Doctors-in-short-supply-responsibilities-for-nurses-may-expand

Why would you not want to collaborate with a physician? I had a moment of clarity in Afghanistan while performing independent medical duties. I had several people present with different types of skin lesions and assorted complaints. I was reduced to playing wheres Waldo in a dermatology text in multiple unsuccessful attempts to identify and treat their problems.

I am not sure a couple of years of classes and 700 or so hours of clinical experience would have prepared me to deal with the said situation. If this is the case, I could not see independently managing people with a plethora of problems spanning the entire range of ages. As an APN, I would be more than happy to work with a physician. IMHO.

Can you please provide the study that you mentioned above? Can you please provide a specific percentage of nurses that have experience when they begin graduate school?

I will provide the medical side of view:

Med student 1st and 2nd years in class from 8-5 every day.
3rd and 4th years in the hospital/clinics 5-6 days per week from 8-5 and staying until 12AM when on call with residents and in some places overnight.

Resident for IM spends 70 hours per week in average at the hospital which translates to 3640 hours per year so at the end of a 3 year residency they have 10920 hours of experience if the avg is 70 hours. This 10920 (give or take since we have 3 weeks of vacation so thats 210 less hours) hours doesnt take into account the hours that resident spend at home/library preparing for the Step 3 (weeks-1 month of preparation) and ABIM (4-5 months of preparation) and reading after their duties in the hospital.

The nurses at the hospital where I work have 12 hours shift 4 times per week= 48 hours per week. Therefore in a year nurses work 2496 hours (if no overtime) and in those 3 years that a resident works its 7488.

10700 vs 7488, and lets not forget one is directed entirely at medicine and the other at nursing (therefore no pathology/treatment training 100% of the time).

In terms of pathology/treatment training you cannot compare one to the other, they are different schools with very different training objectives in mind. And again this is not to flame, is just to ilustrate that physicians and nurses have different roles in the healthcare system and they were trained for a specific objective.

I respectfully disagree. The idea that a midlevel might miss something a physician might catch is a perfectly valid argument. The amount of pathophys/path training that an NP/DNP receives is considerably less that what a physician receives. This can definitely translate to NPs/DNPs missing something, primarily because they've never learnt about it or they've never learnt about it to the extent that the physician has.

I also disagree that whether midlevels get less education than physicians is a matter of perspective. It's a fact that they get less training than physicians. It's nigh impossible to cram 7+ years of physician training (4 years of med school + a minimum of 3 years of residency) into half that time. Also, physicians receive greater than 15000 clinical hours of medical training during M3/M4 and residency compared to less than 1000 that most NP/DNP programs require. Not only that, the basic science foundation of physicians is significantly greater than that of NPs/DNPs, whose curricula contains a significant amount of nurse activism and other courses that aren't very useful clinically.

While prior experience as a nurse might help in the transition to NP/DNP, it is not a replacement for medical training. Unless you're suggesting you practiced medicine as a nurse? There's a significant difference between thinking in a medical manner and thinking in a nursing model, as many nurses themselves are very quick to point out. So, that prior clinical experience you have as a nurse does not compensate for the less than 1000 clinical hours of medical training that NP/DNP programs require. Also, there are several direct-entry programs where you can earn an NP or DNP without any prior healthcare experience at all. That's pretty scary!

I paraphrased you there but the problem with your logic comes from what appears to be your obvious inexperience. The primary flaw in your logic is is the fact that despite the numerous hours of experience med students and residents put into their training, the quality of their care is often comical. How often do I see med students and residents standing around, gossiping, studying? Completely oblivious to the goings on around them? How often are they really part of the hospital team? Not much. Just because you are inside of a hospital doesn't mean your are learning anything that is actually useful. Massively piling hours up sounds like a recipe for incompetence to me.
Since very few doctors have ever gone to nursing school and most to this day truly don't know what a nurse actually does, the unknown fact is that nursing school is at minimum a two year crash course in how TO RUN A HOSPITAL FROM THE GROUND UP. On the flip side, nurse's have to know what a MD does to do their job. MD's frankly consider 90% of the necessary functioning of a hospital someone else's problem. This makes MD's weak and ineffectual. I find med students and even up to R2's utterly clueless on how to contact the resources available to them (i.e. lowly custodial staff, dieticians, social workers) to efficiently wrap up a case and help expedite a patient's care.

In addition, I regularly meet physicians with numerous years of experience who find that when other members of the team ask them to do something a certain way, like writing orders, to follow the standardized procedure, they simply will not do so. The primary reason why MD's are so spectacularly ineffective in their roles is their utter arrogance to admitting the fact that 1) other people are as important as they are and 2)that every time a physician decides to do things "their way" it costs untold man hours to rectify the problem and get the patient back on track.

Nurses are responsible FOR EVERY SINGLE PROBLEM THAT ARISES. WE KNOW HOW TO FIX PROBLEMS QUICKLY AND WITHOUT NURSES DOCTORS ARE UTTERLY UTTERLY USELESS. NURSES ARE ALSO RARELY GIVEN CREDIT FOR SAVES, EMOTIONAL THERAPY TO DE-ESCALATE ASSAULTIVE OR DISTURBED PATIENTS, ALL THE LITTLE FIXES, THE THINKING AHEAD. IT IS EXPECTED OF US. NURSES DO NOT EXPECT TO GET CREDIT. DOCTORS DO. DOCTORS HAVE CREDIT SEEKING BEHAVIOR.

