NYT Today: "Nurses are Not Doctors"

[Winged Scapula]

You guys are tempting me, but I'm not going to read the comments this time. I would rather preserve what neurons I have left.

Don't do it.

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[Instatewaiter]

Why wouldn't someone be satisfied with someone saving their life?

The General public is not rational. People focus more on the personality and bedside manner of their physician than the outcome. I can tell you there have been a handful of patients that I have literally scooped up from the dying ashes after another hospital had been essentially killing them at the time of transfer. If I'm not Mr. Personality when I'm placing the balloon pump, they're not going to be happy with me even if I take them from dead to walking out of the hospital.

However, if I crack jokes yet cause a massive RP bleed, they're more than happy with me.

 

[Darth Doc]

The ignorance is so substantial that you really can't even have a productive discussion about the problem.

The reality is that the scope of practice for mid levels will only continue to increase unless convincing data suggesting poor care is discovered.

The "research" is largely done by the "doctor" nurse practitioners who want to justify their existance and prove they are every bit as good as the doctors they wish they were. I haven't read their research (because I don't want to waste brain space), but I'd be curious to see how flawed their studies are. The one study quoted by the NP in the comment posted in this thread was written by nurses of a summary of articles largely written by nurses. If MD/PhDs did similar research I suspect they'd come up with different results.

"There's lies, damn lies, and there's statistics."

 

[Smurf Account]

In unrelated news, NY Radiologists celebrate as the volume of imaging studies inexplicably doubles and their local job market flowers.

 

[DermViser]

Goddamn it, I read them. I just died a little inside.

If I fail Monday's exam, it's your fault.

To be fair, she told you to Dew It (Drink Mountain Dew), not Do it. And WHY THE HELL are you here, if you have a retake exam on Monday? Download this app and study before I get Anastomoses to smack you: http://selfcontrolapp.com/

 

[Arkangeloid]

To be fair, she told you to Dew It (Drink Mountain Dew), not Do it. And WHY THE HELL are you here, if you have a retake exam on Monday? Download this app and study before I get Anastomoses to smack you: http://selfcontrolapp.com/

It's not the retake, it's another exam. Don't worry, I'm not behind or anything.

 

[PL198]

My question is this: So as we've seen over the years, the gap in capabilities between a physician and other health care professionals has continued to narrow. Isn't it eventually going to come to a point where NPs can do what any MD can? I mean right now they can do 95 percent of what a PCP can in NY right? Isn't the only real exception ordering narcotics? Do these legislative changes eliminate that difference? If so, aren't we reaching a point where if someone is going to be a PCP, it's pointless to go to med school, and they should just be a NP? Even if a NP can do the same thing as a doctor in some situations, I still question how well that can be done. It's just funny to me because the same people that usher in things like this, are generally people that have the viewpoint " You can't put a price on safety," yet they continually increase the capabilities of a lesser trained individual, which are slowly approaching those of a much more trained one.

How long will it be before we see NP surgeons?

 

[SouthernSurgeon]

So as we've seen over the years, the gap in capabilities between a physician and other health care professionals has continued to narrow.

I've yet to see any evidence that the gap in capabilities has changed.

In other words...

 

[DermViser]

It's not the retake, it's another exam. Don't worry, I'm not behind or anything.

Even then. It's an exam, nonetheless. FOCUS.

 

[PL198]

I've yet to see any evidence that the gap in capabilities has changed.

In other words...

I don't understand. If doctors are at 100, and NP of 20 years ago is at 75, and today they are at 95, that difference has changed. Are you saying that the capabilities of physicians has increased as well due to new technology and procedures? If so, I guess that's right, but it still seems to me that the gap is narrowing.

