Nurses are Not Doctors

Nurses General Nursing

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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

Specializes in Nephrology, Cardiology, ER, ICU.

As APNS we should be advocating for our profession by being active in our state's APN organization, being knowledgeable about issues and being aware and contributing to political action committees in our state. It's these kind of editorials that do nothing except to sensationalize one physicians viewpoint. As others have stated there are no hard facts to back up what this physician espouses to be true.

however, as APNS we owe it to ourselves and our profession to be on the forefront of new developments and laws that affect all of us.

Turf battles. This topic reminds me of the issues nurses face with medical assistants. Maybe physicians are facing the same thing with NPs.

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Turf battles. This topic reminds me of the issues nurses face with medical assistants. Maybe physicians are facing the same thing with NPs.

The difference is that NPs do not think they are doctors the way so many MAs think / say they are nurses.

Specializes in Pediatrics, Emergency, Trauma.
The difference is that NPs do not think they are doctors the way so many MAs think / say they are nurses.

This...even though that's a whole other thread. :cheeky:

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

And, FYI, it's "OCNRN," as in "Oncology Certified Registered Nurse."

What's the other N for?

I found it amusing that TU RN called you OCRN and you apparently got offended by that and corrected him/her, explaining that your name stands for "Oncology Certified Registered Nurse" which seems, to me, would be abbreviated OCRN, no?

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
You may not be, but many of us are. I would guess that every nurse here who works in a taching hospital where they get a lot of residents trained abroad does. I certainly do. They may not even know it since their name badge usually says "MD" even when they don't actually hold an MD.

So I just want to make sure I understand what you're saying. You're saying that there are people practicing as MDs and who call themselves MDs who aren't actually MDs? And you know of several of them at your place of work? How is that legal?

I've worked at two large teaching hospitals in a large city and I've never heard of this phenomenon.

Specializes in Oncology; medical specialty website.
What's the other N for?

I found it amusing that TU RN called you OCRN and you apparently got offended by that and corrected him/her, explaining that your name stands for "Oncology Certified Registered Nurse" which seems, to me, would be abbreviated OCRN, no?

Deleted.

Back to the orginial article and discussion.......

The idea of NP's without a physician link deeply concerns me. I have observed exactly what the author of the NYT article describes.....overtesting and over-reaching due to lack of clinical knowledge and experience. I think that NP's as part of a practice are great. The general assessment and history, treatment of minor acute illnesses, and management of chronic disease are all well within the scope of practice of an NP, and frees up the docs for more challenging and difficult cases/patients.

Additionally, far too many NP's, although they do not claim to be physicians, seem to have an underlying "I can handle this" overconfidence in their skill set. Personally, I have worked with several NP's with this issue, and six weeks after a "clean bill of health" from a GYN NP, I had surgery to remove a 12 cm ovarian mass ( Found as an incidental finding after an ED visit with a kidney stone). Speaks to a lack of diagnostic ability that could have cost me my life.

So, I agree with the author....NP's in solo practice are scary (NOT talking about CNM's, who know the limits of both their patient population and daily interventions. Pregnancy is not a disease, either, although it CAN lead to complications requiring an MD level of training and competence). I wait the extra day at my PCP to see a doc, even if the NP has openings, unless I am 100% sure I know what is wrong and what the treatment is. (I am NOT an NP, my MSN is non-clinical).

Specializes in Pediatrics, High-Risk L&D, Antepartum, L.
Back to the orginial article and discussion.......

The idea of NP's without a physician link deeply concerns me. I have observed exactly what the author of the NYT article describes.....overtesting and over-reaching due to lack of clinical knowledge and experience. I think that NP's as part of a practice are great. The general assessment and history, treatment of minor acute illnesses, and management of chronic disease are all well within the scope of practice of an NP, and frees up the docs for more challenging and difficult cases/patients.

Additionally, far too many NP's, although they do not claim to be physicians, seem to have an underlying "I can handle this" overconfidence in their skill set. Personally, I have worked with several NP's with this issue, and six weeks after a "clean bill of health" from a GYN NP, I had surgery to remove a 12 cm ovarian mass ( Found as an incidental finding after an ED visit with a kidney stone). Speaks to a lack of diagnostic ability that could have cost me my life.

So, I agree with the author....NP's in solo practice are scary (NOT talking about CNM's, who know the limits of both their patient population and daily interventions. Pregnancy is not a disease, either, although it CAN lead to complications requiring an MD level of training and competence). I wait the extra day at my PCP to see a doc, even if the NP has openings, unless I am 100% sure I know what is wrong and what the treatment is. (I am NOT an NP, my MSN is non-clinical).

