Nurses are Not Doctors

[Brian, ASN, RN]

An article appeared today in the New York Times as a followup to a bill passed in New York granting nurse practitioners the right to provide primary care without the oversight of a physician. The authors of the bill state "mandatory collaboration with a physician no longer serves a clinical purpose and reduces much-needed access to primary care". The need for more primary care providers is due to the shortage of primary-care physicians, the aging boomer population, and the Affordable Care Act.

Although the president of the American Association of Nurse Practitioners feels that the current "hierarchical, physician-centric structure" is not necessary, many physicians disagree citing that the clinical importance of the physician's expertise is being underestimated and that the cost-effectiveness of nurse practitioners is being over-estimated.

Many physicians also feel that "nurse practitioners are worthy professionals and are absolutely essential to patient care. But they are not doctors."

What are your thoughts on this? Where do nurse practitioners fit into the healthcare hierarchy?

For the complete article go to Nurses are Not Doctors

[anon456, BSN, RN]

I work with several NPs in the ICU setting that are just as good as, if not better than, the MD's who are also on duty. They often train the residents and they provide very good input and collaboration on a patient's care. I will often call the NP before the resident on a patient.

That being said, I think it could be dangerous for an NP who is practicing by himself or herself as far as liability goes. Midwives face this every day.

[TU RN, DNP, CRNA]

This could be a great "pilot study" sort of situation for NPs across the country. I hope it yields favorable (comparable to MD/DO primary care) results and takes of nationwide. There is a shortage of primary care physicians, and an abundance of nurses willing to work in that area of care. My question is why is there a shortage of physicians in primary care, yet plenty of NPs entering that area? Perhaps they don't want that career? I personally feel that if physicians won't deign to work in primary care, then the necessity for them to oversee the provision of such care by autonomous, qualified, willing​ NPs is forgone. Basically, move your meat lose your seat. Besides, I'd rather see a NP working in primary care who views it as the peak of their performance as a nurse; rather than a physician in primary care who didn't get placed into their preferred residency and is choosing primary care as a backup.

[blondy2061h, MSN, RN]

My primary care doc is a DO who is older and semi-retired. I have some complex medical issues. She's very nice and compassionate, which is why I see her, but I can tell she doesn't stay on top of current trends or research. Loves to prescribe Z Packs for everything. Loves to refer to specialists. As a result, I pretty much have a specialist for every body system. I'm not here to bash my PCP, but to point out that this isn't an NP specific issue.

[OCNRN63, RN]

This could be a great "pilot study" sort of situation for NPs across the country. I hope it yields favorable (comparable to MD/DO primary care) results and takes of nationwide. There is a shortage of primary care physicians, and an abundance of nurses willing to work in that area of care. My question is why is there a shortage of physicians in primary care, yet plenty of NPs entering that area? Perhaps they don't want that career? I personally feel that if physicians won't deign to work in primary care, then the necessity for them to oversee the provision of such care by autonomous, qualified, willing​ NPs is forgone. Basically, move your meat lose your seat. Besides, I'd rather see a NP working in primary care who views it as the peak of their performance as a nurse; rather than a physician in primary care who didn't get placed into their preferred residency and is choosing primary care as a backup.

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[blondy2061h, MSN, RN]

I also hate the connotation in the article title that nurses want to be doctors.

[iluvgusgus]

I remember reading that patient outcomes are the same for both...

[TU RN, DNP, CRNA]

Was I randomly bashing? I don't believe I was, but sorry if you read it that way OCRN. I think physicians are well aware of the expense of their career path before they even go to medical school. Plenty of nurses come from tough financial backgrounds too (not just from the student loan debt category) and our career outlook isn't nearly as lucrative as MDs and DOs, so if you're implying that physicians don't want to specialize in family practice because it isn't consistent with their financial goals (as opposed to, I don't know, providing medical care to and developing therapeutic relationships with families in a community) then my point stands. They must not truly want it.

[IrishIzCPNP, MSN, RN, APRN, NP]

I have yet to see an NP who wants to be or think she is a doctor. I'm working on my NP. I won't ever be an MD. I will provide care within the scope of my NP. I don't need a piece of paper spelling out a collaborative agreement to practice safely. Have you ever seen an NP actually overseen by an MD? I haven't. The collaborative agreement is often just a piece of paper.

Studies show the outcomes between NPs and MDs are the same (or better with the NP).

The key is knowing when to seek help and when to refer. I know many MDs who need to learn this!

The very interesting thing...many residents and medical students receive training from NPs. So the NP can train the future MD but she can't be trusted to know when she needs to seek assistance?

[klone, MSN, RN]

Is this new? I thought that in several states, NPs could practice and have prescriptive authority without MD oversight. Just looked - it looks like in approximately 15 states, NPs have full practice authority without the requirement of a collaborative agreement. So this is nothing new, and I don't understand why people would get het up over it, when clearly NPs have been doing this successfully for many years in other areas of the country.

[IrishIzCPNP, MSN, RN, APRN, NP]

Is this new? I thought that in several states, NPs could practice and have prescriptive authority without MD oversight. Just looked - it looks like in approximately 15 states, NPs have full practice authority without the requirement of a collaborative agreement. So this is nothing new, and I don't understand why people would get het up over it, when clearly NPs have been doing this successfully for many years in other areas of the country.

The "new" is really just more states pushing for independence and full autonomy. The idea and the practice...not new across the board. This is pretty current in the NP world.

[Susie2310]

I agree that the clinical importance of the physician's expertise is being underestimated. I am sure too that the cost-effectiveness of nurse practitioners is being over-estimated.

Nurse practitioner training at the master's level involves around 600 hours of clinical training or less according to the web sites of prominent universities I checked. This is but a fraction of the number of clinical hours of training a physician receives. A physician generally has a bachelor's degree in a science, attends medical school for four years, and spends several more years doing residencies, internships and fellowships. To train as a Nurse Practitioner one is required to be an RN, with a BSN, and NP schooling is generally three years.

Most people would agree that a physician undergoes a far more rigorous and extensive training. Because of physicians extensive training in medicine, my family and I choose to receive our medical care from physicians. If someone is standing in front of myself or my family, and is presuming to diagnose and treat us, they are presenting themself as a medical authority, and we are only willing to accept physicians as medical authorities.