Pa/np Article In Ny Times

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Why do I get the impression that the rest of the world views NPs as superior to PAs? Is it just because nursing has been around a long longer than the PA profession?

From what I have seen from shadowing and from looking at curriculum, the PA curriculum looks like it better prepares you to practice than the NP curriculum (not counting what you learn as an RN obviously which may or may not be relevant)
 
But the nursing model encompasses all the same information as the nursing model but also includes compassion and emotional intelligence.



[/sarcasm]

Josh BSN RN MSA LAc BLS ACLS
 
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Josh L.Ac. said:
But the nursing model encompasses all the same information as the nursing model but also includes compassion and emotional intelligence.



[/sarcasm]

Josh BSN RN MSA LAc BLS ACLS
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you are absolutely wrong. Nurse=Nursing model. PA=medical model.
 
foreverLaur said:
Why do I get the impression that the rest of the world views NPs as superior to PAs? Is it just because nursing has been around a long longer than the PA profession?

From what I have seen from shadowing and from looking at curriculum, the PA curriculum looks like it better prepares you to practice than the NP curriculum (not counting what you learn as an RN obviously which may or may not be relevant)
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i received this article in my email today. the DNP introducing herself to pt as a doc is totally not acceptable. the AMA must act immediately.
 
Steps are already being taken...I can't find the letter, does anyone else have a link?
 
princekc said:
you are absolutely wrong. Nurse=Nursing model. PA=medical model.
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hey there prince,
did you NOT read what was said below? i believe there was intent on humor, and NO mention of medical model OR PA.
did i miss something?
maybe it was the 'revolution' that responded ;)

Originally Posted by Josh L.Ac.
But the nursing model encompasses all the same information as the nursing model but also includes compassion and emotional intelligence.
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As far as the "world viewing NP as superior to PA", I just don't see that as true. I believe that a good PA is respected as much as a good NP. It's no wonder that MDs have a problem accepting "mid-level" (i hate that term) providers as valuable members of the health care team, when us "mid-levels" can't even respect each other.
As for the "nurse introducing herself as doctor".... I have been a PNP for almost 10 years, and RN for 15 before that. I have no delusions of grandeur. I do primary care pediatrics...I love what I do...I have a physician preceptor that I consult with...I get specialty referrals when I need them...the family practice MD in our office comes and gets me to look at a kid sometimes when he's stumped about something...point is..We are a team. I didn't want to go to medical school. Didn't want to be a physician. Contrary to what a physician friend of mine told me, I am not a frustrated, middle-aged physician wannabe! (His opinion of nurse practitioners) I am happy with what I am and do.
HOWEVER....if I am forced by my certifying board to get my doctorate degree, then get it I will...but I'll be damned if after 9 years of school...I don't use the title DR! My sister is a PhD speech pathologist...she's a "Dr". My friend the PhD audiologist is a "Dr". My co-worker the PharmD...you guessed it "DR"!!!!! Nobody is getting all pissy that these professionals use their hard-earned title.
I always introduce myself as Nurse Practitioner. The kids I see call me "Dr Patti" now. But I ALWAYS make sure the parents know what I am. I am proud of it and wouldn't have it any other way!
 
PattiCPNP said:
.but I'll be damned if after 9 years of school...I don't use the title DR! My sister is a PhD speech pathologist...she's a "Dr". My friend the PhD audiologist is a "Dr". My co-worker the PharmD...you guessed it "DR"!!!!! Nobody is getting all pissy that these professionals use their hard-earned title.
I always introduce myself as Nurse Practitioner. The kids I see call me "Dr Patti" now. But I ALWAYS make sure the parents know what I am. I am proud of it and wouldn't have it any other way!
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Are you going to call yourself a pediatrician while you're at it?

You'd better tell your patients that you arent one.
 
They must not teach reading comprehension in whatever program that you attend, because you obviously didn't understand one word of what I just said! Perhaps when you are a physician (I am assuming you are pre-med), you can come do primary care at the community health center that I work at and take care of all the indigent, Medicaid children that I see every day that wouldn't otherwise have a medical home.
Again for the record I am a PEDIATRIC NURSE PRACTITIONER...says so right here on my name badge. Not a pediatrician....
 
Patti,

He likes to troll; don't give in to the temptation to feed him what he wants:D.
 
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Members don't see this ad :)
maybe he should just stick to eatin' tacos...
do what's best!
 
