Do you think NP independance push may backfire on us?

jer_sd · Jun 7, 2006

You bring up some good issues to consider.

Looking back to nursing we all diagnose and treat existing or potential health issues, and the responce to illness. As much as I hated learning nursing diagnosis it does provide a foundation for practice thar does seperate a NP from medicine. Forming a "medical diagnosis" and providing a RX pr intervention is overlap to medicine, podiatry, dentistry and other health proffesions. I believe that diagnosing pneumonia and providing a zpack is just part of a job as a np. I still use at least 1 nursing diagnosis on all of my charts not as indepth as when I worked as a rn but it is still part of my practice.

Independant practice I feel is a good thing for all apns. Independant practice does not mean that an apn will practice alone but rather be able to refer and consult as nessisary. With self determination of practice rather than relying on protocols or deligated responsibility it may help advance the profesion.

As a np I am not a replacement to a MD/DO rather I provide care that is similar in some cases but tends to compliment other providers in a team. I do not have the advanced training in pathophysiology equal to a MD, but I do know when to refer or consult someone who does.

Jeremy

fidelio · Jun 7, 2006

Disclaimer: I’m not an NP yet.

Taken out of context, that quote from a 60 minutes story which aired in 1998 can sound like unchecked hubris. Let’s keep in mind though that occasionally, even an MD will say something stupid on TV. MDs have more training than NPs but they don’t have a patent on the process of patient care by diagnosis and prescribing treatment or even meds. Practicing as an MD is about applying the advanced knowledge that one acquires in med school. It’s not about writing scripts. It has been proven that an NP can diagnose and prescribe in the handling of general care and even some specialty care. Much of what a clinical psychologist practices or a doctor of physical therapy or a nurse practitioner could be considered medicine but, if you are trained and licensed to do the job and its in your scope of practice (which was earned) then, its also part of your discipline as well. “Advanced nursing” may just sound like legal semantics to some but, language is a powerful thing in that it has a tendency to change the way that people think. In this case, it may help some people to understand that diagnosis and treatment is not “owned” by MDs. The term “advanced nursing” does not exist to blur the line and make it ok for NPs to practice medicine under the supervision of their own professional boards. The term exists to include diagnosis and treatment of illness as well as prescriptive authority into the scope of nursing practice. Yes, its a relatively new concept and many people resist things that are new but, lets not be overly concrete in our thinking. Its OK for one action to share multiple names. Lots of disciplines share turf. The fact that your scope of practice is similar in some ways to a physician's does not give your state’s medical board the right to claim nurse practitioners under their supervision.

Trauma Columnist · Jun 8, 2006

I hope that it is okay if I post here too. I have just finished an adult health clinical nurse specialist which in the state of IL has the same scope of practice as an NP. I am the first to admit that I'm not the same as an MD/DO. However, I do provide a level of care in independent care but my care is more holistic (or at least it will be once I get a job - lol).

Editorial Team / Admin · Jun 8, 2006

i hope that it is okay if i post here too. i have just finished an adult health clinical nurse specialist which in the state of il has the same scope of practice as an np. i am the first to admit that i'm not the same as an md/do. however, i do provide a level of care in independent care but my care is more holistic (or at least it will be once i get a job - lol).

it is always a pleasure to have you here with us, traumarus. we are all apns and have much to share and discuss along the way in our individual careers.

wishing you all kinds of luck for the future. :balloons:

ERNP · Jun 8, 2006

This is a particularly interesting thread. I agree with the responses that many healthcare domains share tasks that have in recent tradition been considered medical. There was a historical time when nurses didn't start IVs because that common nursing task was the domain of the doctor. So with growth comes transition.

Without telling long stories let me advance what may be a controversial question. Who do you think is largely responsible for convincing various state legislatures that a tethered relationship is necessary for NP practice?

If you guessed the AMA, give yourself a gold star. So in that way isn't the lack of independence already like being under control of the board of medicine? Of course the connection is much more indirect.

I don't think the push for NP independence is an attempt by NPs to be doctors. I think it is more of an attempt to be recognized for the services we do provide and provide well. Many states allow NPs function in any way in which they have had advanced training. Independence simply means our advanced training and practice is not dictated so much by outside influence. Afterall, self governance is one of the defining hallmarks of a profession.

wildmountainchild · Jun 8, 2006

Disclaimer: I too, am not yet an NP, I'm only in NP school.

I certainly agree that doctors know more. I wrote in my essay for admission to my FNP program that I looked forward to "working in a collaborative team with all members of the health care service, including doctors, social workers, nurses, and administrators."

Working together towards the health of the patient is my goal. And I think it's the goal of all NP's. What irks me about the original posting is that the poster assumes she/he is the "only one" who realizes that Docs have more training (duh!), and that she/he is the only one who admits and respects that varience in training.

