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NPs shouldn't perform any surgery. They aren't doctors, no matter what they call themselves.
I agree and that's obviously understandable. I shouldn't think a nurse should perform minor surgeries nor get paid as much as a physician, especially with the amount of schooling involved.
But I guess I'm just wondering what the consensus NPs should be limited to because as far as my experiences (as a patient), they have been valuable resources for teaching technical stuff (ie: how to use an insulin pump, CGM), dose adjustments and following up with questions once patients in primary care settings for issues doctors themselves admit they don't have the time to go over, but obviously not to the extent that it eliminates the obvious need of having a physician.
Funny, bc most PAs are in subspecialty practice with physicians, not primary care like it was intended for. Go figure.Midlevel practice legislation was enacted under the banner of lack of access to primary care. Perhaps they should not be doing anything more than a family medicine physician, general internal medicine physician, or pediatrician would do in normal outpatient practice.
They definitely shouldn't be doing bronchoscopies or be running around playing dermatologist or critical care "practitioner".
Funny, bc most PAs are in subspecialty practice with physicians, not primary care like it was intended for. Go figure.
More with NPs, than PAs really.Same for NPs.
I'd be OK with NPs as long as they had to at least collaborate (meaning chart review) with physicians who would be on the hook for anything the NP missed, without independent practice rights. That's not enough for NPs (and even some PAs) and therefore there is a push for more autonomy.
What's the point in making derm so competitive for MDs then? Seems a little pointless to keep the number of spots low just to have undertrained and undereducated nurses flood the market
It's not just Derm. It's all specialties. That doesn't necessarily mean patients will solely see them for their healthcare needs. If you see the USF website:
DNP Advanced Nursing Practice Immersion Residencies
Dermatology for Advanced Practice Nursing
Cardiology
Orthopedics
Traumatic Brain/spinal Cord Injury and Rehabilitation
Oncology
Neonatal
Clinical Endocrinology
Psych/Mental Health
Yup, and what nursing frequently says when they're called out on it is that they aren't practicing medicine, that they are practicing, "nursing".Why do we even do residency at all, if these wannabes can hang up a shingle as soon as they finish their online DNP programs?
Maybe I should just apply to one of those after I graduate from medical school. I'll charge $$ to write scripts for topical steroids all day long. NP dermatology immer$ion residency, here I come!
I even heard that they are med schools out there that require calculus 2 as a prerequisite... Lol. We really got outplayed by the NP movement.It's quite unbelievable that your nurse doctor did't even have to take things like Organic Chemistry and Biochemistry. I am not at all sure how they understand basic cell biology without the knowledge of Biochemistry. I feel like the profession has been inspired by the game The Sims where you can start with bathing patients (LPN) and in a few years down the road end up practicing in lucrative Dermatology as a DNP, not to mention that you can get all your formal education online one course at a time. The person who is ultimately the victim of this system is the patient and I think patients need to be educated about the background of their healthcare providers. There seems to be no point in keeping (and increasing) such high standards that are expected of physicians and at the same time let mid level practitioners take on the same duties.
Yup, when you can hobnob with politicians, you can get anything they want. They realized this early on and incorporated into their education that "grassroots" activism can reverse scope of practice laws.I even heard that they are med schools out here that require calculus 2 as a prerequisite... Lol. We really got outplayed by the NP movement.
Yup, when you can hobnob with politicians, you can get anything they want. They realized this early on and incorporated into their education that "grassroots" activism can reverse scope of practice laws.
Not when their insurance tells them otherwise and makes them see a NP/PA. Hard to educate the public when media like the New York Times are trumpeting healthcare reform with the narrative of nurse good, doctor bad. That's for the unwashed masses of course, not for their own families.I think that after the initial fervor over this narrative of nurse good, doctor bad, the public will still prefer to put their lives and health in the hands of someone who's taken calculus 2, biochemistry and 3+ years of grueling residency. It is up to us to educate the public on the difference between MD/DO and DNP, lest they be duped.
Not when their insurance tells them otherwise and makes them see a NP/PA. Hard to educate the public when media like the New York Times are trumpeting healthcare reform with the narrative of nurse good, doctor bad. That's for the unwashed masses of course, not for their own families.
And the AMA who sold out physicians long ago since they have a govt. monopoly on CPT codes. They make more money from that than actual members dues.You know, if this sort of thing doesn't make us realize that all media has an agenda, I don't know what will. Who often serves as the voice of physicians for NYT? Ezekial Emanuel, big bro to Rahm. Everyone's in bed together, and we weren't invited.
And the AMA who sold out physicians long ago since they have a govt. monopoly on CPT codes. They make more money from that than actual members dues.
