Did You Know?
allnurses is the largest community for nurses on the web. We now have over 388,775 members! Join today to network with other nurses, laugh, share, and much more.
Thread Closed Available for reading only.
| No. 30 | 
Aug 03, 2009, 04:43 PM
 Re: Doctor Shortage-Who Should Fill the Gap?
Let's face it, in many parts of the country people wait for weeks to be seen by their PMDs and are forced to use the ER for simple things like ear aches, sorethroats and bronchitis. While an earache is innocuous it can be debilitating; as can every other "simple" problem. The cost involved is huge to the patients in the form of insurance going up, and co pays. In the event of Medicaid and Medicare it continues to siphon tax dollars on events that didn't need to occur. PMDs are in short supply and someone needs to fill the gap!
NPs are perfectly capable of independently diagnosing and managing these types of illnesses, they are also perfect managing diabetes and other chronic diseases as they use a nursing approach and really EDUCATE the patient about the disease process with evaluation and re-evaluation of that education. I would like to see NPs expand their practice, be reimbursed for GOOD CARE, and be available en masse to the poor and those requiring disease maitenance. A good nurse with experience is an excellent clinician, an experienced nurse that practices at an advance level is a Godsend to patients. They evaluate the patient as a whole with a practiced eye when a patient presents with a problem; one reason that NPs are trusted by the public as providers of care.
As for physician debt, I was recently advised that they are the biggest defaulters on student loans; leaving less for the rest of us. Of course this was from a nursing professor.
While I believe NPs are the answer I also think more clinical time along with GOOD internships and learning experiences must be made available for NPs to practice even more safely. Programs vary dramatically and the students must be highly motivated during clinicals to learn as much as possible-I was recently told by a co-worker(NP) that she was expected to hit the ground running when she passed her boards-something that may be impossible if your learning experiences are limited and a reason for doubt in NP credentialing. Her advice has driven me to ask my ER doctors who are more than willing to share info and invite me to resident programs(this is not a requirement for my program, but a requirement for myself)
While most clinicals require 400+ hours is that really enough? My program requires 585 hours (14.6 weeks total) a very small amount of time actually using diagnostic skills, so I feel the need to learn as much as possible while I work my day job and am lucky that these great people are willing to provide the support-so xrays, case studies, and pharmacology quizzing(when we have time). Sometimes I feel like an ass when I get the hairy eyeball over something I said way out in left field; other times I am coached to an answer-overall I hope to someday provide good care to those who need it and be able to partner with a healthcare team that is an answer to this crisis in lack of primary care.
M
 | | Advertisement Sponsored Links | | | | No. 32 |
Aug 04, 2009, 06:16 AM
Re: Doctor Shortage-Who Should Fill the Gap? Originally Posted by dgenthusiast  If NPs should be allowed to practice independently with less than a 1000 clinical hours, I think they should allow 4th year medical students to also practice independently. They'll have had 2 years of basic science and year of clinical rotations, which I believe is at least 1000 clinical hours. It makes sense to me, especially considering that there are several direct-entry NP programs that don't require prior healthcare experience. 
Remember most NPs are nurses who have worked on the floor for years, I didn't say they should be performing brain surgery. If you note I said simple, maitenance and education; unless trained in a specialty. As for specialties, most physicians who use NPs as extenders have them doing things that only they did years ago. Of course this is after sometime of internship in their practices. As for the NP programs without "time in" requirements-I'd have to ask who is hiring them and what type of clinical requirements do they have? Perhaps they do full internships and clinicals; however as someone who believes you need a real basis for dx I have a problem with that.
It appears that no one wants to be a PMD when they graduate as doctors, maybe physicians could have an entry level.....but then again if the money isn't there who will sign up for these spots?
In any case, people have needs that must be met-prevention and good maitenance is the key to health. NPs more than fit the bill and the literature supports not only patient's trust in their judgement but the fact that a relationship with an NP or any Primary provider that takes the time to treat the whole person is the type needed for success in the prevention/disease process.
M
| | No. 33 |
Aug 04, 2009, 08:36 AM
Re: Doctor Shortage-Who Should Fill the Gap? Originally Posted by MAISY, RN-ER Remember most NPs are nurses who have worked on the floor for years, I didn't say they should be performing brain surgery. If you note I said simple, maitenance and education; unless trained in a specialty. As for specialties, most physicians who use NPs as extenders have them doing things that only they did years ago. Of course this is after sometime of internship in their practices. As for the NP programs without "time in" requirements-I'd have to ask who is hiring them and what type of clinical requirements do they have? Perhaps they do full internships and clinicals; however as someone who believes you need a real basis for dx I have a problem with that.
It appears that no one wants to be a PMD when they graduate as doctors, maybe physicians could have an entry level.....but then again if the money isn't there who will sign up for these spots?
In any case, people have needs that must be met-prevention and good maitenance is the key to health. NPs more than fit the bill and the literature supports not only patient's trust in their judgement but the fact that a relationship with an NP or any Primary provider that takes the time to treat the whole person is the type needed for success in the prevention/disease process.
M
I personally believe (I truly do) that NPs should be cut loose from the ties that bind them to physicians. No oversight, no nothing. Just purely independent practice in all 50 states. As you all have said, the patients like it, and the outcomes (at least those reported) are comparable in some settings.
With independence, though, should also come full responsibility for one's malpractice coverage. The rates now are often demonstrably reduced for the nurse, as the NP is "overseen" by a physician, who also shares in the liability.
