Should I fear the growing number of NPs?

[Prncssbuttercup]

SBB you are clearly taking it to the extreme. Jagger is stating that NPs should not be allowed independent practice rights; not that they are all incompetant and should be done away with. He is supporting hiring PAs over NPs because unlike NPs, PAs are not fighting to encroach upon the duties of physicians. Furthermore, PAs take the brunt of the bitchwork because they are working direclty under a physicians license. They get paid less than NPs because they assume no responsibility, if they mess up the lawsuit goes toward the physician's malpractice.

IMO, the current model of NPs is perfectly fine, working alongside albeit under the supervision of doctors. When I go to the doctor I expect to see an MD/DO, not an NP in a white coat parading as one. I think that Jagger as well as any other future physician has every right to take offense when someone who has had less schooling and less training in a field attempts to undercut them in the job they were trained to do and claims they are better at it with studies funded by their own organization.

Did you read his posts? In several instances he agrees with and cites his own experience of NPs being incompetent. The vehement disdain for them comes through loud and clear. Again, I still don't see how they are 'parading around as a doctor', I know when I see a person if they're an NP or an MD/DO. Not a single NP has ever tried to pretend they were a Dr...

Jaggerplate, since you doubted my comment about midwives and hand washing, clearly you've never read this:

http://www.experiment-resources.com/semmelweis-germ-theory.html

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Members don't see this ad.

 

[DbDan]

Did you read his posts? In several instances he agrees with and cites his own experience of NPs being incompetent. The vehement disdain for them comes through loud and clear. Again, I still don't see how they are 'parading around as a doctor', I know when I see a person if they're an NP or an MD/DO. Not a single NP has ever tried to pretend they were a Dr...

Jaggerplate, since you doubted my comment about midwives and hand washing, clearly you've never read this:

http://www.experiment-resources.com/semmelweis-germ-theory.html

Yes, he has very strong feelings toward for them due to their unqualified encroachment into independent practice of medicine. Just like any other midlevel, they have their place in the field of medicine. Unless he says otherwise somewhere explicitly I have never seen Jagger advocate the abolishment of the NP degree as a whole.

 

[JaggerPlate]

Did you read his posts? In several instances he agrees with and cites his own experience of NPs being incompetent. The vehement disdain for them comes through loud and clear. Again, I still don't see how they are 'parading around as a doctor', I know when I see a person if they're an NP or an MD/DO. Not a single NP has ever tried to pretend they were a Dr...

Jaggerplate, since you doubted my comment about midwives and hand washing, clearly you've never read this:

http://www.experiment-resources.com/semmelweis-germ-theory.html

Listen to what Dan is saying ... It sums up how I feel. Additionally, I don't think NPs are totally incompetent (though PAs are far better trained to practice medicine), but I don't think they are anywhere near the level of a pc physician, which is what they claim and how they want to practice.

Additionally, I didn't refute your hand washing claim, it's just irrelevant, and in the same vein as my barber comment. Without barbers, surgery could be very different today, but I'm not advocating for super cuts surgical rights because of it.

 

[JaggerPlate]

Runner,

I'm posting this from a mobile device, so I can't go into too much detail, but ...

1. These thoughts about MD vs DO are very outdated

2. Both are bc physicians and physicians taking jobs or spots from each other is a totally different discussion for a different time

3. You didn't do your research here ... Omm has been written up and proven effective for issues like lower back pain in journals like the new England journal of medicine and the journal of ob/gyn

4. This argument is completely unrelated to the point at hand and really weakens what you're arguing for. It's off topic, unrelated, and makes it look like you have no real evidence or proof so you're resorting to cheap straw men and ad hominem arguments.

Altogether, I fail to see how bias or issues between the MD and DO world is anything besides a potentially interesting, but mainly misunderstood issue from your perspective here. Can you explain how MD and DO tension, expansion of DO schools, or omm evidence relates to NPs invading medicine, because thats what were discussing??

 

[JaggerPlate]

Runner,

I just read through your DO rant again and I must say that you are tragically misinformed on even some of the most basic principles of health university tax status, residency training, standardized testing, residency accreditation, etc.

I know you were trying to make a point or state what you've heard from others, but I have a hard time even discussing the issue with someone that appears to be so greatly misinformed.

Additionally, being so impressionable toward these types of anecdotal comments doesn't make me feel any better about your opinions of NPs which, as you stated, come from what you've been told and seen.

 

[Prncssbuttercup]

Jagger so what is the solution to the problem? It doesn't matter whether an NP practices under an MD/DO or not. Your issue seems to be more with the training they have or don't have. A paramedic is under the license of a physician, but they can do far more than any RN with only a 2yr education. In many cases they can do more than an NP can do because it is outside the scope of practice for the NP. For reference, my NP friend who is in psych can't prescribe antibiotics or pain meds. A medic can dose and administer pain meds as well as other drugs in the scope of their practice.... You want them to be under the umbrella, but I think if you were the hiring manager for a clinic you'd be biased toward PAs for any and all mid-level positions. So clearly it isn't enough. As I said before, you want this to change, you're vehement about it, go do something about it! This forum isn't the place to get it done...

 

[Dr Oops]

I didn't say I believed them, I said that your arguments against NP's sound exactly like many of the rants I've heard from MD's towards DO's. Clearly I do NOT believe them, otherwise I wouldn't be seeking to apply DO. You are just trying to evade the discussion.

I am not an impressionable person, just fyi. I was a mechanical engineer for years prior to deciding to go back to medical school and my mind runs solely on logic. Of course you do not know me personally, so you would not know this to be true.

The difference is that DO schools, in order to be considered equal, match the curriculum of allopathic schools. The goto 4 years of med school, take the same classes, then they have to Step 1 2 (of which they can also take the usmles), then they have to goto residency (DOs can do acgme residencies), then they may have to do a fellowship.

