[fuegorama]

Originally Posted by ERNP

In all my years as a nurse and NP, I have never ever met a single doctor that I thought was a decent businessman. They often appear so because they have more to work with, but in so far as the management of it.... not really executive office material.

Agreed. However, the days of the money stupid doc are dying. We frankly are not paid that much anymore. Money management has become a part of some schools' curriculum and the MBA is now a common addition to the educational vitae of many physicians. We have to manage better just to pay our loans and try to retire before 70. Especially us old ones.

My point was that the explosion in beauracracy and zany cost vs. reimbursement paradigms has paralleled the rise of nurses into hospital administrative roles. I don't think it's a reach to draw a cause/effect conclusion.

Without some serious business education neither docs or nurses are prepared to make sound health economic decisions. Frankly this mess will not end until patients realize the true cost of a hospitalization. Unfortunately this is not a realistic desire. Not gonna happen. We are now a nation of entitlees that want the moon but have no intention of paying for it. (see it really does need its own thread)

Originally Posted by ERNP

I also chose to be an NP. Medical school was certainly an option for me. I suppose if I wanted to go to med school, I still could. As recently as last year I did consider it, but in the end it wasn't worth it. I am a FNP working ER. I don't make the ER doc salary, but I am right up there with family physicians working in private practice (and half the work days). I recently found out I am not too far off the hospitalist mark where I am either.
I have all the hospital privileges I want. I have the respect of my physician and nursing colleagues.

Given your success, my decision to go my own route with the accompanying debt, loss of time, emotional and relationship stress looks like a pretty dumb decision.
But then I did contemplate your path. The thing that bugged me about being a nurse and even an advanced practice nurse, is that I didn't want to pretend to know. I wanted to treat my patients with the best education/experience/training that I could muster. This is not just punching the clock and hoping I could correctly guess. I will still be guessing. That's the beast. But my guesses will be very educated guesses and logically the better for them.
This is people's health. As nurses and docs we supposedly do this because we want the very best for that person in the stretcher. It's this nurse's opinion that a solid medical education is the best for that person. It's what I want for me and mine and that in the end is what we all ask when we make decisions around care. Playing doctor without adequate training is dangerous and unethical.

Mid levels have a valuable role. They see people quickly. Their lower patient volume allows more of the get-to-know ya time that is a cornerstone of great nursing practice. They bring into focus the social context physicians sometimes lack. They are an integral part of the healthcare milieu.
They are not equipped to be stand alone clinicians.

Originally Posted by ERNP

All that considered, the rigors of medical school aren't that attractive.

True. So terribly true.

Originally Posted by ERNP

I have looked at a couple of DNP programs. I don't think it is necessarily a bad idea. This argument about confusion with "real doctors" is ludicrous. I always introduce myself as NP, and no matter how many times I correct patients, I always end up being called "doctor" or get some comment like, "same thing" or "you are MY doctor". So the argument is that a DNP will cause this kind of confusion is just unfounded. The confusion already exists.

As an NP in an ED I assume (and for-the-love-of Gawd hope) you have physician expertise to back you up. This is an efficient evidence-based model.
People call you doc. Yippee. When that diagnostic toolbox that got filled in graduate school comes up empty, it is reassuring that a real physician can step in and do what needs to be done.

I will reiterate that the DNP is an attempt by the ANA to supplant physicians under the guise of equivalent training. It is dishonest, confusing and ethically circumspect.

Please prove me wrong.

[brownrice]

Fuegorama:

Oh how you generalize...IF I were to do the same, I would say this:
I have witnessed the practice of God awful physicians, many with an underaverage social IQ, combined with the inability to communicate or maintain direct eye contact with their patients. The entire profession is built on the reductionistic model, which rarely includes preventive nor holistic medicine. Most of the nurse practitioners with whom I have practiced have been perceptive and intuitive, and possess above-average communicative skills. Their education and years of experience have armed them with the tools they need. They always treat the whole person, and teach the patient.

Of course, one cannot generalize like this. There are both bad and good physicians, NP's/PA's. Things are not just black and white.

PS. Funny that the word "doctor" comes from the Latin word 'docere" or teacher. A "docere" was to empower the patient. I've yet to see a doctor that has attempted to teach me anything about how to maintain or improve my health. Yes, this takes time. The time that you mentioned "midlevels" are spending on their patients!

