Advanced Nurses want Medicine Rule Lifted

Agreed....most NPs I know perform thorough exams and are more than capable of prescribing medications. I have to agree that I find it interesting that my opinion is sought often, and I have only been a nurse for<3 years. There is nothing quite as disturbing as the senior surgical resident asking if ativan and propofol is a good idea used together for an intubation : ) Know what I mean?

I am scared by the fact that some NP's (and PA's) have no Nursing experience or only a year or 2 before becoming an NP.

Maybe NP's need a Residency?

I can only speak for my experiences, but the NPs I work with in the ER not only served in other areas (ie. staff RN, or paramedic) prior to returning for their NP. Additionally, areas like mine (ER) and other specialties do have requirements for residency. The PAs while good, don't even hold a candle to the NPs we have. I think they just have a different way of relating with our patients and us.

Vito I agree wholeheartedly that no nurse should be allowed to practice as an NP without some floor time. Additionally, any advanced degree nurse IMHO SHOULD NOT BE functioning in any supervisory, managerial or decision making capacity unless they have some floor time. I know I wouldn't want them to be my manager, director or prescribing without actually having hands on patient experience.

PS...I am sure many will disagree, but as one with an extensive managment background....I am sure I would not have been fair or truly understood the flow of the floor if I had taken any of the myriad positions thrown my way when I graduated.

Maisy

I think MD's just want to keep control of "their" turf.

Playing devils advocate, cannot say I blame them. Nurses act in very similar ways when other providers look at taking on roles traditionally held by nurses. Look after your own, nothing wrong with that.

I very much agree with you.

BUT

I think that its also a sign of progress. Everyone's role is becoming more defined on a continuum. If we can't protect tasks we already do, then shouldn't we (as a group) seek tasks we are presently barred from as well?

The whole thing is neither good nor bad, right or wrong, its got its own life and its going wherever its going...

I really thought this lack of need for a collaborative agreement is what distinguishes the NP from the DrNP. I now a lot of NP's who went directly into NP programs with no floor time. Also, the kind of clinics mentioned are usually the ones where NP's, PA's and new doc's can work to get student loans paid back. The Clinics I am familiar with have few MD's and many NP's. The NP practice is essentially independent with no restrictions on their prescribing. They are the primary care Providers for their own patients. They do have the docs for consultation as needed. Also, I don't know about elsewhere, but here a NP can't have admitting privileges at a hospital so they need a collaborative agreement for their patients who need admission. There are NP's with offices separate from their collaborating physician. I think at the MSN level, collaborative agreements are necessary but not prescribing restrictions or direct supervision.
I know MD's are fighting the whole DrNP role, infringes on them too much. At that level of training, there should certainly not be physician collaboration required. The education and training, including residency, required is at leasy equivalent to that of the now out-dated GP's. It's all well and good that Family Practice is now a specialty with a regular residency and board certification. But, much of the country is underserved for basic medical and the DrNP can fill that void.

the AMA has always fought the role of NPs. Patient safety is one thing, but what it tends to boil down at the community level at leats in my experience is that physicians want NP's to work under them not for patient safety, but ultimately because the visit can get billed under the physicians provider ID number. It's a big battle over medicare billing and reimbursements. If an NP was technically a primary and had 1200 patients that on her panel... yeah, that'd be a hit for the physician run practice if she went and started her own practice

The push for physicians to be anything but a general practitioner due to the low reimbursement rates leaves a huge gap for one of the most needed providers. NPs can fill this gap successfully, and they do. NPs refer to specialists all of the time, let them bill the patients when they receive them. Ultimately the patients will probably be better served.

Lets face it, physicians in the HMO system try to "treat" everything out of their scope of practice instead of referring out . That definately goes against the "do no harm" theory. Additionally, where I work the residents may spend TIME learning, but what keeps them and the patients safe is the nurses. If we are the last line of defense against medication order errors, reconciliations, and patient change in condition....I'd say nurses were pretty important, and on the ball. The physician would never know their patient's status based on their 5 minute appraisal without our observations, care and contact.

For those who mention us protecting our turf....you are right. A one year program, 6 month med tech, CNA or any other program where there is no licensure, ownership, or ultimate responsibility should not be caring for patients in the role of a RN. For the very reasons I previously mentioned.....critical thinking, and patient safety are the very reasons. No one is asking an NP to perform neurosurgery, or cardiac surgery....yet, I have seen them do the things those surgeons "used to do". Again, these are special areas that require internships beyond their nursing experience, and schooling.

When you consider everything, the best doctors may be nurses : ).