Nursing School Vs Med School, no comparison.

[Psai]

If you haven't started residency, you will learn to always go and assess the patient if you get paged by the nurse. I can't count the amount of "chest pain" or "definitely infected" calls I've gotten that turned out to be nothing. "Patient is complaining of shortness of breath." That's because the NC is on their forehead, and they're on home oxygen. "Patient is complaining of nausea and vomiting." Did you give the PRN zofran? "No."

Finishing up intern year soon, and I learned a lot this year. I learned who the good nurses are and especially who the bad ones are. I learned that some interns, residents, fellows, and attendings can also be incompetent and generally unpleasant people, and I learned that this is probably what all of us will experience at some point in our careers. Maybe some of you are the very people you complain about, and maybe I am too. Who knows? It feels good to let it out though. Let the hate continue: I worked with an NP who was very concerned that the patient's white count "went from 8.4 to 9.4" and had a "fever of 99.4" so we should pan-culture him and start him on empiric antibiotics. Don't worry. She's been doing this longer than any of us residents have and will let us pretend to give her orders to "get experience leading a team." Cue eyeroll.

It's the attitude that gets me. Holier than thou because they are holistic and care about the patient plus they learn more in less time lol

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[tvelocity514]

In all seriousness, is there anything that the new generation of physicians can do to halt the progression of increased autonomy by people that don't go to medical school (for knowledge reasons), or even to stop the downward spiral that we seem to be in with losing private practices, money, and respect? I feel like there should be something we could do. I understand it would take a huge commitment by most physicians and therefore probably has no chance- but I'm just interested if anyone has any ideas.

Also, I'm curious as to how it would be if physicians decided to ask why instead of say no to nurses with misguided treatment plans? Do you think it would help to ask them why they suggested it and then follow up with the correct guidelines and ask them why they think it would be better than what's in the literature? It seems like this would make nurses research their decisions after this happened to them enough. You would think they would get embarrassed by saying such incorrect things. I'm sure no one has the time to do this but just a random thought. Would make them smarter individuals and they wouldn't think you were just shutting them down for no reason.

Edit: I meant to preface this with I'm a new M3. I know that one person got mad when you didn't say who you were lol. Personally all the nurse anesthetists I have worked with have been so nice. And most of the nurses. Unfortunately most of the nurse practitioners have definitely acted like I was beneath them and they had no time for me. I'm hoping ones on wards change my perception.

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[giantswing]

In all seriousness, is there anything that the new generation of physicians can do to halt the progression of increased autonomy by people that don't go to medical school (for knowledge reasons), or even to stop the downward spiral that we seem to be in with losing private practices, money, and respect? I feel like there should be something we could do. I understand it would take a huge commitment by most physicians and therefore probably has no chance- but I'm just interested if anyone has any ideas.

Also, I'm curious as to how it would be if physicians decided to ask why instead of say no to nurses with misguided treatment plans? Do you think it would help to ask them why they suggested it and then follow up with the correct guidelines and ask them why they think it would be better than what's in the literature? It seems like this would make nurses research their decisions after this happened to them enough. You would think they would get embarrassed by saying such incorrect things. I'm sure no one has the time to do this but just a random thought. Would make them smarter individuals and they wouldn't think you were just shutting them down for no reason.

Edit: I meant to preface this with I'm a new M3. I know that one person got mad when you didn't say who you were lol. Personally all the nurse anesthetists I have worked with have been so nice. And most of the nurses. Unfortunately most of the nurse practitioners have definitely acted like I was beneath them and they had no time for me. I'm hoping ones on wards change my perception.

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You can't teach someone who knows everything. They have no shame; they think they're smart and or helpful by demanding tests. Plus i have no time. Its not my job to educate nurses. It's not their job to recommend tests or make diagnosis by deciding on tests.
No. Just no.

 

[Psai]

In all seriousness, is there anything that the new generation of physicians can do to halt the progression of increased autonomy by people that don't go to medical school (for knowledge reasons), or even to stop the downward spiral that we seem to be in with losing private practices, money, and respect? I feel like there should be something we could do. I understand it would take a huge commitment by most physicians and therefore probably has no chance- but I'm just interested if anyone has any ideas.

Also, I'm curious as to how it would be if physicians decided to ask why instead of say no to nurses with misguided treatment plans? Do you think it would help to ask them why they suggested it and then follow up with the correct guidelines and ask them why they think it would be better than what's in the literature? It seems like this would make nurses research their decisions after this happened to them enough. You would think they would get embarrassed by saying such incorrect things. I'm sure no one has the time to do this but just a random thought. Would make them smarter individuals and they wouldn't think you were just shutting them down for no reason.

Edit: I meant to preface this with I'm a new M3. I know that one person got mad when you didn't say who you were lol. Personally all the nurse anesthetists I have worked with have been so nice. And most of the nurses. Unfortunately most of the nurse practitioners have definitely acted like I was beneath them and they had no time for me. I'm hoping ones on wards change my perception.

