In Support of Independent NP Practice

Specialties NP

Published

  • Advanced Practice Columnist / Guide
    Specializes in ACNP-BC, Adult Critical Care, Cardiology.

You are reading page 5 of In Support of Independent NP Practice

allnurses Guide

BostonFNP, APRN

2 Articles; 5,581 Posts

Specializes in Adult Internal Medicine.

Not as probable. Seriously....but that's the difference in education, training, mentoring...even selection in the first place in many cases.

Whatever with the teen % for Nps in the hospital. In my region, hospital nps make up a heavy percentage. It doesn't matter, however, b/c, most nps are not working in remote areas of desperate need. They are no different from most doc in this regard. That's truly what I meant. So it's about making laws by exception.

Whatever, I seriously doubt if anyone will change or even dare to change their view...

It is about moving into medicine, bc that's what is being done.. Writing scripts for drugs is medicine. Ordering dx tests is medicine. I could go on, but really what is the point?

I question really what's going on whereby nurses (and often rns that are barely experienced nurses) go to graduate nursing school to practice medicine, unless a nurse is going to an area of true, serious need...very rural areas for example. But this is NOT generally the case.

I'm not telling anyone what to do or not do; but I do believe, for the most part, the practice of medicine professionally should mean medical school--and all that goes along with it.

I am sorry if that perspective bothers some folks.

Again, talk to nps that went on to med school and residencies and fellowships. You will get honest insight.

Despite the national data, we will just assume you are right because "most of the NPs by you" are working in high paid specialities. Are there higher concentrations of NPs in urban areas versus rural? Sure, there is a bigger population need in urban areas, and in fact, urban areas are often the most in need of primary care providers. I hate to admit that the medical-Mecca city I live in has a desperate need for primary care.

As this pertains to independent practice, the in-patient and speciality clinic NPs you mention are not the ones practicing independently, they will likely never be independent in this setting. Shouldn't it say something about the quality of NP practice that all these hospitals and speciality clinics want to hire NPs?

As far as practicing medicine. NPs do not practice medicine, again our scope overlaps with medicine, but we practice advanced practice nursing. Again, if you want to speak in generalities, I do agree most of the public doesn't appreciate any difference in the two practices.

If writing scripts and ordering dx tests "is medicine", then why it within the scope of practice for NPs and PAs in all fifty states? This also now includes clinical psychologists, optometrists, pharmacists, and other that can also write scripts.

elkpark

14,633 Posts

Juan, in regard to the missed sepsis diagnosis, when it is your family member it counts.

You keep bringing this up as if it a known fact that physicians don't ever miss anything. I've been in nursing for decades, in a wide variety of clinical settings in five different states, and I couldn't begin to tell you how many important, even life-threatening, situations I've seen overlooked or misdiagnosed -- by physicians. I'll see your sepsis and raise you -- just recently, a local community hospital ED sent an otherwise healthy young man with an acute ICH home with a rx for Zofran for his nausea when he came in with c/o classic sxs of acute stroke (they did no head workup at all), and a different local community ED diagnosed edema that was actually related to CHF and AKI as cellulitis and sent the guy home with Abx. In both cases, the individuals ended up eventually at the major academic center at which I work (in much worse shape than they would have been if they had been appropriately evaluated and diagnosed in the first place by the physicians who initially saw them. On the other hand, I don't interpret these situations as evidence that all physicians are dangerously incompetent ...

Advanced Practice Columnist / Guide

Corey Narry, MSN, RN, NP

8 Articles; 4,362 Posts

Specializes in ACNP-BC, Adult Critical Care, Cardiology.

Ahhh, the need for care in highly urbanized cities vs the sticks. Both areas need healthcare obviously. But agree that there is a great need in urban areas that NP's have actually filled. Great example: City and County of San Francisco - such a sharp contrast of rich and poor, a city with one of the highest numbers of millionaires living within its borders yet hides a nasty secret of poverty inside its ghettos. Not surprisingly, it is a nurse-practitioner managed clinic that is present in the most crime-ridden, poverty-stricken, drug infested neighborhood of "The Tenderloin". Meanwhile, "boutique clinics" and concierge medical services have sprung up in yuppie neighborhoods with residents of the Silicon Valley types. Not surprisingly, NP's have also been hired in those places. Link to this: Glide Methodist Church Healthcare Services.

TheOldGuy

148 Posts

Ok....back to the ranch.....

