[bollweevil]

Originally Posted by Salesman217

I think docs and nurses have spent way too much time and energy convincing themselves that they operate in different realms. They say medicine is about illness and nursing is about human response to illness. What kind of semantic twisting gobbledy-gook is that?

Nursing is the hands on practice of medicine. If we wanted to we could look at nursing as a sort of medical apprenticeship. We nurses certainly learn a lot from docs. And if docs spent as much time with patients during their education as we do during our practice they'd be a lot better practioners for it.

Since ADNs like myself are practicing alongside BSNs and getting the same pay as if we know the same thing then perhaps it's time to put some more umph into the BSN degree. Why not retool the BSN to make it a premed degree (or at least make that an option) where they take biochemstry and higher level pharm or whatever pre-meds study?

If nurses want to practice like docs the let them become docs. Why does all this healing practice have to be so segregated? Let's lump us all together.

This artificial wall between docs and nurses is not based on any sound objective reality about the difference in what docs and nurses do. It's based on the old gender role seperation of the past that said women were not smart enough to be docs but they could be docs handmaidens. How about nurses as docs assistants and de facto apprentices?

Then you have a vast pool of individuals already in the medical profession who might move on to higher levels of practice.

As it stands now, if a nurse decides to become a doc they're looked at like they are somehow switching to the dark side.

Why are there both there NPs and PAs? PAs exist because men without the time, money, or ambition to pursue an MD choose to attain to a mid level medical profession without having to do "women's work" (nursing). NPs exist so nurses can attain to a higher level of medical practice without abandoning the sisterhood.

If you asked me it's nuts.

Here's my suggestion:

Level 1: current ADN would be - Medical Rehab Technician I - MRT1
Level 2: current BSN would be - Medical Rehab Technician II - MRT2
Level 3: current NP/PA would be - Medical Master - MM - Your primary care providers
Level 4: current MD/DNP would be - Medical Doctor - all of whom would be specialists including specialists in nursing who would be experts on developing and improving the delivery of direct cares

That's just some preliminary rethinking of the situation.

My ultimate point is that the idea that docs and nurses are not both in the same line of work is ludicrous. Let's start merging the profession. Giving BSNs a pre-med track option would be a good start.

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[bollweevil]

Originally Posted by pinoy_guy

how about nurses who used their MD's as a pre-BSN degree?

ask around--a lot of doctors from the Russia, India, and Philippines had taken up Nursing as a way to a better life in the US.

the training is very different: Medicine mashes your face into the nitty-gritty of a dead man's chest cavity as an introduction to Human Anatomy. that's in the 1st Semester.

Nursing focuses less on the Theory and more on the Implementation of the Healing Arts without necessarily understanding the Fundamental Bases of why the Doctor wrote that order (like focusing on dose calculations). Not so where I come from. We were taught the "why's" and all the fundamentals - even if it was so we could be handmaidens.

neither one is better, they're just...different.

now a very seasoned nurse with more than 10 years under his/her belt will learn to anticipate what the Doctor will probably order in a certain situation It doesn't even take that long. ...but since Medicine delves into the basics, Doctors are more equipped to detect the 1 in a million aberrancy. I don't think so. Specifically, doctors are taught a herd mentality, that is, don't look for zebras. Look for horses. And they often miss a diagnosis because why look for 2 reasons for a symptom when 1 will suffice? Lazy, driven to speed by insurers and administrators, doctors often work too fast and the patient pays.

for example: since the Philippine Government is providing enough funds (sarcasm implied) for Government Hospitals, some Government Obstetricians are encouraging Normal Births to go to a Midwife--and the Obstetricians tend to accept only the complicated cases.

another point: Nursing Diagnoses are designed so differently from Medical Diagnoses that they're akin to oil and water.

anyway, it will be interesting what the outcome will be.

It will be more of the same. Docs will retain their primo parking spots, nurses will get more letters after their names. I do applaud those who pursue their dreams of more Medicine-like practice.

[elkpark]

Originally Posted by bollweevil

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(I'm not getting your point)

[mark3274]

DR nurse? sorry no. I know some of you want to go on and be nurse p and such but from what I have seen Thats just not my interest. Heck I want less stress not more lol

[Hopefull2009]

Originally Posted by elkpark

Do you have any documentation or evidence to support your assertions, or is this just your own, personal theory? Have you actually read anything about the historical development of the NP and PA roles? On what do you base these sweeping generalizations?

I have to agree with Salesman 217 on this one.