Where as when the nursing organizations want equality they goto the legislature instead of getting the education. I would have much less of problem with them if they wanted to claim equivalence and through an actual education.

They create a fluff doctorate progam in order to fool patients and get people to call them doctor (google the curriculum of the DNP), and use poorly done studies to say "hey, no one died while we were taking care of these already diagnosed and managed patients, so we are the same!"

 

[Dr Oops]

Jagger so what is the solution to the problem? It doesn't matter whether an NP practices under an MD/DO or not. Your issue seems to be more with the training they have or don't have. A paramedic is under the license of a physician, but they can do far more than any RN with only a 2yr education. In many cases they can do more than an NP can do because it is outside the scope of practice for the NP. For reference, my NP friend who is in psych can't prescribe antibiotics or pain meds. A medic can dose and administer pain meds as well as other drugs in the scope of their practice.... You want them to be under the umbrella, but I think if you were the hiring manager for a clinic you'd be biased toward PAs for any and all mid-level positions. So clearly it isn't enough. As I said before, you want this to change, you're vehement about it, go do something about it! This forum isn't the place to get it done...

I dont get it your saying hes biased because he would rather hire a PA than an NP and then go on to say how NPs arent as good as paramedics.

Why would he hire them if they are worse then another practitioner, and even if they were equivalent, why would he hire the person who thinks their training is superior to his own (a very dangerous situation)?

educating people about whats going on is just as much a part of the battle as calling your representatives etc.

 

[JaggerPlate]

I didn't say I believed them, I said that your arguments against NP's sound exactly like many of the rants I've heard from MD's towards DO's. Clearly I do NOT believe them, otherwise I wouldn't be seeking to apply DO. You are just trying to evade the discussion.

I am not an impressionable person, just fyi. I was a mechanical engineer for years prior to deciding to go back to medical school and my mind runs solely on logic. Of course you do not know me personally, so you would not know this to be true.

How am I trying to evade the discussion? The discussion is regarding NPs and their encroachment into the practice of independent medicine. I asked you to explain to me how quasi-similar, old issues between DOs and MDs relate?

Since you are a logical person, let's explore a logical fallacy here:

Ad hominem:

JaggerPlate makes arguments against NPs -> Runner disagrees -> Runner draws a comparison between my personal feelings against NPs and compares it with issues between DO/MDs -> Runner asserts that I fail to see the irony of this situation (which isn't even valid, just fyi) -> Runner concludes that because I cannot see the similarities inherent in this situation, I must not understand/comprehend the issue at hand, ergo I'm wrong, I'm 'evading' the subject by not addressing these issues in a thread discussing NPs, and I don't know what I'm talking about when it comes to NPs, advanced practice nurses, etc.

Logical fallacy, and it really weakens your point.

Again, if you can explain to me how this actually relates to the discussion of NP encroachment, then I will address it. However, it doesn't, and it's simply an attempt to 'fire back' at me, get a dog in the fight, etc.

Jagger so what is the solution to the problem? It doesn't matter whether an NP practices under an MD/DO or not. Your issue seems to be more with the training they have or don't have. A paramedic is under the license of a physician, but they can do far more than any RN with only a 2yr education. In many cases they can do more than an NP can do because it is outside the scope of practice for the NP. For reference, my NP friend who is in psych can't prescribe antibiotics or pain meds. A medic can dose and administer pain meds as well as other drugs in the scope of their practice.... You want them to be under the umbrella, but I think if you were the hiring manager for a clinic you'd be biased toward PAs for any and all mid-level positions. So clearly it isn't enough. As I said before, you want this to change, you're vehement about it, go do something about it! This forum isn't the place to get it done...

-I don't have an issue with NPs working with a physician in a practice. However, as I've stated numerous times, I feel PAs are simply better trained to practice medicine

-Yes, if I were in charge of hiring mid-levels, I would hire PAs. I think they are better trained, why would I not hire them?

-I'm not sure what 'change' you're referring to (actually, your arguments are hard to follow in general), but I've done much more to battle this issue than simply bitch on SDN about it. However, the 'change' I want to see is the stop of mid-level nurses encroaching in independent care in a VARIETY of medical specialties.

-As far as the 'solution' to a perceived access, primary care, etc, shortage ...

1. It's a complex problem, so I don't think I can sit here and type out a one sentence solution on SDN

2. However, I know allowing NPs to practice cosmetic dermatology in large cities under some sort of guise that they want to 'serve the underserved,' provide access to rural care, close the primary care shortage, etc., isn't going to solve a damn thing.

Look at your NP friend for example. If I'm to believe the NP mantra, a big reason why they feel they are 'necessary' (gag) in our health service system is because we need to fill gaps in primary care fields, increase health service access, and serve in rural areas.

1. She's in psych - which although is sometimes categorized as a type of primary care, isn't the type of service these nurses claim they want to practice or any sort of gap they want to fill.

2. Where does she practice? Is she in a rural area? Practice in a prison system? Does she extend psych services to people who generally want these services, but didn't have access to a BC psychiatrist beforehand?

Also, my wife and I do not agree on everything. You will actually find my position on NP's to be much more conservative than hers, so don't just assume everything she has said is everything I would have said.

Well, when she logs on to your account and replies to me at your request or because you explained the situation to her, I'm probably going to lump you guys together a bit.

 

[cliffhuxtableDO]

Runner, take your wife out of the equation. How do YOU REALLY feel about an NP being called "doctor" in a clinical setting and potentially putting you out of business with a stack of 6 figure loans?

 

[cliffhuxtableDO]

Considering you're nowhere close to applying to residency (neither am I), it doesn't much matter what you're interested in at this point. If you end up with a less than desirable board score you'll be in primary care, regardless of your interests.