We could banter on and on ad infinitum with ANECDOTAL stories about how an NP or an MD or a DO missed something. That is not data, it is not a study, consequently it is not evidence.

Does anybody know of any DATA, any STUDIES, ANYTHING EVIDENCE BASED, that shows NP directed/provided care to be less than excellent (or at least equivalent to physician provided/directed care)? If so, could you provide a link?

Everything that I have seen indicates there is no significant difference (all you have to do is scholar.google it).

Thank you!

allnurses Guide

BCgradnurse, MSN, RN, NP

1,678 Posts

Specializes in allergy and asthma, urgent care.
Ahhh, the need for care in highly urbanized cities vs the sticks. Both areas need healthcare obviously. But agree that there is a great need in urban areas that NP's have actually filled. Great example: City and County of San Francisco - such a sharp contrast of rich and poor, a city with one of the highest numbers of millionaires living within its borders yet hides a nasty secret of poverty inside its ghettos. Not surprisingly, it is a nurse-practitioner managed clinic that is present in the most crime-ridden, poverty-stricken, drug infested neighborhood of "The Tenderloin". Meanwhile, "boutique clinics" and concierge medical services have sprung up in yuppie neighborhoods with residents of the Silicon Valley types. Not surprisingly, NP's have also been hired in those places. Link to this: Glide Methodist Church Healthcare Services.

I worked as a primary care NP in a very poor, very urban setting. The majority of the PCPs at this clinic were NPs and made it possible for greater numbers of patients to access quality care. The clinic had a lot of difficulty recruiting physicians to work there-no surprise. There is no way it could have operated without the NPs and CNMs that were the backbone of the provider staff. We often worked without an MD on the premises and did just fine. Restricting NP practice just hurts patients.

Advanced Practice Columnist / Guide

Corey Narry, MSN, RN, NP

8 Articles; 4,362 Posts

Specializes in ACNP-BC, Adult Critical Care, Cardiology.

Follow-up:

Nurse Managed Health Centers

AJN Article

National Nursing Centers Consortium

Advanced Practice Columnist / Guide

Corey Narry, MSN, RN, NP

8 Articles; 4,362 Posts

Specializes in ACNP-BC, Adult Critical Care, Cardiology.

myelin

695 Posts

Ahhh, the need for care in highly urbanized cities vs the sticks. Both areas need healthcare obviously. But agree that there is a great need in urban areas that NP's have actually filled. Great example: City and County of San Francisco - such a sharp contrast of rich and poor, a city with one of the highest numbers of millionaires living within its borders yet hides a nasty secret of poverty inside its ghettos. Not surprisingly, it is a nurse-practitioner managed clinic that is present in the most crime-ridden, poverty-stricken, drug infested neighborhood of "The Tenderloin". Meanwhile, "boutique clinics" and concierge medical services have sprung up in yuppie neighborhoods with residents of the Silicon Valley types. Not surprisingly, NP's have also been hired in those places. Link to this: Glide Methodist Church Healthcare Services.

Glide is fantastic, and it's owned and run by NPs, though there are MDs on staff. It has a FNP residency, as well.

SycamoreGuy

363 Posts

Not as probable. Seriously....but that's the difference in education, training, mentoring...even selection in the first place in many cases.

Whatever with the teen % for Nps in the hospital. In my region, hospital nps make up a heavy percentage. It doesn't matter, however, b/c, most nps are not working in remote areas of desperate need. They are no different from most doc in this regard. That's truly what I meant. So it's about making laws by exception.

Whatever, I seriously doubt if anyone will change or even dare to change their view...

It is about moving into medicine, bc that's what is being done.. Writing scripts for drugs is medicine. Ordering dx tests is medicine. I could go on, but really what is the point?

I question really what's going on whereby nurses (and often rns that are barely experienced nurses) go to graduate nursing school to practice medicine, unless a nurse is going to an area of true, serious need...very rural areas for example. But this is NOT generally the case.

I'm not telling anyone what to do or not do; but I do believe, for the most part, the practice of medicine professionally should mean medical school--and all that goes along with it.

I am sorry if that perspective bothers some folks.

Again, talk to nps that went on to med school and residencies and fellowships. You will get honest insight.

:banghead: Never mind...

Guest343211

880 Posts

Despite the national data, we will just assume you are right because "most of the NPs by you" are working in high paid specialities. Are there higher concentrations of NPs in urban areas versus rural? Sure, there is a bigger population need in urban areas, and in fact, urban areas are often the most in need of primary care providers. I hate to admit that the medical-Mecca city I live in has a desperate need for primary care.

