Can NPs practice with surgeons?

[mistiffy]

can NPs practice with surgeons? And if so, what would their duties be in that role? Very curious about this!

[jer_sd]

What you describe here, neurology, neprhology, etc. are all medical SUBspecialties. A branch off of the internal medicine specialty. PAs do recieve plenty of didactic and clinical training in both outpatient and inpatient internal medicine which covers the SUBspecialty topics, just not like an MD fellowship would (of course). The same goes for surgical SUBspecialties.. There is required didactic and clinical training in surgery, both intraop and periop in PA programs. In addition, ALL PA programs have these requirements, there is not a PA graduating that hasnt met those requirements. Now, they could still be an AWEFUL PA, but that is a whole nother story.

I also disagree that the "professional" squabble doesn't benefit patients. I think any critical analysis of a persons/profession's background can be VERY beneficial for all parties involved. It is a very hard task to look at your own profession and self too critically, you NEED other people to point these things out or you will never see them. Where it is useless is when it gets backhanded and dirty. I think David does a very good job (better than me) of keeping things very professional and objective. In that kind of atmosphere only good things can come out of it. That is why we are here, to learn, and some of us may be the future policy makers of our profession... don't you think we need input from everyone?

Ok my post was not an attack on the PA proffesion or education. rather it was intended to focus on the need for post graduate training and show that we can progress as proffesionals after graduation. I consider ANPs as the NP equivilent to an internal medicine medical practice, historically NPs have focused on outpatient care but this has changed partly leading to the ACNP credential. I get tired of health care providers complaining of competitors....CRNA vrs AA, CNM vrs CPM, NP vrs PA. DC vrs PT. If studies show deficiencies in care then constructive actions should be taken. I do not feel able to critique PA education since I have not attended that program. As an educator I can look at the program, as a clinician I can look at students and PAs in practice. I enjoy working with other providers most jobs use NPs and PAs in a similar role (surgical to a lesser extent) so if we do the same job with comperable outcomes does the differences in training make that much diffrence?and I am not concerned about DNP students anting to change specilities nursing schools will make $$$ on postdoctorate certificates and really charge high tuition (sarcasm here)Jeremy

[core0]

Ok my post was not an attack on the PA proffesion or education. rather it was intended to focus on the need for post graduate training and show that we can progress as proffesionals after graduation. I consider ANPs as the NP equivilent to an internal medicine medical practice, historically NPs have focused on outpatient care but this has changed partly leading to the ACNP credential. I get tired of health care providers complaining of competitors....CRNA vrs AA, CNM vrs CPM, NP vrs PA. DC vrs PT. If studies show deficiencies in care then constructive actions should be taken. I do not feel able to critique PA education since I have not attended that program. As an educator I can look at the program, as a clinician I can look at students and PAs in practice. I enjoy working with other providers most jobs use NPs and PAs in a similar role (surgical to a lesser extent) so if we do the same job with comperable outcomes does the differences in training make that much diffrence?and I am not concerned about DNP students anting to change specilities nursing schools will make $$$ on postdoctorate certificates and really charge high tuition (sarcasm here)Jeremy

My involvement is mostly practical. As a PA I have an interest in other providers. Also as a PA I have an interest in seeing that NPP's provide quality care. Just as poorly prepared PA's affect me, so do poorly prepared NP's. Organizations tend to lump NP's and PA's together and NP's that are outside their scope of practice tend to make things difficult for everyone. While I understand the desire to obtain employment every NPP must understand their own scope of practice.

Here is an allegory. In land of Crom there lived three peoples. The Wuzzles occupied the mountains and the Moogles occupied the plains. In between there was a small forest occupied by the Foofles. The Wuzzles and Moogles had a long history of conflict. If the signs were right they would declare war on each other fighting in the forest. If there was a comet they would fight. If the moon was full they would fight. If there was an inauspicious augury they would fight. All the Foofles knew was if the moon was full again they were going to get the crap kicked out of them.

PA's are kind of like the Foofles. We tend to be collateral damage in any conflict between nursing and physicians. A classic example around here is when an RNFA sent around a letter to all the credentialling comittees stating that since RNFA's were credentialled to work in the OR all providers had to show credentialls in the OR. The net effect was a requirement for all PA's to have their RNFA to work in the OR (funny how the head of credentialling was the CNO). Fortunately the chief of surgery employs PA's and while his reply was not repeatable did make his point. The funny part of this (in a sad way) is that this was only peripherally aimed at PA's. This was really aimed at some NP's and RN's that did not have their RNFA's. We were just collateral damage. We had a similar problem with an ACNP recently trying to get a job by telling the credentialling comittee that only ACNP's had the scope of practice to practice in the hospital. I get a letter every two weeks or so with PA's having trouble from nursing with credentialling.

I now have the standard PA answer for this:

1. Our scope of practice is what our SP can do and what our SP allows.

2. PA education includes all ages and both inpatient and outpatient training in medicine in surgery (this in answer to a PA can't do what [insert appropriate NP] can do.

So like it or not there are NP's out there who try to use these rules to get jobs by depriving PA's of jobs. Unfortunately these same NP's are not above using these same rules to deprive other NP's of jobs. The problem I see is that the training is so inconsistent that you cannot tell what the scope of practice is for any particular NP. While I have no problem trying to evaluate scope for an individual job (for example if our practice would hire an NP), this is not how organizations work. Instead they want to evaluate based on the acheived credential (certication). I will use an example post earlier on ACNP clinical competency:

"A national survey of ACNP education

programs revealed that the majority

(over 55%) teach skills such as hemodynamic

monitoring, suturing, central

line insertion, and arterial puncture,

while some acute care skills, such as

chest tube insertion, were taught in

only 48% of ACNP programs."

If you look at this statement a majority were taught these skills. Looking at it another way at least 1/3 were not taught skills that I would consider fairly essential for acute care. So if you are looking at the certification you would be unsure if the ACNP had the training in certain basic skills.

Until you have a common didactic and clinical component for NP education you will continue to have this problem. The DNP will alleviate this somewhat , but will make evaluation even more difficult.

David Carpenter, PA-C