 

[postbacpremed87]

My question is this: So as we've seen over the years, the gap in capabilities between a physician and other health care professionals has continued to narrow. Isn't it eventually going to come to a point where NPs can do what any MD can? I mean right now they can do 95 percent of what a PCP can in NY right? Isn't the only real exception ordering narcotics? Do these legislative changes eliminate that difference? If so, aren't we reaching a point where if someone is going to be a PCP, it's pointless to go to med school, and they should just be a NP? Even if a NP can do the same thing as a doctor in some situations, I still question how well that can be done. It's just funny to me because the same people that usher in things like this, are generally people that have the viewpoint " You can't put a price on safety," yet they continually increase the capabilities of a lesser trained individual, which are slowly approaching those of a much more trained one.

How long will it be before we see NP surgeons?

It will never happen. Will nurses do scopes, sure. They will never perform carotids or resect colons....ever.

 

[SouthernSurgeon]

I don't understand. If doctors are at 100, and NP of 20 years ago is at 75, and today they are at 95, that difference has changed. Are you saying that the capabilities of physicians has increased as well due to new technology and procedures? If so, I guess that's right, but it still seems to me that the gap is narrowing.

What politicians allow them to do in legal scope of practice has nothing to do with capabilities

There is no evidence to suggest that nurses are increasingly more "capable" than their physician counterparts.

 

[DermViser]

My question is this: So as we've seen over the years, the gap in capabilities between a physician and other health care professionals has continued to narrow. Isn't it eventually going to come to a point where NPs can do what any MD can? I mean right now they can do 95 percent of what a PCP can in NY right? Isn't the only real exception ordering narcotics? Do these legislative changes eliminate that difference? If so, aren't we reaching a point where if someone is going to be a PCP, it's pointless to go to med school, and they should just be a NP? Even if a NP can do the same thing as a doctor in some situations, I still question how well that can be done. It's just funny to me because the same people that usher in things like this, are generally people that have the viewpoint " You can't put a price on safety," yet they continually increase the capabilities of a lesser trained individual, which are slowly approaching those of a much more trained one.

How long will it be before we see NP surgeons?

The gap in capabilities has not narrowed. What has changed is the legislatively defined scope of practice at the state level, due to intense lobbying by special interest groups both by nurses, and those who want a cheaper alternative to physicians but still be able to charge full price for those services to insurance companies no matter what the deleterious patient effects might be.

And no you will not see NPs doing Surgery. They don't care for primary care either. That's just a line to feed politicians. They are much more interested in going into specialties like Derm, GI, etc. that pay quite well and in which the lifestyle is much better.

 

[PL198]

What politicians allow them to do in legal scope of practice has nothing to do with capabilities

There is no evidence to suggest that nurses are increasingly more "capable" than their physician counterparts.

http://en.wikipedia.org/wiki/Capability

If you want to play semantics and run around in circles, then I won't waste my time. You clearly understand what I mean. Stop trying to look cool on the internet. This is like debating "can i go to the bathroom" or "may I go to the bathroom." Yes nurses are physically capable of doing the same things, however now they are actually allowed to. If you actually want to progress the conversation, you wouldn't get hung up on a trivial point in an attempt to make someone look foolish.

 

[SouthernSurgeon]

http://en.wikipedia.org/wiki/Capability

If you want to play semantics and run around in circles, then I won't waste my time. You clearly understand what I mean. Stop trying to look cool on the internet. This is like debating "can i go to the bathroom" or "may I go to the bathroom." Yes nurses are physically capable of doing the same things, however now they are actually allowed to. If you actually want to progress the conversation, you wouldn't get hung up on a trivial point in an attempt to make someone look foolish.

It's not a trivial point. There is no evidence to support the idea that nurses are getting better relative to physicians.

Congratulations btw...only 37 posts until citing wikipedia and pulling the "internet tough guy" act is very solid. At the current rate you'll be Burnett's lawing me before 50.

 

[NickNaylor]

http://en.wikipedia.org/wiki/Capability

If you want to play semantics and run around in circles, then I won't waste my time. You clearly understand what I mean. Stop trying to look cool on the internet. This is like debating "can i go to the bathroom" or "may I go to the bathroom." Yes nurses are physically capable of doing the same things, however now they are actually allowed to. If you actually want to progress the conversation, you wouldn't get hung up on a trivial point in an attempt to make someone look foolish.