As this pertains to independent practice, the in-patient and speciality clinic NPs you mention are not the ones practicing independently, they will likely never be independent in this setting. Shouldn't it say something about the quality of NP practice that all these hospitals and speciality clinics want to hire NPs?

As far as practicing medicine. NPs do not practice medicine, again our scope overlaps with medicine, but we practice advanced practice nursing. Again, if you want to speak in generalities, I do agree most of the public doesn't appreciate any difference in the two practices.

If writing scripts and ordering dx tests "is medicine", then why it within the scope of practice for NPs and PAs in all fifty states? This also now includes clinical psychologists, optometrists, pharmacists, and other that can also write scripts.

Last first. I already addressed this. It seems silly to repeat it.

Other pieces:

I'd ask anyone to argue that midlevels and physicians go more into suburban and urban areas for practice, in general, than in the very rural areas. This is where the crises is, and it refects on BOTH disciplines that there is less than what is barely needed in those areas.

Back to first reply to yours. . .

Getting the foot in the door with with regard to societal necessity in the areas no one else wanted to go to. After than, once you got the education INDUSTRY involved, they saw opportunity to make money in openning up these programs. They were all for them $$$$. But these are the same people that are OK with nurses with less than five years solid clinical experience in acute or critical care going into their NP and other advanced practice programs. If stronger clinical hour and residency requirements were in place, perhaps, it would not matter so much. But any yahoo with a BSN can go right into these programs, and the clinical hours with proper evaluation are just not there IMHO. I still think it's a good idea, regardless, to have solid physicians overseeing things. NPs and PAs are practicing medicine. There's no reason to dance around it. It is what it is. Now, as I said, for things like writing letters of medical necessity for home care, no. A NP practitioner should not have to jump through hoops with a physician for that. Come on. That's common sense, and evaluating that falls perfectly under nursing domain in any universe.

Personally, I like the idea of NPs and physicians functioning as a team. Systems of checks and balances can be very good things. Even a non-advanced practice nurse has means of circumventing a poor medical decision from a physician many times--if she is a true advocate and has some gonads. Sure, he or she may risk getting peeved at or even losing their job for doing what's in the best interest of the patient--by getting another physician or advanced practioner involved. But that's called integrity, and doing the right thing and having integrity means in real life that you may have to pay a price. Many of us have been their and done that, and we have peace in knowing we did what was right for the patient--or in some cases, even the family. I don't care what level clinician you are. I don't have a lot of respect for those that are so fearful of their jobs or losing their careers, that they would compromise what is in the best interst of the patient or family unit. That's me. Those are the rules I live by, and after a number of decades, I never question those decisions, b/c I know they were right for the patients. I like to sleep with a clear conscience.

Your last point. Yes, these are forms of practicing medicine that these other disiciplines have entered into. As I said. It is what it is. You can see why physicians are concerned. They should be--for themselves, their profession, and for patients. Sadly, IMHO, they have to accept responsibility for this. If they had been about the business of providing care in all areas of need, this would not have happened. Once you allow one group to move the line, other groups will follow, and have followed.

Guest343211

880 Posts

:banghead: Never mind...

I fully expect lawsuits to go up against midlevel practitioners, especially as school have allowed folks with manure for clinical experience to move right into these programs. But hey. Time will tell.

You can't have it both ways and say,"Hey we are not practicing medicine," but then be practicing medicine. And to whatever degree you would like to test it, that is EXACTLY and PRECISELY what these disciplines are doing--practicing medicine. As such, why in the world should they not have physician oversight--oversight by those that actually were educated, trained, board certified, and vetted to actually PRACTICE MEDICINE. See I can just as easily show the head-banging here. It's quite logical.

Of course we will NEVER again, and after all, this is a nursing site, so. . .

Guest343211

880 Posts

I worked as a primary care NP in a very poor, very urban setting. The majority of the PCPs at this clinic were NPs and made it possible for greater numbers of patients to access quality care. The clinic had a lot of difficulty recruiting physicians to work there-no surprise. There is no way it could have operated without the NPs and CNMs that were the backbone of the provider staff. We often worked without an MD on the premises and did just fine. Restricting NP practice just hurts patients.

I would suggest that it protects patients. Again, what is wrong with having sound oversight with physicians. Where's the team effort?

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