In Support of Independent NP Practice

Specialties NP

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

You are reading page 7 of In Support of Independent NP Practice

Guest343211

880 Posts

I'm sorry, but I don't understand how 5 years of ICU experience (compared with other kinds of nursing experience or even a new grad) translates to higher quality FNPs that work in outpatient settings providing primary care. That seems like a very arbitrary condition to make. This is the problem with nursing, IMO. There are too many people who think things should be based on their personal opinion/personal experience, "gut feeling" or whatever, instead of actually looking at what the data says.

Oh brother, OK. Wow

allnurses Guide

nursel56

7,078 Posts

Specializes in Peds/outpatient FP,derm,allergy/private duty.
I apologize to Juan as this is going off-topic.

It has been discussed in several studies, off the top of my head take a look at Rich et al (2005) and Steiner (2008).

OK, thanks I will look for those. I apologize too, Juan. Flying typing fingers get away from me sometimes.

Guest343211

880 Posts

Role resistance? Wow. LOL. I think that is a term of projection—from nursing to physician practice. Holy crap. Scarier and scarier.

"People have lost sight of the fact that it's not supposed to be all about the clinician. It's supposed to be about the patients and society as a whole."

^Ummm, those are statements that support unity in approach and effort. Why would you porifice them and use them primarily for NP practice, lol? That's utterly ridiculous, and you refuse to see any possible bias on this matter. See, and you really think I don’t get it. Nah. Big picture is lost d/t a political agenda that’s all about some ongoing turf wars. Shame on the idiotic turf wars, especially from nurses.

“Well, I work in crititcal care as a nurse practitioner so there's a difference between you making judgments based on medical concepts and myself as a nurse practitioner, fully credentialed by the academic medical center, who can write orders and intervene accordingly. And that is completely legal in the State of California by the way. But again, my thread is not about critical care, it's about primary care.”

^From that comment of yours, the bias and hubris is becoming more clear. I’m talking medical science. And it wasn’t about who you are in X role compared to me in my role, and who is licensed for what. LOL Wow. Absolutely amazing. You missed it. . .entirely. . .b/c of arrogance IMHO.

Once again, I am talking about medical science; it's knowledge and usage, period. End of story. LOL

Hubris and pride makes for unsafe practice. Pride actually is a weakness. I have seen just as much damage happen to patients from arrogance and pride and resistance to listening to others as I have from incompetence . . . honestly, more from the former than the latter.

Personally, I like systems with checks and balances. They usually allow for greater breadth of insight and better safety.

The whole dynamics of what all this really seems to be about is scary politics to me.

Thanks; you have helped to further crystalize the frivolity in any further discussion on this matter—for reasons I suspected all along.

Now, I am taking the advice I gave to Susie. Such circular stuff leads nowhere. It feels like some kind of defensive ego-fest cloaked in "professional rights."

I'm done with this topic. Equal consideration will probably not occur, as I stated earlier.

Have a laugh about getting the last word or feeling superior, or whatever it really is that you want to accomplish--on me. At the end of the day, the turf wars really don't help anyone—not you or me--and not nurses or patients.

PatMac10,RN, RN

1 Article; 1,164 Posts

Specializes in Nursing Education, CVICU, Float Pool.
Role resistance? Wow. LOL. I think that is a term of projection—from nursing to physician practice. Holy crap. Scarier and scarier.

"People have lost sight of the fact that it's not supposed to be all about the clinician. It's supposed to be about the patients and society as a whole."

Ummm, those are statements that support unity in approach and effort. Why would you porifice them and use them primarily for NP practice, lol. That's utterly ridiculous, and you refuse to see any possible bias on this matter. See, and you really think I don’t get it. Nah. Big picture is lost d/t a political agenda that’s all about some turf. Shame on the idiotic turf wars, especially from nurses.

“Well, I work in crititcal care as a nurse practitioner so there's a difference between you making judgments based on medical concepts and myself as a nurse practitioner, fully credentialed by the academic medical center, who can write orders and intervene accordingly. And that is completely legal in the State of California by the way. But again, my thread is not about critical care, it's about primary care.”

From that comment of yours, the bias and hubris is becoming more clear. I’m talking medical science. And it wasn’t about who you are in X role compared to me in my role, and who is licensed for what. LOL Wow. Absolutely amazing. You missed it. . .entirely. . .b/c of arrogance IMHO.

Once again, I am talking about medical science—knowledge and usage, period. End of story. LOL

Hubris and pride makes for unsafe practice. Pride is a weakness. I have seen just as much damage happen to patients from arrogance and pride and resistance to listening to others as I have from incompetence . . . honestly, more from the former than the latter.

Personally, I like systems with checks and balances. They usually allow for greater breadth of insight and better safety. The whole dynamics of what all this really seems to be about is scary in the greater scheme of things to me.

Thanks, you have helped to further crystalize the frivolity in any further discussion on this matter—for reasons I suspected all along.

Now, I am taking the advice I gave to Susie. Such circular stuff leads nowhere. It feels like some kind of defensive ego-fest cloaked in "professional rights."

I'm done with this topic. Equal consideration will probably not occur, as I stated earlier. Laugh about having the last word or feeling superior, or whatever it really is that you want to accomplish. None of that helps anyone—not you, me, nurses, or patients.

Smh. Wow.

Advanced Practice Columnist / Guide

Corey Narry, MSN, RN, NP

8 Articles; 4,362 Posts

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

OK, I have to say this: posters have been civil in this thread for the most part. Opinions can be exchanged freely and no one is preventing anyone from disagreeing. But when one resorts to calling people "arrogant", "missing it", and responding to legitimate poster questions with "oh brother, wow", then I have more reason to believe that one's argument does not come from an intelligent and constructive place. Rather, it is simply an aggressive tone in my opinion that does not prove anything. Please present facts, not personal attacks.