Not exactly. But this sums up why tort reform was effectively removed from the bill:Word on the street is in 2009 or so, when the ACA was in it's infancy, Obama visited the AMA building in Chicago and said from the get-go, there will be no tort reform. Everyone has a price.
I think it's a case of "you don't know what you don't know"
But at least they'll look like they listen and act like they care. In the end, that is what really matters.And, patients don't know that nurses don't know what they don't know... and an extra don't know for good measure.
But at least they'll look like they listen and act like they care. In the end, that is what really matters.
Yup, see the video:All about patient perception I guess.
Yup, see the video:
http://www.vox.com/2014/6/4/5778848...-nurses#ooid=VrYTA2bjqBojQP54WQB52TWxoTEjjwOt
Funny that part of the link says, "silly-protectionist-doctors-colds-are-for-nurses"
Every medical student going into primary care should be thoroughly warned.
Likely nursing studies. I'll have to see the article he talks about and see who the authors are - they're likely health economists who don't work in healthcare.I'm new to this thread, but any idea what studies he's citing in the vid?
Yup, see the video:
http://www.vox.com/2014/6/4/5778848...-nurses#ooid=VrYTA2bjqBojQP54WQB52TWxoTEjjwOt
Funny that part of the link says, "silly-protectionist-doctors-colds-are-for-nurses"
Every medical student going into primary care should be thoroughly warned.
Gotta pay for than million dollar house somehow: http://www.thewire.com/politics/201...-house-stokes-class-envy-conservatives/63440/Haven't sifted through all this, but just in case, here's the actua lthread that a pic was posted of in the first page: http://allnurses.com/general-nursing-discussion/nurses-smarter-than-460225.html
read further down a bit and I think many will be able to rest a bit easier.
but what's up with this yglesias guy and why is he so set on pushing this np as pcp agenda? supposedly he was focused on economics, but seeing as since he started with vox, he's churned out over 200 articles in 2 months, so I doubt he's putting a ton of thought, effort, and research into them.
Wow, subbed for the coming awesomeness.
Honestly, that site makes me jaded man. Now I walk around thinking that every nurse I meet either:
1. Hates me
2. Hates me
3. Thinks I'm stupid
4. Hates me and thinks I'm stupid.
The public cares about two things: cost and perception.I think that after the initial fervor over this narrative of nurse good, doctor bad, the public will still prefer to put their lives and health in the hands of someone who's taken calculus 2, biochemistry and 3+ years of grueling residency. It is up to us to educate the public on the difference between MD/DO and DNP, lest they be duped.
I really don't understand the argument that nurses provide medical care through the practice of nursing and therefore they can set their own standards as they are themselves experts on it. I have been seen by a Nurse Practitioner and he missed a major finding in his medical exam that was later revealed by an MD. I also met a NP who went to medical school and she said it's quite unbelievable how much she did not know despite treating patients independently for years. Also, at my school the college of nursing (the biggest program in the state) is build as stated on their website with accordance to feng shui and they claim to teach principles of aromatherapy and meditation to nursing students as well as do research on similar mumbo jumbo topics. I can also assure you that they do not collaborate with the medical school and their faculty walk around like they are the biggest thing in the world. I've even heard one of the professors there ramble on to a nursing student how hard it was for her to get through school but it was well worth it at the end. Very soon we are going to see RNs not complying with physician orders because they will have just as much autonomy over the patient and a different view on how he should be treated in accordance with the nursing model.
Is it wrong to hate nurses before you even start med school? I really hate people who want to be that guy, without putting in the work it takes to be that guy. But nurses calling doctors dumb is just their way of dealing with that massive inferiority complex.
And every field has dynamics like this, enlisted- hate officers in the military, assistant teachers -hate teachers etc. Everybody likes to feel important.
Yes, it is. As you said, every field is going to have some kinda dynamic like that, but you can't just assume everyone is combative like that. Again, please read the thread from the first page ( http://allnurses.com/general-nursing-discussion/nurses-smarter-than-460225.html ) and read past the first couple posts to see that they are not all just out to start fights. Or even just look at the post above yours.Is it wrong to hate nurses before you even start med school? I really hate people who want to be that guy, without putting in the work it takes to be that guy. But nurses calling doctors dumb is just their way of dealing with that massive inferiority complex.
And every field has dynamics like this, enlisted- hate officers in the military, assistant teachers -hate teachers etc. Everybody likes to feel important.
I'm concerned with the physicians and medical students that are too apathetic or greedy to care. They either don't give a crap, or are too busy raking it in by employing midlevels.