When a nurse decides to transition into the practioner role, if in their practice they are treated with the same professional respect as MD's I have found them to be far more effective, getting the job done with out so many displays of tantrums and blatant disregard for the job everyone else has to do. MD's have the luxury of being told they are so very very important from day one. Nurses are taught we are not as important from day one. We have learned to diagnose and treat in a round about way, integrated into our standards of practice so as to not dare cross over into the "medical" model and dare speak a diagnosis. As if what nurses do isn't "medical" from the second we step into a hospital. Being trained "in the medical model" doesn't make you a jedi warrior, it's hilarious when a M.D actually brays that from their lips. What nonsense.

The bottom line is that this change in roles, this impending tidal wave of need has been brought on by doctor's themselves, who for the last 60 years have been running around touting their incredible powers of mind and yet have been in fact, accomplishing extremely little.

Prime example: Last night I worked registry in a local E.R. The on staff, full time physician ordered a bladder irrigation for a patient, s/p bladder resection from bladder CA. Large amount of spraying blood, gross hematuria, fair amount of blood loss. M.D. refused to consult pt's urologist. I asked the wife to call. She did. We did this without E.R. M.D. knowing.
E.R. M.D. didn't know what type of fluid to use for irrigation. Didn't know how much. Didn't know how fast. Wasn't worried about blood loss. "Have to get the clots out" was his mantra.
Didn't want to pay to have coags drawn. Didn't want to type and cross. Patient nearly died. Pt didn't die because I: 1) drew coags, drew type and screen and broke the rules when I put two on cross later. 2) I called a darn urologist cuz I didn't want the patient to bleed out. 3)I started an 18 guage IV without permission. 4)I demanded he get a uro consult. When uro consult came he admonished moron doc in front of all of us and 5)pt was rushed to or where HE DIDN'T DIE. Doctor didn't thank anybody, was oblivious to THE HOURS OF MANHOURS HE wasted when it took 5 RN's to get the show on the he road and get the work done. AND THEN HE PROCEEDED TO ATTEMPTED TO TAKE CREDIT FOR THE WHOLE SITUATION IN FRONT OF UROLOGIST WHO THEN ADMONISHED HIM. THIS IS A REGULAR OCCURENCE. I was expected to clean up an incompetent doctor's mess.

I can tell you, no med student on earth would ever, will ever, know how to handle that situation. A nurse with one year of experience will. Your argument logically looks great, just like a nice lab coat and a clean pressed shirt with a tie. But the argument is own by the reality of what happens, day in and day out in every hospital in America. No matter how smart the doc is, they simply cannot fix all the problems with any level of efficacy that they think they can.
And I'll tell you something, because of that experience, because of this article, so help me god, I'm going to NP school. And in three years I'll be healing people the right way, with HUBRIS, but I will not hesitate to take or give credit when it is and where it is deserved.

Once again, anecdotal evidence is nearly useless. I don't know what hospital you work in but I can tell you that the majority of doctors are not like this. You should provide adequate data and argue rationally rather than that emotional rant you just tossed out. Provide citations to a valid study that indicates that doctors are arrogant jerks who seek credit even if they don't deserve it. So, to reiterate, anecdotal evidence = nearly useless.

If you think doctors' training is not good, what do you think of NP/DNP training then? It's true that NP/DNP training is considerably less than that of physicians. So, it logically follows that, in your opinion, if the rigorous medical education of physicians isn't enough to properly take care of patients, how can the significantly less amount of training that midlevels receive translate to providing better care?

Just like your quip about "being trained in a medical model doesn't make you a jedi warrior" neither does being trained in the nursing model. You're right that without nurses, it'd be very hard to run a hospital. However, the same goes for running hospitals without doctors.

So, to reiterate, please take the time make a rational arguement instead of responding emotionally since it's pretty obvious, based on your post, that you are anti-physician.

Me pleasure
http://www3.interscience.wiley.com/j...TRY=1&SRETRY=0

http://www.westernu.edu/bin/interpro...ors-nurses.pdf


I'll let you find the rest, I must assure you there are plenty.

First link doesn't work.

Second link: did you seriously read that study all the way through before you posted it? This study was essentially designed to reveal stereotypes held by nursing and medical students about each others' professions. It had nothing to do with objectively assessing whether or not these stereotypes were in any way true.

Sorry, the fact that a group of 39 undergraduate nursing students in the United Kingdom in the 1990's tended to view physicians as arrogant is not evidence that physicians in the United States today actually are. Give me a break.

Ranier beat me to it but yea, the first link doesn't work. And the second link is a horrible study that surveys medical and nursing students about stereotypes. I hope you realize that surveys in general are not really objective studies of something (you know, because there's a lot of subjectivity involved). So, you've linked one study that we can't see and one horrible study that you didn't seem to have read through or if you did read through it, didn't realize what its flaws were. I really hope you're not an NP/DNP because, from the number of statistics courses their curricula offers (and I don't know why it does since it's supposed to be a clinical degree), one would hope that their skills at assessing research would be better. I have also looked around for other studies since you "assure [me] that there are plenty." However, I have not found any such studies at all.

What I never understand is why anyone here even bothers to engage with the APN-bashers who sometimes post here. It's not like you're going to change their minds ... They're entitled to their opinions, and are free to not ever see an APN if they think we're so awful and incompetent. But why waste your time debating with them about this?? Why not just ignore them?

Can't we all get along? Everybody has a role to play. Some have more education. Some more experience. The mid-levels where I work are fabulous. And the docs know they couldn't make it without them (as evidenced when a physician has to do anything their mid-levels usually take care of.) And the mid-levels know when to pass something along to the physicians. And the nurses clean up all the messes made by either. Nobody is saying a PA or NP should go do brain surgery. But my PCP is the PA in the office, and she's fabulous. And having worked with the MD in that office, I'm actually more comfortable with her *judgement* than his. The fact is, how much education/experience you have can be totally irrelevant to how good your judgement of a situation is.
Healthcare is a big world, there's room for all of us.