Advanced Nursing vs Medicine

Dembitz, APRN · Feb 10, 2014

It's not the science prereqs, it's the 4 years of med school + residency. Most of medicine is routine. I think it's a great distribution of resources if I, for example, manage the knee sprain myself and send the guy with the torn ACL to see an orthopedist after he's already had an MRI done. I actually think advanced practitioners (NPs and PAs) should outnumber MDs in an ideal situation.

cayenne06, MSN, CNM · Feb 10, 2014

I especially love the division of labor for CNMs and OBs. Pregnancy and childbirth is inherently a normal event, and midwives are trained to monitor normal pregnancies and deliveries. OBs are trained to manage complications and risky patients. It's not that midwives know *less* than OBs- we have different specialties. We are experts in normal pregnancy and OBs are experts in complicated pregnancies. In my hospital, midwives train all the interns on the LDRP floor.

MDs go through training that RNs and APNs cannot even imagine. Their knowledge base is much wider than ours. Their education deserves special recognition. This does not diminish the knowledge and skill of APNs. APNs are meant to manage the many "routine" issues that really do not need MD attention.

mahaandai · Feb 11, 2014

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.

futureeastcoastNP · Feb 11, 2014

It's the lack of standardization across NP programs, the fact that programs don't even have to provide clinical sites, and the elevation of nursing theory fluff courses over hard science courses that puts NP at a disadvantage.

matthewandrew, NP · Feb 12, 2014

It's the lack of standardization across NP programs the fact that programs don't even have to provide clinical sites, and the elevation of nursing theory fluff courses over hard science courses that puts NP at a disadvantage.[/quote']
I completely agree.

Cardiac-RN · Feb 12, 2014

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?

Just want to put it out there, that many of us in nursing have indeed taken the 'hard-core' science classes. Many nurses have entered in as second degree students, who perhaps did their undergrad in biology, chemistry, etc. Some probably have undergrad minors that include these science classes in addition to their BSN- I know that when I was completing my BSN, I was not sure if I wanted to go the med-school route vs. the NP route, and I made it a point to take the med-school prerequisite courses in addition to my nursing courses to keep the option open until I came to a final decision. I do not think that my fellow NP students are at a disadvantage just because they may not have done this- we may be starting from different points but based on the amount of work and studying everyone is putting into their program, at the end I don't think you can tell a difference from those who had the 'hard-core' sciences and those who did not.

And of course there are protocols, if you are referring to the 'guidelines' that are evidence-based and published by AAFP, ACOG, AAP, etc. MDs and NPs alike follow these guidelines for best practice. Not sure why you would not like this?

Cardiac-RN

futureeastcoastNP · Feb 12, 2014

Just want to put it out there, that many of us in nursing have indeed taken the 'hard-core' science classes. Many nurses have entered in as second degree students, who perhaps did their undergrad in biology, chemistry, etc. Some probably have undergrad minors that include these science classes in addition to their BSN- I know that when I was completing my BSN, I was not sure if I wanted to go the med-school route vs. the NP route, and I made it a point to take the med-school prerequisite courses in addition to my nursing courses to keep the option open until I came to a final decision. I do not think that my fellow NP students are at a disadvantage just because they may not have done this- we may be starting from different points but based on the amount of work and studying everyone is putting into their program, at the end I don't think you can tell a difference from those who had the 'hard-core' sciences and those who did not.
And of course there are protocols, if you are referring to the 'guidelines' that are evidence-based and published by AAFP, ACOG, AAP, etc. MDs and NPs alike follow these guidelines for best practice. Not sure why you would not like this?
Cardiac-RN

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.

PatMac10,RN, RN · Feb 12, 2014

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'm sure you meant well when you said what you said. However, you also seemed condescending in your comment. Nursing and Medicine are two totally different. Nursing is just as much a social science as it is a medical science, which accounts for why the prerequisites for nursing school focus on more sociology/psychology/theory course work.
Would it be awesome to have a gross anatomy course and other "hard science" coursework with less theory? Freak yes! More clinical coursework would be awesome. Those are curriculum changes that can be made in the future, but not by nurses insulting the education system that's already available.
How can we build up the nursing education system if the public can see how little we think if it now? Geez.
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futureeastcoastNP · Feb 12, 2014

I'm sure you meant well when you said what you said. However, you also seemed condescending in your comment. Nursing and Medicine are two totally different. Nursing is just as much a social science as it is a medical science, which accounts for why the prerequisites for nursing school focus on more sociology/psychology/theory course work.
Would it be awesome to have a gross anatomy course and other "hard science" coursework with less theory? Freak yes! More clinical coursework would be awesome. Those are curriculum changes that can be made in the future, but not by nurses insulting the education system that's already available.
How can we build up the nursing education system if the public can see how little we think if it now? Geez.
Sent from my iPhone using allnurses.com

I agree with you to an extent, but the problem is we're going backwards if anything. I may have been harsh, but I sometimes just get so disgusted with what I perceive as complete inaction on the part of accrediting bodies to mandate higher standards. The last few years, rather than advance the profession and increase the knowledge of graduating NPs, those in charge have been motivated only by dollar signs: opening for-profit schools that have NO admission criteria (no GRE, no interview, etc), that have 97% acceptance rates, "educating" NPs in an assembly line fashion with pre-canned online modules, forcing them to utilize anyone with a pulse (even another new grad) for a preceptor, and churning out poorly prepared NPs while oversaturating the market.

I think there are about 50-60 FNP programs in this country that produce quality providers. Those programs care about the future of this profession and really strive to educate their students. They hire top professors, provide clinical sites, constantly update their curriculum to include the latest EBP. I have quite a lot of respect for those programs and their students/graduates. Everything else - not really.

malamud69, BSN, RN · Feb 12, 2014

Of course lets look at the tangible reality as so far everybody is only dabbling in the overarching question here...this may help illuminate what we are ultimately trying to discuss...everybody has anecdotes.

http://well.blogs.nytimes.com/2014/02/10/a-patients-eye-view-of-nurses/?_php=true&_type=blogs&_r=0

PatMac10,RN, RN · Feb 12, 2014

I agree with you to an extent but the problem is we're going backwards if anything. I may have been harsh, but I sometimes just get so disgusted with what I perceive as complete inaction on the part of accrediting bodies to mandate higher standards. The last few years, rather than advance the profession and increase the knowledge of graduating NPs, those in charge have been motivated only by dollar signs: opening for-profit schools that have NO admission criteria (no GRE, no interview, etc), that have 97% acceptance rates, "educating" NPs in an assembly line fashion with pre-canned online modules, forcing them to utilize anyone with a pulse (even another new grad) for a preceptor, and churning out poorly prepared NPs while oversaturating the market. I think there are about 50-60 FNP programs in this country that produce quality providers. Those programs care about the future of this profession and really strive to educate their students. They hire top professors, provide clinical sites, constantly update their curriculum to include the latest EBP. I have quite a lot of respect for those programs and their students/graduates. Everything else - not really.[/quote']
I can appreciate your "frustrations".
I can also agree that there are some programs that do less for the advancement of nursing than others, but I don't believe every practitioner coming from these schools are incapable or incompetent (not that you said you did either).
I also agree that there are a lot of things that could be improved in nursing education. We will never improve them with negativity, that's all I'm saying.
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