NP's are okay to see if you have a cold, BUT... - page 4

I want to become a nurse practitioner. At least, I'm pretty sure I do. I can't say with 100% certainty but it is definitely something I am interested in. I think I would like having my own clinic... Read More

  1. by   gauge14iv
    Ok now I'm just laughing LOL!!!!
  2. by   traumaRUs
    BSNtob2009 - I was in no way denigrating ANY profession. However, my comment that NPs are the wave of the future refers to the fact that there will be many more job opportunities for APNs in the future directly related to the aging population and decrease number of physicians.

    And I do have to comment on this:


    "I feel that the Minute Clinics and Urgent Care Centers in no way henders the "prestigue" of the NP profession. They are not true emergency rooms...there is no way I would go to one of those things if I was having a heart attack or anything else hugely serious, because all the do is call 911 anyway and have you transported to the hospital, so in THAT case, yeah, it's ok to associate the centers with colds and stuff because they shouldn't be treating anything that should be sent on to the hospital."

    Many people, especially women, do not always have classic heart attack signs which is why so many women do not seek ER care immediately. It is a very real possibility that an APN would see a person with an MI and then of course be able to immediately transfer the pt to a higher level of care.
  3. by   gauge14iv
    As for the chip - it isn't about not being perceived as "equal" - it is about being treated as stupid...

    For instance -
    A particular radiologist refuses to give ME the verbal report on a study *I* ordered on a patient *I* worked up. He insists on speaking with my collab who then tells him he needs to speak with me because I saw the patient. THAT is the kind of thing that creates your perceived chips. Or how about a collab (not mine thank goodness) who introduces patients to his new NP by APOLOGIZING! for having one!

    I think a few of you really would be shocked if you were to spend a day shadowing an NP. I remember the couple of days I did that - I was really surprised!
  4. by   traumaRUs
    Gauge14IV - you are so right. I have no chip on my shoulder - I love being an RN and will gladly do whatever needs to be done in order for the pt to get good care. I am extremely fortunate that I work for a large practice that truly values their APNs.
  5. by   scribblerpnp
    Quote from gauge14iv
    As for the chip - it isn't about not being perceived as "equal" - it is about being treated as stupid...

    For instance -
    A particular radiologist refuses to give ME the verbal report on a study *I* ordered on a patient *I* worked up. He insists on speaking with my collab who then tells him he needs to speak with me because I saw the patient. THAT is the kind of thing that creates your perceived chips.
    I'm so glad you said that! I thought I was the only one! And my co-worker MD, tells them to speak to me. (I love it that she backs me up) I also hate when I refer one of my pt's to an ENT, allergist, whatever with only my name on the referal and the letter they send back is written to the MD. Hello! This is my pt, and she probably has no idea I even did this or who you are talking about!

    But my largest pet-peeve is the pharmacies who fill my scripts, which clearly state my credentials after my name ACCORDING TO STATE LAW, and on the scripts it sometimes say (some pharmacies are worse than others for this), Dr. Jane Doe or Jane Doe, MD, not Jane Doe, MSN, RN, CPNP. No wonder some of my patients are confused as to who I am and my role.

    I don't have a chip on my shoulder. In general I don't think NP's are better or worse or even equal to MD's. We are different, but we are't stupid. And being ignored or spoken down to makes me feel at a loss sometimes.
  6. by   MS, APRN, BC, FNP
    Quote from motorcycle mama
    , but a NP is not an MD nor should they be advertised as being "as good or better." Don't tell me no one is suggesting that because I see it all through many posts on this forum. NP's still practice nursing, not medicine. And if they were on the level of MDs they would not work under them. .
    Advertising?? Who's advertising? Where are these ads?



    When I'm diagnosing and prescribing in my practice, what am I doing? I know what the correct answer is, but it kind of feels like the other answer. Although, I do have a nurse that does all the nursing duties. And of course some NPs are as good or better than some MDs and vice versa in primary care. I can cite case after case where that is true. I can choose to work with an MD or I can choose to work independently without them. I don't work under them...well I did once, but that was just for fun. I have a good working relationship with all the docs I associate with. I respect them and they respect me. I collaborate with a great MD currently. I consult with him on occassion, and he consults with me on occassion. I take care of 80-90% of my patients needs and for the other 10% of their problems they count on me to know which competent MD specialist to refer them to, and more likely than not they won't get to see the MD specialist, but they will be fortunate enough to see their NP or PA.

