Latest Comments by Boatswain2PA

Boatswain2PA 1,149 Views

Joined Aug 14, '10. Posts: 23 (43% Liked) Likes: 16

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    Quote from zenman
    Nurses, who spend the most time at the patient's bedside, are the real lifesavers. Any idiot knows that. My last response to you, from a low-level source, was an attempt to match your level of reasoning. Do you not know what your name means still...or you just make up your own definition? Go elsewhere as I don't treat kids.
    Sorry Zen, you gotta dig deeper than Wikipedia to get the true answers to things. I do hope you use more than that when researching the latest Zen fashions to treat your patients.....

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    juan de la cruz likes this.

    This month's ADVANCE magazine had an article on this.

    In the PA world we are seeing a move toward specialization. Whether or not this is a "good" thing for the profession or the patient is arguable, but the move is afoot.

    It sounds like the NP world, which has already been ahead of the PA world in this movement, is heading further down that road.

    I don't really mind it, but I don't like the "portfolio" approach. It is tooooooo easy to pad portfolios without any real knowledge/experience to back it up.

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    Quote from zenman
    Actually nurses are the real lifesavers. I'll leave it to others to explain why.
    Try again Zen. Use your favorite academic source to learn about the U.S. Life-saving Service. It might help tie together some information you missed from the last time we discussed Wikipedia.
    Quote from Jeweles26
    I don't get what everyone has against the South. There are ignorant, bigoted people everywhere, although it seems to be a stereotype mostly associated with the South...
    I've lived all over the U.S., including the Northeast (Boston) and the South (Savannah). It always amazed me how predominate the elitist attitude was in the Northeast, and how they looked down their (often upward pointed noses) at those of us who preferred the rural areas (especially the rural southern areas). Sounds a lot like this:
    Quote from BlueDevil,DNP

    Deep south
    explains everything. My condolences.
    Quote from SycamoreStudent
    It depends on the state and city. All things being equal I believe salary is lower even when cost of living is taken into account.
    Yeah, but much, much, much higher when quality of living is taken into account (well, for many of us at least!) :-)
    Quote from SycamoreStudent
    I'm not sure there is a good term for both NPs And PAs. On the other hand I'm not sure NPs and PAs should be lumped together.
    We are similar enough to be lumped together most of the time, but then referred to separately other times. We do much the same job, at much the same pay, and patients shouldn't seen any difference between the two professions, therefore I don't have a problem with a generic term like Mid-level practitioner to describe a PA or NP. However, when you get down to the academic/experiential pathway one took to get to here, then the differences abound.
    I don't get bent about the term mid-level practitioner. Perhaps it is because I have a good understanding of how much better the physician level education is than what the best PA or NP receives.

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    I understand the argument about practicing nursing vs practicing medicine....although I do not agree that if a (real) medical doctor or PA places a central line it is considered practicing medicine, but if an AP nurse places a central line it is considered practicing nursing. In my opinion, AP nurses practice medicine in addition to nursing, and it is what makes them so effective clinically.

    And I understand your 2nd point - that the future DNP programs will likely be much different from the early ones. They may actually turn into the entry level for Nurse Practitioners, they may continue in their current state, or they may just die away if people do not think they offer what is needed.

    Your 3rd point - you first inferred that your DNP was clinical based, but then you say that your Masters gave you your clinical base but your DNP gave you your knowledge/skills to "develop programs" from nothing & such....hardly clinical (clinical = 1 patient, 1 provider) applications there.

    I still don't see why you would choose a DNP. You had the clinical education necessary to practice medicine/advanced nursing, but you apparently wanted something more to break into the administrative/management/political world of creating new programs & chairs. So why not a MPH?

    And please, do not compare medicine of today with the 1850s. We both know that today's medicine was barely beginning at that time in Europe and didn't make it to the US until Johns Hopkins opened decades later. Nobody will refute the enormous impacts nursing has had in both the history of national or global health care, or or the impacts on an individual patient.

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    oldiebutgoodie likes this.

    Quote from Dr. Tammy, FNP/GNP-C
    Two different animals. One is clinical-based and the other is not. One is within the field of nursing, uses nursing science, nursing philosophy, nursing paradigms and the nursing process (the same that many here scoff at yet without these to inform and direct practice, they would be technicians) and the other is not.
    So, I'm curious....do you think your DNP was more "clinical-based" than MS level NP programs? Did it teach you to practice medicine (nursing) better than a MS level NP program? If so, I would like to hear how it did that. And, if it was more "clinical-based", how did it prepare you for the admin/management aspects of creating positions, chairs, and programs.

    As to the management/administrative stuff that you have achieved and advertised here, I would propose that my MPH helped give me the tools to accomplish those same things (if I wanted to enter management/admin instead of practicing medicine (nursing)). Also, if what you wanted in your career was accomplishments such as successfully chairs, positions, and programs....why didn't you pursue a degree such as an MPH, or Health Care Admin, instead of a DNP?

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    Nurse Tammy - your DNP from Duke has given you the skills to create a program and a chaired position, and has taught you how to do research.

    If this is what you wanted to do with your career, I'm curious why you chose a DNP degree versus a degree in health care administration?