Sent from my iPhone using SDN mobile app

The point of education is to make sure that people graduate that know what the hell they are talking about. Why should I teach someone who is trying to take my job? Makes no sense and a huge waste of time for me. They don't research anything, they just make the same mistakes repeatedly and as a physician, you will likely be liable for patients you never saw. You can't teach someone who doesn't know that they need to be taught. Nowadays, their schools drill into them the whole "just as good or even better than doctors" nonsense from the day they step foot into nursing school

The old generation of nurses are great but a dying breed. They are careful, caring and know how to give and take respect. The new generation is full of hubris, with the idea that they are warriors for justice, going against the unearned privilege and titles of doctors. They just want to rush through their multiple letter granting programs as quickly as possible so they can work as Dr Mary Ann DNP BSN RN MBA ARNP-BC BSN

 

[tvelocity514]

The point of education is to make sure that people graduate that know what the hell they are talking about. Why should I teach someone who is trying to take my job? Makes no sense and a huge waste of time for me. They don't research anything, they just make the same mistakes repeatedly and as a physician, you will likely be liable for patients you never saw. You can't teach someone who doesn't know that they need to be taught. Nowadays, their schools drill into them the whole "just as good or even better than doctors" nonsense from the day they step foot into nursing school

The old generation of nurses are great but a dying breed. They are careful, caring and know how to give and take respect. The new generation is full of hubris, with the idea that they are warriors for justice, going against the unearned privilege and titles of doctors. They just want to rush through their multiple letter granting programs as quickly as possible so they can work as Dr Mary Ann DNP BSN RN MBA ARNP-BC BSN

Is there nothing physicians can do to stop this? It would suck if the only thing that can stop this progression is an increase in patient mortality/morbidity.


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[el_duderino]

Nothing is going to change for the benefit of physicians. The industry is driven by insurance company and large health provider administration. They will do what they perceive to be in their best interests.

 

[MD2BE92]

The point of education is to make sure that people graduate that know what the hell they are talking about. Why should I teach someone who is trying to take my job? Makes no sense and a huge waste of time for me. They don't research anything, they just make the same mistakes repeatedly and as a physician, you will likely be liable for patients you never saw. You can't teach someone who doesn't know that they need to be taught. Nowadays, their schools drill into them the whole "just as good or even better than doctors" nonsense from the day they step foot into nursing school

The old generation of nurses are great but a dying breed. They are careful, caring and know how to give and take respect. The new generation is full of hubris, with the idea that they are warriors for justice, going against the unearned privilege and titles of doctors. They just want to rush through their multiple letter granting programs as quickly as possible so they can work as Dr Mary Ann DNP BSN RN MBA ARNP-BC BSN

Haha I couldmy agree more. DNP, not sure why or how this is allowed to become a thing. Other than some money grubbing nursing admins wanting a fat paycheck to go along with their SJW fallacies

 

[dr zaius]

It's the attitude that gets me. Holier than thou because they are holistic and care about the patient plus they learn more in less time lol

This. They carry that goddamn chip on their shoulder and when you talk to them on the phone they are like "This is DOCTOR nurse-doesn't-really-know-anything." You page me and I call back with "Hey this is FIRST NAME with XXXX service returning a page."

I work with NPs frequently, and they are OK with the stuff they see all the time. As soon as something falls off of the usual trajectory they are typically at a loss. There are some who are better, but for the most part they fit in this category.

And if anything is going wrong outside of whatever subspecialty they chose...which is usually GI/derm/plastics/usual money making specialty...because they are definitely helping with the shortage in primary care which is what their lobbying group says they are doing...they have no idea. None.

**** NPs. They shouldn't be allowed to practice autonomously. They are inferior. There. I said. It's the truth. Maybe if they pass step I-III we can talk. Until then you can keep paging me for colace orders.

PAs are usually better. They have a more well rounded and consistent education. They know their limitations, and they don't have an inferiority complex.

 

[FiveOClock]

This. They carry that goddamn chip on their shoulder and when you talk to them on the phone they are like "This is DOCTOR nurse-doesn't-really-know-anything." You page me and I call back with "Hey this is FIRST NAME with XXXX service returning a page."

I work with NPs frequently, and they are OK with the stuff they see all the time. As soon as something falls off of the usual trajectory they are typically at a loss. There are some who are better, but for the most part they fit in this category.

And if anything is going wrong outside of whatever subspecialty they chose...which is usually GI/derm/plastics/usual money making specialty...because they are definitely helping with the shortage in primary care which is what their lobbying group says they are doing...they have no idea. None.

**** NPs. They shouldn't be allowed to practice autonomously. They are inferior. There. I said. It's the truth. Maybe if they pass step I-III we can talk. Until then you can keep paging me for colace orders.

PAs are usually better. They have a more well rounded and consistent education. They know their limitations, and they don't have an inferiority complex.

There is an intellectual rigor behind medicine that non-MDs will never understand. Ask the NP what the relationship is between serum calcium and albumin, and I highly doubt they could explain this simple concept. Because they have no physiologic understanding of anything. Whats really disgusting are the people attempting to peddle "increased access to healthcare" via cheap midlevel labor. They couldn't give a rats rear about the quality of care being given to patients. They'll fabricate some BS studies that claim that quality is the same or whatever but only a real pinhead would believe that anyone but a doctor could play doctor.

 

[username456789]

"Everybody wants to be a physician, but nobody wants to lift no heavy-ass books."
-Ronnie Coleman

 

[sloop]

If you haven't started residency, you will learn to always go and assess the patient if you get paged by the nurse. I can't count the amount of "chest pain" or "definitely infected" calls I've gotten that turned out to be nothing. "Patient is complaining of shortness of breath." That's because the NC is on their forehead, and they're on home oxygen. "Patient is complaining of nausea and vomiting." Did you give the PRN zofran? "No."