The point of this debate is basically to protect what physicians have now, so that when we're fortunate enough to be physicians we can still make a living, pay off our debt, and practice medicine without worrying about someone who has no business operating on the same level as a physician competing for patients and resources.

 

[cliffhuxtableDO]

And when is it ever in the better interest of a patient to see a practitioner with less training/knowledge/know-how?

 

[Prncssbuttercup]

Jagger my point is that even if an NP was talented/good, you wouldn't hire them because they are an NP. And that paramedics do more with less training, but you're not bitching about their training level.

Hate to break this to you all, but the average stats on a PA don't exactly break the mold either. I easily beat the top score admitted at Duke when I took the GRE. That was their top score, not the average, I blew the average away by 300 or more points... That was pretty consistent across the board for all PA schools I looked at (private mainly). The GRE is a general knowledge test and the ability to do algebra is not the ability to do advanced calc. I wonder how many of these nurses with low scores actually studied or prepared for the test? I'm doubtful it was the best they could do. For some sure, I'll admit its possible. They may have seen it as a formality, and didn't give much thought or effort.

 

[cliffhuxtableDO]

The only tests that should matter in practicing medicine independently are the USMLE/COMLEX steps.

 

[cliffhuxtableDO]

I won't have a less than desirable board score. But yes, I get your point.

Get into school first

 

[Prncssbuttercup]

Cliff, I agree with both of your posts

Runner, I agree with the rural NP to a point. What if they mess someone's meds up, etc... Bad is worse than none and competent by whose standards? About GRE scores, not sure the national average, I looked at 50 schools (I have a rather nice spreadsheet) and the average wasn't 1100 for most of them... It was more like 950-1000, maybe 1050...

 

[Prncssbuttercup]

I'm not saying its necessarily bad either, just saying what one judges to be competent, may not be in my eyes (or yours, and def not in jaggers)

Yes, the PA GRE isn't the best, that's why I brought it up...

 

[JaggerPlate]

Jagger my point is that even if an NP was talented/good, you wouldn't hire them because they are an NP. And that paramedics do more with less training, but you're not bitching about their training level.

I still don't see where you're going with this ... I think PAs are trained better, period. I'd hire a PA above an NP every time because I think their medical training is far superior and it's what's better for the patient.

Let me see if I can reverse the scenario and put some perspective on it:

You're hiring for a 'primary care group' and get two applicants - one is an 'eh' MD who didn't really blow you away, and the other is the smartest, brightest, best Chiropractor (DC) you've ever met WHO considers himself a primary care provider.

Who are you going to hire? My guess is the physician. Why so? Because even though he may be a sufficient candidate at best, you know he's gone through a LCME accredited medical school, you know he passed USMLE, you know he completed a residency, and you know he's BC/BE in FM, IM, etc. The same can't be said about the Chiropractor who trained in a different, less regulated, less standardized, non-medical model.

Hiring the physician 10 times out of 10 doesn't make you some Chiropractor bigot. It just means that you feel the physician is a safer, more responsible choice so you hire them.

Hate to break this to you all, but the average stats on a PA don't exactly break the mold either. I easily beat the top score admitted at Duke when I took the GRE. That was their top score, not the average, I blew the average away by 300 or more points... That was pretty consistent across the board for all PA schools I looked at (private mainly). The GRE is a general knowledge test and the ability to do algebra is not the ability to do advanced calc. I wonder how many of these nurses with low scores actually studied or prepared for the test? I'm doubtful it was the best they could do. For some sure, I'll admit its possible. They may have seen it as a formality, and didn't give much thought or effort.

I would ask you what the average GRE score is for a DNP program, but then I remembered that it's not required. Again, another point for the PAs.

Listen, I know you're pro NP, you think I'm being blindly biased, stubborn, etc, but I've honestly dealt with both models on a decent number of occasions, I know that both can play a role in the system, but I support the PA model not ONLY because their education is standardized, based upon DO/MD curriculum, etc, but also because of they want to work within the model, not practice independently.

 

[Prncssbuttercup]

I'll give you standardization... That is important, but I still think you're jaded...

 

[Charles_Carmichael]

I'll say it again, there are no well-designed studies suggesting that independent NPs/DNPs provide care at a level equivalent to that of physicians. Not only that, as my earlier post indicated, medical students gain a far superior basic science training and receive several times as many clinical hours of training by the end of M3 than any NP/DNP program in the US offers. Do you think it's a good idea for M4s to practice independently? If not, then it doesn't make sense to keep increasing the scope of practice for nursing midlevels when they receive a fraction of the training.

The argument that having any provider is better than having no provider is also a somewhat flawed argument. First of all, intervention by incompetent providers can, in some (many?) instances, do more harm than doing nothing. Second of all, reports don't seem to show that NPs/DNPs are tending to aggregate in the underserved areas to serve those populations. They tend to practice in cities that already have a high concentration of physicians/providers, just like physicians do.

Also, the argument that it's okay for NPs/DNPs to be independent as long as they stick to primary care is flawed. Primary care requires such a huge breadth and depth of knowledge that it would actually make more sense for NPs/DNPs to gain independence in specialties, where the focus is much narrower. That brings me to my next point: NPs/DNPs aren't filling in the primary care gap! Recent reports suggest that the majority of NPs/DNPs are practicing in specialties that pay significantly more than primary care does. There are also many "nursing residencies" rolleyes popping up in lucrative specialties like dermatology, cardiology, etc. These "residencies" basically last several weeks to months and will allow NPs/DNPs to say that they're "board certified" in derm (for example).

So, some of the arguments that the pro-NP/DNP people have been bringing up don't have much evidence behind them. Online/part-time training with very few basic science courses + 500 clinical hours of training =/= medical school + residency. It's not physicians who should be worried about this (we'll continue to be the gold standard of delivery of medical care); it's the patients that need to be worried.

