Antagonistic NP Article

allnurses Guide · Jul 11, 2017

Just continuing the dialogue here not trying to pin you personally to anything.

I agree with you about your second point, but, to me, meh. The ones who didn't want to be identified said that it was because they were afraid of getting in trouble with their employers. I can see that as a concern.

Honestly, I sincerely doubt any physician is going to get fired over voicing their opinion, it suspect this has much more to do with the fact most down want their colleagues to judge them for their opinion, especially given that many physicians rely pretty heavily on NP/PA as a revenue stream.

"a highly qualified nurse who is trained to treat certain medical conditions ..." The author does refer to NPs as "highly qualified," and, yes, says that the NPs referred to studies that have shown similar outcomes -- but the author doesn't dispute the NP's statement about that, or, in my reading, suggest that there is a problem with the studies.

This is the qualifier that I have a problem with. What "certain medical conditions" are NPs trained to treat? In comparison, are physicians then trained to treat all medical conditions? Just like physicians, NPs treat all medical conditions that lie within their scope and training.

But, to each her or his own. I have no dog in this fight (perhaps that's why I don't find the article as slanted as some others do).

We all have our bias for sure. It's interesting for me, as both male and a nurse, because I read in this article implicit bias in word choice from the author that reminds me of implicit bias in gender. Makes me consider my own word choice.

allnurses Guide · Jul 11, 2017

Just continuing the dialogue here not trying to pin you personally to anything.

I agree with you about your second point, but, to me, meh. The ones who didn't want to be identified said that it was because they were afraid of getting in trouble with their employers. I can see that as a concern.

Honestly, I sincerely doubt any physician is going to get fired over voicing their opinion, it suspect this has much more to do with the fact most down want their colleagues to judge them for their opinion, especially given that many physicians rely pretty heavily on NP/PA as a revenue stream.

"a highly qualified nurse who is trained to treat certain medical conditions ..." The author does refer to NPs as "highly qualified," and, yes, says that the NPs referred to studies that have shown similar outcomes -- but the author doesn't dispute the NP's statement about that, or, in my reading, suggest that there is a problem with the studies.

This is the qualifier that I have a problem with. What "certain medical conditions" are NPs trained to treat? In comparison, are physicians then trained to treat all medical conditions? Just like physicians, NPs treat all medical conditions that lie within their scope and training.

But, to each her or his own. I have no dog in this fight (perhaps that's why I don't find the article as slanted as some others do).

We all have our bias for sure. It's interesting for me, as both male and a nurse, because I read in this article implicit bias in word choice from the author that reminds me of implicit bias in gender. Makes me consider my own word choice.

blondenurse12, MSN, NP · Jul 11, 2017

I suppose I found the article to be contradictory. It was 'good cop, bad cop'. The author is putting in these potentially fictitious anecdotes that paint NPs in a bad light but then in her own words, sometimes seems to praise NPs. It's certainly a complex issue and she doesn't do a great job at explaining the issues, only fearmongering. Why are NPs becoming more common? Well medical school is extremely expensive and it is harder for students to get loans. On top of that, there are increasingly limited residency spots available. Our population is aging rapidly and we have a dearth of primary health care providers. So NPs have stepped up to take some of those roles. Most NPs work in primary care, it's not like we're stealing all these specialists' jobs. And truthfully, from my experience, the NPs that I have seen in specialty roles are just workhorses for physicians who want to make bank.

On the other hand, we have this problem of these online universities churning out NPs like crazy. We need legislation to regulate these programs because it seems like whatever is going on right now isn't working. I suppose part of it is self preservation because the more of us there are, the lower they can push our wages. Most NP positions in my area are barely higher than RN wages right now. So much for that 40k master's/DNP. But part of it is we need to be practicing safely. I definitely felt overwhelmed at first and I went to a state university with a robust nursing department. I can't imagine what is going on with these all online "schools".

KatieMI, BSN, MSN, RN · Jul 12, 2017

Dear BostonFNP,

I am pretty much sure that the whole article is written by a person who has no idea about advance practice nursing and about medicine at all. Humans get 90% of information through vision, so the majority of lay persons, when asked about a medical test which can provide definitive answer for most questions, name something which allows visualization, CT or MRI being most popular choices. They think that if something is seen through, there cannot be any further questions. But there are very few drugs, and none used for Parkinson, which produce side effects which could be visualized. The wast majority of side effects are metabolic/immune/etc and can only be accessed through blood work, or functional tests, or something like that, but they cannot be seen on MRI. In addition to this, lower paraparesis is a local symptom, and, save for bleed (which would be WAY more dramatic in presentation, as you know), it just cannot be caused by something within "side effect" realm AND being large enough to be seen on MRI.

This, and many other details, brought me to immediate impression that some dude with M.D. hired a poorly qualified guy and asked to write something about how bad NPs are but remain within PC frames so that he could save his sensitive backside should something happens. Therefore, the vague definitions of "highly qualified nurses trained to treat certain medical conditions" (which is, as you correctly pointed out, a pretty senseless one) were used after a blood-freezing story about a poor old lady and lying, incompetent and not listening NP. He was also cheap and didn't care at all about the writer knowing nothing about subject. So, it is yet another piece of paper and World Web space occupied by something written by one idiot, paid by another, and targeting more of them. The fact that it was allowed in print as it is says a lot about those who paid for it - and about their lack of basic human decency and respect toward others.

elkpark · Jul 12, 2017

Just continuing the dialogue here not trying to pin you personally to anything.
Honestly, I sincerely doubt any physician is going to get fired over voicing their opinion, it suspect this has much more to do with the fact most down want their colleagues to judge them for their opinion, especially given that many physicians rely pretty heavily on NP/PA as a revenue stream.
This is the qualifier that I have a problem with. What "certain medical conditions" are NPs trained to treat? In comparison, are physicians then trained to treat all medical conditions? Just like physicians, NPs treat all medical conditions that lie within their scope and training.
We all have our bias for sure. It's interesting for me, as both male and a nurse, because I read in this article implicit bias in word choice from the author that reminds me of implicit bias in gender. Makes me consider my own word choice.