My experience so far is that NPs practice independantly a lot more compared to PAs. As a result, I see some horrific admissions into our hospital with a bad bad combo of medications. Combos that medicaid/medicare would happily report the MD to the medical board for bad medical practice. At least a PA would be reported to the medical board for bad practice. What will medicaid/medicare do for NPs who combine drugs badly? Report them to the nursing boards? As if they know any better.

It always seems to be depression medications. The pt doesn't know any better and goes and buys the three or sometimes four expensive drugs. Drugs that have subtle side effects often months later.:slap:

I have a much higher opinion of PAs than NPs. The problem is that the patient doesn't know better and often goes for the cheapest available with little insight or foresight.
 
Tired said:
If they're foolish enough to say it in front of me in a hospital, you better believe I'm going to get pissy about it.

Think of it in context. A patient who walks into an Audiologist's office expects to be seen by an Audiologist. Ditto for a Physical Therapy office, or a Pharmacy. There's no confusion there.

Anything less is clearly misleading.
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How about a clinical psychologist working in a psychiatric hospital or medical setting. A Ph.D. in clinical psychology requires as much training as many physicians receive and .. frankly a Ph.D. is a more advanced degree than an M.D. The term "doctor" is a reference to the type of degree one holds not the profession. Why shouldn't a doctorally trained individual use the title as long as the person involved makes their professional role clear. After 4 years for a BA, 3 years full time for an MS in clinical psychology, and now working 5 years full time towards a Ph.D. and still working, thousands of hours of clinical work, plus a fair number of journal articles in the process, I would get real pissy if some MD tries to deny me the right to use the title Dr.
 
Faebinder said:
What will medicaid/medicare do for NPs who combine drugs badly? Report them to the nursing boards? As if they know any better.
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The nursing boards have an obvious conflict of interests. They can't effectively police their members while at the same time try to expand their scope. Look at the FDA or FAA (until 9/11 happened anyways). It puts the public at risk.


Heck, the nursing organizations can't even guarantee a consistent product. That's why there's such a huge variation in the DNP programs. Some are completely online. Their certification exam also doesn't measure up to the PANCE or USMLE.
 
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How about a clinical psychologist working in a psychiatric hospital or medical setting. A Ph.D. in clinical psychology requires as much training as many physicians receive and .. frankly a Ph.D. is a more advanced degree than an M.D. The term "doctor" is a reference to the type of degree one holds not the profession. Why shouldn't a doctorally trained individual use the title as long as the person involved makes their professional role clear. After 4 years for a BA, 3 years full time for an MS in clinical psychology, and now working 5 years full time towards a Ph.D. and still working, thousands of hours of clinical work, plus a fair number of journal articles in the process, I would get real pissy if some MD tries to deny me the right to use the title Dr.
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I don't think most people would have an issue with someone with a PhD in psych who was seeing psych patients introducing themselves as doctor. I think the issue is in a clinical setting the term doctor implies a certain degree of clinical competence. Now I don't know enough about the doctorate of nursing to say it is or is not comprable to being a physican. But if the degree is mainly training on researching improvements in nursing, nursing education, etc rather than in clinical care I would feel mislead if I walked into my doctors office and that person called themselves doctor. There is a difference between someone having a doctorate and being a patient's doctor. I think most patients would be upset if a PhD in pharmacology walked in and said "I'll be your doctor today," even if they have a doctorate. Might be splitting hairs but I don't know why people would want to take on the added liability from patients who could turn around and say "I wouldn't have taken X advice at face value if I knew the person was a PhD in Y, I thought they were an MD since they said doctor." This is not a comment on abilities, but many lawsuits result from a difference between patient expectations and outcomes rather than actual incompetence.
 
jbar said:
I don't think most people would have an issue with someone with a PhD in psych who was seeing psych patients introducing themselves as doctor. I think the issue is in a clinical setting the term doctor implies a certain degree of clinical competence. Now I don't know enough about the doctorate of nursing to say it is or is not comprable to being a physican. But if the degree is mainly training on researching improvements in nursing, nursing education, etc rather than in clinical care I would feel mislead if I walked into my doctors office and that person called themselves doctor. There is a difference between someone having a doctorate and being a patient's doctor. I think most patients would be upset if a PhD in pharmacology walked in and said "I'll be your doctor today," even if they have a doctorate. Might be splitting hairs but I don't know why people would want to take on the added liability from patients who could turn around and say "I wouldn't have taken X advice at face value if I knew the person was a PhD in Y, I thought they were an MD since they said doctor." This is not a comment on abilities, but many lawsuits result from a difference between patient expectations and outcomes rather than actual incompetence.
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I agree with you completely. It is ethically incumbent upon professionals to make their roles and professional affiliations crystal clear. The general public does not have a clue about the differences between many of the healthcare professions. How many times have respiratory therapists been called "nurse" by patients who don't know the differences between the professions. For myself, I will have no qualms using the title "Dr." to introduce myself as long I I qualify that that I am a clinical psychologist/neuropsychologist so that patients can know exactly what profession I belong to.

