mom2cka, BSN, MSN, APRN, NP 6,956 Views
Joined Apr 15, '02 - from 'North'.
mom2cka is a FNP.
Posts: 330 (22% Liked)
I've been at the AANP National Conference in San Antonio the last week. My first time, it's awesome. One of the best aspects is seeing thousands of NP's together for one cause. Truly it was inspiring to see the potential that our profession has when we stand together. If you've never been, I would encourage every NP to attend.
This is exactly why I believe physicians are at the pinnacle of healthcare, and I literally want to hide my face any time some NP blathers away about his or her master's degree and 750 patient contact hours as having parity to board certified physicians. I tip my hat. You've earned your title and degree.
While I envy your education, I am pleased that I spent a decade of my life, after college, doing other things before entering healthcare, but I knew that for me to become clinician satisfied with both work and home life I would need to become a midlevel so as not to displace another decade of my life. I laud your professional and objective demeanor as many physicians would be much more condescending toward the suggestions of the OP. Congratulations on your achievements, and I wish you success in securing the fellowship of your choice.
I was browsing this forum to get more information for my sister who is interested in nursing, with the goal of potentially becoming a family practice NP. I was here to educate myself on how one pursues this track, and I happened to come across this thread, and myself being a physician wanted to know what it had to do with.
Just a little bit of my background, I am a PGY1 Internal Medicine Resident Physician, with the end goal of becoming a Cardiologist. I graduated from an Osteopathic Medical School, and I took the COMLEX and the USMLE exams, and matched into an ACGME accredited Internal Medicine residency.
I wanted to give you my perspective on this. Let me first start off by saying, my main exposure to mid-level providers (that is what we call them at my hospital, no offense intended) are medicine PAs and NPs, and they work on the observation units and non-teaching services under the direction of an Attending Physician.
I wanted to clarify what you meant by 'An NP is qualified to do what a GP does', since my primary residency training will qualify me to become an Internist, aka a GP.
By the time I am a board certified Internist, I will have completed all 3 levels of the COMLEX examination (each exam is 8 hours long, done in two 4 hour sessions, with a 50 minute lunch break, of which the intensity I never want to re-live, let alone countless hours stressing over/studying for), in addition to the USMLE exam (which I personally chose to take, but not all osteopathic physicians do, my reason being I wanted to matriculate into an ACGME program near my hometown), done 3 years of formal residency training, which on average is 70-80 hours a week while rotating through the hospital wards and units (MICU and CCU), as well as more regular hours, from approximately 8 pm to 5 pm when rotating through the outpatient clinics (which include general medicine and every single subspecialty in medicine. In addition to this, we take part in simulation labs (where we walk into room with robots programmed to act as crashing (and sometimes subacute scenarios as well) patients, with other physicians acting as providers (RNs, family members, consulting physicians, etc) to simulate a real life scenario). In Simulation Labs, we also practice procedures such as CVLs, intubation, BLS/ACLS where we are code leaders, and numerous other things. We also participate in evidence-based didactic/journal club sessions, electives and research on a regular basis. In addition to this, while on floor wards, we have formal lectures given by an attending or a senior resident at least once a day. On most days, there are 2 lectures given, in addition to M&M every Wednesday, in addition to Grand Rounds offered not only in Medicine, but our Medicine subspecialties as well.
Every rotation and didactic driven course I described to has a unique flavor and twist, and I could go on for hours as to how they are structured and run, but then I would digress too much, but the common denominator is that, at every single step of the way there is dedicated faculty (board certified internist and subspecialist) teaching us medicine every single day. Oh, and we take a 4 hour inservice exam (of which we receive a detailed score report and breakdown with our strengths/weaknesses) every year (in addition to our Steps and Boards), and we are evaluated by all our Attendings after every rotation (ACGME requires this).
In total, we average approximately 15,000 hours of dedicated clinical training over 3 years, before ever becoming the sole decision maker aka Attending Physician aka 'The Buck Stops With Me'. Not only this, but a majority of us are published in peer-reviewed journals. I myself am currently working on multiple case-reports and abstracts to submit at local and national seminars and the ACC (American College of Cardiology). I will eventually start working on retrospective and prospective studies once my abstracts are accepted (crossing my fingers that they are!).
My point is, this is what I go through to become an Internist, or GP as known by the public. To be honest, I haven't even skimmed the surface of what we had to do to even get accepted into a residency. This is why I have earned the title of 'Physician', and this is why it is a legally protected title in many hospital systems and states. So this is why I advise caution when you decide to make a very general blanket statement such as 'An NP is qualified to do what a GP does'. If I have misconstrued your question, or come off as offensive, I had no intention of doing so, I am simply just trying to help you understand things from my point of view. Like I said, I work harmoniously with many NPs in my hospital, so please do not take this the wrong way. I hope I answered the OPs question.
Please feel free to PM me with any questions.
Hello Forum members.
I have been a practicing nurse for almost 15 years. During that time, an extensive bit of my experience has been within teaching facilities in which I worked side-by-side with fellows, residents, PA students, APRN students, and RN students. I have heard the debate concerning APRN's practicing medicine too many times to count.
As a current student in a family nurse practitioner program I would like to finally throw my opinion on this debate into the ring.