Midlevel practice legislation was enacted under the banner of lack of access to primary care. Perhaps they should not be doing anything more than a family medicine physician, general internal medicine physician, or pediatrician would do in normal outpatient practice.
They definitely shouldn't be doing bronchoscopies or run around playing dermatologist or critical care "practitioner".
It's quite unbelievable that your nurse doctor did't even have to take things like Organic Chemistry and Biochemistry. I am not at all sure how they understand basic cell biology without the knowledge of Biochemistry. I feel like the profession has been inspired by the game The Sims where you can start with bathing patients (LPN) and in a few years down the road end up practicing in lucrative Dermatology as a DNP, not to mention that you can get all your formal education online one course at a time. The person who is ultimately the victim of this system is the patient and I think patients need to be educated about the background of their healthcare providers. There seems to be no point in keeping (and increasing) such high standards that are expected of physicians and at the same time let mid level practitioners take on the same duties.
The logic is "Girl please, I don't need that Organic Chem to prescribe antibiotics, or to first assist on surgeries all day, or to do skin biopsies on derm, or order vasopressors...I just follow them algorithims, hollaback!"
and yet.... http://nurses.3cdn.net/e5a15534f25c2375b8_enm6va18v.mp3 (recent radio ad from a nurse organization talking about how algorithms are bad because "no one" understands them)
and yet.... http://nurses.3cdn.net/e5a15534f25c2375b8_enm6va18v.mp3 (recent radio ad from a nurse organization talking about how algorithms are bad because "no one" understands them)
Would it make you mad if I said that plenty of nurses are basically drug pushing computer workers? After all, the amount of times I've seen calls for relatively innocent labs (the proverbial K of 3.4), vital signs put in without thought (4am SpO2 of 86% without notifying anyone or starting oxygen, or even rechecking and putting in a correct reading if it was wrong), or copying the admission nursing assessment, even though the CHF exacerbation patient hasn't had rales for 3 days and it's still being documented. Because I've seen those actions which indicates that the nurse put no thought into his job in spades, and the hospital I did the vast majority of my rotations at generally has great nurses.
Context, it matters.
Is it wrong to hate nurses before you even start med school? I really hate people who want to be that guy, without putting in the work it takes to be that guy. But nurses calling doctors dumb is just their way of dealing with that massive inferiority complex.
And every field has dynamics like this, enlisted- hate officers in the military, assistant teachers -hate teachers etc. Everybody likes to feel important.
Hey try not to hate on nurses too much for those potassium calls. At our hospital patients are supposed to be placed on K/Mg protocol by the admitting doc or hospitalist, but sometimes the hospitalist forgets or maybe it has been a couple of days and the admitting doc never put them on it and now they're low. We know it's not a big deal but it's not cool to leave things undone for the next shift to clean up. I work nights and if it's like 3.3-3.4+ with no significant history I'll usually wait till the morning (unless I catch it early enough in the night like before 2200, I usually check all my labs and get organized 30 minutes before I clock in but sometimes the beginning of the shift can be crazy and a couple of hours can fly by) so I don't bother some poor guy on call but man do I feel guilty. And technically we are supposed to call and address it immediately.
It also depends who that nurse might be giving report to in the AM. Some nurses will give you a hard time and be snippy about it and others will be cool and just take care of it. We are bound by as much protocol and bs in our jobs as you guys.
Now the oxygen thing is pretty inexcusable. I can't imagine any of my coworkers seeing a patient desat and be like ok cool lets go do other stuff without slapping them on some O2, bringing them up to 90 or higher, and questioning why they might be desatting. Oh, their lungs sound wet and they have a history of CHF. Hmm let me turn off those fluids going at 125, let the MD know and see if they want to give lasix / dc the fluids.
I do see my assessments copy forwarded which bothers me. But I think charting those assessments are a little tedious and worthless. The MD isn't gonna read them let alone glean any info from them. They may ask a few things about your patient but they certainly aren't looking at your assessment. I believe those are mostly for billing purposes and have to be charted bc of regulations.
And @allojay the comment about MDs and Nurses being computer workers. I agree. It feels like a lot of times with charting we are robots putting in similar info over and over. I see inaccurate charting on both sides all the time. Or it appears they chart by exception. I've seen the hospitalist come in to do their assessment on a patient and check their pedal pulses by touching their feet while the patient still has shoes on... Is he totally incompetent because of that? Nah. But it was pretty funny. He probably didn't think it was important especially if the primary reason the patient is admitted is for pneumonia. But sometimes we go through the motions especially when the patient loads, stress, and other responsibilities build up.