However, you are right to point out that a doctoral level professional implies a particular level of knowledge and expertise. During my years as a master's level therapist I used to think that the difference between me and a Ph.D. was a couple of years of schooling and a dissertation. Now that I am finishing up a Ph.D. I think my previous beliefs were not only simplistic but also wrong. There is something about doctoral level training and putting in thousands of hours of free supervised clinical work that has taken my case conceptualization abilities and professional skills to a whole different level.

I have not made up my mind about the the nursing profession pushing for a DNP degree. I love nurses and NP's in particular (my significant other is an NP and is toying with the idea of getting a DNP) and I am all for improving/upgrading education. Most of the NP's I have had exposure to have begun their work in the profession as diploma nurses or AA or BSN level nurses and have gradually gained more education and training while working professionally at various levels in the nursing profession. So they tend to have many years of great experience prior to becoming NP's. Yet I see for myself what doctoral training has done for me. My question is whether the DNP will have the same added value for master's level NP's. That will probably depend on the depth and complexity of their training models.
 
Duke University, arguably one of the best schools in the Southeast. I would assume their DNP would be considered top-tier.

http://nursing.duke.edu/modules/son_academic/index.php?id=109

This is the link to their curriculum. Their DNP is a minimum of 34 creditis over two years, and 5 credit hours of that 34 is in "Financial Management" and "Effective Leadership". A significant portion (3 classes) is devoted to tranforming health care systems.

Sounds like great management level course work, but preparing the graduates to be independent health care providers on par to a family physician as Dr. Mundinger at Columbia has stated? Not even close.
 
jbar said:
I don't think most people would have an issue with someone with a PhD in psych who was seeing psych patients introducing themselves as doctor. I think the issue is in a clinical setting the term doctor implies a certain degree of clinical competence.
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It is definitely up to each professional to be clear at the introduction: "I'm Dr. T4C, your psychologist". The DNP definitely gets a little more confusing, which is why it is even more important to make sure to properly present yourself and your credentials.
 
Neuropsych2be said:
After 4 years for a BA, 3 years full time for an MS in clinical psychology, and now working 5 years full time

... I would get real pissy if some MD tries to deny me the right to use the title Dr.
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So by that logic someone who spent 4 years getting a BSc in chemistry, then 3 years getting a MSPT physical therapy, and then decided to spend another 3 years or so getting a BSN should equally be able to call themselves a "doctor" because they spent the same number of years in school.
 
jbar said:
I think the issue is in a clinical setting the term doctor implies a certain degree of clinical competence... There is a difference between someone having a doctorate and being a patient's doctor. I think most patients would be upset if a PhD in pharmacology walked in and said "I'll be your doctor today," even if they have a doctorate.
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ditto :thumbup:, The issue is about the context of where the term "Dr." is being used. If those who take the counterargument dont understand this objection, it speaks volumes of their intellecutal dishonesty.
 
Dr.Millisevert said:
So by that logic someone who spent 4 years getting a BSc in chemistry, then 3 years getting a MSPT physical therapy, and then decided to spend another 3 years or so getting a BSN should equally be able to call themselves a "doctor" because they spent the same number of years in school.
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yea, when you take the statement out of context and eliminate the PhD portion of it.
it was the years of education along the same path,
with years of hand-on experience, leading to culmination of PhD, that was the concept of it all.
we get your point.
you know, the ones you so eloquently keep trying to make.
 
bradt9881 said:
Duke University, arguably one of the best schools in the Southeast. I would assume their DNP would be considered top-tier.

http://nursing.duke.edu/modules/son_academic/index.php?id=109

This is the link to their curriculum. Their DNP is a minimum of 34 creditis over two years, and 5 credit hours of that 34 is in "Financial Management" and "Effective Leadership". A significant portion (3 classes) is devoted to tranforming health care systems.

Sounds like great management level course work, but preparing the graduates to be independent health care providers on par to a family physician as Dr. Mundinger at Columbia has stated? Not even close.
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Some of the new DNP programs are alarming in their lack of clinical focus. The programs I have looked at seem to be more of a hybrid MBA/MPH/Hosptial Administration degree than a clinical degree. Don't know why clinical material is being ignored.

