Is anybody else tired of the nurse practitioner craze?

[WillRegNurse]

Hi all. I am a new graduate RN who is enjoying his first job as a med-surg nurse. I don't know about everyone else, but I am so tired of the nurse practitioner craze that seems to be overtaking the newest wave of graduate RNs. Half the people I know at my new job are part-timers in grad school for a master's degree as a family nurse practitioner or a psychiatric nurse practitioner. Good on them, but does anyone else think the idea of a mid-level practitioner has been taken a bit too far?

I don't know about all of you, but if I had a medical issue, I wouldn't bother seeing an NP. I'd go straight to an MD. The idea of an NP seems folly to me. Either you are a nurse or you aren't one. Or, either you practice medicine or you don't. A nurse practicing some form of low-level to mid-level medicine seems absurd.

The position also seems discredited by the variance in the scope of practice among different states and the fact that NPs can never do surgery. If NPs had limitless prescription power, and could be trained for some surgeries, we'd be looking at something real. But the NP's that I have seen "practicing" at my hospital just seem to be adjunct to the MDs who see their patients. The patients don't take the NPs seriously for just that reason. They seem roleless. I feel like the hospital hires them just as tokens. I don't see NP's as the future of nursing -- AT ALL. There is this one lady nurse practitioner at my hospital who goes into the patients' room and says "Hi, my name is Kristen and I'm the nurse practitioner," and begins some interview while I as the bedside nurse think to myself "You know that patient doesn't care right? You know they will just forget about you once they are seen by the actual MD?" Of course I never say that. But that's what is in my mind. I see no point in them.

I see pure bedside nursing as our future. Nursing education. Stuff more involved in social services.

I think NPs are suffering from an identity crisis. Let me know your thoughts too.

[NurseGuyBri]

TraceyMarino - BEAUTIFULLY put. You show what a good attitude and education can produce, and I'd be perfectly fine seeing you as a primary (even as a guy). Thanks - It's easy to forget that an NP is still an RN- and that image needs to be upheld and improved, not pulled down and chopped up. It's even more sad that it's our own fellow nurses that is chopping it up Those who are not in healthcare or nursing see us tearing each other apart sometimes and I'm sure that's hurtful to the image- and yes, image IS important. We will get there, especially with nurses that are compassionate, caring, educated and professional. Thank you!!!

[TraceyMarino]

Thanks Bri--just starting out, I am finding the job tough. Patients and other providers tend to "second guess" NP's and PA's, even when their diagnosis and treatment plan are correct. I have to chart more thoroughly, examine more thoroughly, and document and craft my plan of care more carefully than MD's. I am beginning to appreciate why so many NP's and PA's get frustrated with working as hard or harder than their MD counterparts, while getting paid less money. Focusing on the real reason I do what I do helps keep me sane!

[Psychcns]

Thanks Bri--just starting out I am finding the job tough. Patients and other providers tend to "second guess" NP's and PA's, even when their diagnosis and treatment plan are correct. I have to chart more thoroughly, examine more thoroughly, and document and craft my plan of care more carefully than MD's. I am beginning to appreciate why so many NP's and PA's get frustrated with working as hard or harder than their MD counterparts, while getting paid less money. Focusing on the real reason I do what I do helps keep me sane![/quote']

"Second guessing", I think, can also be looked at as questions, or testing a provider new to the practice. I do locums and there is sometimes a testing period in a new job. I try to listen and consider what people are saying and incorporate into my assessment and treatment plan. Getting support for your thinking can help too. I think especially when you are new it is good to be very thorough. Surprising other providers have time to "second guess"..(maybe they should mind their own business or they aren't busy enough..

[JeanettePNP, MSN, RN, NP]

No matter how proficient a nurse you think you are, you don't know what you don't know. Learning occurs through education and experience at the bedside. IMO, too many inexperienced practitioners are simply looking to jump to the next level, without putting in their time, and far too many programs make this possible. I could enroll for an NP program now, but with only 2.5 years at the bedside, how proficient am I, really? If you want to be a half decent NP, you should have at least 4-5 years prior to entering any program.

You know what? That's very nice if you get hired straight out of nursing school. I searched for my first nursing job for 6 months and then went back for my NP. I just refused to keep sitting on the shelf letting my degree and education go to waste. And I am getting offers for NP jobs. I'm sorry if that doesn't meet with everyone's approval. I'm way past caring.

[PatMac10,RN, RN]

Hi everyone: I recently graduated with my FNP and I am working 3 days with a terrific family practice MD, and one day a week iin the urgent care at the hospital. Just a few thoughts:

I became an NP because I love taking care of people. I love the autonomy, yet I always have back up from my MD, who I consider a mentor and friend.

He is male and I am female. He now gives all his female patients the option of having their annual exam with me---so far, all the female patients have opted for me doing their annual. I asked him about this, and he said, "you did 200 hours of women's health and OB, that's more than I did in medical school---you enjoy women's health, and having you here in my office gives my female patients a choice, and I am very glad for that". So are the female patients.

I don't feel like a second fiddle, and I know I am not a doctor. That is okay. It is important to not get your ego wrapped up in what you do for a living. I understand and accept the fact that there are patients who would rather see a doctor. That is fine with me.