    I don't make decisions about my healthcare based on someone's credentials. I make it based on their reputation. I suggest you do the same, or you might find yourself all jacked up blubbering in the corner muttering "I don't understand it, he had the initials MD after his name". I think for some here the term MD means Magical Degree.
    Last edit by MS, APRN, BC, FNP on Nov 29, '06
  7. by   core0
    Quote from gauge14iv
    For instance -
    A particular radiologist refuses to give ME the verbal report on a study *I* ordered on a patient *I* worked up. He insists on speaking with my collab who then tells him he needs to speak with me because I saw the patient. THAT is the kind of thing that creates your perceived chips. Or how about a collab (not mine thank goodness) who introduces patients to his new NP by APOLOGIZING! for having one!
    \

    This is an easy one. There are plenty of places around that want your business. There is a big sign over my schedulers desk that says DC - No radiology tests at ****** hospital. The reason they are unable to send me a report. It goes to my SP which creates unacceptable delays in care. I spoke to them about this and they said it was a problem with their computer. I said fine call me when it gets fixed and maybe you will get some of my business. When they noticed that their volume was down noticeably they complained to my SP who backed me up 100%. Where I practice you can throw a rock and hit 10 radiology centers. Use the ones that respect you.

    David Carpenter, PA-C
  8. by   gauge14iv
    core0 - great minds think alike - that is precisely what I do Just send my referrals someplace else - I can look out my office window and see 3 more!
  9. by   CrazyPremed
    Quote from MS, APRN, BC, FNP
    Both providers go through a kind of residency where they see patients until they're competent enough to be independent. For a NP that is more vague, but they do an equivalent residency. The NP gets their residency through their work experience.

    I'm not sure what your saying about the knowledge base. I see some docs that don't seem to have a knowledge base from some of the things I've seen from their standard of practice. Again, it comes down to the competence of the individual not the credentials after their name. When it comes to the specialties, I'll give the docs their due (I know some great ones), but in general practice ask around who the best primary care provider is and you'll find just as many patients that prefer the NP over the MD as those who like their MD. I've had many patients leave their MD and come to me on a regular basis. Now, why is that? Even docs don't respect each other based on that MD after their name. Respect the person not the credentials. I'll take my reputation over some of the jokers that just happen to have an MD after their name in primary care any day. Having an MD after your name isn't like buying meat that has the USDA label on it. You can't always trust it by a long shot. Actually, you can't always trust the USDA label either. It would be nice if we could determine the quality of the health care we're getting just by looking at the credentials after the name but it's just not possible from my experience. It's better just to look at the providers name and then ask around.

    You sound like idealistic premed student. Don't worry, you'll learn.
    Thanks for the generalization about me. I'm not as idealistic as you think. I will, however, refrain from turning this into a flaming war.

    Common sense tells us that there are good and bad NP's and MD's/DO's. Common sense also tells us that there is a great deal more training in becoming a medical doctor than an NP. Does this mean NP's are inadequate? NO! Does this mean every doctor will catch every disease and every NP will miss? NO! But we both know the comparison of the training (I can't believe that I even need to argue this). Let's face it, doctors get much more.


    The truth is, most medical professionals begin to feel that they can do most - if not all - of the jobs of those more academically trained. The other ER techs feel that we should be able to start IV's (with our CNA and EMT - B licenses). When I say that I don't know enough about medication administration to decide on a 21 gauge buff cap in the hand for NS (dehydration) or a 16 gauge for a pending CT angiogram (R/O pulmonary embolism) in the antecubital, it becomes painfully obvious that we don't have the background to make these decisions. As phlebotomists, we felt as though we knew more about lab tests than the RN, but most of us didn't know whether PT's were ordered with Coumadin and PTT's for pt on IV Heparin, or vice versa. I've seen many RN's order portable chest Xray's, cardiac enzymes, and 12 leads on patients with anxiety attacks(misdiagnosed by the nurses as a pending MI), but still fell like they knew just as much as the MD.

