Rnis 2,465 Views
Joined Jun 22, '10.
Posts: 84 (48% Liked)
I think this article actually makes the most cogent arguments I've ever heard on the issue (which is basically the only cogent argument). True NP autonomy and access to care has not been well studies or established. Rather, it's assumed that more providers means more patients will get seen. This ignores the complexity of healthcare delivery especially funding and distribution. No provider can afford to see people for free for any length of time. Most people who lack access to healthcare are not unable to get to a provider but rather unable to pay. Yes, I realize this isn't always true but most often that is the case. NP autonomy does nothing to address this issue.
Again, the author makes a good point that most providers are concentrated in urban areas and in specialties vs primary care. NPs, in general, are very similar to physicians in that they tend to want to live/work near cities and are not terribly interested in primary care. This forum is replete with posts of "can I practice in a hospital as an FNP/primary care NP" and "how do I get into X, Y, or Z specialty." As a group, I don't think NPs are any more interested in primary care than physicians it's just that we graduate much more FNP/AGNP/PNP in primary care specialties.
All that to say, I think the author entirely misses the point of NP autonomy which is able elimination unnecessary oversight. With or without collaborative practice agreements, NPs work within their scope of practice. Removing requirements for such agreements isn't going to make them stop practicing as part of the healthcare team, it's just going to mean they don't have to pay some MD to sign a paper that says they will. The NP who has a patient that is beyond his or her scope is still going to refer regardless if there is a paper on file that says they have to.
It's not surprising the head of the Texas Medical Association would be against this. Especially when there is a bill stuck in committee to give APRN's more autonomy in Texas. His job is to protect physician interests.
If I were to critique this article from an objective standpoint, it wouldn't hold up in even an undergraduate nursing program as a reference. It is almost purely opinion and lacks peer reviewed content to justify his claims. He cites a single small sample size study published almost 20 years ago to justify his position. When in the medical field is that ever acceptable?
Since that time, many more states have obtained full practice authority and there are numerous recent studies readily available that show NP's are about the same as physician's in terms of overall quality. Think about how much primary care and the medical system has changed since 1994 when the studies he cites were conducted. It looks like he had to do some really deep digging to cherry pick his claims, ignoring a whole slew of evidence to the contrary.
He also makes an argument that most NP's are working in the states most populous counties which is true, but it's probably a chicken and egg scenario where the current practice environment influences this since we are required to be tethered to a physician, and most physicians also work in these counties. If an NP in the state of Texas could just move to a rural area and open up shop without all the extra red tape that is required, my guess is thousands would do so in a heart beat. I live close to New Mexico (which is independent practice) and this is very common in more rural areas where you have NP led primary/urgent care clinics.
Full disclosure, I work in Texas and I really don't mind the current practice environment, but I also have 3 great collaborative docs that I work with. For me personally gaining independent practice would just remove a lot of hospital credentialing red tape and make it so I don't have to hunt down providers to make sure they cosign my notes on time. The real change will be for primary care providers that want to open up shop in Iraan, Texas or other similar rural locations without the silly requirements currently in place. Ultimately, not much will change in the large urban areas that are already physician dominated, and the model won't change much there either.
All in all, the argument that hurts NP's the most is they have a lot less training and education than a physician, but lots of research shows that in practice, all the extra education doesn't translate into better outcomes. That's why there are poorly authored articles like the one you linked that have to resort to opinions and cherry picked outdated research to try and justify their claims. Unfortunately Texas has one of the largest medical associations in the country, and I doubt they every get this bit of legislation out of committee.
If your concern is your acute care skills, then I recommend pursuing the acute care certificate. BONs in some states are pushing forth legislation that only allows ACNPs to work in hospitals. If your goal is to work in the hospital, and you're responding to acute situations, it seems most fitting to pursue to the acute care certificate. Perhaps you can find a dual ACNP-DNP, feed two birds with one worm kind of thing, but at a minimum go for the ACNP.
I find it interesting that some NPs are reporting higher than average incomes for MDs in their specialty.
I've only been an NP for a few months, but I must say that it is probably the best decision I ever made. I feel extremely lucky to have had the opportunity to go to school with my husband's support and blessing. I can't imagine ever regretting making this career choice. Even if I was in a position that I hated, I could take a different position. There are opportunities to change and grow all the time. No regrets here.
Many nurses find they are unhappy because nursing has become a very blue collar type position (based on the way bedside nurses are treated). Nurses are expected to jump when the hospital says jump, and basically devote their lives to the job. In many cases, employers don't care about personal events that you might miss by working a specific day, and a nurse is seen as an easily replaceable hourly laborer.
At the NP level, there is just more respect. Nurse practitioners are seen as individuals, and (because they generate revenue) employers strive to keep them happy. It's a move from blue collar to white collar in terms of employers and coworker attitudes.
I keep reading posts of nurses unable to find jobs. I"ve been an RN for 18 years and I don't think in all my 18 years, I have ever been on a unit that is adequately staffed. I don't believe the problem is oversaturation of nurses. I believe the problem lies in administrations that don't want to shell out the money to properly staff their facilities. For every new nurse out there that is complaining that he/she can't find a job, there are 3 working nurses complaining of understaffing and ridiculous work loads. The poor economy is also partially to blame. We accept poor working conditions because we are afraid to be out of work. We set the bar low and then complain in the coffee break room. (Ha! that was funny. Has anyone ever even seen their break room?) Does anyone out there feel the same? Does anyone buy the "oversaturation of nurses"? I don't believe it. I believe as a profession, we need to set the bar higher, make our voices heard and demand better and safer staffing. Lord knows, there are enough of us out there.
Of COURSE you shouldn't have the additional duty of phlebotomy.
A cost cutting measure by the facility that makes them money and loads more on the backs of nurses.
I find many comments regarding: keeping my skills up, labs are the nurses's responsibility.. ad nauseum.. have been made by failry new nurses who have been brainwashed to accept the HUGE time consuming chore of drawing their own labs. Let's do the EKG's, the respiratory treatments.... baths , beds, feeding ,ambulation now that's primary care!
Great for the PRIMARY goal of the administration..... profits.
Now when your patient complains of chest pain, add several blood draws to the other additional nursing interventions such patient would need.
Been there, did that with 6 on a telemetry unit ... it was enough to put the already overworked nurses over the edge.
If I felt unsafe, I would have awakened the guards.
I wouldn't have reported them it that were the first time I found them sleeping.
I never get in a hurry to report anybody, without attempting to remedy the situation myself.
I'll agree that it's unacceptable.
Just as it would be unacceptable if I were sleeping on the job.
In that situation, I'd hope another nurse would wake me, instead of just turning me in.
I prefer "meat curtain"
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