 

[cliffhuxtableDO]

But that's just not true. My wife has a B.S. in Biology, plus additional pre-med prerequisites that she had to take to get into nursing school (400 level Human A&P's because her "animal" A&P's from her Bio degree "didn't count"). Then, after her B.S. in Bio, she earned her RN and then her MSN. Her Bio GPA is higher than many I have seen on this forum from DO pre-meds, comfortable above 3.0 with a very strong upward trend, and her GPA for her Master's was very high (but I guess that's nursing coursework and so "doesn't count"). (In retrospect, she probably should have gone DO, but no one really knew about DO schools back then.)

In regards to clinical hours, she did well over 1000 hours of clinical work to get her MSN in Nurse Midwifery, closer to 1500 hours, really. So I am a little confused as to where you are getting your information?? Also, a GRE was definitely required for her MSN program, so I also have not at all heard of these MSN programs that do not require GRE's.

This is LAUGHABLE. You're comparing undergrad bio courses to medical school?!

Oh mannn 1500 hours!!! That's hardly a tenth of a residency.

 

[Dr Oops]

I'll give you standardization... That is important, but I still think you're jaded...

a fine line between jaded and informed i suppose.

But when u get a bit into school, you will see. Anybody who claims they are better or even just as knowledgable, as physicians while only going to school for 2 years, is full of it.

You will have years of harder schooling and realize you still know nothing and it will scare the crap out of you that someone withless than half the years training (and less than a quarter of the clinical hours) is practicing independently.

 

[cliffhuxtableDO]

You're distracting from the argument at hand by putting words in my mouth. Of course I'm not comparing undergrad bio courses to medical school. But she's not practicing as a doctor, now is she? She's practicing as a midwife. And as a midwife, she has a very narrow scope of practice that is nowhere near the scope of practice of an OB. Go educated yourself about what a CNM actually does, and then we can talk. Until then, you're just talking out your ass.

Now to the original post that I was replying to, the first charge was that MSN's don't complete science coursework. Clearly, they do. My wife has the undergraduate degree that many MD/DO's have, including yourself. Then, on top of that, she also has her RN coursework, and then her MSN coursework. The second charge was that MSN's only get 500 hours of clinical time. Clearly, they receive much more than that. The charges are false.

Sure man, whatever you say...

 

[JaggerPlate]

I'll give you standardization... That is important, but I still think you're jaded...

Huh? I'm not even sure what you're trying to say here, but I can't even express how little correlation I personally see between GRE and any sort of competence in health science school or clinical practice. Have them all take the MCAT, then we'll standardize it (also, this isn't coming from someone who dismissed standardized testing - it's very important, when focused and appropriate, but I just don't see the GRE correlation as relevant, especially when NP/DNP schools don't require it).

Like someone else said ... informed, not jaded. If I were jaded, I'd be one of the people trying to specialize my FACE off to avoid any sort of NP interaction (which is a mistake regardless).

But that's just not true. My wife has a B.S. in Biology, plus additional pre-med prerequisites that she had to take to get into nursing school (400 level Human A&P's because her "animal" A&P's from her Bio degree "didn't count"). Then, after her B.S. in Bio, she earned her RN and then her MSN. Her Bio GPA is higher than many I have seen on this forum from DO pre-meds, comfortable above 3.0 with a very strong upward trend, and her GPA for her Master's was very high (but I guess that's nursing coursework and so "doesn't count"). (In retrospect, she probably should have gone DO, but no one really knew about DO schools back then.)

In regards to clinical hours, she did well over 1000 hours of clinical work to get her MSN in Nurse Midwifery, closer to 1500 hours, really. So I am a little confused as to where you are getting your information?? Also, a GRE was definitely required for her MSN program, so I also have not at all heard of these MSN programs that do not require GRE's.

Just for some perspective, the average residency is going to run between 15,000 - 18,000 hours, and this, to my knowledge, doesn't even take clinical rotation hours into account.

 

[cliffhuxtableDO]

So Cliff, noticed you were in NC. NC has some great public med schools, man. With all of those great NC public med schools, I couldn't help but wonder what made you decide to go DO? Your stats holding you back?

Talk about derailing the thread... if you'd like to know my story, and not be a jackass, you can feel free to PM me.

 

[Charles_Carmichael]

And the scope of practice of a CNM is proportionate to the clinical hours required. Do you know what the scope of practice of a CNM is, compared to an OB?

The problem with that view is that, since the scope of practice (and knowledge due to lack of extensive training) is so limited, how will a CNM differentiate between an uncomplicated birth and a complicated one?

If you've never learnt about or seen something before, how will you be able to diagnose it in time? That's the problem. Even as a premed, it's been beat into my head by physicians I've shadowed, interacted with, etc, that many problems (whether complex or not) present with "simple" symptoms. It's the difference in training between physicians and midlevels that'll allow physicians to separate the zebras from the horses. Midlevels, on the other hand, will likely only think of horses until further complications reveal a zebra. By that time, the risk of irreversible damage would increase (whether significantly or not, I don't know).

(I hope those last couple of sentences made sense. I can clarify further if I was unclear)

Edit: Btw, clinical hours as a nurse don't replace clinical hours as a physician. I'd imagine there's a pretty huge difference between what a nurse-in-training focuses on during their clinical training and what a physician-in-training focuses on during their clinical training. And APNs are essentially practicing medicine but calling it "advanced nursing." So, those hours are not interchangeable. Several nurse-turned-MD/DO and NP-turned-MD/DO posters have pointed out the same thing as well. You can search for their posts in the Clinicians forum of SDN if you're interested.

 

[JaggerPlate]

So Cliff, noticed you were in NC. NC has some great public med schools, man. With all of those great NC public med schools, I couldn't help but wonder what made you decide to go DO? Your stats holding you back?