DO's, MD's, and PA's are taught reactive treatment. They specialize in treating a disease process that has manifested and is active.
NP's/APRN's are taught proactive treatment. We specialize in health, lifestyle, and behavioral interventions to prevent disease and illness.
** This is an abstract of thought, not a definitive definition for all DO's, MD's, NP's, and APRN's
I believe each group can do the work of the other (medicine vs nursing), but I believe MD's/DO's/NP's have a slight advantage in some areas thanks to high levels of biochemistry/biology training. I believe APRN's have slight advantage towards holistic care and prevention as these are two components of throughout the core nursing philosophy. I will also state that the best and most effective health care teams I have had the privilege of working with are composed of a variety of providers (MD's, PA's and APRN's) in which no one is the defined leader. Instead each member has a 51% vote on matters. If a PA or NP does not agree with a MD's plan of care, they can stall the action until it can be discussed and a mutually agreeable solution can be found. When this model is used in a professional manner, it is quite effective. Unfortunately some want to be the boss or refuse to concede to group decisions as a means to subvert authority from the group.
In the end, nursing and medicine follow similar but slightly different paths to end at a mutual goal: to provide care and support to our patients, families, communities, and state/country in regards to health and well-being.
APRN's are not going away. Several states are on the move to have PA's follow a path similar to APRN's for an autonomous role. Some MD's and DO's are resistant to change, but change is inevitable.
Thank you for taking the time to read this. Have a good day.
A few interesting links on related material:
A Doctor Confides, âMy Primary Doc is a Nurseâ | Health Beat by Maggie Mahar
Stop calling nurse practitioners mid-level providers
Okay. I did know the different educational trajectories, of course, I just get a little lost when hearing nursing vs medicine. I know the differences in definition, but wasn't sure if there was a practical difference.
But can you explain what that means, please?
I've been a CNA working in acute rehabilitation for about 5 years now. Mostly, I just wanted to get my foot in the door, so to speak. I just sort of stumbled upon rehab, and am so glad I did. I really think this is the specialty I was meant to be in.
To see someone walk in 2 weeks out from having a CVA and thinking that their life was over and see them WALK out our doors 2 months later is just the greatest feeling.
I was reminded of that feeling a few weeks ago when I found out that a patient I had two years ago is doing fantastic.
This patient was a young parent and spouse who had suffered a massive stroke. The pt. was completely aphasic but understood EVERYTHING. The whole thing was just so heartbreaking and sad. I really didn't think there was a whole lot of hope, and the pt. left us about 4 weeks later a little bit better but not by much. Couldn't walk, speak or eat solid food. Pt was so driven to do well and wasn't getting the results they wanted. For some reason this person just touched my heart so much and I remember every detail about them.
Just found out pt. is WALKING, TALKING, DRIVING, eating, ...... Just makes everything so worth it. Oftentimes we have no way of knowing what happens when they leave us and its so refreshing to hear this kind of news.
Wanted to share.
Only 30K for a BSN....and you don't have kids. Does your husband/wife work & contribute to the bills? Does your mom help around the house? In my opinion if its only 30K, and you have support like this and no kids, you need to GO FOR IT. BSN will soon become the standard, it opens doors for you to get certifications and go to grad school. It's not always about the money. Things are changing, they will NOT stay the same!!! Lock in a BSN NOW before more "curveballs" get thrown your way. You'll be much better equipped to handle them with more education instead of less!
This morning I had the following conversation with my kids (ages 5 and 3):
"Mommy, why are you dressed up?"
"I'm going on a job interview."
"Why do you go to job interviews?"
"You meet with people and if they like you they offer you a job."
"I like you, Mommy!"
"I like you, Mommy!"
I am so excited! I will be transferring to the physician group in the hospital system I work in, which is a plus because I won't lose seniority,etc. This may sound weird, but a big thing with me was being able to work 4 days a week, Mon-Thurs. They said that was fine!!!
Anyway, pay is OK, will be fully vested in their pension, which is good as I am 55. So pension and time is a big deal for me. Also no non compete.
So excited, now have to pass final exam next week, and boards!
Please see this effort to encourage the White House to remove scope of
practice barriers for APRNs through a petition campaign. You can access the
petition by going to:
is required in order to sign; the goal is 100K signatures.
orientated is a perfectly fine word....you just aren't used to hearing it.
"Orientated". I got 'orientated' to my job today. Mrs. Smith is alert and 'orientated'. . .
You learn that it is almost always not about you
You learn how to spell HIPAA
You learn that there are many, many, many ways to be a real nurse without working bedside in a hospital or SNF
You learn that they don't do it that way everywhere just because they do it that way where you are
You learn where critical thinking can take you
Hey it's work folks. I actually know nurses who would be offended by this email BECAUSE they feel they have some sort of constitutional right to constantly conduct personal business at work. A call once in a while is fine, but it's always overboard - a generational change, I think.
Go ahead and be annoyed. But know this, she has spoken, and I'd applaud her if she actually follows through. When you send an email drawing a line in the sand, you better enforce it, or you will be forever ignored - by me as well.
For a NM to send a mass email, sounds like the unit has some issues. E mail is a great way to get the message to everyone. Morning meetings only reach a selected number of staff. I have no issues with this type of message.
No manager should have to say that. Apparently professional behavior is hard?
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