Finishing up intern year soon, and I learned a lot this year. I learned who the good nurses are and especially who the bad ones are. I learned that some interns, residents, fellows, and attendings can also be incompetent and generally unpleasant people, and I learned that this is probably what all of us will experience at some point in our careers. Maybe some of you are the very people you complain about, and maybe I am too. Who knows? It feels good to let it out though. Let the hate continue: I worked with an NP who was very concerned that the patient's white count "went from 8.4 to 9.4" and had a "fever of 99.4" so we should pan-culture him and start him on empiric antibiotics. Don't worry. She's been doing this longer than any of us residents have and will let us pretend to give her orders to "get experience leading a team." Cue eyeroll.

Going into psych, so haven't started intern year yet.

However, I have realized even as a medical student that people can be painfully incompetent. When I was on my psych clerkship, I ran a consult with one of the non-psych residents rotating through. That resident was awful. Truly awful. Got called in because somebody answered too many questions in the affirmative on one of nursing's post-partum depression screens (tbh, kind of a BS consult IMO—OB should be able to handle that on their own, but that's beside the point). The resident literally takes a look at the completed screening form, grabs another blank of the same exact form, walks in and starts asking the questions from the form, going down the list . . .

I was going to just sit back and observe because it was technically her consult to write up, but when I saw this I literally comandeered the consult because it was clear that she wasn't going to actually take a history or do a MSE. I then had to respectfully talk to the resident afterwards about wtf she actually thought she was there to do. This was the most incompetent I've ever seen any provider be so far in medical school—truly stunning.

I mean really, who thinks "We were consulted because X screening test was positive, I repeated X and it was positive" constitutes an appropriate consultation service?

 

[Psai]

This. They carry that goddamn chip on their shoulder and when you talk to them on the phone they are like "This is DOCTOR nurse-doesn't-really-know-anything." You page me and I call back with "Hey this is FIRST NAME with XXXX service returning a page."

I work with NPs frequently, and they are OK with the stuff they see all the time. As soon as something falls off of the usual trajectory they are typically at a loss. There are some who are better, but for the most part they fit in this category.

And if anything is going wrong outside of whatever subspecialty they chose...which is usually GI/derm/plastics/usual money making specialty...because they are definitely helping with the shortage in primary care which is what their lobbying group says they are doing...they have no idea. None.

**** NPs. They shouldn't be allowed to practice autonomously. They are inferior. There. I said. It's the truth. Maybe if they pass step I-III we can talk. Until then you can keep paging me for colace orders.

PAs are usually better. They have a more well rounded and consistent education. They know their limitations, and they don't have an inferiority complex.

The f? Our fellows don't even introduce themselves as dr. who on the phone. That's really obnoxious

Also, it's unsafe for the patient. When someone introduces themselves as doctor, that implies a certain competency. Obviously their goal is to borrow our legitimacy but it's a waste of time when it's clear that the person you're talking to has no idea wtf they're talking about.

You need to nip that in the bud

 

[chillaxbro]

A bone marrow transplant nurse was explaining risks of BMTs. She tries to explain GVHD but was describing HVGD and talking about how your body senses the transplant as foreign and tries to attack it. Literally one sentence before, she said they have to wipe your immune system to a blank slate before giving you donor stem cells.

So this BMT nurse either doesn't understand how the immune system works or has no critical thinking skills whatsoever. How can you work as a BMT nurse and not know simple things like this?

 

[Psai]

A bone marrow transplant nurse was explaining risks of BMTs. She tries to explain GVHD but was describing HVGD and talking about how your body senses the transplant as foreign and tries to attack it. Literally one sentence before, she said they have to wipe your immune system to a blank slate before giving you donor stem cells.

So this BMT nurse either doesn't understand how the immune system works or has no critical thinking skills whatsoever. How can you work as a BMT nurse and not know simple things like this?

Because they're a nurse and not a doctor. You don't need to understand how bmt works to be a bmt nurse

 

[psychMDhopefully]

I'm a second year, we have preceptorships this year, not rotations, but we see patients with attendings a few times a year. So the attending told me to go take a history of the patient in room X. I get stopped at room X by the nurse who tells me " Why are you using the patient as a guinea pig" I told her the attending wanted me to take a history its no big deal. The she screams 5 minutes you have 5 minutes! I haven't even started 3rd year yet and I already dislike nurses.

 

[sloop]

I'm a second year, we have preceptorships this year, not rotations, but we see patients with attendings a few times a year. So the attending told me to go take a history of the patient in room X. I get stopped at room X by the nurse who tells me " Why are you using the patient as a guinea pig" I told her the attending wanted me to take a history its no big deal. The she screams 5 minutes you have 5 minutes! I haven't even started 3rd year yet and I already dislike nurses.

The appropriate response to this is "why were you using patients as guinea pigs in nursing school?"

Don't worry too much about this, dude. It's not your fault. I had a floor nurse stompade out of a room and try to berate me in front of the resident who assigned me the task when I politely called to inform her that the team had put in orders for a test. I literally had no ****ing clue what was happening at the time.

Most nurses are nice people who want to help. There is however, a not insignificant minority who resent doctors for some reason and take it out on med students because they think they can get away with it.

 

[Psai]

I'm a second year, we have preceptorships this year, not rotations, but we see patients with attendings a few times a year. So the attending told me to go take a history of the patient in room X. I get stopped at room X by the nurse who tells me " Why are you using the patient as a guinea pig" I told her the attending wanted me to take a history its no big deal. The she screams 5 minutes you have 5 minutes! I haven't even started 3rd year yet and I already dislike nurses.

