Advanced Nursing vs Medicine

[matthewandrew]

Besides the whole nursing vs medical model (treating pt vs disease), do you think hard-core science prerequisites (org chem, biochem, physics, etc) is what differentiates medicine with advanced nursing? Do you think this puts advanced nursing to a disadvantage?

I often time hear that APRNs practices "routine care" via protocols, dealing with common chronic and acute diseases while MDs handle more "complex cases." Which is why I understand why insurance companies refer to NPs as midlevels. I do not like this.

Do you think premed/hard-core science prerequisites should be taken by students panning to go into advanced practice?

[BostonFNP, APRN]

I too took a hard science pre med curriculum before nursing school, and was surprised at how much easier nursing courses were. Very dumbed down. I think the issue is not lack of hard sciences in the BSN program, but in the NP program itself. There should be more clinical and science, such as immunology, gross anatomy, etc. I think it's sad that there is only patho and pharm. Some programs have genetics, but never immunology, medical microbiology, parasitology, etc.[/quote']

I appreciate that you are so passionate about this and have done so much research, but you haven't been through NP school yet. Withhold judgement until then as you may find it much more challenging and broad in scope that you assume it is. Undergrad nursing it is not.

And, for clarity, I graduated with honors from a top tier undergrad as a biology pre-med, took the MCAT, and went through the medical school interview process, so I can compare it to that at least.

[cayenne06, MSN, CNM]

cayenne06, "MDs go through training that RNs and APNs cannot even imagine...", please explain? First, it is wrong to club RNs with APNs, and it has been stated several times in this forum that beside the keyword "nursing" in their titles, there is nothing in common in their training and experience. APNs are highly trained professionals and their experience is more like of MDs since they diagnose and treat the patients independently without any direct supervision, which is why states like Kansas and New York are passing the bills to let NPs practice without any collaboration with physicians after 2000 hours of their service.

Further, more and more NPs are voluntarily taking USMLE3 ...

Also calling NPs as mid level is a big mistake because their malpractice insurance is pretty high because of their scope of practice.

I know that lots of NPs object to the midlevel description. I, myself, find it descriptive and accurate, but I understand why some disagree. I am well aware of the frighteningly high cost of malpractice, especially in OB, which is my specialty. CNMs (and other APNs) deserve to be reimbursed at the same rate as MDs when we provide the same services. We also deserve independent status in all 50 states. CNMs just got supervisory requirements removed from our regs in Mass, and this is a huge thing for us.

Listen, I am currently in my second semester of an APN program- nurse midwifery. I know how rigorous a good APN program can be, and I absolutely agree that APNs are highly trained professionals. However, it is crazy to say that our training and experience is comparable to that of MDs. It's just NOT. And it shouldn't be. APNs have a different scope of practice and a different model for providing health care. We don't need or want training that at the MD level. It's not a criticism of APNs to say our training is different and less comprehensive than that of MDs.

[BostonFNP, APRN]

The term "mid-level" implies negative things about RNs and MAs and aides etc besides the fact it somehow implies that some providers, even though they are held to the same standards, are somehow subpar.

As for MD/DO education/experience, it's not debatable. Physicians, on the whole, have more education and experience, at least when they enter practice. The real argument is outcomes:

what's does that extra education/experience gain the patient in outcomes balanced against cost to the system. In primary care the scope is the same and NPs are held to the same standards.

[futureeastcoastNP]

I agree with Boston:

obviously NPs receive less education. The schooling is half as long and not nearly as intense (med students eat, sleep, and breathe school for 4 years while NP students can continue working and have free time during school). The thing is, is the extra training necessary? I think, no, for common ailments and primary care, it's probably not. As long as NPs can catch the zebras and refer, all is good. I think most primary and well care should be NPs, with all specialists physicians.