Several of the doctors in our area bring their children to me for their care. I am honored and humbled that they have faith in my skills.

In the urgent care clinic, I have had patients ask me if they can come see me for all their care---I let them know that yes, they can come see me in the family practice office. I have also had patients get angry with me when they disagree with my plan of care, or diagnosis, and say right to my face--"you're not a doctor, you don't know anything". That's okay.

Medicine is a very subtle, very subjective process. I have known providers of all stripes who had terrible clinical skills but great bedside manner, and patients flocked to them. I have also known providers who had amazing skills, could save your life, but had terrible bedside manner and therefore patients hated them.

Go to who you like, trust, who you can talk to. Go to who you have easy access to. I agree with above posters that without NPs and PA's, access to care would be worse than it is now. Other countries have utilized NP's for years with excellent outcomes, and I believe that "mid-levels" are here to stay. I had 7 job offers before I even left school, at every location where I did clinicals. These offers came from physicians, not from administrators, all of whom loved having PA's and NP's working for them and with them. I am always shocked when these "anti-mid-level" comments come from nurses, who, after years of experience will finally appreciate that having an MD is no guarantee that you are gifted at caring for others!

Beautiful well written and balanced experience and response. I hope I have similar experiences when I become an FNP!

[PatMac10,RN, RN]

TraceyMarino - BEAUTIFULLY put. You show what a good attitude and education can produce and I'd be perfectly fine seeing you as a primary (even as a guy). Thanks - It's easy to forget that an NP is still an RN- and that image needs to be upheld and improved, not pulled down and chopped up. It's even more sad that it's our own fellow nurses that is chopping it up Those who are not in healthcare or nursing see us tearing each other apart sometimes and I'm sure that's hurtful to the image- and yes, image IS important. We will get there, especially with nurses that are compassionate, caring, educated and professional. Thank you!!![/quote']

I agree with you. Before you are anything else, you are a nurse, at least that's my belief. I think its important to never forget the "basics" and that your advanced training and experiences will be successful if you build off of the solid foundation your initial licensure and desire to become a nurse gave you...... And some critical thinking and humility of course.

[NPAlby]

Who is this guy (the initial poster)?

[NPAlby]

And why are we arguing with him? Its pointless. I'm an NP and I know what I do is important. We dont need to convince this person of anything. Once he/she gets some experience they will understand why there is such an NP "Craze."

[MissM_RN]

I'm not very familiar with any family nurse practitioners, but I would think an NP would be very competent and comparable to that of an MD in a PCP position. An NP would be able to consider a patient's complaint, look at lab work and figure out what is going on and what needs to be done. No offense, but you're a MedSurg nurse. You know what your patients need, but when you work in critical care as an RN (which I do) you learn that there's no time to wait for orders from MD. You just do it. If your patient is crashing, you just hang the drips. You know what they need and you do it. If you stood around waiting for a Dr. the patient would be dead. Also, not sure how much experience you've had with House Dr's (especially on night shift) but sometimes you, the RN, knows more than they do and you need to just tell them what to order for the patient, what dose, etc. So maybe you should think about these things before saying the NP is invaluable to primary care. I think they're very valuable and I honestly think NPs listen more and have much better "bedside manner" than Dr's. Gee, I wonder why that would be?? Oh, because they worked at the bedside as RNs before!!!

Bedside nursing is not the future of nursing at all, especially with Obamacare coming. My hospital just had a meeting and talked about how most care will be done outside of the hospital in outpatient care, home care, clinics, etc. Nurse Practitioners will be very valuable. Also, when you talk about NPs not being able to do surgery. I am pretty sure NPs and PAs harvest saphenous vein grafts from patients during open heart surgery at my old hospital. You are obviously a new nurse and have not seen much in the line of what NPs do. They do the same things PAs do and let me tell you, when the patient's about to crash and burn, having an NP on your unit to give your orders or basically serve as an MD, you will be grateful they are there!!! Like I said, not to belittle you as a medsurg nurse, but if you worked critical care you would probably have a much different viewpoint.

[phillycpnp-pc, MSN, RN, NP]

well said!

[w158jld]

Bronze1, I am sorry you feel this way. It is obvious you are a new nurse because you are uneducated/ inexperienced as to what nursing is. I am an ICU nurse and about to be an adult NP. There is a huge need for NPs. We are not a physicians assistant and we are not a RN with a script pad. We take bedside nursing and combined it with advanced medicine to provide a holistic care. It is a very exciting time for nursing and advance practice because we are expanding our scope and growing constantly. There is a large demand for more health providers and the public's expectations are continuously growing. RNs and NPs need to rise to the occasion and provide high quality, patient centered care. As a nurse you should be motivating yourself and coworkers to advance yourself and the nursing profession, not slamming it! I urge you to educate yourself on the scope of NPs because many do procedures and they are far from "role less." I bet you many patients would prefer their NP over their PCP because they bring more to the table. The ignorance in this post is insulting, especially coming from a "nurse"

[w158jld]

Donnacarol, Did you not have to do clinical time? I had to do 700 plus hours. Although I agree the NP program could be approved upon, I am scared to think your education did not require structured patient experience?