It's a teaching hospital. Tell her to mind her own damn business and go back to charting nonsense

 

[psychMDhopefully]

It's a teaching hospital. Tell her to mind her own damn business and go back to charting nonsense

I really wish I could say to people what I feel, I really wish I could. But I'd get an email from the administration with the subject line " unprofessional behavior" med students have to go through this as punching bags with their hands tied behind their backs.

 

[Mad Jack]

http://www.huffingtonpost.com/brie-...-a-nurse-is-utterly-exhausting_b_9647426.html

Why Working ‘Just’ Three Days a Week As a Nurse Is Utterly Exhausting

I mean, I'm not saying the work isn't hard, but... Well, I'm just sayin' they probably wouldn't be too thrilled with 60-80 hour weeks, particularly in procedural specialties.

 

[W19]

http://www.huffingtonpost.com/brie-...-a-nurse-is-utterly-exhausting_b_9647426.html

Why Working ‘Just’ Three Days a Week As a Nurse Is Utterly Exhausting

I mean, I'm not saying the work isn't hard, but... Well, I'm just sayin' they probably wouldn't be too thrilled with 60-80 hour weeks, particularly in procedural specialties.

The public has a lot of sympathy for nurses; it's the evil doctors that are money-grubbing idiots... They are also better at PR than physicians.

 

[FiveOClock]

The public has a lot of sympathy for nurses; it's the evil doctors that are money-grubbing idiots... They are also better at PR than physicians.

They are SOOOOO much better at PR. Many patients trust the nurse more than the doctor. In many ways, I think people subconsciously do not feel threatened by nurses but may feel very threatened by doctors.

 

[el_duderino]

They are SOOOOO much better at PR. Many patients trust the nurse more than the doctor. In many ways, I think people subconsciously do not feel threatened by nurses but may feel very threatened by doctors.

Well, yes. Nurses have less responsibility and don't have to make treatment decisions, and people aren't intimidated by their salary or education. Nurses also get to spend much more time with the patient, just talking to them instead of interrogating them. None of that is ever going to change.

 

[Psai]

http://www.huffingtonpost.com/brie-...-a-nurse-is-utterly-exhausting_b_9647426.html

Why Working ‘Just’ Three Days a Week As a Nurse Is Utterly Exhausting

I mean, I'm not saying the work isn't hard, but... Well, I'm just sayin' they probably wouldn't be too thrilled with 60-80 hour weeks, particularly in procedural specialties.

Lmao. Any other job saying that working 3 days a week is hard would be laughed at

 

[YellowfinGuy10]

Everyone has to defend their ego I guess. I'm not in medical school yet but I work as an EMT and see all this with both medics and nurses. Not all of them, but a large majority of the ones who are burned out or feel they don't any respect. Again not trying to compare the training or education of medics v. nurses v. MD's. MD's are at the top and take on the responsibility and burden of decisions made. In my very small scope of practice I have made decisions that have kept me up at night which I know can't compare to the choice MD's make. My 2 cents

 

[magicdock]

I'd say it's the opposite. I don't hate anyone. Personally—and I am saying this as a person who recognizes that I don't have a medical background—all three professions (NPs, PAs, and MDs) seem like they can offer real value to patient care. Perhaps I simply don't have enough experience with the industry to know better – but, I expect that I'll learn pretty quickly by actually working at a real hospital (as opposed to reading through threads of rants on the internet).

In fact, it seems that you, and many others in this thread, are hating on NPs. Do you really, truly, believe that NPs and PAs can't handle routine activities? That they aren't capable of knowing when it's time to refer to a physician? Do you believe that they shouldn't have a right to exist as a profession? What are your credentials anyways? Are you actually a medical student? How do medical students, with the rigor of medical school, have time to write and follow 18 pages of rants? When I was doing my undergrad, in a technical subject, there is no way I would have had time for that. Do you have extensive medical work experience, or are you making the statements that you've made simply based on some 3-4 month clinical rotations as a medical student?

Yes, I do have good grades, and I did study hard, but I am actually quite humble due to life experiences. Basically, I was just searching these threads to try and learn more about the differences between these various professions (i.e. to see where I might fit in, if I even decide to go a clinical route). It seems that I will have to search elsewhere for answers.

You use way, too many, commas and italicized words for emphasis


Sent from my iPhone using Tapatalk

 

[ChrisNP87]

I think that most on SDN will agree that we RESPECT nurses, they play an integral role in healthcare today, and our patients need them. They have a skill that they gained nursing school in being able to recognize when a patient might be going south (crashing). I'm strictly referring to the nurses that buy into that BS produced by the ANA lobby groups that say we physicians are interchangeable with mid levels (extenders) what ever the new politically correct term is nowadays. How can the USA be the only 1st world nation, to
Start experimenting with this? This is where I think lawyers become our friends in regulating the notion that we are equal.

For example, let say a patient develops recurrent pneumonias and the NP just keeps treating it with ABX's following her fancy algorithm, not realizing this person has 5 risk factors and is developing a cancerous lesion in the bronchus causing an obstructive effect producing a breading ground for bacteria leading to recurrent pneumonias. I want to be the lawyer on that case. "Mam, where did you get your medical degree?" Oh you don't have one? Ooooohhhhhh you're a nurse practitioner???? Okay well let me ask a DOCTOR who went to medical school and residency what he thinks? "Doctor X what is the most likely cause of a recurrent pneumonias in a 50 YO, with a 30 lbs weight loss in 3 months and a 1Pack/day/30 years smoking history? " Sounds like Cancer! "Your honor I rest my case, you had this negligent nurse be the leading cause of this pt developing an un resectable squamous cell tumor in the lung that has now has METS to the brain. MOST doctors would of picked this cancer up at an earlier resectable stage.

