RN to Medschool 977 Views
Joined: Jul 8, '08;
Posts: 33 (15% Liked)
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It's true that society places substantially more value on you, the physician.
For example, physicians who verbally abuse nurses repeatedly get away with it, because they are the 'Money Makers' for hospital systems. Nurses who verbally abuse physicians will be shown the door if too many complaints are made. The nurse is considered an expense on the hospital's account, along with the courtesy soap and bedpan.
In addition, the patient who becomes silent and respectful when the physician enters the room is the same patient who berates the nursing staff 24 hours per day. Sorry, but society will always bestow more respect upon you, and it is probably deserved due to your substantial level of educational attainment and importance to humankind.
Let's look at some of history's greatest change agents
Its really difficult if not impossible to make money in primary care. In a shortage market specialty care can offer more money. Exactly and that’s why groups have so many us running around seeing patients for them. Cost benefit ratio: More seen more money in the bank.
Advancement of nursing education + sicker population + shortage of providers + delegation of authority = Certain providers are losing ground (i.e. money, prestige)
Nurses have been diagnosing, ordering test, intervening well before any of us even existed. Still happens now, tomorrow and the next. Hospital nurses, office nurses doing what needs to be don. Doctors have not only delegated this authority but they have given it away. [
Again, we can argue about which professionals lack what courses and how long the training is for this field and that field. But is there proof that there is a difference in the product of training between a primary care physician, a primary care PA, and a primary care NP? It is easy to assume that a clone of a medical school program will produce a competent clinician in primary care if you apply the standards of medical school education. But isn't advanced practice nursing with its current model of education producing just as competent a clinician in primary care? Prove to me that this is incorrect and not with anecdotal evidence and unconfirmed data.
There are currently less than a quarter of all states that allow no physician involvement in NP practice and even less if you factor in prescriptive authority. If that is your definition of autonomy then, you are right. But my idea of the word "autonomy" is not exactly the same. Are family practice physicians truly autonomous? I think not. There are a multitude of disorders and conditions that a family practice physician could not manage on their own, hence, they need to refer their patients to specialists. Some even ask colleagues who are primary care physicians themselves for their opinion. Heck, I don't even think any physician is really independent.
Primary Care NP's, even in those states that require some form of physician involvement, are the sole health care provider in a given rural clinic in some instances.
The collaborating physician may be miles away only available by phone.
Does the physician get to see the NP's patients? Not unless the NP thinks they need to be seen by a physician.
This happens in some states and is completely acceptable as the NP is not breaking any practice act or federal law in this case.
Now I know that there are certain states out there where this scenario would never happen because of restrictive practice acts for NP's but in this particular case I described, I WOULD call that autonomous practice.
I have to go for while, please keep posting, I have no problem with you disagreeing with me, in fact I expect some to, I wish I had all the info in front of me, I have to study for clinicals tomorrow (IM) some review.
Maybe in time I will understand this better and in time you will understand what I and others fear.
Thanks to those of you willing to discuss this.
I would like to see advanced nursing education changed. The first year would be devoted to clinical sciences such as bio, genetics, gross anatomy, and pharm. During the later part of first year start going through the ten systems and clinical application. Then the last 2 years full time clinical residency. Or instead of requiring a BSN make the requirement a BS in biology or biochemistry. I agree nursing does need to have more science in it's curriculum.
That's your opinion. If it looks like medical school, then shouldn't we be calling it medical school then and not a NP program?
Autonomous practice in primary care already began before the DNP was even made public. And what makes you think NP's do not need CME's or read journals because we do? The next time you attend a medical conference, look around you because you may be sitting next to a NP.
Show me the studies and the figures to support this claim and how NP's contributed to these unsafe procedures and treatments.
as i understand the debate rages on over the equivalency between physicians and np's, especially in the sense that soon we will all possess clinical doctorates-physician and apn alike. many have stated that physicians and np's are not "equivalent." although i believe that most are stating this in the context of comparing medical school training and np training, i am starting to get a sense, however, that this is transcending into a different area--that is from a training point of view to a product/professional standpoint. this concerns me.
to that end, i think we can all agree that medical school is not the same as np school, just like md school is not the same as podiatry or optometry school. from a license structure, md's and anp's are quite different. apn's are no more licensed to practice medicine than physicians are licensed to practice nursing. the danger lies, i feel, when we start on a path describing discrepancies and disparities in the form of inequalities in the form of equivalencies between the two separate disciplines from a training and licensure standpoint to that of a profession and product.
the oxford english dictionary, the gold standard for defining and initiating concept analysis provides the following definition for "equivalent":
1. of persons or things: equal in power, rank, authority, or excellence.
with the contemporary power structure there is much evidence to support the notion that physicians have superior power, rank and authority in comparison to np's (for now) in the health care industry. this is evidenced by the medical communities power in attempting to suppress nursings utility of clinical doctorate titles in the health care setting, while at the same time, supporting the use of other clinical-based" doctor" titles for other disciplines, such as dentistry and podiatry. this clearly sets the tone, as just one example, especially if supported by apn's that physicians truly do have more power, or i should say the power apn's allow them to have.
i'm curious, though with regards to "excellence" in the definition. how many np's out there feel that the excellence they demonstrate through caring, practice and leadership are less than that of a physician?
