Scary reading doctor forums about NPs...

Specialties NP

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So as I've been winding my way through the decision-making process of NP/PA/MD/DO I found myself at a very active forum community of medical students/professionals/etc. across all parts of the field. I learned LOTS when i was specifically researching what was needed for the medical school process. (I removed the name of the forum due to an administrator PM I got)

I did a search of the term "nurse practitioner" within their forums to get a sense of the thoughts on the field from that angle...

:eek:

Wow! I was not prepared for the amount of negativity and vitriol I saw. Most of what I read was very damning of the NP field (specifically in regards to the progression of NPs to have scopes similar to MD/DOs and independent practice rights).

Is this the feeling everywhere? I'm excited about the opportunity to practice primary care medicine in a primary care clinic without the massive sacrifices of MD/DO school. But I sort of get the sense that NP's are becoming pariahs.

Now I know this is just an internet forum, but I wondered if practicing NPs or NP students were getting a similar impression?

Thanks!

Thank you Kanzi, that was very encouraging.

What track did you take, working surgery?

I'll be doing FNP with the goal of working primary care.

I actually went the ANP primary care route myself. After graduation I applied for a range of positions just to get a foot in the door anywhere. I found that my ANP license was good for most NP postings (other than positions that required peds) and very few positions REQUIRED an ACNP certification. I DO think there's a bit of a learning curve for me as opposed to ACNPs or PAs in an acute care setting since I didn't have very much formal acute care training at an advanced level, though my RN experience is helpful. I DON'T work in the OR at all, though if I were to pursue a First Assist certification, then I theoretically COULD assist in surgery. However, I work in a teaching hospital, so OR time is at a premium for the younger docs, and I am perfectly happy managing the floor while they get their experience. Ultimately I intend to work in a primary care or clinic setting, but for now things are pretty great. There's a lot of research, technology, support, and super motivated people around me every day, and it's a good place for a first NP experience.

I don't think you can go wrong with an FNP--you will have many many options when you graduate.

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Most people believe a CNA shouldn't start IVs, RNs shouldn't start central lines, and PA/NPs shouldn't practice independently.

lolwut?

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People do realize it was an MD that started the NP profession, right?

I always thought Loretta Ford RN and Henry Silver MD collaborated to develop the 1st PNP program in Colorado

I heard many years ago that it was originally Dr. Silver's idea; he went looking for a nursing program to collaborate on developing an educational program, and ended up working with Dr. Ford at the University of Colorado. Since the larger nursing community is understandably reluctant to give any more credit than absolutely necessary to a physician for the invention of the NP concept, it's probably impossible, at this point, to get a definitive answer to this question.

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Originally post by newguy8

"I'm still excited about the opportunities but I'm planning to augment the regimented education with pre-medical science courses and as much clinical as I can manage to stuff in."

Hello,

I am a student in the second half of the BSN portion of my DE program. First I wanted to comment on taking lots of medical classes. My first degree was in biology and I focused very strongly on medical biology. Totally premed education. I took immunology, medical microbiology, drug research, abnormal psych, genetics, cell biology, neuroscience, ect as part of my degree. They have proven to be a great help and a bit of a burden. Having a strong science background can mean you have a great insight into the physiological process or a disease such as an additional HIV reading that talked about the human leukocyte antigen alleles. I was one of the few people who understood that part of the reading.

The downside is the nursing undergrad programs tend to generalized things. We cover three lectures on communicable diseases when I have taken an entire class which covered one disease every class, which was nothing in the scheme of things. It can be a bit frustrating. The generalization of the education allows nurses to go into some many different areas in new grad programs to get their specialization.

I hope/think the pre-med background will pay off more in the NP program or if I chose to pursue nursing in one of the specific areas. My only advice is depending on the strength of your background it is easy to come off as a "smarty pants" when it comes to physiology and science. For example in my eye a question about the mechanism of changing oxygen and hemoglobin binding affinities in relation to increase pH is a perfectly valid question when discussing ABGs. In the professors eyes, it was irrelevant and she couldn't answer the question. She chose to ignore me. Another student was angry with me for asking question she didn't understand. But there are other student who appreciate the knowledge a EMR sales person (one of my classmates) or biologist brings to the table.

Overall I am very glad I have such a strong science background and recommend taking as many science classes as possible before an NP program.

In relation to the message boards:

I did get a lot of junk from my undergrad friends who went to med school. They said I was taking the easy route out blah, blah, blah. Some were convinced once I explained more about why I wanted to be an NP. Truthfully I would rather have my NP friend provide my primary care than some of my MD friends. But I would rather my MD friend be the one to perform heart surgery on me. Some of it is a lack of knowledge and beliefs about NPs. Hopefully they will have respect for NP once they realize what NP really can and can't do and do and don't know and we can respect their expertise in turn.

The third eye stare is amusing on interprofessional days when I get introduced to med students as the undergrad friend who chose the nursing school for my second degree!

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There is definitely some interesting posts out there involving NP's. Since I'm currently working on my FNP with only a year left, it is interesting to see what others are writing about the profession I will soon be entering. I have not experienced any dislike from MD's to NP's that I have currently being precepting with. But that doesn't mean that it doesn't happen when students are not around.