I, too, am just continuing the dialogue, not trying to personally attack or criticize anyone here. And I certainly don't want to give the impression that I consider the article to be well-written or particularly worthwhile, haha.

I didn't say anything about physicians getting fired -- there are lots of ways to create friction and problems for yourself at work that don't involve getting fired, and it's easy to get on some superior's s*** list simply by saying something impolitic in the press (or even just out loud at work). If you don't have any personal awareness or experience of that, I envy you! :) While I would prefer that people either comment on the topic under their real names or keep their mouths shut, as we all know, "anonymous sources" are common in journalism.

As you note, all NP specialties (all advanced practice specialties) have a defined scope of practice. I can see how you and others may bristle at the description of "certain medical conditions," but what really is the substantive difference between saying that NPs are trained ("educated" would be a better term, obviously) to treat "certain medical conditions," as the article's author does, and saying that NPs are educated to treat "all medical conditions that lie within their scope and training," as you do? Both statements set some limitation on the number of conditions NPs are prepared and credentialed to treat, and the author's description is going to be a lot easier for a general audience to understand. I read the statement in the article as an attempt to provide a basic description of what an NP is for an audience that is presumed to not be familiar with them (that seems to be kind of the point of the article). I don't read any comparison with physicians in the statement, and I believe most people are familiar with the idea that physicians have specialties and don't all treat everything.

Sure, we could quibble about specific word choices in the article all day. But, in general, I find it a lot more positive than many other pieces I've seen in the press over the years that basically present NPs as dangerous, incompetent frauds being allowed to prey on the unsuspecting public (you know, the op ed pieces by physicians that keep getting published. :)). This article at least balances the (inevitable) negative comments by some physicians with some positive comments by physicians and positive presentations of and comments by NPs and, in my reading, the author appears to not be taking either side (unlike the articles that are thinly veiled NP hit pieces). So, that's a plus!! :)

rescueninja1987 · Jul 12, 2017

I see where they're coming from, but as a whole the article is a condescending piece of garbage.

popopopo · Jul 12, 2017

I wish there are MD/DO vs NP debates in a townhall style setting. Bill Nye vs Ken Ham style debates, you know?

JellyDonut · Jul 12, 2017

The article has a slant to it and a lay person reading it would be concerned with the issues it brings up. However, everything they bring up about NPs also happens with MDs. Physicians miss diagnosis all the time or convince themselves it is one thing and stop listening. Yup, NPs can be just as bad. In the GP/FP I do not really see much benefit of an MD over NP, but in the specialties I think it is a bigger deal. I hope I never see a specialty NP clinic open up. Just no!

I have seen cosmetic injections/fillers etc run by NP and family clinic, but nephrology, cardiology, neurology, pulmonary, etc.. should not ever be a NP run practice.

The article peeved me off from the get go with the NP introducing herself as "DR". I always introduce myself with my first name and explain i am a NP with the group. My physicians introduce themselves to the patients with their first names and I alway thought that gave a more personal touch to their introductions and if I were a patient I would appreciate that over the introduction of DR SOnSO.

Truth is you find examples of NP and MD doing some boneheaded things everyday. Another article could shed the light on many wrong decisions physicians make...we are all human and we miss things or make mistakes....what is this grid they are talking about? I was taught to interview, examine and work through my differentials...I never has a grid or checkbox...that is just nonsense.

allnurses Guide · Jul 12, 2017

The other thing I noted is that the APRN in the scenario introduced herself as a "Doctor" which I find both pretentious and disingenuous. While she may have a doctoral degree she is not a medical Dr. which is the implication of her introduction. This is just another example of how the "Educated Elite" try to hoodwink the poor dumb rabble. Most people are perfectly capable of understanding that they are seeing an experienced and highly trained professional but they are also within their rights to ask to see a "Real Doctor". I love the whole idea of becoming MHNP because of how underserved the psychiatric population is. They are swimmers in a sea of sharks and need more lifeguards with eyes on the water. I have had great experiences with NP's over the years but some NPs do not understand their role in the system. They are not Medical Doctors and should not pretend to be such.

Hppy

prelift · Jul 13, 2017

could have been written better but it isnt lies.

Not as bad as the "studies" provided by nursing organisations trying to say they can 100% doctor with less education and more online discussion posting.

orangepink, NP · Jul 19, 2017

Antagonism between NPs and physicians exist everywhere. I don't think a solution will come to passim this decade. Personally, I come across physicians like this all the time and what I do is find employment where they truly welcome mid levels.

gettingbsn2msn, MSN, RN · Jul 22, 2017

I have never heard a NP introduce themselves as a doctor. I have attended two seminars in my state where a chiropractor introduced themselves as a medical doctor in a round about way. They introduced themselves as a "sports medicine doctor" and talked about when they attended med school. They never mentioned the med school. These are local lunch and learns. I attend all kinds of events and this took me by surprise. Is a chiropractor able to introduce themselves as a sports medicine doctor? I would think not.