Computerized charting made me feel like I was caring for the computer, not the patient. The EHRs require so much redundant charting that takes up time, time that could be better spent with the patient.
As for that video...that's just embarrassing. Don't judge an entire profession based on a video made by a bunch of immature people who happen to be nurses.
I think that the OPs thread was targeted more to that segment of the nursing population who is of the opinion that RN/BSN/NP = MD. It wasn't an attack on nursing competency in general.I'm really sorry for bumping an almost six month old thread, but I just can't resist replying. I actually made an account to just reply because I found the OP's post so outrageous
I graduated from nursing school several years ago, worked as an ICU nurse for three and a half years, and now I'm currently in a CRNA program.
OP, what I really want to know is what nursing program you were in that gave you this perspective. In my experience, most nurses understand the difference between nursing school and medical school. In medical school you learn to treat the disease and to medically come up with a plan of care for the specific problem the patient has. With that as common knowledge, it's not difficult to deduce that it's necessary for medical students to have much more extensive education on diagnosing and treating different pathologies and also need to know the body down to the cellular level. In nursing school you learn to carry out the plan of care as formulated by the physician, and also create your own plan of care in regards to not necessarily the pathology, but the overall wellbeing of the patient and their family from a non medical standpoint. It baffles me that you seem to think that medical school and nursing school can even be comparable, considering you've been through both and should be able to recognize the critical differences between them.
"Those science courses were no where near the complexity that medical schools dig into, where things get broken down into the mechanism of protein structures that allow them to function a certain way."
Of course: since nurses don't diagnose diseases or prescribe medications they don't need to go as much in depth. It's a whole different argument for Nurse Practitioners, but even then, no reasonable individual is going to argue that NPs and MDs have the same level of knowledge or education. They're both excellent and thorough, but still very different. Even in school for CRNA, I would never think that my knowledge is the same as the Anesthesiologists, because I never went to medical school. With that being said, that doesn't mean that I am not excellent, thorough, meticulous, proficient, and extremely good at what I do.
"but when I was a nursing student at that time I thought I knew just as much as a doctor, and I was dead wrong."
I'm sorry, but this blows my mind. If you were in my nursing class I probably would've either avoided you at all costs or risked slapping you out of sheer annoyance. It's not even like you thought you knew as much as a medical student, you thought you knew as much as a doctor! This is a whole new level of delusion. Seriously, I've never met a nursing student who is that arrogant. Sure, there's some old salty dogs on the ICU units who are know it alls, but the majority of nurses understand that doctors inherently know more about diseases and treatments than a nurse... Or at least they'd better. I don't diagnose and prescribe medications on a daily basis, therefore my knowledge is different than a physician's. Again that doesn't mean that as a nurse I am not an integral part of the patient care team, I just have a different role than the physician. Different education, different priorities, different job.
"So when they claim they have a BSN not an associates in nursing, there is NO difference, and I dare you to find me a BSN who would say there is."
There is. BSN students are required to take classes that are focused on leadership, research, etc etc. The hospital that I worked at has stopped hiring RNs who do not have a BSN, so apparently the hospital feels that there is a difference as well. Having a BSN doesn't make a better nurse, but it does open the door for more opportunities later on.
"I am not knocking down the profession of nursing, what I am annoyed with is NURSES/NP's claiming to be equivalent to MD’s."
Again, in my experience this is a small minority. And in reality, the worst of the profession are those who feel they have knowledge equivalent to doctors especially while they are a nursing student. Yes, I am talking about you.
"I love nurses, yes I would trust a seasoned ICU nurse's opinion vs a Freshly minted MD out of med school in July as an Intern, but I guarantee that by the end of 3-4 months of intern year, his knowledge base will increase exponentialy (edit: it's exponentially) to surpass that of any ICU nurse due to his knowledge base gained from 8 years of education that doesn't stop during residency, and now applying it daily as a intern."
Yes, eight years of education and residency will most likely lead to you trusting their opinion even more than a nurses. And if they're worth their salt, then you should be able to. From a nursing perspective, theres no hard feelings there. Additionally, you should be able to trust the opinion of a well seasoned ICU nurse, which is why we work as a team. For god's sake, your attitude sucks so bad it literally drives me insane.
TLDR: the OP was filled with obvious conclusions, hypocrisy, and what I personally feel is arrogance. I may be wrong, but that's my perception. I don't know what kind of nurse you were or what kind of nurses you hung out with, but I can guarantee you that this is not representative of the general nursing population, at least in my area. I'm glad you decided to become a doctor and that you've found success there, because it seems that you really would've been unhappy as a nurse and really crappy to work with.