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    Practicing medicine means your mistakes can have dire consequences, including killing someone. Unfortunately, those who practice medicine are mere humans, which means they are imperfect and will make mistakes.

    Offer your profound apologies to the child/family (if allowed in your state), accept the administrative consequences, look for systemic changes which could prevent this mistake from happening again, and, most importantly, learn from your mistake so you are less likely to make this mistake again.

    Good luck!

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    Quote from ominous
    If you diagnose and treat patients, you are practicing medicine.

    This is an old article and he is way off base!
    If you are practicing medicine....shouldn't you be regulated by the board of medicine?

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    kanzi monkey likes this.

    Wowza has an important point that should be reiterated.

    These issues rarely have to do with individual NPs, but rather given roles within the heatlhcare system. Many of us believe that Doctors (physicians) should be in charge of the healthcare team caring for patients, including mid-level providers. There is simply no comparison between the amount of training and education a board-certified Doctor (physician) has and the training/education of a PA or NP. Same can be said with a PA/NP and a RN, or a RN and a CNA. Most people believe a CNA shouldn't start IVs, RNs shouldn't start central lines, and PA/NPs shouldn't practice independently. Unfortunately the incredibly powerful nursing lobby is using their political power to push for expanded practice - including clinical independence.

    Other hot topics, as I'm sure you've read, include the transition to the DNP, and the propensity of a select few DNPs to call themselves Doctor in a medical setting. A lot of people disagree with these trends, and for a lot of good reasons.

    However heated disagreements about the politics of a profession does not mean there is any sort of "hate" for the professionals who do the job on a daily basis. I disagree with NP independent practice, with the DNP, and with DNPs calling themselves "Doctor" in medical settings...but one of my greatest friends is a NP who helps me with my homework just about every day. (of course, she also disagrees with the independent practice, the DNP, and with the "Doctor" thing as well!!)

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    Jer - Thanks. The numerous RN/NP certification boards can get confusing to someone outside the profession (and, likely, to those inside as well!)

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    Guinea likes this.

    To the OP - nobody hates DNPs....but many people have a problem with Doctorate degree folks trying to pass themselves off as "Doctors" in clinical settings, with the lack of clinical experience DNP programs provide, and with the perceived goal of the NP profession in general.

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    David - this is probably a stupid question, but who awards the RNFA title? The state BON?

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    Quote from core0
    Thats not correct. You can find the full prescribing information here:
    http://www.aapa.org/images/stories/A...s/Rx_Chart.pdf
    There are 12 states that we cannot prescribe schedule II's and one state (Florida) where we cannot prescribe any schedule drugs.

    For NPs if I remember correctly no schedule drugs in Alabama and Florida. Various other states have restrictions on Schedule II's.

    David Carpenter, PA-C
    Thank you, and my apologies. I had recently read about Missouri being the "last state" to finally allow PAs to prescribe, and assumed it meant sked II drugs instead of III-IV.

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    Quote from Dr. Tammy, FNP/GNP-C
    ...I produced an action plan video (which somehow got picked up by a half dozen nursing leaders throughout the US), presented my plan to three health care lobbyists at Duke, had two op eds published on the importance of independent NP practice, I found myself being requested to introduce and present my friend and mentor, Dr. Loretta Ford (the one and only) to our State NP conference.... I was approached by a large national non profit organization out of the blue (not related to health care, but having access to health care as a critical issue to the organizations constituents) and I was asked by their president to join the board of directors as their health chair! So, now I'm drafting, in collaboration with other NP's, forward thinking physicians and other members of the community, a resolution calling for the immediate dissolution of NP barriers to practice with research to support, and the positive consequences to select PARs as a result--with the full weight of this organization behind me!
    Outstanding example of why NPs are getting independent practice in more and more places. It has nothing to do with your education or ability, but rather simply relies on your political acuity. Instead of working hard and EARNING what you want, you choose to simply hang with the lobbyists and politicians to you get all you want.

    I think Meg Whitman was called a name for such actions.

  • 2
    ominous and Kuryakyn like this.

    You make a great point. The current supervisory laws do not require a great deal of supervision. And it seems like only a small step from 'bare supervision' (ie - just blindly signing charts) to unsupervised practice.

    However I think you are missing the benefits of such a flexible system. When you and I graduate there is no way in hell we should be unsupervised. I know I will seek out a SP who will watch over me relatively closely - hopefully in an ED or something. Furthermore, there shouldn't be a SP anywhere who would turn me loose on patients and just blindly sign my charts. With the 'unsupervised NP' model, however, you may find a 'boot' NP with minimal medical experience hanging her/his own shingle in independent practice...and this puts patients in danger.

    Now, with the flexibility inherent in the current PA supervision model, those experienced PAs do NOT have to be babysat by physicians. I did a FP rotation with a PA yesterday who has been practicing for 35 years. He had 2 docs in his office as well, but he said they very rarely have to consult with each other. He is completely independent - except for the rubber-stamping of his charts by his SP.

    I guess what I'm saying is the PA supervision scheme allows a progressive scale of autonomy for PAs, and let's the highly trained Doctors determine where on that scale 'their' are at. I think that is much better than either alternative (overly restrictive supervisory requirements or complete independence).


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