Wow, totally uncalled for.

Runner, if you're so sure in your convictions, I don't know why you keep resorting to this type of child's play. Stick with the facts.

 

[Charles_Carmichael]

Have you ever seen a birth up close and personal from the clinical side of things? Just curious. It's absolutely phenomenal.

Routine birth with a low risk patient (as determined by prior medical record) is not rocket science. That's why CNM's are fully capable of attending low risk births. When an otherwise low risk birth becomes high risk, that's easier to identify than you would imagine. You have many data generators spitting data at you constantly during the birth. You have the fetal heart rate monitor, the toco monitor, the mother herself, the RN who is doing periodic assessments of urine output, vitals, and cervical checks. There are graphs and algorithms that you follow- procedures and protocols. Of course, it's more complicated than that, and that's why CNM's have to go to school for 2 years post-bacc to learn how to do it and obviously you integrate your own clinical experience, critical thinking skills and expertise into developing a management plan. But, like I said, low risk birth is not rocket science. In the UK, midwives manage the vast, vast majority of vaginal births and they don't even have master's degrees- they just have a bachelor's AND those midwives routinely do homebirths.

The scope of a CNM is a very narrow scope. That narrow scope is why CNM's can be so good at what they do. Obviously you are always going to have those odd zebras that come through every now and then, but it's rare. One I can think of right now is amniotic fluid embolism. That's some scary ****. That's the type of thing that keeps you awake at night. But it's rare. Would a CNM know what to do? She'd know where to start. Would an MD/DO be a better attending at that birth? Sure. But how often do AFE happen? 1 in 50,000 vaginal births?

You will find that birth with a low risk woman is extremely low risk procedure. It's a normal, natural, physiological process. Women have been having babies for thousands and thousands of years- attended by midwives. You really can't compare midwifery to any of the other APRN fields. It really is that different. It's night and day, because 95% of the time, with a previously low risk woman, even if you didn't touch the woman at all, but just assisted the baby in it's exit out of the womb, that baby would come out perfectly fine on it's own. The baby would be naturally stimulated after the birth, the mother's uterus would clamp down afterwards, and it would be one happy party. It's a natural physiological process. That's the way evolution designed for it to work.

Fair enough. I don't know enough about CNMs and OB/Gyn to make serious comments on that issue so I'll let others more experienced in that area to comment.

I am, however, very familiar with NPs/DNPs and I stand by the rest of my post.

 

[cliffhuxtableDO]

I didn't intentionally do anything. The way I interpreted your poorly written babble was the first and natural response. Never did I bring your personal life or your career goals into the argument in a condescending manner. Get a life. Go study for the MCAT.

 

[crazynate]

But she's not practicing as a doctor, now is she? She's practicing as a midwife.

isn't that the point of this whole argument? The CNM is fine the way it is but when they try to cross the line to become independent medical caregivers, their education pales in comparison to a MD/DO.

 

[Prncssbuttercup]

Hi can we get back on track? Lets keep this all above the board. Insulting one another doesn't get the discussion very far...

Jagger, my point isn't that they should take standardized tests, it's that they should have a standardized curriculum across the board. There should be some kind of ability to prove that everyone is getting the same information. The PAs have to take a test at the end to prove their knowledge, so should NPs. I know they had to take the NCLEX to become RNs but what is the regulatory test to be an NP or APRN? Not sure, couldn't find anything on the NCLEX website...

The reason I say jaded is because you're angry-ish about it, it's not just something you feel strongly about, you're vehement about it. There's a difference... It's like you feel threatened by them. Which, given that you clearly have stated how inferior you feel they are, surprises me...

 

[cliffhuxtableDO]

Hi can we get back on track? Lets keep this all above the board. Insulting one another doesn't get the discussion very far...

Jagger, my point isn't that they should take standardized tests, it's that they should have a standardized curriculum across the board. There should be some kind of ability to prove that everyone is getting the same information. The PAs have to take a test at the end to prove their knowledge, so should NPs. I know they had to take the NCLEX to become RNs but what is the regulatory test to be an NP or APRN? Not sure, couldn't find anything on the NCLEX website...

The reason I say jaded is because you're angry-ish about it, it's not just something you feel strongly about, you're vehement about it. There's a difference... It's like you feel threatened by them. Which, given that you clearly have stated how inferior you feel they are, surprises me...

That's exactly it!!!

 

[JaggerPlate]

Hi can we get back on track? Lets keep this all above the board. Insulting one another doesn't get the discussion very far...

Jagger, my point isn't that they should take standardized tests, it's that they should have a standardized curriculum across the board. There should be some kind of ability to prove that everyone is getting the same information. The PAs have to take a test at the end to prove their knowledge, so should NPs. I know they had to take the NCLEX to become RNs but what is the regulatory test to be an NP or APRN? Not sure, couldn't find anything on the NCLEX website...

The reason I say jaded is because you're angry-ish about it, it's not just something you feel strongly about, you're vehement about it. There's a difference... It's like you feel threatened by them. Which, given that you clearly have stated how inferior you feel they are, surprises me...

Patients are the ones who should feel threatened.

Furthermore, I agree there should be some sort of standardized testing ... it's pretty pathetic if there isn't some type of 'board' exam (which I naturally assume exists). However, even if there is, I highly, highly doubt it would be on the level of USMLE/COMLEX.

Like someone else posted earlier, a while back, a group of NPs took a watered down version of USMLE step III and over 50% failed. In comparison, this is a test 98% of medical students pass on the first try (with minimal effort compared to something like studying for Step I).

 

[Prncssbuttercup]

Since I have a better grasp of the I/II tests, I have to ask, in the III does it cover a specialty area or is it based on general knowledge? Reason I ask is that NPs are very limited in scope of practice, so if it isn't Gyn, FP, Psych, etc which they are trained for, they shouldn't be expected to know the information.

