, this is just wishy washy bullcrap that doesn't address the question: what is a reasonable scope of practice for a nursing practitioner as a profession?

As someone said above, physicians have minded their Ps and Qs, played nice, didn't rock the boat, while nursing advocates have aggressively sought to define and expand their scope of practice. They don't want to "get along". They want my job. As someone dedicating my life to the competent care of my patients, I have a problem with that. It makes me upset that you don't.

I enjoy your posts.

You getting excited for match day? (...I've noticed you're a 4th year from previous posts...not a cyber-creep!).

 

[Critical Mass REACHED]

That highlighted sentence wasn't meant to be taken literally, because I knew that the fight/ disagreement between nursing and medicine will perpetuate. You have a valid point, and objectively speaking I think that the MD vs. NP mentality isn't beneficial. As much as I think that some NP's are competent, you can't compare the NP's education to that of a physician's. From the look of it, I think docs are losing the political battle because NP's are easier to utilize. With all due respect to NP's, NP's are cheap labor compared to docs and from a political standpoint appears to be financially preferable. Do i agree with that? Of course not. But it's sad that we'll start seeing the uprise of more NP's in practice that are not as experienced as docs out there.

We have to disagree there, MD's don't have work unions (nurses are unionized), and MD's are distributed among different specialties. Second, nurse P's are not cheaper. Studies show they order more test, and 3rd they charge Medicare/Medicaid the same fee due to what they call (equal work for equal pay). Is it cheaper and quicker to produce a NP, it sure is. But, like with any mass produced item, the quality is substantially decreased.

 

[allojay]

I think we should refocus our case to account for equity and justice. The issue is not just the competency of NP's but how they achieve it at our expense. And how they and the tax payers are willing to ride our backs to train a scab work force.

The fact is that with enough effort the training plateaus will meet. I think it's foolish to think otherwise. Eventually we tend to forget all the complexity we learn academically and they tend to pick up enough clinical judgment on the job that I don't believe 10 years or less down the road there is a measurable difference at least with our average lot. The top of each of our specialties will remain as such. But I think means and medians of groups in these discussions is far more important.

If nurses had to train LVN's to replace them fire and brimstone would break forth from the heavens and righteous anger would befall all the enemies of the Nursealites.

Why is it different with us? How did we learn to be such pansies?

Lol at your quote "If nurses had to train LVN's to replace them fire and brimstone would break forth from the heavens and righteous anger would befall all the enemies of the Nursealites"...But the truth is that i can see that happening in the years to come (And i hope it does) bc LVN's are cheaper to use, though not as educated as an RN in some cases.

But I completely understand what you're saying and I agree. I don't think the 'average' NP should have the same rights as an MD, and it's simply not fair especially since its significantly easier to attain an NP than an MD.

 

[Nasrudin]

I completely understand what you're saying, but you can't disregard a whole field because of their aggressive advocates. I think that both nursing and medicine should cut the BS and work together to heal patients appropriately. Do docs need to be more aggressive in their pursuit to keep their jobs? Hell Yea! But at the same time, you have to realize that it's all about money nowadays. Would a practice rather pay a physician 100k annually or pay an NP 70/80K? I'm sure you know the answer to that. Do I agree with this? No. I think that the years that doc's put in, in addition to their experience, residencies, and so on..puts them in a prime position to take 'great' care of their patients. I don't know if i can say the same thing for your typical NP.

To answer the question..what is a reasonable scope of practice for a nursing practitioner as a profession? I really don't know. I'm not sure why the NP position was created, especially when you have PA's. But it's a very tough question to answer. The more I think of it, the NP position seems to be something created to give nursing a way to sort of compete with medicine and declare autonomy in healthcare. I'm disappointed that NP's with far less experience and education will have the same rights as an MD, but that won't make me go out and bash the field. The sad truth is that it all comes down to money, and NP's are cheaper. I'm upset that if this ends up being the case, that we'll see a decline in the quality of healthcare in the years to come.

Ok. But who said anything about going in to work tomorrow and treating people poorly. When you put enough effort into training to realize whole groups of midlevels will have started after you and will finish before who feel indignant that they shouldn't be granted 1st total autonomy and 2nd for us to train to them to be able to do it on the job....then you'll know that a political bashing is exactly what is in order.

I swear to god. We need a medical general Patton to get to young docs' minds before the PC nazis do.

 

[allojay]

We have to disagree there, MD's don't have work unions (nurses are unionized), and MD's are distributed among different specialties. Second, nurse P's are not cheaper. Studies show they order more test, and 3rd they charge Medicare/Medicaid the same fee due to what they call (equal work for equal pay). Is it cheaper and quicker to produce a NP, it sure is. But, like with any mass produced item, the quality is substantially decreased.

Thanks for all that info. I honestly didn't know they charge the same for Medicare/ Medicaid. I agree that it all comes down to quality at the end of the day. But do politicians see it that way?