Come on! Desiring autonomy and respect for what NPs CAN do on thier own is not the same as blind ignorance and denial of the differences b/w docs and NPs. Numerous studies have conclusively proven that NP's, within thier scope of practice, provide the same level of care as doctors. Therefore, within that defined scope of practice, NPs should have autonomy. BUT, per law docs are always around for NPs to consult and refer to in cases that move beyond the scope of practice.

I don't think the issue is hubris. I think it's respect. NPs are used to being treated like crap by docs, being second guessed by docs on diagnoses (only to be proven right w/ testing), and being belittled (this is certainly NOT true of all, or even the majority of docs). APNs are professionals and want to recognized as being distinct from the role of Dr., not being the same as a Dr., but different yet professionally competent within thier field.

Noreaster · Jun 8, 2006

The original post raises a valid concern/issue. I really appreciate the OP's humble attitude but also loving and not short-changing being an NP. PNP2005, keep that heart and mindset!!!

Working among a good number of NPs I see different attitudes. My favorite NP where I work has a very similar attitude as PNP2005; she is a joy to be around, is well-respected, and is very strong at what she does.

For some reason, some NPs feel either threatened, prideful, presumptuous, or any combonation, while others feel secure in what they do, while able to admit other's differing training, strengths and weaknesses, and are the first to recognize an other's training--without feeling defesive.

In other words: this quote that the OP'er quoted is not necessarily a rare thing. I hear things like this on a regular basis, unfortunately. It creates a closed mindset and a defensive stance, and is frankly hard to work with.

If ANY mid-level feels pridefull enough to not collaborate and practice like that, they are only setting themself up for trouble. As a mid-level practitioner, I, too, must keep this in check.

Just listen to the OP'er. He/she has first-hand experience with his/her brother physician and simply raises factual info of the differences--without bias, feeling threatened, defensiveness, or the like.

So, PNP2005, you are not alone in your observations. Please keep that humble mindset; I'm sure you make an amazing practitioner!

Editorial Team / Admin · Jun 8, 2006

nurse practitioners have always taken the heat ~ from the very beginning. we have paved the way for change and change is something most individuals do not like. i don't think we "shoot ourselves in the foot" when we advocate for the profession.

if it were not for our pioneers in this profession, we all would not exist. yes, we make waves and many times, we are not well-received by the physicians. we have to constantly sell ourselves to not only the physician, but to our colleagues and to the public. that has been true since ~ well, forever.

if we do not advocate for ourselves and attempt to better the profession, we will fall by the wayside. some nps are egotistical and arrogant. most are not. those who are, are not well-received and are viewed as troublemakers and trying to "upset the applecart", if you will.

those who are professional and knowledgeable are accepted more readily and possess credibility. still, acceptance by the physicians, colleagues and the public can be difficult at best.

yes, we must advocate for the profession. but, by the same token, the np must realize he/she is not a physician and does not have the same training as such. imho, the np must know when and where to refer the patient to a physician. the np should work in close association with the physician, but not necessarily under his/her direct supervision. in my state, collaboration is necessary and for that, i am grateful. yes, i am independent, but must work within that collaborative agreement. not one thing wrong with that. i am autonomous and my physicians treat me as their colleague and for that, i am fortunate.

so, to sum up, nps should fight for our rights to exist ~ diplomatically, professionally and with vision for the future.

Noreaster · Jun 8, 2006

...we must advocate for the profession.
so, to sum up, nps should fight for our rights to exist ~ diplomatically, professionally and with vision for the future.

amen to that! it didn't sound like the op'er was questioning advocating, just raising a concern of some "thinking more highly of themselves then they aught" kind of arrogance, which is--in some places--more prevelent than some may know or think.

carachel2 · Jun 9, 2006

And I can confidently say, we are NOT doctors and do not have anywhere near the in depth medical knowledge and training that doctors have.
Our pathophysiology, pharmacology, pathology, physiology, and so on is a drop in the bucket compared to what my brother got in medical school.

I completely agree with this (and my brother is an MD too) It is much like LVN's saying "I can do anything RN

s can do." I'm only an NP student, but I already recognize that we should stay within a certain scope of practice.

SharonH, RN · Jun 9, 2006

II'm only an NP student, but I already recognize that we should stay within a certain scope of practice.

And that is the point that I think the OP is missing. (By the way, I am not a NP but a CNS). NPs are not proposing practicing outside of a certain scope of a practice, never have. They just want independence within their own skill set and educational level and I think that is entirely appropriate.

It has been my observation that some nurses are highly uncomfortable with the idea of independence and/or autonomy. Even at a BSN level, nurses have this capability and many of them are able to function as so but a lot of them do are more comfortable being "other-directed". That's too bad but if that's your bag then go for it.

But for those nurses and nurse practitioners who are able to function independently, who have confidence in their skills and knowledge and who are able to accept accountability for their actions, then I say go for it. There are already nurses who do it, I admire them for it.

Someone made the point that the AMA is behind much of the legislative push to regulate and limit NPs' independence. Now why do you think that is? If you guessed it is because they want to protect the public's safety then you could not be more wrong. It is about money, power and control. Period.