I would also hope that NPs no longer are granted access to MDs/DOs for their clinical training preceptorships. NPs should be trained by other NPs only, so as not to confuse the practice of nursing with the practice of medicine. The two professions should become inextricably separated. Only then will the NP profession truly be allowed to flourish.
| | No. 34 |
Aug 04, 2009, 10:45 AM
Updated
Aug 04, 2009 at 11:04 AM by lamazeteacher
Re: Doctor Shortage-Who Should Fill the Gap?
forpath's post#20 quote: ".......I seriously doubt that NPs would turn down equivalent reimbursement as physicians, especially since so many of them feel they provide the same services as physicians. Which brings us back to the original question-How do NPs make things cheaper?"
Since nurses traditionally spend more time with patients, than do MDs, and there are only so many hours in the day, they usually see fewer patients daily .
Nurses could never make as much as MDs do (unless they invented something essential to medicine or something else), without a hue and cry heard 'round the world, from MDs!
I hope that someday I'll eat those words........
| | No. 35 |
Aug 04, 2009, 10:58 AM
Re: Doctor Shortage-Who Should Fill the Gap? Originally Posted by dgenthusiast If NPs should be allowed to practice independently with less than a 1000 clinical hours, I think they should allow 4th year medical students to also practice independently. They'll have had 2 years of basic science and year of clinical rotations, which I believe is at least 1000 clinical hours. It makes sense to me, especially considering that there are several direct-entry NP programs that don't require prior healthcare experience.
I'd appreciate it if you would support this post with facts out of the curriculum for the 1000 clinical hours. It's one thing if you perform examinations for patients and walk away (hopefully after covering them up); and quite another if you spend hours with them to make them comfortable, give them their medications, food and fluids and hear what they think will happen as a result of taking them; and actively listen to their goals for wellness.......
By the way, congratulations on graduating from med school. Now if only you'd graduated from any form of nursing school...... spent some time in our shoes, and those of patients........  | | No. 36 |
Aug 04, 2009, 11:27 AM
Re: Doctor Shortage-Who Should Fill the Gap? Originally Posted by lamazeteacher forpath's post#20 quote: ".......I seriously doubt that NPs would turn down equivalent reimbursement as physicians, especially since so many of them feel they provide the same services as physicians. Which brings us back to the original question-How do NPs make things cheaper?"
Since nurses traditionally spend more time with patients, than do MDs, and there are only so many hours in the day, they usually see fewer patients daily.
Nurses could never make as much as MDs do (unless they invented something essential to medicine or something else), without a hue and cry heard 'round the world, from MDs!
I hope that someday I'll eat those words........
I'm sorry, I don't follow your logic. Because a nurse sees fewer patients per day, he/she is cheaper? That may be in absolute terms, but I was asking more about how nurses make things cheaper per patient.
| | No. 37 |
Aug 04, 2009, 11:52 AM
Re: Doctor Shortage-Who Should Fill the Gap?
I thought it was clear about cost savings-access to care =care; no access equal exacerbations of the chronic conditions-which leads to the ER-increased specialist costs-increased lab and procedure cost-increased morbidity and co-morbidity-increase in taxes-increase in death-increase in lawsuits.
Having NPs and or, adequate primary care would ensure prevention;therefore a cost savings to us all would be seen whether in our taxes from government programs or in our insurance rates. I question critical thinking ability in anyone who doesn't understand this very simple concept.
M
| | No. 38 |
Aug 04, 2009, 12:05 PM
Re: Doctor Shortage-Who Should Fill the Gap? Originally Posted by MAISY, RN-ER I thought it was clear about cost savings-access to care =care; no access equal exacerbations of the chronic conditions-which leads to the ER-increased specialist costs-increased lab and procedure cost-increased morbidity and co-morbidity-increase in taxes-increase in death-increase in lawsuits.
Having NPs and or, adequate primary care would ensure prevention;therefore a cost savings to us all would be seen whether in our taxes from government programs or in our insurance rates. I question critical thinking ability in anyone who doesn't understand this very simple concept.
M
Were you questioning my critical thinking ability with your comment or just anyone in general who does not understand the fiduciary benefits of primary prevention? If so, no reason to flame. I understand the simple logic of "A stitch in time..."
The post to which I was referring (and quoted) stated nothing about prevention in terms of economic costs and spoke solely of how seeing fewer patients per day is cheaper.
| | No. 39 |
Aug 04, 2009, 02:13 PM
Re: Doctor Shortage-Who Should Fill the Gap?
You asked a question that seems to boggle many medical minds and I am not sure why. If Canada spends 50% of what we do on healthcare costs and has better outcomes; the only difference in our usage of funding seems to be on the emergent, and end of life issues. How about plenty of primary care and prevention for all, so that we don't spend the lion's share of healthcare dollars on fixing what should have been avoided.
As for critical thinking, the hardest push has been from specialists-gee, I wonder why that is? So maybe I shouldn't question critical thinking, just medical and moral ethics.
M
|
| 93 members
1,019 guests 1,112
| 5 | | | 48 | | | 0 | | | 7 | | | 12 | | | 26 | | | 2 | | | 14 | | | 63 | | | 14 | |
| 45 | | | 1 | | | 13 | | | 2 | | | 10 | | | 17 | | | 11 | | | 16 | | | 16 | | | 42 | | | 14 | | | 21 | | | 23 | | | 20 | | | 24 | |
|
Nursing News