American Academy of Family Physicians thoughts on NPs - Page 3

studentdrtobe,

You need to sniff around and see how things work. Who makes the decisions for most of you guys? Administration. When you get out of your cloistered world there and enter the big world, you will get no sympathy for your tuition and years spent in school. Nobody does. It's only about money and you are a drain on somebody else's take. So much to learn and catch up on in the real world for MDs once they get pushed out of the nest. Gonna be a shocker, but I'm pull'in for ya.

Exactly. This is not a personal attack. I'm sure the NP's are hardworking, caring people. Still can't get around the education issue. The fact that I'm an RN is really irrelevant. I'm also a patient. As such, I want the best care for myself and my family. I want the expert, not the stand in. And, after being educated in my program by a few NP's, I can honestly say I was not impressed with the depth of their knowledge. Often they could not answer my questions. At the free clinic where I volunteer and have access to physicians who also volunteer, I can tell you how quickly they can answer my questions. Critical thinking through medical pathophysiology is second nature to them, its automatic, thanks to those many years of training.

oh dear "whatdoidonow?", If I could tell you how abused our poor NP's were at my work. They do the call, do all of the clinic PE's, routine med orders, take care of all of the difficult mucisitis, hemoturia, unstable BP's, anemia, malnutrition, dehydration, pain, extracurricular social outpatient needs, and all of the other small organ dysfunctions/failures that come from mega-chemo doses. The MD's are brilliant and write the protocols, clinical trials etc, but good lord please don't let 'em show up during a true crisis. Let it be the Critical care doc, a fellow or a nurse practitioner if we want the patient to recover quickly or survive at all. I have to say even our staff RN's are above average in a lot of knowledge and skill if they've been there longer than 2 yrs, but from the day the NP's walk through the door they are assigned to a physician and specialty clinic and are busting their butt's. Monitoring electrolytes, cardiac and endocrine systems that have been permanently impaired, and managing crisis after crisis. I have no desire to do that job.

I'm proud of what I've done at the bedside, burned out and had to quit that one after over 20 yrs, gone to a different job were the NP does the same thing alone, but receives little respect and it is really upsetting me. I'm about to let the other RN have it because there is no way he can do her job at all, and he's mad because she doesn't do his. Idiot! Oh well, maybe not yet, soon enough, but I see dumb people. She is wearing 3 hats right now quite well. It's interesting being an outside observer to an area. It's very busy but not difficult in relation to my old job. I'll keep my mouth shut for a while, and help her as much as I can. Him too, but I see how he creates extra on occasion, lack of organization. Not always one of my better attributes either, but having done the "nurse thang" for 30 yrs. I definitely have some powers of observation.

I love the NP at my MD's office, she knows me better than he does, and I can get straight to the point without repeating my whole hx. She remembers it somehow and easily takes up where we left off with a brief peek at her last note. I trust her as much as my Doc, love her as much too. Long term relationship with both, she is a replacement picked by the previous NP who I really miss, but I grew to trust her quickly, she's good, just cares in a different way than my old NP. (I'm very loyal when I like someone, so I was a bit "testy" at first, but I'm not exactly a spring chicken anymore either.) So please don't consider yourself short-changed at all seeing the NP. You may actually be getting a little more quality time in the long run.

My personal opinion is that, regardless of what healthcare profession you go into, a significant portion of how much you learn and how large your knowledge base is is dependent on you. You don't have to only learn what a professor teaches you. It's easy to go beyond and get a more in-depth understanding of something. You just have to be willing to put in the effort to achieve that.

I think this statement really is the key. It is amazing to me how lazy some of the NP students and NPs are. I have been outright embarrassed for my chosen profession by some of my NP preceptors, by their obvious lack of knowledge in front of the MDs that they work with. The excuse they give me for not knowing something they should in their specialty? "School didn't teach us that." Never mind the fact that there are CEs offered and books out there that could teach them it, but they don't care to spend the time.

Then there are the NPs that still wear nursing scrubs, because they are cheap and comfortable. Instead of wearing professional dress, like their physician counter-parts. How you look makes a huge difference in how people treat you, and how you are viewed by your patients.

There is so much discussion about the lack of rigorous NP training on these forums, but very little discussion about other important factors that hurt our image a lot more. My experience is most physicians know very little about the details of our education, but rather form their opinions about nurses and NPs based on their experience working with them. When the NPs they work with put in no personal effort to learn their area of specialty, they will never be respected. Regardless of how much discussion there is here about the abilities of NPs vs. MDs, the fact remains that MDs spent years studying all day probably pretty much every day. And then they generally work long hours after they are done with school, never mind residency. So we will not earn their respect if we are unwilling to work as hard as they do.

I want to clarify some of my statements. The PAs I know want independent practice. They don't want to be called Assistants anymore, they want independence, freedom and the ability to practice like NPs. PAs haven't been able to get their independence because they are associated with the AMA. When the only power you have comes from physicians it's hard to break away. How can you stay licensed if your authority comes from the AMA and you want independence? The AMA isn't going to give that control up, they don't like NPs on their turf, which is why they created PAs in the first place. So, while the nursing board lobbied for NPs, the AMA isn't going to lobby for PAs and neither are physicians. Why would you? You don't want more competition...