I think that ivory tower nursing educators think that the more "policy/management/leadership" nonsense they throw in, the more credence their programs will have. A shame.

Oldiebutgoodie, RN, in an NP program
 
She also introduces herself as “Dr. Lyons”; doctors of nursing practice can use the title, though they must also introduce themselves as nurse practitioners. “I’ve worked hard to obtain this degree and I make no false pretenses about who I am,” she said. “I’ve earned it.”
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:rolleyes:
 
dfk said:
yea, when you take the statement out of context and eliminate the PhD portion of it.
it was the years of education along the same path,
with years of hand-on experience, leading to culmination of PhD, that was the concept of it all.
we get your point.
you know, the ones you so eloquently keep trying to make.
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Well it was stated here (see below) too.. (and not about a PhD)
PattiCPNP said:
I'll be damned if after 9 years of school...I don't use the title DR!
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Pretty much says the same thing. i.e.: just cause someone goes to school for x number years doesn't mean they can go around the hopsital callin themselves a doctor in front of patients (even if they do have a PhD) ...or a clinical nursing "doctorate".
 
oldiebutgoodie said:
Some of the new DNP programs are alarming in their lack of clinical focus. The programs I have looked at seem to be more of a hybrid MBA/MPH/Hosptial Administration degree than a clinical degree. Don't know why clinical material is being ignored.

I think that ivory tower nursing educators think that the more "policy/management/leadership" nonsense they throw in, the more credence their programs will have. A shame.

Oldiebutgoodie, RN, in an NP program
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not to mention the fact that you can get them through nothing but online coursework in many places.
 
Dr.Millisevert said:
Well it was stated here (see below) too.. (and not about a PhD)

Pretty much says the same thing. i.e.: just cause someone goes to school for x number years doesn't mean they can go around the hopsital callin themselves a doctor in front of patients (even if they do have a PhD) ...or a clinical nursing "doctorate".
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i guess i took it as her doing 9 years of school, getting her doctorate, to then "be damned"...
if she got it.
that's all.
 
For as smart as you guys claim to be...you sure are missing the point here! Just because nurse practitioners one day will be required to have a doctorate degree doesn't mean we will be "doctors". And by that I mean "doctor" the term which you all are so territorial of. I believe (and I'm just a nurse so forgive my ignorance) that you are PHYSICIANS, right? Just because somebody's title is "Dr. whatever", doesn't mean they are medical doctors. Audiologists, speech pathologists, physical therapists, pharmacists, nurse practitioners...ALL can have doctorate degrees in their fields...doesn't make them PHYSICIANS! Only you "medical doctors" can lay claim to that! More importantly, believe it or not....all these other professions....WE DON'T WANT TO BE "YOU"! We are not sad that we didn't "go on" to medical school...we don't feel like we settled for second best. Believe it or not, I am very happy being what I am. I do not EVER let a patient or parent ( I do primary care pediatrics) believe for ONE SECOND that I am a physician. I can't speak for the entire NP population, but for the hundreds that I do know...we are very satisfied being what we are. I would never misrepresent myself in front of a patient.
I would really be interested in hearing what the real issue is here? Certainly you are not threatened by NPs or PAs...do you not believe that there are plenty of sick people to go around? Do you want to come to the community health center where I work and see indigent, Medicaid patients all day? Remember that's why NPs exist in the first place because rural areas couldn't recruit "doctors" to see the indigent pediatric populations there! Now before you all go off on that one, just how many of you are going into Primary care????
Maybe I have been in health care too long...26 years, 10 as NP. Maybe I am spoiled because the physicians that I work with respect me as a professional and value my contribution to our team. Maybe back when I was in the hospital as a new nurse, physicians weren't so overworked and frustrated by HMOs and low reimbursement rates. But I don't ever recall, EVER, and I have worked all across the country, the animosity towards nursing in particular that I have encountered on this message board. Last time I checked we all shared a common goal and that was quality patient care with positive outcomes. Nurses respected physicians and visa versa.
I found this message board because my daughter is pre-vet and we were looking for help with applications etc. My only consolation is that all you pre-meds don't like pre-vets either.....so maybe it's not us!
 
patticnp, you should go to allnurses.com and see how they talk about PHYSICIANS, this is little leagues compare to that forum.

Second, what are nurses going to do with the nurse shortage in the USA, which is worse than the physician shortage, if nurses continue to go out and cover the physician shortage?

you guys have a shortage of your own even worse than we do but i dont see anyone doing something about it, and this DNP thing is going to make becoming a nurse even more difficult becaues it will require more years of education, something that I have seen in allnurses as the number one complaint for nurses not going for the DNP.
 
