I dunno. I would be fine with NPs managing chronic patients with straight-forward medical conditions (DM, HTN, etc), as long as they are appropriately, and extensively, trained in it.
Ditto. And in a lot of places, I think this is what happens. Or (like with my PCP) they handle appointments made for common ailments. Actually, I think pretty much any time I've made an appointment because I have a sinus infection or persistent sore throat, I'm told my doctor doesn't have any available appointments for a few weeks but the NP or PA (my PCP employs both) have almost immediate availability. And this isn't necessarily a bad thing, because the physician is free to concern himself with more unusual, intensive, or specialized concerns. The only thing that does suck is if there's something more going on, the NP/PA may be less likely to spot this, because they aren't trained as in depth as MDs.
For example, I saw an NP at a minute clinic before getting my tonsils out. I understand strep throat may have been going around at the time, but she wouldn't give any kind of prescription or treatment without me getting a strep test. I had been having chronic sore throats that, despite having prior strep tests (my PCP no longer tested me for strep), was irrelevant. I understand she had never seen me before, but the test was $90 on top of the $50 visit (it was a Sunday and my PCP was closed) just for a lidocaine throat spray (turns out she couldn't prescribe antibiotics until my throat culture, which was negative, came back) ended up being a waste of money. At my PCP it's been a bit better, though I had to fight the NPs a few times on the strep tests (I had been there MULTIPLE times for sore throats and had prior negative strep tests). I finally was able to get an appointment with my actual physician, who told me on the first visit that I needed to go to an ENT. Oh, and all of this happened despite the fact I had been seen by an ENT about a year prior (transferred there from an ER after my throat had nearly closed off from swelling) who wanted to take my tonsils out.
My nursing instructors (some of which, if not all, are NPs) typically can't answer more in depth or logic based physiology questions. And if it involves chemistry/biochemistry, they seem even more lost. The material I've learned so far is not much more in depth than information I can find on webmd. Granted, I *am* only in my first semester of the nursing program (ie, Fundamentals and Pharmacology), but my teachers are very reluctant to answer any questions I have that go more into the sciences.
Now, to have them see every patient in the ED is a different story. Until there is sufficient evidence to the contrary, I don't expect that a person trained in the nursing model has sufficient background to diagnose the nuances in patient presentation that would lead to a different, potentially more emergent diagnosis.
Exactly. See above.
This doctor thing, honestly I care less and less the more I hear and talk about it. I think it's a semantic power play, but whatever. The big names in medicine I've had the fortunate ability to be mentored by all introduced themselves by their name - title and white coat excluded. I plan on doing the same. The title and the coat are just getting awfully pretentious. If people are fighting just to be able to get these status accessories, then I want no part of it. I think that introduction by name (sans title) and position is the most honest, and most informative to patients - not to mention the most likely at building rapport.
YES. I like you...all of your responses I've seen in every thread I've seen you write in, I have the same opinions. My nursing instructors very much have this "semantic power play" attitude...both in relating their career experiences with "evil doctors" and in their attitudes toward students/educational structure (ie, there's no consistency, they tell us we won't be tested on things that actually DO end up being on tests, and when students bring this to their attention, they merely complain in front of us that we expect them to spoon-feed us). To be honest, so much of the nursing materials I've learned makes the nursing profession out to be about semantics. While from the documentation aspect of things (and liability), I think nursing diagnoses are a good idea, the way they are phrased and the fact that we have to learn the difference between medical and nursing diagnoses (because nurses can't use medical diagnoses) is ALL semantics. And after a while, it REALLY starts to piss a person off. To me, it feels like one big, pointless game, when we should really be focusing on the tasks/information at hand.
My problem isn't with charting, it's with the semantics and HOW MUCH that's a part of nursing. Semantics plus power struggles equals a person I'd like to smack across the side of their head. Pretentious is a VERY good word for it. I have a GREAT PCP, and even though I use "Dr. ---" with him, he's always been personable and treats patients as equals. The last visit I had we even poked fun at each other (which was the first visit with him in about a year). But despite having seen the PAs and NPs more frequently over the past few years, I wouldn't joke around with them. The one time I made a joke, crickets chirped, and that has pretty strongly established an uncomfortable atmosphere with the health care professionals who are supposed to be more concerned with "comfort" and "caring" than physicians. *shrugs*
When did it stop being about treating patients and become about status? I know MDs had a reputation for treating nurses poorly in the past, but is this all a backlash toward that or am I missing something?
People, regardless of what you call yourselves, I hope everyone takes a good hard look in the mirror before they start their day and acknowledge their strengths and limitations. The moment you start overestimating yourself and not seeking help from people more knowledgeable is when you'll see an increase in poor patient outcomes.
Again, spot on the money. Nurses/nursing students are ALWAYS bringing up this "MDs treated nurses poorly in the past" thing. I'm always hearing this from my other students ("they probably had to fight so much for respect throughout their careers that they just ARE bitter"). But that's not an excuse. Fighting for respect is one thing, but going overboard is another.
It does seem that a lot of nurses think they DO know more because of what they learn clinically. From what I understand, a lot of nurses DO get a better knowledge base/understanding from clinical experience than what they learn in school. But if that's the case, that should cause an educational reform, NOT a "we deserve more" attitude. I am HIGHLY dissatisfied with my nursing education thus far and STRONGLY believe there needs to be a reform in nursing education standards and structure. Quite honestly, it's been nothing short of absurd. But this self-pitying/righteous/"we deserve more" attitude is NOT the way to handle the situation. It's also not appropriate to instill this attitude in future nurses (which is what's happening in my program).