 

[Critical Mass REACHED]

Lol at your quote "If nurses had to train LVN's to replace them fire and brimstone would break forth from the heavens and righteous anger would befall all the enemies of the Nursealites"...But the truth is that i can see that happening in the years to come (And i hope it does) bc LVN's are cheaper to use, though not as educated as an RN in some cases.

But I completely understand what you're saying and I agree. I don't think the 'average' NP should have the same rights as an MD, and it's simply not fair especially since its significantly easier to attain an NP than an MD.

Hmmm maybe you should go to Allnurses.com, I posted a link a while back here, and the LVN vs RN thing is real. They got pretty heated, which is funny how they couldn't understand why we get heated when NP try's to call equality in training. But nurses think it's unfair that physicians shouldn't get mad at them because they are fighting for increased scope and pay.

I recommend you sift through this thread, you'll see the heated exchange between the LVP vs RNs

 

[allojay]

Hmmm maybe you should go to Allnurses.com, I posted a link a while back here, and the LVN vs RN thing is real. They got pretty heated, which is funny how they couldn't understand why we get heated when NP try's to call equality in training. But nurses think it's unfair that physicians shouldn't get mad at them because they are fighting for increased scope and pay.

I recommend you sift through this thread, you'll see the heated exchange between the LVP vs RNs

Will do...And I won't waste my time on that site. It has too much nonsense. If nurses actually think that about the LVN debate, then they're purely being hypocritical in regards to wanting the same rights as NP's.

 

[Critical Mass REACHED]

Ok. But who said anything about going in to work tomorrow and treating people poorly. When you put enough effort into training to realize whole groups of midlevels will have started after you and will finish before who feel indignant that they shouldn't be granted 1st total autonomy and 2nd for us to train to them to be able to do it on the job....then you'll know that a political bashing is exactly what is in order.

I swear to god. We need a medical general Patton to get to young docs' minds before the PC nazis do.

Trust me, the lines have been drawn by the ANA, and this generation of docs will not sit back with political correctness. We should still be the professionals that we are, and fight with the brand name Physician. Because at the end of the day, we have our brand name that stands out, and patients know the difference between an MD, and a Nurse who is now a practitioner. Give them the option, and let's see what they decide. My money is on the physicians.

 

[Anastomoses]

This thought process is what is getting our ass kicked in the political arena. Physicians want to be PC, not stir up trouble, etc. etc. when the vocal minority of NPs are willing to do just that. Push to go from the nursing field into the medicine field. Physicians not holding their ground in the past has led to this issue in the first place (allowing NPs to exist and practice medicine put us on the slippery slope to NPs wanting independent practice and claiming equivalency).

At some point we have to hold our ground, or cede ALL of primary care to them (as equal reimbursement means FM/Peds/Outpatient IM gets downward pressure on reimbursement rather than NPs making more money). Then they'll start aiming for independent practice in specialties (which is limited at this time except for CRNAs and maybe Derm).

I swear to god. We need a medical general Patton to get to young docs' minds before the PC nazis do.

Actually you and evil just got to my mind. I never thought of it so much as being PC but I just tend to feel things will fall in place. You've actually changed my mind. Perhaps physicians are allowing very vocal mid-levels to convince politicians that they are just as effective - which they obviously are not. Perhaps this issue needs to be dealt with clearly in the public's mind.

 

[Critical Mass REACHED]

Actually you and evil just got to my mind. I never thought of it so much as being PC but I just tend to feel things will fall in place. You've actually changed my mind. Perhaps physicians are allowing very vocal mid-levels to convince politicians that they are just as effective - which they obviously are not. Perhaps this issue needs to be dealt with clearly in the public's mind.

I've said this before, but if people recall how how crazy the fight to appeal Obamacare was, and how ugly it got "senators/congressman" lost seats due to voting yes on on the bill. Now imagine how crazy citizens will be on the streets when they already feel they got ripped off in regards to their new health care premiums going up. But now throw in "you have to see a NP/PA because that is all we will pay for," you will have a mess of people calling and harassing their politicians. I just can't imagine a politician trying to pass a bill like that, it would be AUTOMATIC political suicide! Which is why I am comfortable saying the public will make sure physicians are here to stay.

I am not saying that we can't hold our own, but we don't need to justify our cause. The public will know what to do. The Democrats will probably lose the senate because of how they voted on the adorable health care act. They will contain this problem, if not, then physicians will need to go on a PR campaign and unite as one force and not broken down by special interest among individual specialities. I'm talking FP's, Surgeons, IM, peds, Anesthesiologist etc uniting for one cause, and that's Patient safety.

 

[@JackShephard]

I agree with VisionaryT. Physicians need to band together. We can no longer ignore these thing and just focus on the medicine and the patients. Look at fields like anesthesia. Physicians work like dogs for decades and improve standards of care, research, technology, even training nurses and then when its simple enough the nurses swoop in and claim they are just as good. Well great. When someone has basically handed you the keys to the kingdom it's easy to walk in the door.

It's like physicians are designing and refining the iPod and then nurses are coming in and selling cheaper imitation with the governments good graces.

It's no longer friendly when their leadership wants to replace our job because of our research, blood, sweat and tears.