PattiCPNP said:
I would never misrepresent myself in front of a patient.
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Good for you.

PattiCPNP said:
I would really be interested in hearing what the real issue is here?
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If you haven't done so already, look at other threads that have discussed this specific issue to really understand what the general objections are from many of us.
 
mig26x said:
...

Second, what are nurses going to do with the nurse shortage in the USA, which is worse than the physician shortage, if nurses continue to go out and cover the physician shortage?
...
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i don't think the answer should be keep nurses at bedside just because there's a shortage. IMO, bedside sucks. it was my avenue to move on.
some people like it.

i also see this as being similar to the FP shortage.
why do MDs decided to specialize? i'm sure it's in part
because they don't want those other jobs (FP/IM/etc...),
as well as a better lifestyle, honed expertise, and so on.

this whole thing is almost cyclic.
you have nurses covering physician shortage, leaving nurses short.
if nurses stopped covering, maybe the nursing shortage would lessen.
this in turn would leave the physicians even worse off.
is there one right answer?
no.
damned if i knew what it was too.

there's just not enough clinicians all around.
period.
 
PattiCPNP said:
For as smart as you guys claim to be...you sure are missing the point here! Just because nurse practitioners one day will be required to have a doctorate degree doesn't mean we will be "doctors". And by that I mean "doctor" the term which you all are so territorial of. I believe (and I'm just a nurse so forgive my ignorance) that you are PHYSICIANS, right? Just because somebody's title is "Dr. whatever", doesn't mean they are medical doctors. Audiologists, speech pathologists, physical therapists, pharmacists, nurse practitioners...ALL can have doctorate degrees in their fields...doesn't make them PHYSICIANS! Only you "medical doctors" can lay claim to that! More importantly, believe it or not....all these other professions....WE DON'T WANT TO BE "YOU"! We are not sad that we didn't "go on" to medical school...we don't feel like we settled for second best. Believe it or not, I am very happy being what I am. I do not EVER let a patient or parent ( I do primary care pediatrics) believe for ONE SECOND that I am a physician. I can't speak for the entire NP population, but for the hundreds that I do know...we are very satisfied being what we are. I would never misrepresent myself in front of a patient.
I would really be interested in hearing what the real issue is here? Certainly you are not threatened by NPs or PAs...do you not believe that there are plenty of sick people to go around? Do you want to come to the community health center where I work and see indigent, Medicaid patients all day? Remember that's why NPs exist in the first place because rural areas couldn't recruit "doctors" to see the indigent pediatric populations there! Now before you all go off on that one, just how many of you are going into Primary care????
Maybe I have been in health care too long...26 years, 10 as NP. Maybe I am spoiled because the physicians that I work with respect me as a professional and value my contribution to our team. Maybe back when I was in the hospital as a new nurse, physicians weren't so overworked and frustrated by HMOs and low reimbursement rates. But I don't ever recall, EVER, and I have worked all across the country, the animosity towards nursing in particular that I have encountered on this message board. Last time I checked we all shared a common goal and that was quality patient care with positive outcomes. Nurses respected physicians and visa versa.
I found this message board because my daughter is pre-vet and we were looking for help with applications etc. My only consolation is that all you pre-meds don't like pre-vets either.....so maybe it's not us!
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Dear Patti,

I'm glad that you feel this way. I think you and I share many of the same views.

Like me, I'm sure you would agree that it confuses the patient if someone who introduces themselves as "Dr.", wears a white coat, takes history, does a physicial exam, writes orders, but is not a physician. That's why the AMA wants to restrict the use of "Dr." in a clinical setting. It is to reduce patient confusion. Don't you agree? DNP's, like PharmD's, DPT's, etc can still call themselves doctor in academic settings, at parties, at home, etc.

I know you would agree with me that it borders on fraud for the DNP's to claim that they are equivalent to physicians in ability and knowledge. Yet, that's what Mary Mundinger, the leader of the DNP movement, claims. Bear in mind that the DNP can be done completely online and many times can be done with just 700 or so clinical hours. Many of these DNP programs are recruiting students directly out of nursing school without any prior floor experience. Physicians have at least 17000 hours of clinical training (5000 from med school + >12000 during 3 years of residency). The AMA wants to ensure the highest level of patient safety by making sure that DNP's and PA's work under the supervision of physicians. I'm sure you would agree that this best ensures patient safety.