So I had a pediatrician tell me my daughter was fine. She was actually dying. So by your theory that means the MDs shouldn't have independent practice because I had a bad experience.

Also, a CNM is an NP with a different name. Her training is no superior. But that type of APRN is okay? Pregnancy isn't an issue...an APRN can handle that? Have you work in L&D? Oh wait...I've seen MDs royally screw up there too and the day saved my the CNM (APRN). So again...MDs are bad because I saw it.

I get it. Studies are meaningless. We will just go by personal opinion. Perfect except...we won't have any medical professionals.

My daughter who was dying is thankfully alive. Her main specialist...an NP. The speciality that keeps my daughter (and son alive) and they see an NP and not an MD. Just saying...

Specializes in Med-Surg, NICU.

Here is my problem with comparing NPs to MDs:

1. The low standards needed to enter NP school. You can have people attend these University of Phoenix-type schools and receive their NP license online with little to no previous RN experience or NP clinicals. I take GREAT issue with grad-entry programs where people can come in with no healthcare experience and start practicing as APNs without ever having touched a patient before.

MDs, on the other hand, spend four years in medical school and a minimum of three years in residency. That is not including internships and fellowships and research that many choose to participate in before becoming attendings.

2. The lack of (or little) clinical hours. What is it, 600 clinical hours for NPs WITHOUT NP residencies? Most residents will get those six-hundred hours in eight months or less in their first year. I mean no disrespect to NPs, but if I were a resident, I would be ******. NPs shouldn't expect to have the same level of autonomy as their MD counterparts because they did not have to endure intensity and years of training and sacrifice. One can't possibly have that same level of expertise in 600 hours as someone with 15,000+ hours of clinical experience (and that 15,000 is on the lower end, by the way!).

3. NPs practice under an entirely different model (nursing) while MDs practice under the medical model. NPs typically take on a more holistic approach than their MD counterparts.

If NPs want the same amount of autonomy and respect as their MD counterparts, there needs to be a standardization and higher expectations for NPs. Eliminate these grad-entry and online programs. MAKE people have their BSN prior to entering an NP program. Raise the amount of clinical hours and MAKE tese schools incorporate an NP residency prior to setting their new grads off into the world.

Agree, or disagree.... I think The Affordable Health Care Act will drive this debate. I think we will see NP's opening private practices nation wide. It's simple math, you can't dump 30 million plus recently uninsured people into a system that already had a shortage of Family Care Doctors and expect anything but delayed health care. This delayed care will drive the need for more NP private practices. NPs will just need to be aware of their limitations and when to refer patients to Specialists when treatments fall outside of their scope of training.

Specializes in Pediatrics, High-Risk L&D, Antepartum, L.
Here is my problem with comparing NPs to MDs:

1. The low standards needed to enter NP school. You can have people attend these University of Phoenix-type schools and receive their NP license online with little to no previous RN experience or NP clinicals. I take GREAT issue with grad-entry programs where people can come in with no healthcare experience and start practicing as APNs without ever having touched a patient before.

MDs, on the other hand, spend four years in medical school and a minimum of three years in residency. That is not including internships and fellowships and research that many choose to participate in before becoming attendings.

2. The lack of (or little) clinical hours. What is it, 600 clinical hours for NPs WITHOUT NP residencies? Most residents will get those six-hundred hours in eight months or less in their first year. I mean no disrespect to NPs, but if I were a resident, I would be ******. NPs shouldn't expect to have the same level of autonomy as their MD counterparts because they did not have to endure intensity and years of training and sacrifice. One can't possibly have that same level of expertise in 600 hours as someone with 15,000+ hours of clinical experience (and that 15,000 is on the lower end, by the way!).

3. NPs practice under an entirely different model (nursing) while MDs practice under the medical model. NPs typically take on a more holistic approach than their MD counterparts.

If NPs want the same amount of autonomy and respect as their MD counterparts, there needs to be a standardization and higher expectations for NPs. Eliminate these grad-entry and online programs. MAKE people have their BSN prior to entering an NP program. Raise the amount of clinical hours and MAKE tese schools incorporate an NP residency prior to setting their new grads off into the world.

MDs do spend more time in school but again...NPs specialize from almost day 1. So our education is going to be shorter.

Why should a resident care? We aren't trying to be them or making their salary. We are a different field with a different approach and proven to be fully capable of positive outcomes.

Residencies...I never expect to see that across the board. Who is going to pay the residencies of the NPs? The residents I worked with had a decent salary and lots of bonuses. Who is going I foot the bill?

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