It's not just semantics man. You're tossing around terms that have precise meanings and then dismissing it as semantics. That's a result of your ignorance not others making a poor argument.


Sent from my iPhone using Tapatalk

 

[DermViser]

http://en.wikipedia.org/wiki/Capability

If you want to play semantics and run around in circles, then I won't waste my time. You clearly understand what I mean. Stop trying to look cool on the internet. This is like debating "can i go to the bathroom" or "may I go to the bathroom." Yes nurses are physically capable of doing the same things, however now they are actually allowed to. If you actually want to progress the conversation, you wouldn't get hung up on a trivial point in an attempt to make someone look foolish.

How is scope of practice as defined by the state legislature and actual intellectual/critical thinking/analytical capability, playing semantics? @southernIM is not trying to play semantics. Calm down.

 

[PL198]

It's not a trivial point. There is no evidence to support the idea that nurses are getting better relative to physicians.

Congratulations btw...only 37 posts until citing wikipedia and pulling the "internet tough guy" act is very solid. At the current rate you'll be Burnett's lawing me before 50.

When did I say better? I simply said they are allowed to do more. Their skill level is irrelevant in this conversation. Before they were allowed to perform X actions, now they can do X + 10 actions, I'm not sure how this is difficult to understand.

 

[PL198]

How is scope of practice as defined by the state legislature and actual intellectual/critical thinking/analytical capability, playing semantics? @southernIM is not trying to play semantics. Calm down.

State level regulation sets the licensing of attendings, does it not? That's like saying that the speed limits on the road don't set the scope of driving on the road. Ok, yes they literally don't, however obviously due to people not wishing to be penalized, they tend to follow that guideline.

 

[deleted564496]

My roommate, whose about to graduate PT school, has had to take a few classes with the NP students… He ended up getting over a 100 in several of them, including their pathophysiology.

If you can get over a 100 in a class in professional school, then somethin ain't right.

 

[SouthernSurgeon]

Their skill level is irrelevant in this conversation

Their skill level is the entire point of this conversation. The legislatures keep increasing what we let nurses do, without any evidence to support the boundaries of what they are capable of doing.

The limited evidence we do have is that when you attempt to hold nurses to the same standards as physicians, they don't do well (i.e. the study demonstrating that 50% of DNP candidates failed a watered down version of Step 3).

 

[DermViser]

State level regulation sets the licensing of attendings, does it not? That's like saying that the speed limits on the road don't set the scope of driving on the road. Ok, yes they literally don't, however obviously due to people not wishing to be penalized, they tend to follow that guideline.

Your exact quote was, "My question is this: So as we've seen over the years, the gap in capabilities between a physician and other health care professionals has continued to narrow. Isn't it eventually going to come to a point where NPs can do what any MD can?"

Either your purposefully being obtuse, or you don't know what the real meaning of the word "capability" is. If today, as a state legislator, I pass a bill saying that pharmacists and optometrists can manage diabetes and HTN very well, doesn't mean that their capability increased today from a week ago. Get it?
http://medcitynews.com/2013/02/cali...sts-eye-docs-diagnose-and-treat-diabetes-hbp/

 

[Nasrudin]

Their skill level is the entire point of this conversation. The legislatures keep increasing what we let nurses do, without any evidence to support the boundaries of what they are capable of doing.

The limited evidence we do have is that when you attempt to hold nurses to the same standards as physicians, they don't do well (i.e. the study demonstrating that 50% of DNP candidates failed a watered down version of Step 3).

What do you suppose is the underlying phenomenon here?

For instance ask any rising 4th year medical student if they're ready to go to work in a specialty and they look at you like you were crazy. And yet the NP is cocksure such that they make ceaseless political fights out of it.

What is it that enables them to believe so strongly and unequivocally in less training being sufficient for independent practice?

 

[PL198]

Their skill level is the entire point of this conversation. The legislatures keep increasing what we let nurses do, without any evidence to support the boundaries of what they are capable of doing.