Editorial Team / Admin

sirI, MSN, APRN, NP

17 Articles; 44,729 Posts

Specializes in Education, FP, LNC, Forensics, ED, OB.

Agree with Juan. If member cannot professionally express an idea w/o attacking (calling members ignorant), then as they point out, "I'm done with this topic ... Have a laugh about getting the last word or feeling superior, or whatever it really is that you want to accomplish--on me.

It's probably time to step back/take a break from the discussion until replies can be more inline to the professional debate necessary in this thread.

Let's keep to the topic w/o making it personal and see if we an keep this thread viable w/o closing for time out or close permanently. Thanks.

Annaiya, NP

555 Posts

Specializes in PICU.

To samadams8:

I know you said you're done with this thread, and you seem to feel like you have made a point or something, but I have read through this whole discussion, and I have no idea what your point is. The only thing I got out of your postings is that you are opposed to NP independent practice and feel it is unsafe without physician overview. The only reason why seems to be based on a personal experience with an NP. I do not understand the link between this and the politics and political agenda stuff you keep mentioning. I don't see a link there.

You also seem to have an issue with current NP education, but haven't stated how it fails in your eyes. You mentioned needing 5 years of critical care bedside experience, but didn't state why you think this is important. How would that experience help a primary care NP? You seem to think it is obvious, but I do not see how that experience would ensure "better" NPs.

You have mentioned several times the superiority of medical education over NP education, but have not addressed how different these two things are. They are in place to educate and produce health care providers who will fill different roles. As has been stated, those roles in different settings do have a lot of overlap, but at the end of the day, they are different roles and different education is appropriate. The fact that NP education is not the same as medical education does not, in and of itself, mean that NPs are therefore unqualified to do their jobs. Medical education is much longer, but how much of that time is spent learning areas that the physician will never use in their practice? Extra training and education never hurts, but it doesn't mean that it is necessary to be a competent, safe provider. NP education is very focused, which is why there is a push to require that NPs can only work in areas that they were trained for in school. This is why the NP model works. It is not medical school, the NP role is not exactly the same as a physician role. However, the education and training is appropriate to produce safe, high quality practitioners. I would really like to understand why you feel it is so inadequate.

TheOldGuy

148 Posts

LOL - Ok....back to the ranch.....again....

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?

So far, it seems like the answer is no.......

SycamoreGuy

363 Posts

If there were data that showed NPs were inferior MDs would have no problem keeping NPs from practicing (not that they have a hard time restricting practice now). Opposition to NP practice comes from two places: MDs wanting to protect their turf, and uneducated / irrational people (no offense and I'm not pointing fingers). Obviously MDs have "more" education in terms of credit hour and academic study and that should, in theory, equal a more competent provider. But, there is no data to show that. I think we should find out why there isn't a difference OR actually provide evidence that NPs are somehow quantitatively inferior (other than saying they have less education).

I can understand MDs concerns, Imagine how we would feel if MAs wanted licensure and wanted to practice the same as nurses. With a little more formal education it wouldn't be out of the question. The big difference is that there isn't a nursing shortage as much as there is going to be a primary care shortage.

TheOldGuy

148 Posts

We shouldn't give in as readily on the more education argument. Longer training yes - more education maybe. Lots of foreign MDs in the US went straight to med school from high school (yes it is true!). Like nurses, US trained docs have bachelors degrees and while prerequisites are tougher for medical school, they don't have the hands on that we did in nursing school as undergrads. The prereqs are tougher but not impossible - I know cuz I took them. Medical School is 2 years didactic, 2 years clinical. Residency varies but is hands on. In nursing we have a Bachelors in nursing specifically. NP school builds on our assumed nursing undergrad education and nursing experience with additional coursework in advanced pathophysiology, advance pharmacology, advanced assessment, etc. Unfortunately we do waste time with useless theory courses. The biggest problem I see in NP program is the lack of consistency. Some programs are very strong - others not so much. This situation is similar to that of medical education prior to the Flexner report. Changes will occur over time I'm sure as advanced practice nursing evolves.

I think one of the great advantages of nursing education is that it prevents you from getting too cocky and thinking you know everything - which is what gets docs in trouble as we have all seen far too many times in far too many settings...NPs are far more willing to ask for help!

In the meantime, we seem to be doing a heckuva job!

PatMac10,RN, RN

1 Article; 1,164 Posts

Specializes in Nursing Education, CVICU, Float Pool.
We shouldn't give in as readily on the more education argument. Longer training yes - more education maybe. Lots of foreign MDs in the US went straight to med school from high school (yes it is true!). Like nurses, US trained docs have bachelors degrees and while prerequisites are tougher for medical school, they don't have the hands on that we did in nursing school as undergrads. The prereqs are tougher but not impossible - I know cuz I took them. Medical School is 2 years didactic, 2 years clinical. Residency varies but is hands on. In nursing we have a Bachelors in nursing specifically. NP school builds on our assumed nursing undergrad education and nursing experience with additional coursework in advanced pathophysiology, advance pharmacology, advanced assessment, etc. Unfortunately we do waste time with useless theory courses. The biggest problem I see in NP program is the lack of consistency. Some programs are very strong - others not so much. This situation is similar to that of medical education prior to the Flexner report. Changes will occur over time I'm sure as advanced practice nursing evolves.

I think one of the great advantages of nursing education is that it prevents you from getting too cocky and thinking you know everything - which is what gets docs in trouble as we have all seen far too many times in far too many settings...NPs are far more willing to ask for help!

In the meantime, we seem to be doing a heckuva job!

I agree.

Specializes in Anesthesia, Pain, Emergency Medicine.

Samadams8,

Are you an NP?

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.

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