That would be a 2,000,000 dollar law suit. Nurse Practitioner in the court of law vs a Lawyer & Doctor, done deal for the practice she if affiliated with. It will take a few cases like this to turn this around. Let them think they are equal, until Obama Care nurse practitioners working solo missing things like Carcinoid tumors, Wegners Granulamatosis, Kawasakis, ect, those little annoying complex diseases that takes years of training to recognize and not miss.

I'm not saying doctors don't miss things, but in the court of law, it would be MD vs MD, and the MD can argue standard of care. The standard of care is not using NPs to treat cancer, which they can easily miss. We might save money short term, but when we see all the crazy tests NPs order, sometimes wrongly, and lawsuits like the one above, this little experiment will run wild on the media headlines, and back the Physicians come, but this time society will learn the cost of having well trained Physician.

How unprofessional could you get?! Really? Could you site your references? There are board certified Oncology Nurse Practitioners that are absolutely phenomenal! You're hypothetical story is a bunch of nonsense... An associate degree registered nurse would even know that it's time for more testing if the patient comes back a second time with recurrent pneumonia considering the patient's history. It's called common sense. Oh, and please do tell us the algorithm a nurse practitioner follows... I'm dying to know!!

 

[ChrisNP87]

You use way, too many, commas and italicized words for emphasis


Sent from my iPhone using Tapatalk

Okay and you're trying to get at what exactly by commenting this? Oh, you have nothing to say, that must be it.

 

[magicdock]

Okay and you're trying to get at what exactly by commenting this? Oh, you have nothing to say, that must be it.

To aware him on how he types like how trump talks. What's the pony on your post? Oh, to be an Internet vigilante , that must be it.


Sent from my iPhone using Tapatalk

 

[ChrisNP87]

To aware him on how he types like how trump talks. What's the pony on your post? Oh, to be an Internet vigilante , that must be it.


Sent from my iPhone using Tapatalk[/QUOTE

Lol! Such a disgrace! Carry on!

 

[StreetPharm]

I'm a RN and studying to be NP. I couldn't agree with this post more. I've always respected the depth of knowledge that doctors have. It's not comparable. As I'm going through my course work as a Family NP, I just find the education is a joke.

Our degree is basically handed to us. I was curious to see what the path of an MD was and decided to look up some sample questions in the USMLE step 1 2 and 3. Give any of those questions to an RN or an aspiring NP and I don't think they would be able to answer 50% of those questions, I would venture to even say 25%. It baffles me that NPs in some states are able to practice autonomously.

This post sounds like I'm trolling but I really am an RN studying to be an NP. I love my profession but also know my limitations and lack of the education process. It just doesn't give me the thinking process that MDs have. It's scary that all these programs are easily allowing people to practice. Inpatient is more regulated and there is always someone to oversee your work. But in the clinic outpatient setting an NP can sit with the patient and be prescribed something , medication or procedure that can just be totally erroneous.

I wish that our education gave us a stepping stone to actually try to think critically. It's a disservice to our patients. The autonomy that NPs have gained is purely political.

 

[StreetPharm]

Not to derail the thread but I do have a question for the MDs and students. Do you guys believe that as an NP I can self study your course work and be able to handle USMLE step 1 and 2? Do you think that would make an NP more competent in their practice? I know Step 3 is during residency.

 

[TedStark]

I think that most on SDN will agree that we RESPECT nurses, they play an integral role in healthcare today, and our patients need them. They have a skill that they gained nursing school in being able to recognize when a patient might be going south (crashing). I'm strictly referring to the nurses that buy into that BS produced by the ANA lobby groups that say we physicians are interchangeable with mid levels (extenders) what ever the new politically correct term is nowadays. How can the USA be the only 1st world nation, to
Start experimenting with this? This is where I think lawyers become our friends in regulating the notion that we are equal.

For example, let say a patient develops recurrent pneumonias and the NP just keeps treating it with ABX's following her fancy algorithm, not realizing this person has 5 risk factors and is developing a cancerous lesion in the bronchus causing an obstructive effect producing a breading ground for bacteria leading to recurrent pneumonias. I want to be the lawyer on that case. "Mam, where did you get your medical degree?" Oh you don't have one? Ooooohhhhhh you're a nurse practitioner???? Okay well let me ask a DOCTOR who went to medical school and residency what he thinks? "Doctor X what is the most likely cause of a recurrent pneumonias in a 50 YO, with a 30 lbs weight loss in 3 months and a 1Pack/day/30 years smoking history? " Sounds like Cancer! "Your honor I rest my case, you had this negligent nurse be the leading cause of this pt developing an un resectable squamous cell tumor in the lung that has now has METS to the brain. MOST doctors would of picked this cancer up at an earlier resectable stage.

That would be a 2,000,000 dollar law suit. Nurse Practitioner in the court of law vs a Lawyer & Doctor, done deal for the practice she if affiliated with. It will take a few cases like this to turn this around. Let them think they are equal, until Obama Care nurse practitioners working solo missing things like Carcinoid tumors, Wegners Granulamatosis, Kawasakis, ect, those little annoying complex diseases that takes years of training to recognize and not miss.