The limited evidence we do have is that when you attempt to hold nurses to the same standards as physicians, they don't do well (i.e. the study demonstrating that 50% of DNP candidates failed a watered down version of Step 3).

You're pulling stuff out of a hat. I completely agree with you, yet you jumped on me to be the cool guy that says " no professor may 10th is a saturday, we can't have an exam then." when everyone knows what he/she means. I completely agree with what you are stating. Hence my question. When you ALLOW nurses to do more, that they are not as qualified/trained to do (while still being allowed) it's going to compromise care and safety eventually. It's just hilarious that the exact essence of my question is what you are saying as well.

 

[DermViser]

Their skill level is the entire point of this conversation. The legislatures keep increasing what we let nurses do, without any evidence to support the boundaries of what they are capable of doing.

The limited evidence we do have is that when you attempt to hold nurses to the same standards as physicians, they don't do well (i.e. the study demonstrating that 50% of DNP candidates failed a watered down version of Step 3).

And these DNP candidates were from one of the most prestigious of universities, with the first DNP degree program in the US, and even then 50% failed a watered down version of USMLE Step 3.

 

[PL198]

Your exact quote was, "My question is this: So as we've seen over the years, the gap in capabilities between a physician and other health care professionals has continued to narrow. Isn't it eventually going to come to a point where NPs can do what any MD can?"

Either your purposefully being obtuse, or you don't know what the real meaning of the word "capability" is. If today, as a state legislator, I pass a bill saying that pharmacists and optometrists can manage diabetes and HTN very well, doesn't mean that their capability increased today from a week ago. Get it?
http://medcitynews.com/2013/02/cali...sts-eye-docs-diagnose-and-treat-diabetes-hbp/

The title of that article has let in it. One of the definitions in webster's for capable: " having legal right to own, enjoy, or perform" Again, I can understand where the confusion comes from ,but you're still incorrect. My usage of the word is correct, and it still doesn't matter.

Bottom line: See above post.

 

[DermViser]

What do you suppose is the underlying phenomenon here?

For instance ask any rising 4th year medical student if their ready to go to work in a specialty and they look at you like you were crazy. And yet the NP is cocksure such that they make ceaseless political fights out of it.

What is it that enables them to believe so strongly and unequivocally in less training being sufficient for independent practice?

Several things: hubris, the ability to band together at the grassroots level in a coordinated effort, and gaining control of the messaging: http://campaignforaction.org/resource/new-talking-points-future-nursing-campaign-action

 

[touchpause13]

Screw this I'm gonna do a cash only practice.

 

[JP2740]

To be fair, in this case the "Thanks Obama" meme applies, bc Obama and Dr. Emmanuel have been advocating for NPs and PAs to be taking over much of what is current scope of practice for primary care.
Mary Mundinger, a Dean of Columbia's Nursing School, who has the ear of Obama and other elites, has been advocating the take over of primary care by NPs for decades: http://observer.com/2009/12/the-nursecrusader-goes-to-washington/

For her part, Ms. Mundinger readily concedes that there are some things nurses are not educationally equipped to do: oncology, surgery, things that call for medical specialists. But she argues that, if anything, primary care physicians are overeducated. “I spoke to the Federation of State Medical Boards, the people who run all board certifications, and a primary care physician stood up and said, ‘Are you saying I wasted my time going to medical school?’” recalled Ms. Mundinger. “I wanted to say, yeah.”

I swear, I truly believe for those who go into primary care, no good deed goes unpunished.

This post made my heart hurt

 

[DermViser]

This post made my heart hurt

Tell me about it. Heartburn and High blood pressure.

Funny though, when you actually look at the distribution of NPs, it isn't mainly in primary care but in specialty care, even though they lobby themselves as the solution to the primary care shortage. Wonder why that is?

