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.

[NRSKarenRN, BSN, RN]

unleashing nurse practitioners' potential to deliver primary care and lead teams

if primary care is the foundation of the future health care system in this country, and if access to primary care for all is to be ensured while containing or reducing costs of care,then nurse practitioners will be crucial to achieving these aims.

published in: health affairs

[ZippyGBR, BSN, RN]

I think the OP is expressing frustration with the number of new grad RNs going straight into the NP program without even getting their feet wet. Yes, we all know many GREAT providers but all of them were RNs for years before becoming an NP. This new crop will be Nurse Practitioners without ever having been a nurse!

Yes, 7 years of education is alot but every single PA-C out there will argue to the death they have harder, more in-depth clinical instruction making them "better" then NP/FNP. The NP's I know win that argument everytime as they have the bedside experience to back them up.

the question is why are NP programmes taking people without the necessary consolidation of clinical practice ...

yet another reason whya degree of centralised workforce planning to manage numbers and access criteria to preand post registration education and training is desirable.

[Adenium]

People are commending NPs without any actual reasoning here, it seems. I think this is due to loyalty to the profession rather than actual logic. You guys are just giving anecdotal "crappola" testimony rather than showing any data that warrants the notion that FNP's provide equal to or better care than medical doctors. That just does not fly in an academic setting.

.

Remember that NPs work in multiple arenas (and I disagree that FNPs are inappropriate for primary care). But let me tell you about my own daily experience, definitely not "crappola" anecdote. My ICU (cardiothoracic surgery) is staffed 24/7 by NPs and PAs. They are Acute Care trained and thus also handle the overflow traumas, SBOs, etc. that come in, but they do CT surgery care day in and day out. They've seen the sequelae, they know what to do. They know how to fine tune the inotropes and pressors and diuretics. They see the patient multiple days in a row. If a chest tube or central line or A-line is needed, they put it in...we don't have to wait until a surgeon can be called in or until he finishes with his case in the OR. This is invaluable. MLPs also follow our patients when they get to the floor, again providing valuable continuity.

Our regular cardiac medical ICU has residents. That rotate through. That are sometimes readily available and sometimes not. That sometimes know their stuff and sometimes don't. Residents do need a setting to learn in, but there's a lot of variability in the quality of pt care while they're learning...and then they move on. If I were having open heart surgery I'd want to be followed by folks who were available right then, who were experienced in that type of care. I say a prayer of thanks every day for having the NP/PAs in our unit. I'm sure when they were brand new there was a learning curve, but these are smart and knowledgeable folks. And by the way, I career-changed into nursing and do not identify myself by it or feel any knee-jerk loyalty to the profession. Give folks some credit.

[nurseprnRN, BSN, RN]

"

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."

this'll probably get me a tos warning, but i gotta say your assumptions are really ******* me off. you clearly think that nps practice some sort of watered-down, low-budget subset of physician care. and you are soooo very wrong. if you had a clearer vision of what's possible in your nurse practice act, you wouldn't make this error.

my husband and i both get our primary care from nps. there's a reason for that... they are better.

here's one study you probab;y haven't read:

patients of advanced practice registered nurses have similar or better results in many outcome measurements compared with physicians and other healthcare teams without aprns, according to a new study.

published in nursing economics, the report "reinforces that aprns provide effective, high-quality patient care and play an important role in improving the quality of care in the united states," according to a news release.

robin p. newhouse, rn, phd, nea-bc, associate professor at the university of maryland school of nursing and assistant dean for the doctor of nursing practice program, and co-authors conducted a systematic review comparing aprn processes and outcomes to those of physician providers. they analyzed 69 studies published between 1990 and 2008 and summarized 28 outcomes for nurses in aprn roles.

the authors described patient outcomes for each of three patient groups — nurse practitioners, certified nurse-midwives and clinical nurse specialists. outcomes with similar or better grades than those of physician comparison groups included:

• nurse practitioners: glucose control, lipid control, patient satisfaction, functional status, mortality.

• certified nurse-midwives: cesarean, low apgar score, episiotomy, labor analgesia, perineal lacerations.

• clinical nurse specialists: satisfaction, length of stay, cost.

the authors wrote that the results "could help address concerns about whether care provided by aprns can safely augment the physician supply to support reform efforts aimed at expanding access to care."

the complete article is available as a pdf at http://bit.ly/oefilw.