Currently, there is a shortage of PCP's and most new MD's are not entering primary care due to the fact that it doesn't pay as well as specialties these days. Does anyone feel that MD's feel that NP's can and will take over the primary care in the near future? Is this why that is a dislike from MD's? If this is true, then why are they so upset if they are not choosing primary care themselves?

Any Thoughts?

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I have also found this article that was written in Chicago for the magazine Modern Healthcare that was called Primary Dispute by Joe Carlson. This article summarizes how doctors feel that nurse practitioners are putting patients at risk because they are less trained and not qualified to provide patient care in certain areas in healthcare. This is not only damaging to the NP's profession as a whole, but who can sit there and say that NP's are not qualified or trained enough to provide healthcare. Who decides if we are or not? With such an increase in demand for primary care doctors, how can one say that seeing an NP is putting you at risk?

http://www.modernhealthcare.com/article/20100405/MAGAZINE/100409984

(If you don't want to login to the free site, you can always search google for Primary Dispute - Joe Carlson and it is the first link that is provided for the whole free article.)

Carlson, J.. (2010, April). Primary dispute. Modern Healthcare, 40(14), 28-30.

Any thoughts with this article?

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RLTST10,

That was a really great article! I am unable to believe that this article was published less than one year ago. This is not what I have encountered in my journey with my NP degree. I have been an NP for 18 years now and have worked for multiple different doctors in different states and have NEVER had any bad feedback. I have always been treated with up most respect and have been treated like a professional with all the specific training.

Don't let this discourage you from finishing your degree. There is a lot more opportunities with having an NP than just an RN. Another piece of advice is if the place you do work for treats you like this, that you are not a qualified provider and less trained than MD's, then you need to find another place to work.

This article really fires me up! I can't wait to show this to my partners, (which are all MD's) and see what they have to say about this. I don't think that this Joe Carlson has ever worked in healthcare because he apparently only got one side of the story and probably only asked one MD that has a grudge or had a bad experience with one NP.

Well I hope you finish your schooling strong RLTST10, and Good luck to you!

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This article doesn't surprise me at all. I used to work for a doc that hired me but had no idea what nurse practitioners really do and i felt like i was just there to assist him as a nurse. There are many people out there that have no idea that nurse practitioners actually see patients on their own and do everything independently without a doctors consent. I have since moved from that job feeling that no one really understood what nurse practitioners do and i have since been a voice for nurse practitioners in today's society.

I think this article being published shows that many people don't really know what our scope of practice is and we need to show them. They state that nurse practitioners go through less training than doctors and we are not prepared to take care of patients. If i remember correctly, most nurse practitioners have worked as nurses for many years before going back for our practitioner license. I had many years experience in ICU, Post op, and ER. I then got my practitioner license and moved on. Many of us nurses have taken our education and experience from nursing and applied it with the education that we gained from practitioner school and has made us a better and knowledgable resource for patients. Doctors may go a few more years of schooling but i feel that we had more years experience with patients, emergency situations, and knowledge of medicine already.

Don't let one article change your mind about a subject. If you entered practitioner school for a good reason, then you will succeed in it. It has been the best thing that i have done in my years and continue to get benefits from it everyday.

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SandyNP,

This is great that you have never had an experience like this article. I haven't been in the profession long, only being a student for a few years, but even as a nurse, I never go the impression that MD's didn't like or think highly of NP's. That is one of the reasons that I wanted to be an NP.

I'm glad to hear that this article is not the typical norm since I will be entering the profession in a year! You have had alot of experience with 18 years as an NP, do you have an advice that a fresh new NP may need to know?

I'm really curious what your co-workers think about this article and what their input is on this topic.

Thanks for your response!

FraksNP,

I'm sad to see that you have had a bad experience. I guess not everyone can have the best work experiences and i'm glad to see that you have learned and moved on from this. I could not imagine what that was like, having a MD look down on you like he did. I wonder why that was? Do you have any insight into why he may have done that?

I see that you have had alot of experience as a nurse prior to your NP. Do you feel that it helps if you switch jobs or specialties prior to your NP? I have tried to switch different floors and specialties within my hospital every year for a new fresh start and to learn as much as I could. I feel that it helps me keep up with things that I may not have remembered if I didn't work in that special field.

Thank you for your response as well!!

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I think that doc was like that because he was older and stuck in his ways. He would never change the way he did stuff, and would not believe new research that was out there. I had tried to tell him one time that a new medication is better to treat hypertension but he just continued to use an older one that he felt worked better, but tended to have more side effects. I don't think he would ever be up to date, and I believe docs should be since the medical field is constantly changing. But as I have learned, you can't change people's way of thinking.

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yikes

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]The only advice that I can give would be to always trust your gut when it comes to patients. If you feel that something is wrong and you can't find it, always keep looking!

]

]I showed the article to my coworkers, who are all doctors, and they were shocked as I was. We sat there and discussed this, and we all came to the conclusion that this article didn't give the side of many doctors. They felt that they didn't show the side of how grateful the doctors can be for help with patient load. They stated that they felt we are equally prepared with all the necessary tools to take care of patients like doctors, but in a different way. NP's are more patient focused where doctors are more prepared with disease processes.

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