So why even bother with getting an RN? - page 5

Saw an ad for urgent care wanting to hire MAs. They want you to be able to provide compassionate nursing care, assessing patients & taking effective action. They also want you to be able to triage... Read More

  1. by   samadams8
    Quote from duskyjewel
    You know, it's really no wonder this country is going to hell in a handbasket, with thinking like this. The solution to your problem is to sic the government on someone else, to take away their job by regulating it out of existence? Who else's job would you like to use the power of overbearing government to destroy?
    IDK, you would be hardpressed to find someone that detests government overlording and excessive government intervention than me. At the same time, consider this. What happens if you are caught practicing medicine w/o a license? Why should it be any different with practicing something that falls within the legal and professional domain of nursing? Just saying. . .
  2. by   samadams8
    Quote from BlueDevil,DNP
    No, our MAs do a great deal more than that. I'm very comfortable with their performance and scope. They do a great job and we could not operate without them. We also have one nurse. The only point of my post was the correct the misimpression that one must possess a MD degree to direct MA activities. It may be thus in some states, but not in mine.

    I don't identify my location, but there are less than 20 states with completely independent NP practice, so that should narrow it down for you somewhat.

    There is a long tradition of MA disdain on this website. My experience with them has been nothing but positive. However, I have only worked with 6 in my entire career, lol. Those 6 have been outstanding members of our team and I've never had any reason to want to replace them. There has never been anything in a primary care office that I have needed that made me wish my MA were a nurse. We don't need nurses in the office. The nurse we have is a wonderful person, but spends most of her time ordering doing inventory and ordering supplies and does very little actual nursing activity. She really is unnecessary, and when she graduates from her NP program and resigns, it has already been decided she will not be replaced, and her responsibilities will be assumed by the office manager.
    All I can say is, WOW. So when your MA is listening to heart and lung sounds, what do they really know of it? Yes, in my physician's office, a RN takes VS, input information, and does a focused assessment, to include lungs and heart. Personally, when certain people, physicians, NPs, PAs, or RNs listen and assess heart sounds, I take it with a grain of salt. Most of the miss things. Sure, we could be talking functional murmurs, etc, but still. Many health professions, in general, IMHO, suck at heart sounds. And some of them aren't all that great with lung sounds either. Yes, OK. So, I'm a critical care nurse, and these things can be more of an issue is that setting.

    What do I think? I think MAs are not only cheaper, it's the whole "less is more" mentality from the primary provider. Listen, most people don't want anyone to question them. If they miss something, it not only ****** them off (stupid pride and what not), but they feel it may put them in a legally precarious situation should something missed is or may become an issue. Nurses would be obliged to document their assessment findings. Now, if you have a strong RN, with strong experience and good judgment, it would behoove the primary provider to give heed and consider whatever difference or distinction is made. Sure the final word would still come down to the primary, but someone of real integrity, who put the patient first, would put aside any possible pride or excessive worries, and take a closer look at the findings of the experienced RN. Since visits won't be reimbursed, physicians and primaries may not include them in their practices. It would also mean that you would have to take more time to closely vet the RN. This takes time from primaries' practices, for which they are also struggling to optimize patient visits and compensation. In my practice, at least I'd try and I'd bite the bullet and use highly experienced RNs with sound clinical judgment. Systems of checks and balances are good things. There's a big difference in the functioning and thinking of most MAs to most experienced RNs. But very few practices are willing to pay about a third or so of a physician's income to an office RN. For NPs in similar situations, that would make up generally 50-70% of their income.

    It seems to also depends on how big the practice is and how many primaries are in it.
  3. by   samadams8
    Quote from Altra
    In my experience, NPs in primary care are providers. I have not seen it suggested that NPs should function otherwise in an office setting.

    Well, this is a whole separate discussion.
  4. by   samadams8
    Quote from exit96
    Here's a liberal position for you, tell everyone to kiss your rump. Whether they are so called " democrat or republican" they do not care. The top echelon that has the money pulls the strings.
    Off topic, but I just have to say, this is so the truth. This is true for all government systems too. You just have to find the one that limits the controls as much as you can.
  5. by   BrandonLPN
    Stupid question, is NP an "add- on" to RN licensure, or completely separate? You can't be a NP without also being a RN, right?
  6. by   nurseprnRN
    Quote from BrandonLPN
    Stupid question, is NP an "add- on" to RN licensure, or completely separate? You can't be a NP without also being a RN, right?

    Umm, yes. And far be it from me to disagree with your original assertion so late in the discussion. (walked right into that one, huh?)
  7. by   BrandonLPN
    Quote from GrnTea

    Umm, yes. And far be it from me to disagree with your original assertion so late in the discussion. (walked right into that one, huh?)
    Yes as is "yes thats right" or yes as in "Yes you can be a NP without first having been a RN"? Cause I was under the impression that one had to already be a RN to enter a NP program.

    And my original assertion? That "specialist" UAPs will push nurses away from traditional bedside tasks? Already happening in LTC. And if (when) hospitals throw a couple medication aides and wound techs on the hospital floor, acute care will see it, too. But since some seem to associate the "tasky" side of nursing with mindless, menial labor, maybe this is a change that will be welcomed by some?
  8. by   nurseprnRN
    "Yes," as in, "Yes, you have to have an RN license before you can pursue and obtain an APRN license." The original assertion: that it was really a pretty silly question when you think about it.
  9. by   BrandonLPN
    Oh, ok.

    well I said it was a stupid question, after all.