I know that PA schools vs a Masters or Doctorate NP programs are set up differently, however, having had both treat me in a hospital/office on numerous occasions, I have yet to figure out what they do that is different.

Both walk in, both listen to the problem both write prescription, both work under the supervision of a physician. Both are billed under a physician....and they sure don't charge less than a physician.

Sounds pretty much the same to me.

[czyja]

Originally Posted by Hopefull2009

Both walk in, both listen to the problem both write prescription, both work under the supervision of a physician. Both are billed under a physician....and they sure don't charge less than a physician.

Sounds pretty much the same to me.

You note that NP's work under the supervision of a physician. This is not true in all states. For example in Washington state NP's can and do practice independantly. I am not aware of any state where PA's practice without a physician.

As for billing, NP's and PA's bill for their services separately from their collaborating physician (if there is one).

[CityKat]

I was taught that the clear difference between a PA and an NP is that the NP is an independent practitioner and COLLABORATES with the physician. On the other hand, the PA works UNDER THE SUPERVISION of the physician. That's a pretty significant difference. I remember when I was working in NYC, the NP's were paid a little bit LESS than the PA. Totally unfair, but sounds political to me.

[Hopefull2009]

Originally Posted by czyja

You note that NP's work under the supervision of a physician. This is not true in all states. For example in Washington state NP's can and do practice independantly. I am not aware of any state where PA's practice without a physician.

As for billing, NP's and PA's bill for their services separately from their collaborating physician (if there is one).

I am sure you are correct, just I know in my state, they cannot work independently. I didn't know it was different in other places.

The physician doesn't have to be physically present (such as a Health Departmet or Urgent Care center), but one does have to be licensed where they practice.

[core0]

Originally Posted by StudentNurseBean

I was taught that the clear difference between a PA and an NP is that the NP is an independent practitioner and COLLABORATES with the physician. On the other hand, the PA works UNDER THE SUPERVISION of the physician. That's a pretty significant difference. I remember when I was working in NYC, the NP's were paid a little bit LESS than the PA. Totally unfair, but sounds political to me.

You state this like it has any real practical meaning. You can read lots of discussion about this on the NP board but the practical reality is that it has little to no effect. According to the best data, 98% of NPs work for either a physician practice, HMO, hospital or University. Interestingly almost exactly the same percentage of PAs are working for these same groups. The practical effect is that for the 2% of PAs that are practicing independently, they have to structure their practice differently than the 2% of NPs that are practicing independently. For the rest, they are practicing in an environment where there is a chain of command and medical responsibility somewhere above them. Just like employee physicians in those areas. There are some differences in the numbers, for example more PAs work in private practice groups. More NPs work in hospitals, but the net effect is the same.

The word that you are really looking for is autonomy. Autonomy speaks to how much control you have over medical decision making, practice style and even practice environment. How much autonomy a practitioner has (whether its NP, PA, or physician) depends on state law, how the practice is structured and the relationship between the providers. If you want autonomy (as opposed to being caught up in the mechanics of collaboration vs. supervision) then you have to seek a practice environment that will give you more autonomy. This is irregardless of whether you are a PA, NP or physician.

As far as the differences in pay, this is generally thought to be related to the larger number of PAs practicing in surgery and specialty medicine. This gap has narrowed (nationally) in the last five years but whether that is due to increased RN salaries or increased movement by NPs into specialty medicine awaits more data.

To: hopeful2009, for the most part, practices that use both NPs and PAs use them interchangeably. The primary difference (in my opinion) is scope of practice. The PA scope of practice is defined by the supervising physician. The NP scope of practice is defined by the type of NP (their training) and the state nursing act. For example if we get a 17yo patient in the ICU, the ACNPs are not allowed to see the patient but I can since my SP sees pediatric patients.

David Carpenter, PA-C

[Hopefull2009]

Originally Posted by core0

To: hopeful2009, for the most part, practices that use both NPs and PAs use them interchangeably. The primary difference (in my opinion) is scope of practice. The PA scope of practice is defined by the supervising physician. The NP scope of practice is defined by the type of NP (their training) and the state nursing act. For example if we get a 17yo patient in the ICU, the ACNPs are not allowed to see the patient but I can since my SP sees pediatric patients.

David Carpenter, PA-C

That is what I have been sitting here wondering while reading this thread...I had remembered reading somewhere about the difference in the scope of practice, but couldn't remember exactly where, but had never actually seen it in use, so I wasn't sure if that was the case or not.