Patti, you'll be glad to know that the AMA is listening to the concerns of its members and the public who want the best and safest healthcare as possible. That's why the AMA passed resolutions this past summer to ensure more patient safety by updating our state laws. Seven states have already passed laws restricting the use of the title "Dr." in a clinical setting and hopefully more in the near future.

 
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:thumbup:
Taurus, well put - appreciate your determination to hang in on this mega-thread !
 
Tired said:
Although many of our most vocal posters are pre-med and med students, please don't confuse the relative silence of the fully-licensed resident and attending physicians with disagreement.

Most, if not all, physicians agree that the use of "Doctor" by NPs in clinical settings is misleading and should not be allowed.

Most, if not all, physicians are concerned with the ever-expanding independent practice rights of APRNs, especially in the realm of primary care and anesthesia.

Of course you have never heard physicians express these concerns in your work environment. We don't talk about these issues with non-physicians, and certainly not the NPs who work for us and make money for us. This is an issue that needs to be dealt with on a political/leglislative level, and doesn't need to be discussed between individual doctors and nurses.

I am tired of the constant accusations by the NPs on this board that physicians are somehow "hateful" because we don't support independent practice by nurses. The independent practice of medicine runs counter to the traditions and philosophies of the nursing profession. And if these posters truly had patients' interests at heart, they would advocate that all patients (especially the indigent) have access to fully-trained Board Certified Physicians to care for their health care needs.
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sans disagreement here,
you sound rather hypocritical ..
you want the help.
you want the extra money.
you want to complain.
you don't want to confront the "enemy".
you hold discussion behind the "enemy's" back.
well,
WTF?
i could go on,
but i think you'll only push this by the wayside.

dude,
take out all mid-levels (as MDs like to call'em),
and physicians would be drowning well more so than they already are.
i'm not saying give the NP/PAs complete hands-on with a label,
but admit...
you (read MDs) can't do without.
 
Tired said:
Of course you have never heard physicians express these concerns in your work environment. We don't talk about these issues with non-physicians, and certainly not the NPs who work for us and make money for us. This is an issue that needs to be dealt with on a political/leglislative level, and doesn't need to be discussed between individual doctors and nurses.
And if these posters truly had patients' interests at heart, they would advocate that all patients (especially the indigent) have access to fully-trained Board Certified Physicians to care for their health care needs.
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So...let me get this right...you would hire a "mid-level" to work for you...make money for your practice...but you don't discuss concerns with them because "OH MY GOD..they are "non-physicians". You guys are too full of yourselves.
Well...I give up...you win! I'll just go back to rubbing patients backs and fetching you all coffee in the hospital and everyone will be happy. Oh wait...I can't do that...I see 125 kids a week and make sure they have their immunizations and school physicals and treat their little problems...They will call me "Dr Patti" and I will correct them because its what I always do (good for me as one previous reply told me)and btw..all NPs don't want independent practice, myself included. I like my collaborative practice with my physician preceptor and we work great together.
And NO..I don't think physicians are "hateful" because they are against independent practice. But I do think it's hateful to say that I don't have my patients best interests at heart. I am board certified in pediatrics ( I know, I know..not by a medical board, but by our nursing board) and I am good at what I do (again good for me).
I see I am fighting a losing battle here...so good luck to all of you. Who knows...maybe one day we can all get along!
 
dfk said:
i don't think the answer should be keep nurses at bedside just because there's a shortage. IMO, bedside sucks. it was my avenue to move on.
some people like it.

i also see this as being similar to the FP shortage.
why do MDs decided to specialize? i'm sure it's in part
because they don't want those other jobs (FP/IM/etc...),
as well as a better lifestyle, honed expertise, and so on.

this whole thing is almost cyclic.
you have nurses covering physician shortage, leaving nurses short.
if nurses stopped covering, maybe the nursing shortage would lessen.
this in turn would leave the physicians even worse off.
is there one right answer?
no.
damned if i knew what it was too.

there's just not enough clinicians all around.
period.
Click to expand...

there was a nurse shortage prior to nurses covering for docs. It has been made worse since then.
 
It's amusing to see how everyone is jumping saying NP/DNPs are helpful blah blah blah. In the last 4 weeks I had 3 admissions of psychiatric patients that have been seeing a DNP for years now and are on multiple psych drugs. These are not your simple cheap no side effect drugs either.

