Help-Real quick question: I want to get a balanced view from all sides on this issue.

zenman · Nov 15, 2006

I want to get a balanced view on an issue I've seen many times.
Nurses are the real heroes of healthcare!

You won't get a balanced view, even from CNN, except for your last statement.

augigi, CNS · Nov 15, 2006

I don't think anyone thinks NPs are a clinical equivalent of a physician. That's why they are nurses. They do different work.

PMFB-RN, RN · Nov 15, 2006

Throughout both experiences I've heard plenty of talk from physicians about NP's, much of which is negative. This is obviously preaching to the choir here; I'm sure this is no news to you guys.

*** I'm not an NP but I would like to ask those docs a question. If they are so down on NPs then why do all of them refuse to provide care in so many areas? I recently moved from a very rural area where there was no MD or DO within 100 miles despite years of advertizing for one. All care in the area was provided by a couple of really good NPs. To the people in that area the question of MD vs NP was moot.

America has many places where docs refuse to practice. What are those people to do?

ERNP · Nov 15, 2006

Oh Bob,

What a can of worms. I think the question you are asking is if I think my practice is equivalent to that of the mighty physician. I would have to say no. I also don't think that necessarily has to be a bad thing.

Let me help you achieve some balance. I have often heard medicine referred to as a science, while the idea that nursing could be a science is often not taken as seriously. However, consider that many physicists, chemists, and the like would consider the idea of medicine as a science equally laughable.

One thing that nursing and medicine have in common is that neither is a basic science, but both are applied sciences. We apply the concepts developed by chemists, physicists, biologists, ect. to the human condition, whether it be well, ill, or injured. Medicine and nursing both do research to determine how new science can help, alter, or be a detriment to the human body.

Although the physicians I work with have taken a few more science courses that I have taken, I can't recall the occasion when some obscure factoid from physics class has come up in practice. I can only assume this is because it is the application of such facts that make up the practice of medicince rather than reciting off flash cards the actual facts themselves.

I realize there is some feeling of threat and fear from many physicians that NPs will take over the world or something equally inane. The fact is there is plenty of work to go around. Even with the addition of NPs to the care mix there are many people going without needed healthcare provider attention.

Perhaps it could start with you. Don't sweat the small stuff, and a lot of it is small stuff. Don't let the point get lost in the semantics. Don't be dragged into a one sided turf war that has no exit strategy.

Everyone who needs to be comfortable with my abilities is comfortable with my abilities. Sometimes I put in the femoral line and the ER doc does the intubation..... sometimes the ER doc puts in the femoral line and I do the intubation. In the end what matters is someone put in the femoral line and someone did the intubation. As long as we are both capable of getting the job done, what difference does it make who actually did the job??

zenman · Nov 15, 2006

Let me help you achieve some balance. I have often heard medicine referred to as a science, while the idea that nursing could be a science is often not taken as seriously. However, consider that many physicists, chemists, and the like would consider the idea of medicine as a science equally laughable.

And some scientists think that medicine is not a science, it just "employs" the sciences...and that is still teaching sciences that are not even current.

Consider one of my roles, that of a Zen Shiatsu therapist. Now, if a patient was getting no relief say, from back pain even after seeing several physicians and getting meds, etc....and I knocked the pain out in an hour...would that make me "a full, equal clinical substitute for a physician"...or even "superior?" I might have less schooling and knowledge than a physician, but maybe I have the "right knowledge" or "different knowledge." In any case, as ERNP says, it's who can do the job.

jov · Nov 21, 2006

I would like to ask those docs a question. If they are so down on NPs then why do all of them refuse to provide care in so many (rural) areas?

ummm...kinda hard to pay back medical school loans with no $$?

please replace "refuse" with "choose"

makes it oh so much clearer

PMFB-RN, RN · Nov 21, 2006

ummm...kinda hard to pay back medical school loans with no $$?
*** Yes I understand that. Exactly why certain docs should refrain from the type of comments about NPs written about by the OP. Besides eventually they will have the student loans paid off and thus free to practice in underserved areas. Most don't. So long as docs refuse to serve certain areas and populations they should refrain from commenting on those that do IMO.
please replace "refuse" with "choose"
makes it oh so much clearer
*** I think "refuse" fits perfectly.