 

[PL198]

Several things: hubris, the ability to band together at the grassroots level in a coordinated effort, and gaining control of the messaging: http://campaignforaction.org/resource/new-talking-points-future-nursing-campaign-action

I agree with this, especially about the hubris part. The whole " The more you know, the less you realize you actually know," quote seems pretty valid. I know I'm a huge offender of just this, but anyway I think it fits

 

[circulus vitios]

No Oregon is up there too now judging by a comment that one poster made...
"It is even worse than Dr. Jauhar knows. Oregon passed HB 2902 last year which mandates that physicians practicing primary care or psychiatry may not be reimbursed more than nurse practitioners or physician assistants for their services. This applies to all commercial health plans in the state. Given the fact that NPs were already granted the same scope of practice as physicians in these specialties, the state appears to have determined that the additional 5-7 years of physician training and hundreds of thousands of dollars of additional debt do not matter. In other words, education doesn't matter. It is truly astonishing. I can't imagine that any rationale person will choose to go to medical school with the plan of practicing internal medicine, family practice, pediatrics or psychiatry in the state of Oregon."

If NPs make the same as physicians on a given procedure, what's the point of employing an NP? I thought their purpose was cost reduction.

 

[Nasrudin]

Several things: hubris, the ability to band together at the grassroots level in a coordinated effort, and gaining control of the messaging: http://campaignforaction.org/resource/new-talking-points-future-nursing-campaign-action

Agree. This ^^^ part is the one I find most fascinating. It is not unlike a cult phenomenon we're dealing with. One that unfortunately has hypnotized the public at large.

It's as baffling as it is sad.

Their propaganda machinery puts me in awe. They're as certain of their rightful claims as fundamentalists. But as sophisticated in mass hypnosis of the public as any mass political movement of the last century. And their social message is pitch perfect with current public imagination.

The situation in Oregon is foretelling. Aging, spoiled, baby boomer hippies who got their educations nearly for free and who received all the benefits of the zenith of american economic boon, selling out anyone and everyone who doesn't cough up what they want...now. They are the perfect public for the Rise of the NP's.

 

[Darth Doc]

And these DNP candidates were from one of the most prestigious of universities, with the first DNP degree program in the US, and even then 50% failed a watered down version of USMLE Step 3.

They weren't even from one of the internet NP schools.

 

[CarlosDanger]

.

 

[DermViser]

Agree. This ^^^ part is the one I find most fascinating. It is not unlike a cult phenomenon we're dealing with. One that unfortunately has hypnotized the public at large.

It's as baffling as it is sad.

Their propaganda machinery puts me in awe. They're as certain of their rightful claims as fundamentalists. But as sophisticated in mass hypnosis of the public as any mass political movement of the last century. And their social message is pitch perfect with current public imagination.

The situation in Oregon is foretelling. Aging, spoiled, baby boomer hippies who got their educations nearly for free and who received all the benefits of the zenith of american economic boon, selling out anyone and everyone who doesn't cough up what they want...now. They are the perfect public for the Rise of the NP's.

When you unionize, you get a lot of practice in putting together the underlying resources necessary to affect change that you want: media relations, grassroots lobbying, hob nobbing with state legislators, distributing talking points, etc. Just look at Barack Obama, Mr. Community Organizer.

Ironically enough the governor of Oregon, is an EM doctor.
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/01/18/can-oregon-save-american-health-care/, so really this wasn't a shock to me.

 

[PL198]

If 50 % fail a watered-down version of step 3, how do they manage to not **** stuff up majorly on their own? Seems to me like that would be a major red flag to our policy creators.

 

[DermViser]

If 50 % fail a watered-down version of step 3, how do they manage to not **** stuff up majorly on their own? Seems to me like that would be a major red flag to our policy creators.

Bc they have a supervising Physician who corrects their mistakes. Just like CRNAs have Anesthesiologists who save them from killing a patient. Those instances never get reported.

 

[adenocard]

And these DNP candidates were from one of the most prestigious of universities, with the first DNP degree program in the US, and even then 50% failed a watered down version of USMLE Step 3.

http://www.cumc.columbia.edu/nursing/dnpcert/rates.shtml

Here are the data from 2008-2012 showing this in case anyone was wondering if this was true.