>>>>>

here's another from that flaming radical nursing journal, the jama:

jama. 2000 jan 5;283(1):59-68.

primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial.

mundinger mo, kane rl, lenz er, totten am, tsai wy, cleary pd, friedewald wt, siu al, shelanski ml.

source

school of nursing, columbia university, new york, ny 10032, usa. [email protected]

abstract

context:

studies have suggested that the quality of primary care delivered by nurse practitioners is equal to that of physicians. however, these studies did not measure nurse practitioner practices that had the same degree of independence as the comparison physician practices, nor did previous studies provide direct comparison of outcomes for patients with nurse practitioner or physician providers.

objective:

to compare outcomes for patients randomly assigned to nurse practitioners or physicians for primary care follow-up and ongoing care after an emergency department or urgent care visit.

design:

randomized trial conducted between august 1995 and october 1997, with patient interviews at 6 months after initial appointment and health services utilization data recorded at 6 months and 1 year after initial appointment.

setting:

four community-based primary care clinics (17 physicians) and 1 primary care clinic (7 nurse practitioners) at an urban academic medical center.

patients:

of 3397 adults originally screened, 1316 patients (mean age, 45.9 years; 76.8% female; 90.3% hispanic) who had no regular source of care and kept their initial primary care appointment were enrolled and randomized with either a nurse practitioner (n = 806) or physician (n = 510).

main outcome measures:

patient satisfaction after initial appointment (based on 15-item questionnaire); health status (medical outcomes study short-form 36), satisfaction, and physiologic test results 6 months later; and service utilization (obtained from computer records) for 1 year after initial appointment, compared by type of provider.

results:

no significant differences were found in patients' health status (nurse practitioners vs physicians) at 6 months (p = .92). physiologic test results for patients with diabetes (p = .82) or asthma (p = .77) were not different. for patients with hypertension, the diastolic value was statistically significantly lower for nurse practitioner patients (82 vs 85 mm hg; p = .04). no significant differences were found in health services utilization after either 6 months or 1 year. there were no differences in satisfaction ratings following the initial appointment (p = .88 for overall satisfaction). satisfaction ratings at 6 months differed for 1 of 4 dimensions measured (provider attributes), with physicians rated higher (4.2 vs 4.1 on a scale where 5 = excellent; p = .05).

conclusions:

in an ambulatory care situation in which patients were randomly assigned to either nurse practitioners or physicians, and where nurse practitioners had the same authority, responsibilities, productivity and administrative requirements, and patient population as primary care physicians, patients' outcomes were comparable.

>>>>>>>>>>>>>>>>>>>>>>>>>>>

[kellygirl101]

All I have is my personal experience with an NP which is this:

My 6 year old daughter would go to the pediatrician at least one a month for coughing. She was given prescription for cough suppresants time after time. It was a nurse practitioner who recognized her as having allergies. Once she was diagnosed properly, her coughing was under control.... That being said, I don't care what you are - NP or MD... as long as you know what you're doing!

[MissJulie]

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.

As a student, I've thought about becoming a NP or a nurse educator. But, for my two cents worth, I prefer a NP to an MD any day...

Actually, I don't like how MDs practice, generally, and my current physician is a DO, but I see their PA instead. In my experience, MDs (and some DOs) usually wind up too busy to let the patient voice any concerns while NPs and PAs are usually able to take their time and let you talk about any issues.

As far as NPs go, I used to go to a traditional OB/GYN for treatment, but I have been currently going to a NP at a clinic in my area and I love it so much more! She is better overall, at least in my opinion, and, when was the last time that the MD took your blood pressure?

May I add, too, that it almost seems that you are undervaluing what a NP can bring to the table. NPs serve a very important function in the community. Sure, there may be some NPs out there that don't belong in their position, but the same can be said about MDs, DOs, PAs, and even RNs. At the end of the day, if a patient needs treatment, does it matter what letters come after the person's name, so long as they provide proper care to the patient?

[anurseatlast]

Just as all docs are not the same, neither are NP. There are good docs and bad docs; good NP and bad NP. In general, I personally would prefer to see a NP. I have nothing against doctors but NP are trained nurses with a more holistic approach.

When my mom had multiple myeloma, I much preferred the NP to the MD. The MD was good at what he did but the NP really listened to what was said and what was not said. She looked at my mom as a whole person and listened to my input (I was not a nurse at the time but was the caregiver). I always felt we got more out of the visits with her. She may not have known everything, but she was very good at what she did - not any different than docs, huh? Doctors know their area of practice. Even if they are an "expert," they are an expert in their field - not in all medicine. The important thing is the expertise of that individual - not the title. Perhaps someday in the future, NP will have the same scope of practice as docs (especially once a PhD is required) but in the meantime, I am still happy to see a good NP.