I'm not saying doctors don't miss things, but in the court of law, it would be MD vs MD, and the MD can argue standard of care. The standard of care is not using NPs to treat cancer, which they can easily miss. We might save money short term, but when we see all the crazy tests NPs order, sometimes wrongly, and lawsuits like the one above, this little experiment will run wild on the media headlines, and back the Physicians come, but this time society will learn the cost of having well trained Physician.

Can't wait to be the expert witness taking a commission on that case.

 

[Instatewaiter]

Not to derail the thread but I do have a question for the MDs and students. Do you guys believe that as an NP I can self study your course work and be able to handle USMLE step 1 and 2? Do you think that would make an NP more competent in their practice? I know Step 3 is during residency.

So it is not passing step 1 or 2 that make someone a physician. Honestly, these are not that hard to pass if you study. You are given the pertinent physical exam findings, the appropriate tests were ordered and all you have to do is put the pieces together.

What makes one a physician is the extensive clinical training upon which you build a lifetime of practice. So could you self study and have the knowledge to pass step 1 and 2- likely. Could you gain the expertise that a physician has after years of residency training- less likely.

 

[hallowmann]

Not to derail the thread but I do have a question for the MDs and students. Do you guys believe that as an NP I can self study your course work and be able to handle USMLE step 1 and 2? Do you think that would make an NP more competent in their practice? I know Step 3 is during residency.

You could certainly study enough to pass those exams on your own. It will likely help and make you more competent as an NP (particularly studying Step 2 and Step 3, although Step 1 lays the foundation) than those that don't. Like Instatewaiter said, clinical training time is even more important than that. The only way to get that is to spend years working combined with some oversight and training.

Keep the attitude you have now. Study as much as you can about your patients. Ask the docs around you for guidance/help. Always recognize your limitations, its what physicians have to do every day also.

 

[cbrons]

There is an intellectual rigor behind medicine that non-MDs will never understand. Ask the NP what the relationship is between serum calcium and albumin, and I highly doubt they could explain this simple concept. Because they have no physiologic understanding of anything. Whats really disgusting are the people attempting to peddle "increased access to healthcare" via cheap midlevel labor. They couldn't give a rats rear about the quality of care being given to patients. They'll fabricate some BS studies that claim that quality is the same or whatever but only a real pinhead would believe that anyone but a doctor could play doctor.

The vast majority of NPs do not know what albumin is.

They do not have even the most basic understanding of physiology.

They memorize protocols and follow them, which is why they are "extenders" and never were meant to be autonomous.

Contrary to the big lie, they are NOT more equipped than PAs to practice solo. If anything, they are less prepared.

 

[FutureInternist]

The public has a lot of sympathy for nurses; it's the evil doctors that are money-grubbing idiots... They are also better at PR than physicians.

They spend more time with patients so its only natural that patients trust them more. They are the ones actually relieving their pain by bringing them their meds, getting they Zoran, taking them to the restroom.

If patients had any idea how much "behind the scenes" work we do, calling consults, checking UpToDate, reading X-rays, checking UpToDate, responding to all the pages, checking UpToDate , I think they would have much more appreciation for us.

I had one ICU attending who would pull the portable computer into the room & have the intern discuss the whole case in front of patient & family. Intimidating as heck, but it showed them how much work goes into it before we see them "for five minutes a day"

 

[Zenman1]

I'm a RN and studying to be NP. I couldn't agree with this post more. I've always respected the depth of knowledge that doctors have. It's not comparable. As I'm going through my course work as a Family NP, I just find the education is a joke.

Our degree is basically handed to us. I was curious to see what the path of an MD was and decided to look up some sample questions in the USMLE step 1 2 and 3. Give any of those questions to an RN or an aspiring NP and I don't think they would be able to answer 50% of those questions, I would venture to even say 25%. It baffles me that NPs in some states are able to practice autonomously.

This post sounds like I'm trolling but I really am an RN studying to be an NP. I love my profession but also know my limitations and lack of the education process. It just doesn't give me the thinking process that MDs have. It's scary that all these programs are easily allowing people to practice. Inpatient is more regulated and there is always someone to oversee your work. But in the clinic outpatient setting an NP can sit with the patient and be prescribed something , medication or procedure that can just be totally erroneous.

I wish that our education gave us a stepping stone to actually try to think critically. It's a disservice to our patients. The autonomy that NPs have gained is purely political.

What school are you going to? You should have at least touched on critical thinking while getting your BSN.

 

[Promethean]

The vast majority of NPs do not know what albumin is.

They do not have even the most basic understanding of physiology.

They memorize protocols and follow them, which is why they are "extenders" and never were meant to be autonomous.

Contrary to the big lie, they are NOT more equipped than PAs to practice solo. If anything, they are less prepared.

Don't overstate your case. It actually undermines your argument when you resort to absurd and easily disproved claims like the above.

Every 2 year Associates degree RN knows wtf albumin is, and has a basic understanding of physiology, let alone an NP who presumably has at least 4 years of undergrad nursing.

There is a very good case to be made about why NPs are not replacements for fully trained physicians. You could make that case without resorting to hyperbole that demeans not only the professionals that you slander, but also casts doubt on your own credibility.

 

[cbrons]

Don't overstate your case. It actually undermines your argument when you resort to absurd and easily disproved claims like the above.

Every 2 year Associates degree RN knows wtf albumin is, and has a basic understanding of physiology, let alone an NP who presumably has at least 4 years of undergrad nursing.