The patients' argument to me on why they aren't following up with a psychiatrist to tailor the correct meds despite their mental illness and access of care was that they thought they were seeing a doctor. The three were seeing two different DNPs. Worse, 1 patient had an absolutely wrong diagnosis and the drugs he was taking should not have been prescribed. I tried not get pissed when the patient complained how he was having difficulty purchasing them.

So while I do acknowledge that this experience is n=3 for 2 DNPs, at this point I recognize that DNP is misleading. :thumbdown:
 
mig26x said:
patticnp, you should go to allnurses.com and see how they talk about PHYSICIANS, this is little leagues compare to that forum.

Second, what are nurses going to do with the nurse shortage in the USA, which is worse than the physician shortage, if nurses continue to go out and cover the physician shortage?

you guys have a shortage of your own even worse than we do but i dont see anyone doing something about it, and this DNP thing is going to make becoming a nurse even more difficult becaues it will require more years of education, something that I have seen in allnurses as the number one complaint for nurses not going for the DNP.
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I think you need to put the idea in the CNA's mind.:smuggrin:
 
PattiCPNP said:
For as smart as you guys claim to be...you sure are missing the point here! Just because nurse practitioners one day will be required to have a doctorate degree doesn't mean we will be "doctors". And by that I mean "doctor" the term which you all are so territorial of. I believe (and I'm just a nurse so forgive my ignorance) that you are PHYSICIANS, right? Just because somebody's title is "Dr. whatever", doesn't mean they are medical doctors. Audiologists, speech pathologists, physical therapists, pharmacists, nurse practitioners...ALL can have doctorate degrees in their fields...doesn't make them PHYSICIANS! Only you "medical doctors" can lay claim to that! More importantly, believe it or not....all these other professions....WE DON'T WANT TO BE "YOU"! We are not sad that we didn't "go on" to medical school...we don't feel like we settled for second best. Believe it or not, I am very happy being what I am. I do not EVER let a patient or parent ( I do primary care pediatrics) believe for ONE SECOND that I am a physician. I can't speak for the entire NP population, but for the hundreds that I do know...we are very satisfied being what we are. I would never misrepresent myself in front of a patient.
I would really be interested in hearing what the real issue is here? Certainly you are not threatened by NPs or PAs...do you not believe that there are plenty of sick people to go around? Do you want to come to the community health center where I work and see indigent, Medicaid patients all day? Remember that's why NPs exist in the first place because rural areas couldn't recruit "doctors" to see the indigent pediatric populations there! Now before you all go off on that one, just how many of you are going into Primary care????
Maybe I have been in health care too long...26 years, 10 as NP. Maybe I am spoiled because the physicians that I work with respect me as a professional and value my contribution to our team. Maybe back when I was in the hospital as a new nurse, physicians weren't so overworked and frustrated by HMOs and low reimbursement rates. But I don't ever recall, EVER, and I have worked all across the country, the animosity towards nursing in particular that I have encountered on this message board. Last time I checked we all shared a common goal and that was quality patient care with positive outcomes. Nurses respected physicians and visa versa.
I found this message board because my daughter is pre-vet and we were looking for help with applications etc. My only consolation is that all you pre-meds don't like pre-vets either.....so maybe it's not us!
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If you don't want to be a medical doctor, why do you want to do the doctor's job? These tasks are related to the doctors' tasks. They are not nursing tasks.
 
dfk said:
and your point?
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that by nurses covering for doctors in rural areas they have made the nurse shortage worse but they continue with the idea of covering for doctors. and then they want us to believe that the DNP is not so they can be doctors, LOL, or at least feel like one.
 
Faebinder said:
It's amusing to see how everyone is jumping saying NP/DNPs are helpful blah blah blah. In the last 4 weeks I had 3 admissions of psychiatric patients that have been seeing a DNP for years now and are on multiple psych drugs. These are not your simple cheap no side effect drugs either.

The patients' argument to me on why they aren't following up with a psychiatrist to tailor the correct meds despite their mental illness and access of care was that they thought they were seeing a doctor. The three were seeing two different DNPs. Worse, 1 patient had an absolutely wrong diagnosis and the drugs he was taking should not have been prescribed. I tried not get pissed when the patient complained how he was having difficulty purchasing them.

So while I do acknowledge that this experience is n=3 for 2 DNPs, at this point I recognize that DNP is misleading. :thumbdown:
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I am confused, I thought the DNP programs just started. Now they have been treating patients for years?
 
I beileve they have been around since 2005
 
Faebinder said:
It's amusing to see how everyone is jumping saying NP/DNPs are helpful blah blah blah. In the last 4 weeks I had 3 admissions of psychiatric patients that have been seeing a DNP for years now and are on multiple psych drugs. These are not your simple cheap no side effect drugs either.