Like I said, I'm all for standards, I had to meet standards in order to graduate with my BS, it shouldn't be different for an MS and it certainly is needed for anyone in charge of someones health!!

 

[OzelloPiRat]

It's fluff work. I think it's great that some RN's can administer IV medications and interpret vital signs so efficiently, but that doesn't qualify them to be able to manage independently the care of a patient. You need a certain level of intelligence and education to manage those patients, and you don't gain that intelligence and critical thinking skills through being a floor RN.-The Runners Wife

Ok, I admit that I did not read past this statement. But you frigging pissed me off. You are a CNM. You obviously have NEVER been on the floor! What the heck do you think we do in the middle of the night when there are NO docs around and a pt codes? When the OB, or the CNM, leave and the neonate is unresponsive?
I guess we sit on our collective arses and call 9-1-1.
Take the nurse out of your CNM, you don't deserve it.

 

[JaggerPlate]

Since I have a better grasp of the I/II tests, I have to ask, in the III does it cover a specialty area or is it based on general knowledge? Reason I ask is that NPs are very limited in scope of practice, so if it isn't Gyn, FP, Psych, etc which they are trained for, they shouldn't be expected to know the information.

Like I said, I'm all for standards, I had to meet standards in order to graduate with my BS, it shouldn't be different for an MS and it certainly is needed for anyone in charge of someones health!!

It's required for a general license and a lot of residency programs need it done before you start, so no, it isn't like taking a test for certification with a specialty college.

Plus, even if it was, NPs can do everything a physician can + care about the patients more + cost less right??? They should be able to handle it no prob

 

[Prncssbuttercup]

I thought we discussed that they have limited scope and can only do FP/Gyn/Etc... ?? I did catch the sarcasm, don't worry. So it's general knowledge and I assume covers what you learned in clinicals? Since I don't know what a watered-down version would entail, I can't say. I kind of wonder how many lay people, or people like me* would pass/fail the version given to NPs or how we would compare.

People like me refers to people with more than a basic UG knowledge of medicine or anatomy, etc... Having worked in a clinical lab, and biotech for years, as well as being an EMT, I consider myself to not be a 'lay' person....

 

[Charles_Carmichael]

SBB2016, you continually seem to ignore important facts that myself and others have pointed. Why don't actually take a look at NP/DNP curricula and compare it to that of med school + residency? Why don't you try searching PubMed for well-designed studies comparing physicians and NPs/DNPs (I'll save you a lot of time: there aren't any)?

You keep arguing based on anecdotes and emotion rather than any actual evidence. Btw, the scope of practice for NPs/DNPs in several (many?) states is full-independence. That's not a narrow scope of practice.

The DNPs at Columbia (supposedly the cream-of-the-crop of the DNPs and groomed by Mary Mundinger herself) had a 50% failure rate on a watered-down version of the easiest Step exam to take even after the passing score was lowered. I believe Step III is taken during intern year and many residents don't study much, if at all, for it (or so I've been told). There's a saying that goes "Two months for Step I, two weeks for Step II, and bring a number 2 pencil for Step III." The interns have a near 100% pass rate btw. That alone speaks volumes regarding the lack of adequate training that NPs/DNPs get.

Edit: Every intern is required to take Step III. It's not reserved for specialties. It's a generalist exam. And primary care = generalist. You keep confusing that. Primary care = very broad scope of practice. Not narrow.

 

[JaggerPlate]

SBB2016, you continually seem to ignore important facts that myself and others have pointed. Why don't actually take a look at NP/DNP curricula and compare it to that of med school + residency? Why don't you try searching PubMed for well-designed studies comparing physicians and NPs/DNPs (I'll save you a lot of time: there aren't any)?

You keep arguing based on anecdotes and emotion rather than any actual evidence. Btw, the scope of practice for NPs/DNPs in several (many?) states is full-independence. That's not a narrow scope of practice.

The DNPs at Columbia (supposedly the cream-of-the-crop of the DNPs and groomed by Mary Mundinger herself) had a 50% failure rate on a watered-down version of the easiest Step exam to take even after the passing score was lowered. I believe Step III is taken during intern year and many residents don't study much, if at all, for it (or so I've been told). There's a saying that goes "Two months for Step I, two weeks for Step II, and bring a number 2 pencil for Step III." The interns have a near 100% pass rate btw. That alone speaks volumes regarding the lack of adequate training that NPs/DNPs get.

Edit: Every intern is required to take Step III. It's not reserved for specialties. It's a generalist exam. And primary care = generalist. You keep confusing that. Primary care = very broad scope of practice. Not narrow.

Knowing that Mary Mundinger's specially grown army is the group that failed it puts a smile on my face.

 

[Prncssbuttercup]

SBB2016, you continually seem to ignore important facts that myself and others have pointed. Why don't actually take a look at NP/DNP curricula and compare it to that of med school + residency? Why don't you try searching PubMed for well-designed studies comparing physicians and NPs/DNPs (I'll save you a lot of time: there aren't any)?

You keep arguing based on anecdotes and emotion rather than any actual evidence. Btw, the scope of practice for NPs/DNPs in several (many?) states is full-independence. That's not a narrow scope of practice.

The DNPs at Columbia (supposedly the cream-of-the-crop of the DNPs and groomed by Mary Mundinger herself) had a 50% failure rate on a watered-down version of the easiest Step exam to take even after the passing score was lowered. I believe Step III is taken during intern year and many residents don't study much, if at all, for it (or so I've been told). There's a saying that goes "Two months for Step I, two weeks for Step II, and bring a number 2 pencil for Step III." The interns have a near 100% pass rate btw. That alone speaks volumes regarding the lack of adequate training that NPs/DNPs get.