There is a very good case to be made about why NPs are not replacements for fully trained physicians. You could make that case without resorting to hyperbole that demeans not only the professionals that you slander, but also casts doubt on your own credibility.

Who is overstating? If you quizzed the majority of NPs on what the physiologic function of albumin is, I am willing to bet an enormous sum of money that most wouldnt give a correct answer. But since this is purely speculation, theres not much use arguing about it.

Sent from my SM-N910P using SDN mobile

 

[StreetPharm]

What school are you going to? You should have at least touched on critical thinking while getting your BSN.

Hey Zenman
I'm currently at Pace University. There is critical thinking to some degree but I feel that it lacks major structure. The exams and course work just doesn't encourage mental exercise. When I was younger I majored in Biochemistry for the love of it (did not want to become an MD at the time at all) and the knowledge was extremely satisfying. The professors challenged you to think farther than what you're taught. My BSN and now my NP coursework is no harder than high school exams. You just regurgitate answers.

I'm trying to supplement my learning now by looking at USMLE study guides. And hopefully I can find a really supportive collaborative practice once I start working so I'm not just randomly ordering tests and really pinpointing on my diagnoses and management.

Thanks for all the responses everyone.

 

[Redpancreas]

Hey ya'll.

If you're upset about things you've witnessed while practicing that's different.

If you're upset because of perceived sentiment on allnurses.com, I visited the site the other day when I googled a SaO2 Iron, etc. and ran across that post thru a search function on the site. One year ago, OP actually posted this on there (against the will of our moderators) and then got flamed by their versions of moderators who were quick to just say that no one saw nurses as equivalent to doctors and wanted him to just stop misrepresenting nurses opinions. I browsed through the rest of the thread and didn't find a single post by a nurse who was trying to say something to make an equivalency argument. In other words, OP is just trolling hard.

Now with DNP (Do Not Practictioners ) , there were a couple threads and again no one was making an "equal to doctors" argument but few were saying they were qualified to practice and should be called doctors in a health care setting.

One thing I did find that was annoying was that a few were saying their job was more intuitive because they looked at how a patient felt, etc. and didn't just look at the tests but to be fair that was in a separate thread about "Why nursing and not medicine" so you're bound to get bias there. Some even pointed to doctor's mistakes. I just see that as a self-serving bias people like to notice.

 

[giantswing]

One thing I did find that was annoying was that a few were saying their job was more intuitive because they looked at how a patient felt, etc. and didn't just look at the tests

LMAO. All my patients, pretty much every single one of them, would be dead from some combination of dilaudid and benzos. Kills me when a nurse calls and asks for a sleeping aid or a second hit of IV vitamin D when the pt has been desating and can bearly slur out that their pain is a 10, because they know that will automatically warrant a page to the person in charge of the narcs.
ETA: and then the nurse adds, when I say no way, "But they say they're in pain!"

 

[clamsauce]

Misconceptions in NP/PA/MD education: experiential requirements, online, and for-profits - pg.5 | allnurses

Nurses arguing with an im resident hoe they know more than the docs lol

 

[Crayola227]

allnurses lol

gotta love how long this thread has been going

great topic

 

[Trogghunter]

So many opinions, so little experience. Posts like this come up every few years, usually after solar/astrological events, and they get everyone all riled up. Things aren't changing much until Elon Musk figures out how to download information directly into the brain. Until then, any field that requires higher order non algorithmic thinking and difficult to master skill sets will resist the tide.

 

[SpiteFire101]

So I've gotten to about page 5 and stopped reading. Not because it isn't an enjoyable read, but because limited time available to waste.

I'm currently in nursing school. About to graduate in 20ish days. My plan, which I have every intention to follow through with is applying to med school after getting my BSN and taking other required pre-reqs.

I just wanted to provide a different view on the subject, and in no way defend or pick a side of the argument; although to be honest if I were to pick a side it would be with OP. In nursing school (no one that has any common sense would argue it is equivalent to med school) you are bombarded with extremely in depth information every day. I say to myself at least once a week "No idea why they are teaching us this. This is doctor level stuff". Of course I'm appreciative of the in depth details but forcing too much in too little of time the outcome is nothing is retained.

Anyway, that was a little side rant, my original point is the nurses this thread was originally talking about (I say originally because I've only read about 3/11ths of this thread and not sure what the topic of discussion is now) are the people that feel as though they were genuinely taught MD level courses in nurse school, because it feels like that.

I'm currently precepting in the ER finishing up my last few shifts this month, and the other day I started to document a CN assessment on a pt that was reported by family to have a decreasing LOC. My preceptor stopped me quick and said "You absolutely can't document that. The residents, interns, and attendings do that." Mind you our neuro test this semester was the largest section of this semester.

Nursing school sets you up to have the mentality that the nurses you all were/are talking about have. The instructors tell you everyday how if the MD orders the wrong medication, wrong dose, wrong treatment and you administer it, it's your fault. They tell you stories of when they were a practicing nurse and catching MD's mistakes and arguing with them about ordering the correct thing. So although I'm sure some of these nurses that feel they should be treated as equal would exist regardless of the atmosphere they were taught in, nursing school exacerbates the number of nurses that actually think that way. In my opinion anyway.