[fuegorama]

Originally Posted by brownrice

Fuegorama:

Oh how you generalize...IF I were to do the same, I would say this:
I have witnessed the practice of God awful physicians, many with an underaverage social IQ, combined with the inability to communicate or maintain direct eye contact with their patients. The entire profession is built on the reductionistic model, which rarely includes preventive nor holistic medicine. Most of the nurse practitioners with whom I have practiced have been perceptive and intuitive, and possess above-average communicative skills. Their education and years of experience have armed them with the tools they need. They always treat the whole person, and teach the patient.

Of course, one cannot generalize like this. There are both bad and good physicians, NP's/PA's. Things are not just black and white.

PS. Funny that the word "doctor" comes from the Latin word 'docere" or teacher. A "docere" was to empower the patient. I've yet to see a doctor that has attempted to teach me anything about how to maintain or improve my health. Yes, this takes time. The time that you mentioned "midlevels" are spending on their patients!

Actually, I didn't generalize. the NP model was built on nurses that had years of clinical experience prior to seeking a a higher degree of training leading to advanced practice. Today, this generation is fading away. The majority of NPs being churned out today from nursing programs typically graduate in less than 3 years and the vast majority of those do not have 3+ years of clinical experience.

Agree? yes/no

If your beloved spouse/son/daughter/mom/previously-unnamed-someone-important is presenting to an ED with a complaint. Do you want them seen and treated by someone that has 5 semesters of dissertation based "clinical training" that pats a good hand, oooooorrrr do you want them seen by someone who has 4+ years of hardcore pathphys based diagnostic skills + 3-7 years of apprenticeship tutelage training under a master in this art?

I'm betting on the latter.

Look. We all have known the socially dysfunctional physician. I happen to got to class with about thirty of them. These people are frequently emotionally stunted by the direct to doctor path they took. Many of them don't know why they are there. But, at the end of the H&P, the vast vast majority of them make the right call and compile an accurate plan of care.

I don't want a friend when I'm sick. I want a physician.

Oh. We are not reductionist. We can't be. No matter how expansive our differential for a specific complaint might be, we know there are at 5-10 things either we haven't thought of, or that haven't been yet elucidated.

And re: the teacher remark...maybe they gave you credit for being a nurse. Teaching patients is an integral part of what I am taught in my rotations. This has been over-the-top emphasized on OB and Peds.
Maybe you oughta see a DO. (smiley thingy and all that)

[brownrice]

Now, do you really believe an ED is going to hire "someone that has 5 semesters of dissertation based "clinical training" that pats a good hand." ?!!!! I don't think so! Every hospital has had many lawsuits, many well publicized. What type of an administrator would deliberately place themselves in such a precarious position? NONE.

IF however, the PA, NP or MD is experienced in emergency medicine, then yes, all of the above can treat myself, my mom, dad or other. And, should anyone needs anesthesia, I would choose a CRNA. (topic for another thread).

Does one need a doctorate in nursing to do the job~~they have done a beautiful job so far without it.

[SharonH, RN]

Originally Posted by fuegorama

My point was that the explosion in beauracracy and zany cost vs. reimbursement paradigms has paralleled the rise of nurses into hospital administrative roles. I don't think it's a reach to draw a cause/effect conclusion.

*snicker* It's more than a reach, it's completely absurd. Your dislike/resentment of nursing/nurses has seriously affected your ability to view things objectively. Factors affecting the explosion in bureacracy and zany costs vs reimbursement as you call it include the influence of JCAHO, Medicare regulations, the increase in healthcare technology and consumer demand and influence. Those are only some of the factors. It has nothing to do with the rise of nurses into hospital administration. I'm not a philosopher but that looks like flawed reasoning if I've ever seen it. Give me one example of how having a nurse in a managerial role has led to decreased reimbursement to a physician. If that's what they are teaching in those business classes you are taking in med school, then you are getting cheated.

[fuegorama]

Originally Posted by brownrice

Now, do you really believe an ED is going to hire "someone that has 5 semesters of dissertation based "clinical training" that pats a good hand." ?!!!! I don't think so! Every hospital has had many lawsuits, many well publicized. What type of an administrator would deliberately place themselves in such a precarious position? NONE..

And you would be wrong. There are fresh-faced master's holders right now that are being employed in ED fast tracks across the country one month after graduation. There are NPs being put into clinics with no clinical experience outside of their shadowing time. I know this because I know them!
You have beautifully illustrated one of the points I am trying to make. Your faith that hospital administration would not hire an inexperienced NP is 1. incorrect 2.based on an ideal where the administration actually recognizes a difference between clinical accumen and legal allowance. NPs are allowed to dx/write scripts/do procedures/refer etc. Therefore, they must have the requisite training/experience to do these things. We now have a situation where admin is counting on NPs ability to do what they claim, and in-the-know nurses believe administrators will vet NPs before they get hired.
It's a terrifying blind leading the blind situation.