Edit: Every intern is required to take Step III. It's not reserved for specialties. It's a generalist exam. And primary care = generalist. You keep confusing that. Primary care = very broad scope of practice. Not narrow.

Where have I ignored this information? Did I not state two posts ago that yes their curriculum should be standardized as well as having a test to prove competency? I asked why Jagger felt an NP was inferior to a PA, never once NOT ONCE have I EVER said that an NP was as good as a Doc. Have you been paying attention? Did you confuse me with someone else?

In my state, my NP can only practice FP and Gyn, those are the things she is licensed to practice. Until recently, she could only do gyn because she wasn't 'trained' in FP, she had to do additional training. My psych friend, as I stated earlier (maybe you didn't see), isn't allowed to prescribe ABX because she's a psych APRN, and it ISN'T IN HER SCOPE OF PRACTICE, so I'd say that's pretty narrow. She can prescribe drugs for things she has training in. My general NP cannot prescribe psych drugs, it's out of her scope of practice. I fail to get where you get YOUR information, I get it straight from the NPs I am friends with. They know their work best, they know what they can/cannot do, and believe it or not, they can only work 'independently' in their scope of training, it is not a general free-for-all!

Do not sit and chastise me about 'confusing' things when you don't thoroughly read all the posts yourself! Because there is state-state variability, what I know to be a fact here, may be different elsewhere, that alone is an issue. So remove yourself from your tall soapy horse please because if Jagger and I can keep things relatively civil, you should be able to as well!

 

[Charles_Carmichael]

Where have I ignored this information? Did I not state two posts ago that yes their curriculum should be standardized as well as having a test to prove competency? I asked why Jagger felt an NP was inferior to a PA, never once NOT ONCE have I EVER said that an NP was as good as a Doc. Have you been paying attention? Did you confuse me with someone else?

In my state, my NP can only practice FP and Gyn, those are the things she is licensed to practice. Until recently, she could only do gyn because she wasn't 'trained' in FP, she had to do additional training. My psych friend, as I stated earlier (maybe you didn't see), isn't allowed to prescribe ABX because she's a psych APRN, and it ISN'T IN HER SCOPE OF PRACTICE, so I'd say that's pretty narrow. She can prescribe drugs for things she has training in. My general NP cannot prescribe psych drugs, it's out of her scope of practice. I fail to get where you get YOUR information, I get it straight from the NPs I am friends with. They know their work best, they know what they can/cannot do, and believe it or not, they can only work 'independently' in their scope of training, it is not a general free-for-all!

Do not sit and chastise me about 'confusing' things when you don't thoroughly read all the posts yourself! Because there is state-state variability, what I know to be a fact here, may be different elsewhere, that alone is an issue. So remove yourself from your tall soapy horse please because if Jagger and I can keep things relatively civil, you should be able to as well!

And I've also pointed out a while back why PAs are considered superior to NPs/DNPs: it's because the training a PA gets, both basic science-wise and clinical hours, is far superior to that of NPs/DNPs. You seemed to have missed or ignored it. However, I fail to see where I was uncivil. Did my "you seem to be confusing..." statement really offend you that much?

You're right about my comment regarding scope of practice though. I meant to say that primary care = broad knowledge base, not scope. So, that's my fault and I apologize for the error.

 

[Prncssbuttercup]

Ok, really, I'm just edgy cause I'm tired, if I had read this earlier today, it may not have... I've been up for a while, and it's been a long day (it always is when you loathe your job)

Back to the point at hand, I agree, I don't think that the way things are set up now is ideal. I'll never agree the training is as good as DO/MD, but I think it should be made to be similar to that of a PA. If this weren't an open forum, I could tell some stories that would make the rest of you even more scared... A coworker of mine has a PhD in A/P and used to teach at a local CC for nursing school... she said what passed was scary, and she never in her life wants an AA nurse to touch her... Then she said it frightened her that she didn't think they were required to take a different A/P to get a BSN... if that IS true (I don't know 100%) that is frightening... my UL A/P wouldn't get me into nursing school, they said they couldn't verify that it was 'adequate'... ??? (no, not kidding) I was also told that my year of calc didn't fulfill the math requirement to waive the 'accuplacer' math test... ???? (still not kidding) I just think NPs have a place in all this too, but ya'll (sorry listening to Huck Finn on audiobook ) have converted me that there needs to be some changes...

 

[Charles_Carmichael]

Ok, really, I'm just edgy cause I'm tired, if I had read this earlier today, it may not have... I've been up for a while, and it's been a long day (it always is when you loathe your job)

Back to the point at hand, I agree, I don't think that the way things are set up now is ideal. I'll never agree the training is as good as DO/MD, but I think it should be made to be similar to that of a PA. If this weren't an open forum, I could tell some stories that would make the rest of you even more scared... A coworker of mine has a PhD in A/P and used to teach at a local CC for nursing school... she said what passed was scary, and she never in her life wants an AA nurse to touch her... Then she said it frightened her that she didn't think they were required to take a different A/P to get a BSN... if that IS true (I don't know 100%) that is frightening... my UL A/P wouldn't get me into nursing school, they said they couldn't verify that it was 'adequate'... ??? (no, not kidding) I was also told that my year of calc didn't fulfill the math requirement to waive the 'accuplacer' math test... ???? (still not kidding) I just think NPs have a place in all this too, but ya'll (sorry listening to Huck Finn on audiobook ) have converted me that there needs to be some changes...

Fair enough. And for what it's worth, I didn't mean to come off in an insulting way. I've just posted in way too many NP/DNP threads over the past year or so that it gets to the point where I sometimes become snarky in my responses.

 

[Prncssbuttercup]

Yeah, I misread a post by Jagger on the Bra thread and almost posted a nasty response until I happened to reread it and was like "well, I'm glad I didn't post THAT"

This thread has gone to four pages, clearly there are some strong feelings about the topic. Seriously though jagger, you should start getting into lobbying, you are strong-willed enough to do it at least on this topic... or call Ron Paul, he's an MD... maybe he can do that instead of run for president for the 10th time...