    There were posts somewhere upthread that questioned whether a NP could function as a staff nurse in a clinic. That's what got me wondering.
  10. by   ThePrincessBride
    I don't understand why some RNs fear that they will be replaced with techs, etc. It will NEVER happen, from a liability standpoint. Just imagine the number of (med) errors. They would be through the roof if we allowed improperly-trained staff do what a nurse SHOULD be doing.
  11. by   exit96
    Even if I know that techs will never take my RN job from me, the more they are qualified/ allowed to do makes them more valuable, and me less valuable...or stated another way; the gap between the 2 jobs narrows. So $$ is used to pay MA's and less is available for,RN's. comparatively then, why go to school to be an RN, if this gap continues to close up? The amount of schooling an RN gets through compared to an MA isn't even comparable.
    I guess it's really not a battle of mine. I don't work in a private practice anyway...
    Last edit by exit96 on Apr 15, '13 : Reason: Needed to add something
  12. by   BlueDevil,DNP
    Sam Adams:
    MAs do not assess heart and lung sounds in our office and neither does the RN, but I'm assuming that was a hyperbolic comment. I certainly know how to assess heart and lung sounds and am quite expert at it. I don't know what the rest of paragraph 1 was about, but certainly not about anything I've written in this thread.

    Regarding the next section- Are you suggesting we don't want to have a RN because we are afraid of being contradicted by her in the medical record? Nurses don't do patient assessments or document in the patient charts beyond entering the chief complaint and the VS. That is truly baffling. That is simply not how primary care operates, man.

    skipping to here:

    Quote: "There's a big difference in the (functioning and) thinking of most MAs to most experienced RNs."

    I completely agree with most of this comment. My point of contention is, no, there is not a big difference in the function between the two in a primary care office. In the thinking, yes, I'm sure that is true. However, there is very little we need that the MAs cannot do. They can do the tasks. They may not understand the rationale, the pathophysiology involved, or implications of said tasks, but I don't care if they do or not. I don't need them to understand, because I understand. Understand?

    Quote: "In my practice, at least I'd try and I'd bite the bullet and use highly experienced RNs."
    I submit that your practice would be broke and out of business in less than 6 months.

    I think that members of this site get overly defensive on the issue of Medical Assistants. The role of the MA in the outpatient setting is not comparable to the role of the Registered Nurse in an acute care setting. The scope of practice, tasks, expectations, and responsibilities are so different as to be totally unrelated. Outside of taking vital signs, I cannot think of much else they would have in common.

    This reminds me of a conversation I had with recently my sister-in-law. One of our children is a graduate "teaching assistant" to a distinguished professor/department chair at one of the best Universities in the world. My sister-in-law said, "Oh, <insert her kid's name> is a teaching assistant too!" She marveled at how amazing it was that our children had had such diverse paths in school (ahem) and ended up "doing the same thing" at age 23. My niece is a teaching assistant in a Day Care Center.

    Now, I submit that my daughter is overqualified to be a teaching assistant at a Day Care Center. They could hire her, but why on earth would they? Would she be happy at a day care center? Fulfilled? I doubt it. My niece seems to like it. She was apparently employee of the month recently, and is much loved by the children and parents. If she is good at it, likes it, is appreciated by the people she positively impacts, should be be denigrated because she is potentially taking a job away from my daughter, who is arguably better qualified for it? After all, my daughter is a mathematician, and could surely teach those 2 year olds to count better than my niece!

    The University is unlikely to hire my niece. She can call herself a TA if she wants to (although by law MAs can not call themselves nurses, due to laziness more than anything, many people-patients, providers, etc., do use the label 'nurse' inappropriately) but she isn't qualified to try to teach undergraduate math and stats courses at UC Berkley.

    The cousins have similar titles, and on the surface, vaguely similar job descriptions ("teacher's assistants"). They both do various scut work their superiors do not want to have to bother with, or do not have time to do, or that has been deemed an inefficient use of their more valuable time.

    By the same token Sam, why would I hire you to take VS and send faxes to the pharmacy in my office? I could, but why? Would you be happy and fulfilled with that kind of work? Like my daughter, aren't your talents put to better use in the environment you are in now?

    It's the same thing. No one is going to put my niece in charge of teaching college algebra to undergrads at Berkley and no one is going to let MAs start operating balloon pumps and otherwise running ICUs. But my niece deserves to be respected for the good work she does, and so do the MAs.
    I am not my sister-in-law, and I am not pretending that the two roles in this case (nurse and MA) are remotely the same. What I am saying is that in the primary care office, the MAs can assume all of the tasks that we require, perform them well, and as a part of the team, help us to deliver safe, high quality care while keeping health care costs from becoming even more unmanageable than they already are. They deserve a high five for that, and not petty derision.
  13. by   GabyPleasant
    Quote from Fiona59
    Brandon, up here RNs are at $50/hr and LPNs are $33.
    Where is up here? Just wondering