2. equal in value, significance, or meaning.
how many np's out there feel that their value, significance or meaning to themselves, clients, the profession or intuitions are less than the physician?
3. that is virtually the same thing; having the same effect.
for those np's who consider themselves as practicing medicine: is the medicine you practice of any lesser quality than the medicine practiced by the physician? if not, does adhering to the same standard of care yield the same results--that is provide the same effect? for those who consider their apn practice as nursing and only nursing--that is functions of advanced nursing overlap with other disciplines (e.g. medicine) are the outcomes of your clients inferior to that of the outcomes effected by the physician?
4. having the same relative position or function
think about the term, concept and practice of "primary health care." how many np's feel they cannot perform primary care functions to the same standard and yield equivalent outcomes for their clients as the physician? do you take care of clients knowing they would have received better care and consequently a better outcome if they would have been seen by the physician?
5. something equal in value or worth.
how many np's out there feel they have less value or worth than that of a physician?
to sum it up, when apn's state that md's and np's are "not equivalent" i am hopeful this is only in the context of training and licensure and not practice, outcome or product-based.
in this context for anyone to claim that apn's and md's are not equivalent, they would have to subscribe to the following system of beliefs:
1) apn's do not demonstrate the same excellence in care and practice as the physician,
2) apn's are insignificant; of lesser value and ultimately mean less to themselves, their clients, their profession and the institutions in which they are employed.
3) clients have less than a positive outcome when treated by apn's as compared to those who are treated by physicians.
4) apn's provide primary health care services to clients in an inferior manner as compared to the physician.
5) apn's have lesser of a value than physicians.
i hope, in this context, that i will not be the only one on this board who believes apn's are equivalent to physicians.
AN yet a new thread pops up, for those of you who say NP's are not being equated to MD/DO's
To sum it up, when APN's state that MD's and NP's are "not equivalent" I am hopeful this is only in the context of training and licensure and not practice, outcome or product-based.
In this context for anyone to claim that APN's and MD's are not equivalent, they would have to subscribe to the following system of beliefs:
1) APN's do not demonstrate the same excellence in care and practice as the physician,
2) APN's are insignificant; of lesser value and ultimately mean less to themselves, their clients, their profession and the institutions in which they are employed.
3) Clients have less than a positive outcome when treated by APN's as compared to those who are treated by physicians.
4) APN's provide primary health care services to clients in an inferior manner as compared to the physician.
5) APN's have lesser of a value than physicians.
I hope, in this context, that I will not be the only one on this board who believes APN's are equivalent to physicians.
I think that you should probably research the studies on nurse practitioner care outcomes before you post your opinions. Many regular members here have posted links to them and I know that they are not perfect studies. In fact, there will never be a perfect study because no study involving human subjects can allow a strict manipulation of variables for ethical reasons. Like you said "we are talking about life and death here".
But one thing nurses in general are aware of is the fact that health care can be a matter of life and death. Nurse practitioners no matter how independent they are in their practice, will know when things are beyond their knowledge and expertise. We did not earn the reputation of being the most trusted profession in the US for years on end for nothing. I am not a primary care NP and I am not independent in my practice either. My NP specialization deals with clinically complex critically-ill adult patients. Nothing less than an interdisciplinary team of collaborating professionals will suffice in my setting.
I invite you to take the time to talk to primary care NP's who have successfully practiced with little physician involvement and then let me know if there is anything they do that is unsafe and beyond what is expected in a primary care environment.
yes, no one here is arguing the equivalency of the dnp to a physician. the op seems to have a huge chip on his/her shoulder -- bordering on being a big ole' troll. any more passive agressiveness should lead to banning the hairy thing under the bridge.
as for the time it takes to do the programs... a dnp and md *are* the same amount of time (a doctoral degree is a doctoral degree is a doctoral degree)
the american association of colleges of nursing (aacn) is calling for the requirement of doctorate in nursing for advanced practice nurses, such as nurse practitioners, nurse midwives, clinical nurse specialists, and nurse anesthetists. this new degree will be called a doctor of nursing practice and, if the aacn has its way, will become the entry level for advanced nursing practice.
Prior to the advent of the DNP, NP's have already been training at the master's degree level and were already providing safe, cost-effective, and quality care to all types of patients. Primary care NP's have been able to practice with little physician involvement in rural and underserved areas of the country. There is approximately 1% of NP's who are independent but this number is likely inaccurate.
To answer an earlier Question IM residency:
Long before the DNP became public, nurse practitioners have been providing primary care to many patients. The nurse practice acts of each state have provisions that allow this to happen. Physician involvement varies but that does not in any way discredit the fact that NP's have been providing primary care.
I'll man up here. I apologize for my unprofessional comments. Blame it on a job where a bad week means people die.
David Carpenter, PA-C
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