@Ozello, I'm going to say this to you too... no spewing of insults, it's just bad form... doesn't help the content at all, just makes hard feelings and will result in this thread getting locked or it turning into something you'd find in pre-allo. We're pre-DO, and like Non-trad, we're better than that... I have been mad at people on here, but I try to act the same as I would if we were having this discussion face to face at a party.


Additionally, these phrases catches my mind (they're good for everyone):
make your words soft and sweet, then it's not as awful if you have to eat them... always be kinder than necessary, everyone you meet is fighting some kind of battle... and
don't put both feet in your mouth at the same time, you won't be left with a leg to stand on...

Seriously, it's late, I'm tired, and don't want this to be like the pre-allo forum. I left it because little kids piss me off too much with their insulting nature... let's have a debate, nothing more... ok... ok...

 

[OzelloPiRat]

This AA nurse is going to bed now. That's like saying you only want a paramedic and not an EMT. My courses were the same as those of my sister, who finished her BSN. The CNA, LPN, ASN, BSN, MSN, CNM, CCRN, CRNA, ARNP, DNP, IMG, DO, MD war will go on forever. I left out the therapist, dietary, social workers, housekeepers, landscapers, trash collectors, incinerator workers blah blah blah. Everyone can do everyone elses job better. That is not what is being discussed here. It is that NPs do not have the knowledge base to practice independently.
Let me ask, have you assisted in placing a VP Shunt in a neonate? No? Hummm....
That is all I am going to say about my experiences. Anyone in the medical field have had diverse ones. I take it as total disrespect to be thought of as less for being an ASN or "just a floor nurse". I know this is not the subject, but it keeps coming up. I get scared at some of the med students I see! But then they learn, get experiences and mature. If your nursing educator friend feels that way about the ASNs she should not be graduating them.
Before I started looking in depth at the education one received in medical school, I was always grateful for the knowledge the Docs had. Now that I know, I am in awe.
Same for the ASN to BSN to NP. There is a huge change in knowledge, but one that never, ever comes close to that of a physician.
And SBB, sigh, we clash, eh? I doubt you could pass the NCLEX, or the Steps as you have stated. There is more to nursing than meds and vitals. And there is way frigging more to the Steps.

 

[OzelloPiRat]

Oh, lol....
So you can spew insults and I cannot? It was not even directed at you in the first place. I admit, it was harsh. But the content of what was said was so misinformed that a true person that had ever worked on any nursing floor, wing, OR, would never say that. It was demeaning and insulting to state that I have no intellect and critical thinking skills.
Thinking back over 12 years of experience, that makes me laugh. We can be preDO and non trad and not be friends. You expect me to conform to your beliefs while blatantly disregarding mine. I would say these things face to face. And your words have hardly been soft and sweet. And then you call me a child. No insulting, right?
Yes, I will agree that it is late and my plate is full.
Think I will go back to lurking again as it is much better for my indigestion.

 

[Prncssbuttercup]

Wtf? Umm, ok... Have fun...

 

[DocEspana]

So wait... are we afraid of nurses? This girls don't seem that scary.

Actually. I watched the movies. They have AK47's. I am fearing their growing numbers if they are all packing heat

Also, one thing that did annoy me (and prob shouldnt have) was that half the images that came up when i image searched 'nurses' had them using a littman cardiology III or similarly expensive stethoscope. Nurses should be using nursing stethoscopes. Thats not even me trying to hold them down, they're just not qualified (with few exceptions) to use the bell anyway, so why the hell would you pay literally 10-20x the amount of money to have something that you never actually have to use. It annoys me only a little less than when I see pictures of 'doctors' with nurse stethoscopes. Nothing screams 'this is not a doctor' louder than that on an ad.

 

[Prncssbuttercup]

I guess we're afraid and we're all insulting the nurses and saying horribly mean things. Not sure where, but clearly it happened... There was a two post rant about it...

 

[DocEspana]

I guess we're afraid and we're all insulting the nurses and saying horribly mean things. Not sure where, but clearly it happened... There was a two post rant about it...

Reductionist but true: There is a massive deficiency of (Specifically) family medicine and (less so) internal medicine. This has lead to people across medicine to scramble to fill the hole. Doctors cared in theory but not in practice as PAs are the greatest thing ever, they do all the work with *enough* education and we get a cut of the pay. Doctors continued to go off and become lentigo maligna and mycosis fungoides specific patho-dermatologists. The problem got worse.

Nurses for years have felt that they may not be doing enough by simply caring for the patient and that being able to respond to the complexities of specific disease is vital to their careers existence. Nurses begin studying the clinical presentations and drug dosings in order to function as more complete caregivers. Specifically so that they can identify doctor errors not inherantly to *steal our jobs*

The demand for more primary care physicians is getting louder every day. These nurses are *not* qualified to be primary care physicians. The average one isnt going to identify any zebra at all or many of the uncommon, but seen, complications of therapies. The average PA would get most of these and the average MD/DO all of them. Its a difference in training. Yet they would prob make totally fine family med doctor facsimiles in 85% of the cases. I dont think any physician is okay with the 15% miss, nor do I think anyone can argue that they wouldnt be a great cost effective method for the other 85%.

So this is where we stand. Docs moving away from primary care (not totally true as US-trained FM residents are rising, but not by much), PAs are not changing at all and NPs are becoming doctor like. Lets just call it as it is. NPs want to say they can have limited practice even though they truly *cannot* without a supervising doctor. Doctors want to block NPs because we're arrogant and defensive so we take people who *would* do our job perfectly fine the majority of the time and paint them as malpractice murderers.