The patients' argument to me on why they aren't following up with a psychiatrist to tailor the correct meds despite their mental illness and access of care was that they thought they were seeing a doctor. The three were seeing two different DNPs. Worse, 1 patient had an absolutely wrong diagnosis and the drugs he was taking should not have been prescribed. I tried not get pissed when the patient complained how he was having difficulty purchasing them.

So while I do acknowledge that this experience is n=3 for 2 DNPs, at this point I recognize that DNP is misleading. :thumbdown:
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Well, anecdotal evidence may be fun, but unfortunately doesn't really hold water. Statistics, anyone.

In my experience, pretty much EVERYONE in a psych hospital has been seeing a psychiatrist/psychologist/RN/counselor etc. So does that mean all these other health professionals are also wrong/bad diagnosticians/etc.?

If you want to slam DNPs, at least have better evidence.

Oldiebutgoodie
 
oldiebutgoodie said:
Well, anecdotal evidence may be fun, but unfortunately doesn't really hold water. Statistics, anyone.

In my experience, pretty much EVERYONE in a psych hospital has been seeing a psychiatrist/psychologist/RN/counselor etc. So does that mean all these other health professionals are also wrong/bad diagnosticians/etc.?

If you want to slam DNPs, at least have better evidence.

Oldiebutgoodie
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I think that that's part of the problem-- there's really no good, reliable statistical evidence that nurse practitioner's can independently provide care that is equivalent or superior to an attending physician, particularly in complicated cases like an inpatient setting. The burden of proof is not on the physician's groups, it is on the nurses-- it's like with a new drug... you don't give it to a bunch of patients and wait to see if it's safe, you do a ton of research and prove it's safe before you set it loose on the patient population.

Everyone in a psych hospital has been seeing a psychiatrist/psychologist/RN/counselor/etc. because they are all part of the healthcare team. However, there is also something to be said about the massive shortage of psychiatrists. Do I think the solution is for nurse practitioner's to pick up the slack and to give prescribing rights to psychologists? No. The more I learn about medicine and pharmacology, the more I believe that this is not the answer, particularly in the more involved cases (i.e. those with complicated medical histories). I think we should train more psychiatrists by increasing the number of medical school seats.
 
silas2642 said:
I think we should train more psychiatrists by increasing the number of medical school seats.
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1. Allowing more people in does not mean they will fill that "need", they will most likely be distributed in a similar way to the people before them, which increases the # of people going for other positions, and ultimately defeats the purpose of expansion.*

2. Not all N is created equal. An increase of N may introduce a more heterogeneous population, which introduces more variability into the process. More is not always better.

*This is a common issue when trying to address a need by increasing the N, but not adjusting other variables that arguably have a greater influence on a person's choice to pursue a certain path.

Some people definite insanity as doing the same thing over and over again and expecting a different result. Increasing the N without addressing the other variables will simply perpetuate the problem instead of address it.

As for increasing mid-level participation and allowing psychologists to prescribe.....those are both reactions to an unmet need, which are actually independent of the equation. N is different, the parameters are different, though the final goal is the same: to meed the need. Failure to fix one model made necessary alternative models. I don't want to take this off track, but I thought it an appropriate place to point this out.
 
Tired said:
Congratulations on making the most demeaning comments about nurses in this thread. As many problems as I have had with nurses, I have never suggested that all they do is give back rubs and bring me coffee. I can disagree with RNs, even dislike them personally, while still respecting their skills and profession. How come you can't?

I guess that's why you guys have "NP" plastered on your coats and nametags, but never put the "RN" title.
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:thumbup:
 
silas2642 said:
Everyone in a psych hospital has been seeing a psychiatrist/psychologist/RN/counselor/etc. because they are all part of the healthcare team. However, there is also something to be said about the massive shortage of psychiatrists. Do I think the solution is for nurse practitioner's to pick up the slack and to give prescribing rights to psychologists? No. The more I learn about medicine and pharmacology, the more I believe that this is not the answer, particularly in the more involved cases (i.e. those with complicated medical histories). I think we should train more psychiatrists by increasing the number of medical school seats.
Click to expand...

Well, the midlevel model should be that PAs and NPs consult with their SPs or attendings to discuss the treatment of those with more complicated medical histories.

Also, correct me if I'm wrong, but isn't psychiatry looked down upon in the medical school culture? Perhaps those interested in psychiatry are discouraged by others from entering it? Just wondering.

Oldiebutgoodie
 
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