Take a look at the American Association of Nurse Practitioners facebook page: https://www.facebook.com/AmericanAssociationofNPs

Nearly every article is about practicing autonomously and with equal pay and rights with less than half the training of a physician. Make no mistake, this isn't about increasing people's access to care, this is a money and power grab by one of the most powerful lobbying group in the country.

 

[Gifted Hands]

I thought this reply was a gem. The original post said physicians and nurses have vast differences in the focus of their learning and physicians train for 7+ years.

Mon from Chicago writes:

Not everyone who is capable of providing primary care can afford medical school, and not everyone with 7 years medical training has the people skills necessary to utilize that training. That's why we need NPs.
You could even say that NPs joined the profession without promise of a huge salary, therefore would be more impartial and sincere.
If bean counters are able to save patients money, why not compensate them?

Ummmm what? I don't even know where to begin

 

[DermViser]

http://www.cumc.columbia.edu/nursing/dnpcert/rates.shtml

Here are the data from 2008-2012 showing this in case anyone was wondering if this was true.

Take a look at the American Association of Nurse Practitioners facebook page: https://www.facebook.com/AmericanAssociationofNPs

Nearly every article is about practicing autonomously and with equal pay and rights with less than half the training of a physician. Make no mistake, this isn't about increasing people's access to care, this is a money and power grab by one of the most powerful lobbying group in the country.

Bingo. They advocate for themselves as being a cheaper and better alternative with less years needed to physicians on the one hand to legislators, but once they get that fixed in legislation increasing their scope of practice, they then demand that ALL insurers pay them on par with physicians, thus destroying any cost savings. Very crafty, if you ask me. Meanwhile they can wrap themselves in the flag of doing what's best for patient care and increasing access.

Meanwhile, you have the consequences of this, where a NP missed a neuroblastoma a in child due to failing to collaborate with a physician:
http://www.louisianapersonalinjurylawyerblog.com/2011/02/increased_awards_for_victims_o.html

 

[DermViser]

I thought this reply was a gem. The original post said physicians and nurses have vast differences in the focus of their learning and physicians train for 7+ years.

Mon from Chicago writes:
Ummmm what? I don't even know where to begin

I guarantee you nurses joining the profession of nursing definitely care about their salary. They bring down clinical operations to a halt by going on strike for this, esp. in a liberal haven like Chicago, where unions are powerful.

 

[PL198]

I thought this reply was a gem. The original post said physicians and nurses have vast differences in the focus of their learning and physicians train for 7+ years.

Mon from Chicago writes:



Ummmm what? I don't even know where to begin

Lol what a gem... They don't have to do residency, which id assume is about 100x the learning a medical students gets in school, yet want to be paid as if they did. It's hilarious to me that a NP would be making more money straight away from graduating than an MD resident.

 

[DocVapor]

Bingo. They advocate for themselves as being a cheaper and better alternative with less years needed to physicians on the one hand to legislators, but once they get that fixed in legislation increasing their scope of practice, they then demand that ALL insurers pay them on par with physicians, thus destroying any cost savings. Very crafty, if you ask me. Meanwhile they can wrap themselves in the flag of doing what's best for patient care and increasing access.

Meanwhile, you have the consequences of this, where a NP missed a neuroblastoma a in child due to failing to collaborate with a physician:
http://www.louisianapersonalinjurylawyerblog.com/2011/02/increased_awards_for_victims_o.html

The link is awful and should certainly get more publicity. However, physicians still miss things. And because they have been around a whole lot longer, there are many more instances. Even if the prevalence of these kind of errors and oversights was twice or thrice that of physicians, those fighting for NP status will just use the higher absolute count of physicians. And the general public will let their eyes glaze over and just ignore the inconvenient information.

 

[deleted480308]

http://www.cumc.columbia.edu/nursing/dnpcert/rates.shtml

Here are the data from 2008-2012 showing this in case anyone was wondering if this was true.