    Honestly, we never know how little we know until we learn more (does that make sense?).

    I LOVE the bedside manner of NP's. I also love that NP's are commonly put in a situation where they can spend more time with patients, and have been thoroughly trained in the psychosocial aspects of medicine. I love knowing that there is a wonderful working knowledge of medication administration, and - generally - a more holistic view of health. Does this take of the place of intensive science classes, medical rotations, and structured 3-7 year, 80-100 a week, progressive residencies (with the occasional 2-3 year fellowship)? No. Fortunately, many NP's have a collaborative relationship with a doctor that can fill in the very real gaps that remain. Thank you.

    CrazyPremed
  10. by   EricJRN
    Quote from CrazyPremed
    The truth is, most medical professionals begin to feel that they can do most - if not all - of the jobs of those more academically trained. The other ER techs feel that we should be able to start IV's (with our CNA and EMT - B licenses).
    Crazy,

    Keep in mind that if your CNA's and EMT-B's are licensed, that makes your state a rarity. Given that, it makes sense that the practices of nursing and advanced practice nursing may also be significantly different in your area, making for poor comparisons. Here in Texas, we've started licensing some degreed paramedics in the last few years, but the CNA and EMT-B still just hold certifications.

    Regarding ordering labs/X-ray/EKG on an anxiety patient, surely you know that we order medical diagnostics and interventions in this country based on what could be wrong with a patient and not based on what we actually think is wrong. It's not generally an issue of assessment gone awry, but one of liability.
  11. by   CrazyPremed
    Quote from EricEnfermero
    Crazy,

    Regarding ordering labs/X-ray/EKG on an anxiety patient, surely you know that we order medical diagnostics and interventions in this country based on what could be wrong with a patient and not based on what we actually think is wrong. It's not generally an issue of assessment gone awry, but one of liability.
    So true. Especially in the case of emergency medicine.

    The point of my earlier reply is to respond to a poster's idea that the training of NP's in general practice equals that of MD's, due to pt's preference to see an NP instead of a medical doctor.

    CrazyPremed
  12. by   gauge14iv
    Quote from CrazyPremed
    So true. Especially in the case of emergency medicine.

    The point of my earlier reply is to respond to a poster's idea that the training of NP's in general practice equals that of MD's, due to pt's preference to see an NP instead of a medical doctor.

    CrazyPremed
    I don't see where that was even implied!
  13. by   Jo Dirt
    Quote from MS, APRN, BC, FNP
    Advertising?? Who's advertising? Where are these ads?



    When I'm diagnosing and prescribing in my practice, what am I doing? I know what the correct answer is, but it kind of feels like the other answer. Although, I do have a nurse that does all the nursing duties. And of course some NPs are as good or better than some MDs and vice versa in primary care. I can cite case after case where that is true. I can choose to work with an MD or I can choose to work independently without them. I don't work under them...well I did once, but that was just for fun. I have a good working relationship with all the docs I associate with. I respect them and they respect me. I collaborate with a great MD currently. I consult with him on occassion, and he consults with me on occassion. I take care of 80-90% of my patients needs and for the other 10% of their problems they count on me to know which competent MD specialist to refer them to, and more likely than not they won't get to see the MD specialist, but they will be fortunate enough to see their NP or PA.

    I don't make decisions about my healthcare based on someone's credentials. I make it based on their reputation. I suggest you do the same, or you might find yourself all jacked up blubbering in the corner muttering "I don't understand it, he had the initials MD after his name". I think for some here the term MD means Magical Degree.

    Certain posters here don't understand jack about what I'm talking about. And no, a certain poster here doesn't know the answer to his/her own question. Just more posturing and defensiveness because not everyone will blindly regard him/her as a pillar of knowledge and authority because he/she has a master's degree and works in a clinic.
    I hate what this has turned into, because I don't disrespect nurse practitioners or belittle what they do. But obviously, as with any profession or group of people, there are egos out there that will not respond to any amount of reason. Give some people a little authority and it makes their heads swell up so big they need to be tied down to keep from floating away.

    (And speak for yourself about the blubbering.)

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