Hellllllo Nurse, BSN, RN · Nov 21, 2006

ummm...kinda hard to pay back medical school loans with no $$?
please replace "refuse" with "choose"
makes it oh so much clearer

I know an MD who is practicing in a very rural area, because his employer is paying off 80% of his med school debt. Besides that, the medical ins and retirement plan he's getting are fantastic.

This doc is caring for an underserved population AND

reaping financial reward$.

But, this doc's focus is different than most other docs', anyway. After all, he started as a nurse's aide, became an RN and is now an MD. He actully helps a pt to the bathroom and empties a bedpan every once in awhile. Nurses AND pts love him.

jer_sd · Nov 21, 2006

here is the way i look at scope of practice in my head:

nurse practitioners no have overlap to the practice of physicians especially in primary care settings. however they are educated in different manners and receive vastly different training. i relate to this as od vrs md, both can do primary eye care yet surgical intervention is not included in the od practice. vision therapy is not usually found in a md practice. likewise a np and md may have overlap but they are not a replacement for each other. both provide needed services but with a slightly different approach to care of the patient.

all health care providers should know the limits on their personal practice and consult with other providers as needed.

for my full time job i work for a radiology group. i am not a replacement for a radiologist but i do bring skills and abilities they have not developed. i have a more updated knowledge in medication management, and some basic patient care issues. i do not have the technical skill to do complex procedures or read mris. i do some basic procedures, read some vascular ultrasound exams, and follow patients even after discharge. my skills compliment the radiologists so that as a group we provide better care for the patients. i can focus on essentially routine or well patients allowing the interventional radiologists to do procedures and the imaging radiologists to read films. i function more as a physician extender than a replacement for a physician.

in primary care there is more overlap but just because a np sees a patient does not mean that the np is replacing a physician. a basic example can be foot pain; a dpm, np, pa-c, pt or md can all see the patient. if it is a simple condition all should diagnose and treat correctly. if there is more care needed than the provider can accomplish they refer to another provider; pt refers so that pain meds, internal medicine md, pa-c or np refer for surgical intervention, dpm refers if the pain is caused by occluded sfa and needs bypass, ect.... yet each also has specific strengths due to the differences in their respective education that may be lacking or deficient in the training of other providers.

jeremy

Trauma Columnist · Nov 22, 2006

Jeremy - may I ask what you do? You have listed in your profile that you are an RNFA, PCNP (unsure what this is), and a WHCNP. What made you choose such a diverse career path?

jer_sd · Nov 22, 2006

Jeremy - may I ask what you do? You have listed in your profile that you are an RNFA, PCNP (unsure what this is), and a WHCNP. What made you choose such a diverse career path?

My career path could look a bit schizophrenic... . I started working in interventional radiology close to 10 years ago wanted to learn more from the procedural standpoint so I completed my RNFA with a clinical emphasis in vascular and endovascular surgeries. That was a great learning experience but did not open many doors for me in southern California there are not a lot of jobs for a RNFA plus I realized how much I had left to learn.

So I searched various NP programs until I found a Canadian one that looked interesting. It was a primary care NP that was modeled after a family practice residency and it included labor and delivery, in addition to the standard FNP programs. It was weak on clinical hours but an excellent learning experience. No nursing fluff just health assessment, pharmacology, pediatrics, obstetrics, gynecology ect.

During my clinical time I enjoyed Woman's Health rotations actually having health patients for a change especially the chances to offer health promotion so I completed a certificate as a woman's health NP.

Currently I am completing a FNP program (now I am taking nursing theory and the non clinical related courses) plus some more clinically realted courses and clinical time.

So I work full time as a radiology NP, part time as a program director for a nuclear medicine technology school, and then some cosmetic laser and skin care with 2 friends (one CNS and one RN) in a nurse owned and operated practice we started 2 years ago.

My career as an advanced practice nurse is great I have a lot of flexibility and have a job (jobs) I love even if I do work too many hours most weeks. My role in my full time job is expanding and I work for a great medical group that I am always encouraged to learn more and gain further skills and expertise.

I really enjoy procedural medicine and I am able to bring my training together in a nice package; RNFA for the procedures, primary care patients pre and post procedure and following them with management of PVD, lipids ect, and WHNP we have a strong fibroid embolization and woman's imaging practice. If I wanted to change specialties I would still have the flexibility and the foundation that all of my advanced practice programs have provided.

Jeremy