Take a look at the American Association of Nurse Practitioners facebook page: https://www.facebook.com/AmericanAssociationofNPs

Nearly every article is about practicing autonomously and with equal pay and rights with less than half the training of a physician. Make no mistake, this isn't about increasing people's access to care, this is a money and power grab by one of the most powerful lobbying group in the country.

To me, the biggest evidence against parity isn't howbadly they did on step 3 back then...it's that they have been wise enough to not repeat the test each year or expand the study.

They want no part of physician exams

 

[Gifted Hands]

Lol what a gem... They don't have to do residency, which id assume is about 100x the learning a medical students gets in school, yet want to be paid as if they did. It's hilarious to me that a NP would be making more money straight away from graduating than an MD resident.

But also we need to allow a back door to NP for people that can't afford med school? How about make it more affordable for people who want to do primary care to train the right way?!

We are losing the PR battle horribly. We need to work on our image and job protection as well as patient care. I don't see lawyers or teachers or other professional groups dealing with this belittling of their degree. Ugh the future looks bleak my friends.

 

[touchpause13]

God we need better PR. Like so much better

 

[DermViser]

The link is awful and should certainly get more publicity. However, physicians still miss things. And because they have been around a whole lot longer, there are many more instances. Even if the prevalence of these kind of errors and oversights was twice or thrice that of physicians, those fighting for NP status will just use the higher absolute count of physicians. And the general public will let their eyes glaze over and just ignore the inconvenient information.

Yes, but the point is based on the person's credentials and training she was supposed to collaborate with the physician on site as defined by Louisiana's scope of practice. She didn't. She had the typical hubris of an NP who thinks she knows it all.

• Duhon did not collaborate with Dr. Bergstedt concerning Taylor’s condition. Instead, she verbally reassured Taylor’s mother and prescribed over thirty medications to treat the child’s multiple complaints and observable symptoms. Additionally, Duhon stated that Taylor only needed to see Dr. Bergstedt in connection with admission to a hospital. After no progress in her condition, Taylor’s mother eventually brought her to Women & Children’s Hospital in Lake Charles, where she was treated for the first time by Dr. Bergstedt. Taylor was diagnosed with neuroblastoma..

Seems like she treated each sx separately, instead of putting it together.

Stuff like neuroblastoma is pounded on our skulls on our shelf exams, and USMLE Step 2 CK, etc. and while we may laugh at it, isn't until it actually pops up and saves someone's life that we actually appreciate having learned it. The ability to come up with an extensive differential diagnosis to rule things in and out, and knowing what warning signs to watch out for can't be replaced by flowcharts and algorithms. For an NP who doesn't even have neuroblastoma on her differential to begin with, there is no way she could have caught it. That's why you have a collaborating physician.

 

[DermViser]

To me, the biggest evidence against parity isn't howbadly they did on step 3 back then...it's that they have been wise enough to not repeat the test each year or expand the study.

They want no part of physician exams

Or as they officially say it:
http://www.nursingcenter.com/lnc/JournalArticle?Article_ID=942576&Journal_ID=646631&Issue_ID=942575
http://allnurses.com/nurse-practitioners-np/dnps-taking-certification-301106-page2.html

In sum, the DNP is a degree for ANPs. The NBME DNP examination is therefore unrelated, extraneous, and immaterial to advanced nursing practice. NPs do not need another examination. Moreover, an examination for the NP would add yet another layer of certification, resulting in a barrier to clinical practice. For these reasons, advanced practice nurses do not support credentialing or regulation of the ANP profession by the NBME.

"AANP is not supportive of plans for an added layer of certification for DNP's at this time, particularly one that involve the profession of medicine. It is inappropriate for one profession to credential or regulate another, as this is clearly in the purview of nursing"

Funny how things change when you can't finagle the failure results like you can on your nursing-sponsored studies on patient outcomes.

 

[calvnandhobbs68]

In unrelated news, NY Radiologists celebrate as the volume of imaging studies inexplicably doubles and their local job market flowers.

Seriously, maybe I should switch over to radiology. That bad job market might just reverse itself in a few years here.