Originally Posted by brownrice

IF however, the PA, NP or MD is experienced in emergency medicine, then yes, all of the above can treat myself, my mom, dad or other. And, should anyone needs anesthesia, I would choose a CRNA. .

Hey. Did you see that guy that BASE jumped off a bridge 200 times in Twin Falls Idaho? He lived too.

Originally Posted by brownrice

Does one need a doctorate in nursing to do the job~~they have done a beautiful job so far without it.

Um......Um.....I do not know how to respond to this since I totally agree.

[fuegorama]

Originally Posted by SharonH, RN

Your dislike/resentment of nursing/nurses has seriously affected your ability to view things objectively. .

This is not true. I respect and enjoy working with nurses/nursing. I AM A NURSE!! A good bit of my angst here is stemming from my belief that nursing is stretching far from its primary role that is direct, bedside, patient-based care. This most recent absurd proposition by the AACN is simply the culmination of the self-loathing rampant in the profession. "Just being a nurse" is not good enough for the self-promoters. It seems from this insiders perspective that the only thing the NP lobby and AACN borg machine do these days is self promote regardless of consequence.
The second prong of this issue is the blatant end run around paying required dues to gain a title and its accompanying benefits. This is a back door, a short cut, a cheat, a scam...you get it.

Originally Posted by SharonH, RN

Factors affecting the explosion in bureacracy and zany costs vs reimbursement as you call it include the influence of JCAHO, Medicare regulations, the increase in healthcare technology and consumer demand and influence. Those are only some of the factors. It has nothing to do with the rise of nurses into hospital administration. I'm not a philosopher but that looks like flawed reasoning if I've ever seen it. Give me one example of how having a nurse in a managerial role has led to decreased reimbursement to a physician. If that's what they are teaching in those business classes you are taking in med school, then you are getting cheated.

Oh I'm getting cheated on a lot of things in med school! but this point about nurses+administration=high cost is something I would like to read a bit about.
I will get back on this later.
Right now I need to start my 12 hour day on inpatient Peds. This is week four of 6. How much time do NPs get again?

[sirI]

All opinions are equally welcome.

However, to come to the boards and simply make comments that only serve to be divisive is not necessary.

We ALL, the physician and the NP/CNS/PA, serve the public. Please, let's work together. After all, we are all professionals in the name of healthcare.

[texas-rn-fnp]

It appears the doctors are uncomfortable with the new NP degrees because it may infringe more on their turf. Are they worried that the NP will take all their business away and the poor doctors will not have any work and not be able to feed their families? (ok, I am being a little sarcastic) Every place I have been that was in civilization has had a large demand for appointments and bed space. I have never found a civilian provider that I could get an appointment in less than a month. That goes for both primary care and specialty. Most places don't have bed space either. If someone needs to get admitted, they have to wait for someone else to get discharged.

There is enough work to go around for everyone. There is also an appropriate niche for NP.

NP is not the same as a doctor, but an NP can do a darn good job at taking care of 60-80% of the work the doctor does. The doctors should be happy to have NPs to take care of the routine patients, so the doctors can focus their time and special skills on patients that truly need to be seen only by a doctor. I would think it would be boring for a doctor to not be doing exciting things everyday. Does a doctor really need to or want to see a well baby, well woman exam or every cold, rash ,etc? No. Unless they live in the middle of nowhere with only them and the cows, then there is more work then they will ever be able to take care of. We are all on the healthcare team. It should not be us versus them. It should be how can we all work together as a team so that we can give the best care to the patient. The NPs are a vital part of that team with an expanding role.

[fuegorama]

Originally Posted by siri

All opinions are equally welcome.

However, to come to the boards and simply make comments that only serve to be divisive is not necessary.

We ALL, the physician and the NP/CNS/PA, serve the public. Please, let's work together. After all, we are all professionals in the name of healthcare.

I'm not the prettiest ham around, but I think this may be directed at me.
I did not come to the boards to be "divisive". I post here in an attempt to give what I believe is a fairly unique perspective. RN turned DO.

I am a fan, cheerleader, patient and pupil of NPs. However, I believe the AACN's unwavering thrust to create a stand alone role for the midlevel provider is a terrible mistake. This is crummy for the profession and frankly dangerous for our patients.
The DNP is a farcical effigy of the doctoral training and accumen of America's physician workforce. Nursing as one pillar of patient advocacy in this country MUST stand up to its purported leadership and demand a return to common sense.