-Side subject-
Someone else's comment was talking about how nurses eat their young, and I can say 100% unequivocally it is true. Not with all of course but the majority. It's nothing but gossip and BS most of the time in this field, so disheartening, because as I have a great respect for everyone in the healthcare field, I would also like to be respected and I can't speak for MD's because they kind of stay in their own bubble at the facility I'm at, but in regard to nurses (majority) pseudo-respect is given and the first chance they get to speak poorly about you, trust me it will be taken.

Anyway, sorry for the long winded comment. Also, pretty sleep deprived at the moment and I tend to wander when I'm tired. So if sentences in my post don't seem like are connecting too well, or just abruptly stop and transition to something unrelated, I apologize. I'll elaborate or clarify what I meant (if quoted or asked) tomorrow after I get some sleep.

 

[Psai]

So I've gotten to about page 5 and stopped reading. Not because it isn't an enjoyable read, but because limited time available to waste.

I'm currently in nursing school. About to graduate in 20ish days. My plan, which I have every intention to follow through with is applying to med school after getting my BSN and taking other required pre-reqs.

I just wanted to provide a different view on the subject, and in no way defend or pick a side of the argument; although to be honest if I were to pick a side it would be with OP. In nursing school (no one that has any common sense would argue it is equivalent to med school) you are bombarded with extremely in depth information every day. I say to myself at least once a week "No idea why they are teaching us this. This is doctor level stuff". Of course I'm appreciative of the in depth details but forcing too much in too little of time the outcome is nothing is retained.

Anyway, that was a little side rant, my original point is the nurses this thread was originally talking about (I say originally because I've only read about 3/11ths of this thread and not sure what the topic of discussion is now) are the people that feel as though they were genuinely taught MD level courses in nurse school, because it feels like that.

I'm currently precepting in the ER finishing up my last few shifts this month, and the other day I started to document a CN assessment on a pt that was reported by family to have a decreasing LOC. My preceptor stopped me quick and said "You absolutely can't document that. The residents, interns, and attendings do that." Mind you our neuro test this semester was the largest section of this semester.

Nursing school sets you up to have the mentality that the nurses you all were/are talking about have. The instructors tell you everyday how if the MD orders the wrong medication, wrong dose, wrong treatment and you administer it, it's your fault. They tell you stories of when they were a practicing nurse and catching MD's mistakes and arguing with them about ordering the correct thing. So although I'm sure some of these nurses that feel they should be treated as equal would exist regardless of the atmosphere they were taught in, nursing school exacerbates the number of nurses that actually think that way. In my opinion anyway.

-Side subject-
Someone else's comment was talking about how nurses eat their young, and I can say 100% unequivocally it is true. Not with all of course but the majority. It's nothing but gossip and BS most of the time in this field, so disheartening, because as I have a great respect for everyone in the healthcare field, I would also like to be respected and I can't speak for MD's because they kind of stay in their own bubble at the facility I'm at, but in regard to nurses (majority) pseudo-respect is given and the first chance they get to speak poorly about you, trust me it will be taken.

Anyway, sorry for the long winded comment. Also, pretty sleep deprived at the moment and I tend to wander when I'm tired. So if sentences in my post don't seem like are connecting too well, or just abruptly stop and transition to something unrelated, I apologize. I'll elaborate or clarify what I meant (if quoted or asked) tomorrow after I get some sleep.

When I was in med school, I dated a girl in nursing school. I was surprised at the depth in which they went but it wasn't even close to what we learn.

I also took some nursing classes before I decided what I wanted to do with my life and they didn't even match up to the undergraduate biology level, never mind medical school.

There's really no such thing as doctor level material and nurse level material. You should strive to learn as much as you can to be the best nurse you can be. But in terms of breadth and depth, there is no comparison.

 

[Lagrange]

I also stopped reading after page 5 or something. Why to even compare doctors and nurses, those are two completely different professions. I have to say things are completely different here in Scandinavia. We work here as a team, nurses and doctors are colleagues and as a nurse I can always discuss about my ideas of treatments with doctors. I am now the 2nd year med student working as critical care nurse and still I think my critical thinking as a nurse has always been good. Well, honestly, you never know when you meet a nurse what kind of background he/she has...

PhD in physics, RN in critical care, 2nd year medical student

 

[el_duderino]

I also stopped reading after page 5 or something. Why to even compare doctors and nurses, those are two completely different professions. I have to say things are completely different here in Scandinavia. We work here as a team, nurses and doctors are colleagues and as a nurse I can always discuss about my ideas of treatments with doctors. I am now the 2nd year med student working as critical care nurse and still I think my critical thinking as a nurse has always been good. Well, honestly, you never know when you meet a nurse what kind of background he/she has...

PhD in physics, RN in critical care, 2nd year medical student

That's how it is the vast majority of the time here too. It's just the people with inferiority complexes that go online and complain.

 

[Stagg737]

I also stopped reading after page 5 or something. Why to even compare doctors and nurses, those are two completely different professions. I have to say things are completely different here in Scandinavia. We work here as a team, nurses and doctors are colleagues and as a nurse I can always discuss about my ideas of treatments with doctors. I am now the 2nd year med student working as critical care nurse and still I think my critical thinking as a nurse has always been good. Well, honestly, you never know when you meet a nurse what kind of background he/she has...

PhD in physics, RN in critical care, 2nd year medical student

A large part for the current comparison is that there are places in the U.S. where nurses can work independently without physician supervision and essentially do the same things a primary care physician can do. Most nurses don't want the responsibility or to work independently, but there are some who want to basically be the doc without going to medical school and that's where the argument for comparing the two comes in.