Changing of our proffesion

JDCitizen · Dec 23, 2008

I have been thinking about this for a while, if the DNP movement comes to pass and it is a true clinical doctorate with all NPs haveing a common foundation what new specilities will be needed to support patients in your area? And considering babyboomers what are anticipated needs. What should be residency/fellowship trained compared to added qualification.

Maybe DNP should be the foundation in training?

We have a good foundation for primary care, peds, FNP, ANP, GNP none of these will go away.
Specilties- ACNP, peds acute, WHNP, PMH are well established not going to go anywhere either.

These should be the specialities?

Here is some general thoughs on specilities
Oncology- there is a projected shortage of MDs in this role, we have a certification available and some organized programs. This is one that I expect will increase in need

I guess since there are oncologist there could be an APRN of oncology? There is a shortage now of family medicine.

ER- there have been threads discussing this do you think there is a need or not? True ER compared to urgent care?

ACNP and the trauma residency programs poping up for NPs/PAs probably will handle this. Although there are some crossover with the present degrees now.

Eye care- not needed since there are ODs as a priamry care provider already

??? There are lots of eye conditions that don't need surgery....

Foot care- DPMs have gone to a surgical care focus rather than routine care, is this a potential role worth exploring given number of diabetics, PVD, ect. In my area the patient needs are meet curently, this could be bundled into orthopedic, DM, or even GNP rather than a new focus.

From the doctors I have contact with some do a good amount of surgery, some don't.

Nerovascular- there is a fellowship for NPs already but this is a very narrow specilty area with a limited number of needs.

I don't know neuro vascular as the baby boomers age and length of life increases I don't really see this being narrow. We may not do brain surgery but we may reach the point to assist... But its so much more than surgery....

Surgical- Should NPs support the RNFA role and provide pre op, post of care as a specilty, I don't forsee NPs becoming primary surgeons and how is this different than a ACNP role?

I don't know when I first entered the medical field the doctors I worked with took care of problems from birth to death. We still have multiple areas in the country that are way undeserved.

Of that short list the only one I think will be needed from my view is Oncology. What does everyone else want to guess there will be a need for care provided by NPs?

Way to narrow of a focus. As medicine expands and nurses seek further training and expertise there is way more out there and unfortunately more toes will be stepped on.

Urology

Hematology

Dermatology

Neonatal

Cardiology

Public Health

Etc..

How do you see the NP proffesion changing? Will we go back to a primary care focus or will we continue to expand what we do? Will we be able to keep seperate from medical education and stay in nursing or will we evolve to mirror medicine much as osteopathic schools changed?

I think in 20 years with the rising cost of medical care big changes are coming...

Any one want to share their ideas?
Jeremy

Look for the rise of the gatekeepers.

One day maybe their will be focus on prevention.

:twocents:

SteveNNP, MSN, NP · Dec 26, 2008

As someone pursuing my Neonatal NP, and having worked in the neonatal medicine field for several years, I can only see the field expanding rapidly. With the explosive increase in fertility treatments, as well as a decreasing age of viability as new treatments are discovered, the rate of premature births continues to rise.

Unfortunately, the need for NNPs has increased drastically, but being an extremely sequestered subspecialty, not many NNPs graduate each year in comparison to other advanced practitioner roles. I believe in the NY tri-state area, only about a dozen graduate each year, compared with hundreds of other NP specialties.

The NNP degree is one of the few that REQUIRE nursing experience before practicing as an APN. As it should be, IMHO. Unfortunately this further delays new NNPs entering the market.

Trauma Columnist · Dec 27, 2008

Nephrology will remain a viable outlet as medicare (who administers payment for dialysis) demands 4 visits per month and only requires that one per month be an MD/DO.

JDCitizen · Dec 27, 2008

Nephrology will remain a viable outlet as medicare (who administers payment for dialysis) demands 4 visits per month and only requires that one per month be an MD/DO.

I can't believe I left that one out... Man those patients do seem to really need multifaceted approach in there care needs (to the maximum degree). If I get into the ACNP course that is definitely going to be a choice for some of my clinicals.

Trauma Columnist · Dec 28, 2008

Nephrology encompasses a lot of cardiology plus endocrine and of course renal. We deal with a lot of fluids/electrolyte issues, as well as HTN and DM which are the two main reasons people in the US end up on dialysis.

If anyone lives in central IL and would like some clinical time in nephrology, just PM me. I work for a very large practice and you can see a lot.

ANPFNPGNP · Dec 28, 2008

The doctoral program should include all of the specialties you mentioned. We should have training in cardiology, ortho, pedes, gero, psych, etc...JUST LIKE A GENERAL PRACTITIONER! Those doctoral programs should require a MINIMUM of 3,000 clinical hours!

I'm fully supportive of the doctorate degree b/c I don't feel that FNP's get enough clinical hours at this time. What I've seen out there truly scares me. Can you imagine if your physician completed a total of 500-700 clinical hours AND did all of his/her courses online? Remember, there are some states that don't require NP's to have any supervision by physicians. Hmmm, 500 clinical hours, all online classes...I certainly don't want to have THAT person diagnosing and treating me!

ANPFNPGNP · Dec 28, 2008

The NNP degree is one of the few that REQUIRE nursing experience before practicing as an APN. As it should be, IMHO. Unfortunately this further delays new NNPs entering the market.

Fortunately, most of the specialty NP programs require experience. If you think about it, it really doesn't make much sense to require nursing experience for the primary care programs (FNP, ANP, PNP), b/c very few RN's ever work in primary care. That's probably why so many NP programs are allowing "direct entry" students.