NinerNiner999 said:
Just how have the nurses been outflanking doctors? To this date, I can't recall a nurse calling me in the morning to tell me all the orders she wrote, faxed to the pharmacy, and administered to the patient her/himself. I can't remember an attending ever being told not to sign a chart before a patient goes to the floor or goes home. I can't remember a PA ever being named individually on a law suite (or an NP for that matter). I guarantee you that if this happens just once, it will open the eyes of the midlevel providers to the level of the game they want to play. But, I think we all know that the liability falls on the shoulders of the MD, and this will continue as long as credentialed hospitals have deep pocketbooks.
Your view is shaped by speaking from the sheltered tower of JH. In the rest of the world NPs do everything you listed as not witnessing and more.
http://www.aafp.org/fpm/981000fm/nurse.html
NPs have mastered the art of advancing their goals of complete autonomy. With stand alone practices here in the great, bleak North their incomes rival PCPs. They reap 6 digit salaries after 5 semesters of "advanced nursing".
A large chunk of their successes lies w/ their command of semantics. Right now the big push is to have state nursing and medical boards refer to the physician/NP relationship as "collaborative" rather than "supervisory". How many state senators would care, nuch less balk at such tiny requests? The answer is very few, because what nurses say right now goes. As Apache says, it's the baby steps under the radar. While medicine fights the big wars over tort reform (that will eventually benefit PEs) the NPs are spending all of their considerable lobbying energy on obtaining evrything doctors have traditionally held except the title. Oops! They want that too!!!
The PE moniker used to mean
physician extender. As of this week in the FP practice I am rotating with PE now means
physician equivalent So I was instructed by an NP. She detailed how she has 7 years of education. "just like a doctor". This lengthy process included her BSN of 4 years, her 2 years of graduate nursing and six months "interning" at a family practice clinic. "See it's really the same", she beamed.
As a nurse who didn't want to fake it as a midlevel provider, I resent the heck out of the equal recognition, equal pay, and fraction of the risk that these people now enjoy. I am now squandering 7 years of income, incurring mammoth debt, and living a less than pleasant existence for the pleasure of running a higher risk and hopefully providing the best care.
My quest for doctor hood was driven by a desire to guess a lot less and know a lot more as a hopeful EM physician. The privilege of practicing Emergency Medicine was something
I felt could only be accomplished as a DO/MD. I would be lying if I didn't think the cost would carry some fiscal reward in addn to the ability to provide the best care.
Looking at the evolution of midlevel encroachment onto what once physician ground and privilege I realize I have way more education. But, at the end of the day and at the bank......who's the stupid one?