[ZippyGBR, BSN, RN]

another issue which has been barely mentioned is the continuity that having NPs as part of the team can bring - (same as having proper NCCG docs in the UK ) that having 'fully trained' providers instead of or as well as the qualified as a Doctor but in speciality training staff helps to keep things consistant and coherent as you aren't spending all your time breaking new staff into the role for them to leave at the end of a 4- 6- 12 month rotation

[czyja, MSN, RN]

I agree with the above poster.oNPs are playing an increasingly important role in acute care settings- especially at academic medical centers. They manage patients in the icu, provide coverage for the surgical services when the surgeons are operating, and play an important role in teaching the residents. They provide continuity when the residents change services.

IMO this sort of discourse does little to advance nursing. Staff nurses are important, NPs are important, lvns are important CNSs are important. Nursing offers the patient a continuum of care from the icu to the home. We are all part of that continuum.

If we cannot trust and support each other, how can we expect the public to support us?

The OP seems interested in the great NP v MD battle. I would suggest she go to the student doctor network. It is a favorite topic of discussion there.

[FNPdude74]

Nah, don't agree with you OP. Maybe if you went through NP school, you'd know what we went through. Most primary care family physicians don't perform surgery on a regular basis. Now, even NPs are getting loaded with complicated cases in "medicine". Sure the MD route has much more medical/biological based formal training, but most NPs have past RN experience that can be "sort of" carried over to their NP role. I say sort of because if you worked in a ICU and now you're a lets say, FNP, rules of the game has changed. Remember, it all comes down to patient outcomes. Would a family physician treat a patient with community-acquired PNA in the outpatient setting differently than a FNP considering there is no drug resistance and no past abx use? Probably not. I have an uncle who is a general surgeon, neighbor who is a radiologist, and friends who went through my NP program whose parents were primary care physicians (family, internal med, etc) and they suggested that if you were already a nurse and want to become a independent licensed health care provider in primary care, then go the NP route because to them, "the MD route in primary care isn't worth it now days" and "medicine isn't the same anymore unless you're going into a procedure heavy field like surgery, anesthesia, or radiology". Unfortunately, the thought of NPs shouldn't exist and that MDs have way better patient outcomes than NPs still exist. NPs do not practice "low-level or mid level" care. We do our best just as how MDs do their best. We help each other out.

On a good financial note, the outlook on the potential to advance in this day in age with a NP degree is good. Why do you think some FNPs in the US make six figures working a 9-5 hour (with some after clinic hours on some days if needed), monday through friday with no overtime? CRNAs start out in six figures just as a side note. This is because of high demand for the services that NPs provide.

So all in all, I do not agree with you OP. I also don't agree with the saying that NPs take "less complicated" cases than physicians in the primary care setting. However, we all know that there are legal scope of practice limits of NPs. So if a case was indeed very complicated, then the physician would be involved, but most of the time, the physician would recommend consulting a specialist physician for these types of very complicated cases. So each NP must know their scopes of practice on what they may or may not do. With specific wording, they CAN do things, but the question may arise as to, are they allowed to? Go to NP school if you want to see how things are on the other side of the fence and if you're interested in the field. Otherwise, go to MD school if you want a change in profession. I'm already a nurse who became an FNP. For me personally, it probably would not make sense for me to attend medical school to become a physician working in primary care and deal with the same amount of paperwork and non-medical issues such as politics.

Everyone has their own preferences in seeing either an NP or an MD. For me, it does not matter as long as you treat me correctly or guide me in the right direction to seek treatment. Also, if you're very rude, I would not want to see you again no matter what profession you are. It's also about providing good customer service because we all know healthcare in todays world is a business.

[anotherone, BSN, RN]

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.

I agree completely with you and have thought the same thing for YEARS.

[anotherone, BSN, RN]

Ok, lets look at this from another angle. By your logic, Midlevel's can not give a level of care equal to a MD/DO. So get rid of midlevels. Now, same argument, CNA's, MA's, LPN's can not give the same level of care as an RN so why not get rid of them as well. Since an RN can do the job they do but they can't do the job of the RN then I guess they serve no role, going by your logic.

There are hospitals that operate under this logic and do not have any cnas or lpns.

I don't blame med students for not wanting to go into family practice. why should they ? the pay is ALOT lower than other fields. if there are places that will hire nps /pas and have one dr "oversee" them there is little incentive to hire more mds/dos and pay them accordingly.