Why are NP's with terminal degrees (MSN for now DNP by 2015) with advanced NP certification considered midlevels? Does the affirmation and utility of this title suggest NP's lay somewhere in the spectrum between basic RN (within the discipline of nursing) and physician (not within the discipline of nursing)?
In reviewing ANCC and AANP NP certifications it appears that the ARNP and NP certification appears to be the highest certification for NP's. So if NP's are midlevel, and the ANCC/AANP NP certification process is considered at the highest-level certification for NP's, what exactly would be the next step to advance out of the "mid-level" tier in the nursing discipline in the context of NP practice?
I understand PA's are considered midlevel providers because PA's practice medicine under the supervision and direction of the physician. There is no doubt or contest as to PA's following medical-based models for both training and care of patients. Do you think because PA functions (medicine) overlap with NP functions (nursing practice) that by association NP's and PA's are lumped together as "midlevels?" If so, since many basic functions of unlicensed assistive personnel (UAP's) overlap the practice of nursing, would it be appropriate to categorize UAP's and RN's both as "nurses"?
For those NP's that work in states where no physician supervision is required for NP practice including independent prescribing (AK, AZ, DC, IA, ME, MT, NH, NM, OR, UT, WA, WI, WY) do you consider yourself a "midlevel" practitioner?
Lastly, if NP's are truly "midlevels" wouldn't a better title be "Midlevel Practice Nurse" instead of "Nurse Practitioner?"
WOW you are 100% off the mark here. I support PA's and NP's 100% I do not support that a PA and a NP or DNP are equals to MD's and DO's not as a Nurse or a MD.
I think you bring too much emotion into this. and your posts prove this fact.
You want to insult me and discriminate against me because I have an opinion and belief that is in contrast to yours? WOW I do not know how to respond friend? The exchange of beliefs and Ideas are part of being an educated individual.
Doctors in the state of GA that went to the Caribbean cannot be Licensed in a year of residency, you refused to acknowledged that, its a plain fact I posted it yet you still say I'm wrong.
I posted the DNP program for the University of Maryland and you post another state, they may be different, If you post one medical school and another they may differ some but not as much as you posted the with the two DNP programs.
DNP's are not licensed to practice medicine, they are not under the board of Medicine but the state Nursing board,
MD and DNP are not equal, and because I do not agree that DNP and MD (Or DO ) should be equals that makes me a BAD PERSON and someone to be put into a new catagory WOW
WOW all because I have an opinion that is important to me.
WOW I hate all PA's and NP's
How do you get this? WOW I do not know what more to say
CORE0
First off I'm a guest here, you're a guest here, this is a nursing board where nurses discuss issues. This thread is about "Do you think NP's are midlevels" and had some interesting discussion until the annual July SDN invasion (although I'm as guilty as anyone as diverting it).
As far as what you said:
This is 100% wrong
US MD grads can be licensed after 1 year of residency true but cannot practice without finishing a residency, it is all specialties now, Family practice is 3 years, IM 4 years, you cannot just "Practice" you need the full license, if they are a FMG then they must complete a residency before License, at least 3 years.
No insurance company will pay for care without this anyway.
What I said:
For someone that purports to be in medical school you certainly need to study more. First IM=3 years. Second you can practice in many states after finishing one year of residency (1-3 if an IMG). There are only a few states that you need to finish a residency to practice in. You are correct about being credentialled with insurance companies. So that would be a 33% mark on this post. For more information on licensing requirements please visit the FSMB here:
So lets see. Your comment as you have posted was incorrect. In the State of Georgia (and most other states) you can practice medicine with only an intern year. Now you can try to later add qualifiers that Carribean grads cannot practice in Georgia etc, but thats not what you said. There are other states beside Georgia and IMGs can practice in some of them without three years of residency. BTW every single one of the IM residencies in the great state of Georgia continues to be three years long despite what you "heard".
As far as the rest:
Core0 You fullfill my expectations of a PA, LOL Insults are very mature......
IM is now 4 years in many progrems, there are a Few that are 3 Years, , I was speaking in general but when Nurses and PA's start to argue, emotions are used as facts. This is one reason why I'm becoming a Doctor verses staying an RN, just tired of the BS in the profession.
Yea right as much as we are to believe you are a PA-C,
CORE0, it must frustrate you that DNP's, NP's and PA's will not by law be called Doctor in the clinical setting, if you want that there is Medical School.
As far as training for full License Here's Ga law for an example
I put in bold the 3 years.
This is typical of many states laws and should be the standard posted.
You see Medical Students do not pick the lowest standard as a rule we pick the highest.
Good Luck
PA's in GA are kept under close Physician supervision even in satellite offices:
If you are not practicing this way in GA ( as the other PA's ) then the law is being broken.
What? Medical School and CME's are not the same thing? You understand this right?
YES, I did need to go to medical school to understand this, like many other nurses here I thought there was not so much difference, now I understand there are differences, a RN is not almost a MD like some believe.
I think the public want accurate treatments and Diagnosis, what good is care delivery if it is the wrong treatment and the Patient Dies,
Plus many MD's and DO's treat the whole Patient not just "Push Pills" this is very condescending and cynical, nurses do more then "Just clean Butts too" we can through insults all day.
Doctors do not usually say they are Nurses, but do give Nurses orders and in my state NP's and DNP's,
Plus I guess I can say I'm an RN too since I am and I hold a current License.
I have already done the research on this and its not 23 states, its about 4. Advocates want to count states where NP's can write scripts as independent practice, when in all but 4 NP's must have collaboration with MD's at least! this is not 100% independent, I doubt on a Nursing forum I will ever get agreement. But this is a fact. A recent study was done that has charts to prove this...
I expect open hostility from Nurses towards Physicians, a copy of this should go to congress un altered to show the logic of some nurses, I do not know why you want to try and replace MD's and DO's and the high level of education required to practice medicine, how does this better medical care? :argue:
Unfortunately the same thing can be said for doctors towards nurses. When you say "you" who is the you? The great "I am" coming from nurses (no matter what level), PAs, doctors and/or any other health care provider is the reason why patients/families are screaming and confused and wanting something different.
I won't even comment too much the rest because "I" as a nurse practitioner never said I wanted to replace "you" the doctor. But when a doctor doesn't want to take Medicare or Medicaid or serve the undeserved in rural America I will be more than happy to do so. I do so now! I admit I work with a doctor under protocols and with collaboration. He depends on my judgment and I depend on his. I will say the days of nurses having to be totally subservient are gone...
One word with wide, wide variance in definition:
Webster:
Collaboration:
1 : to work jointly with others or together especially in an intellectual endeavor
2 : to cooperate with or willingly assist an enemy of one's country and especially an occupying force
3 : to cooperate with an agency or instrumentality with which one is not immediately connected
Hmmm after the tempers flared and now back to the mid-level thing. With all the flavors of NPs out there now and more coming down the road: Will we be arguing among ourselves about who is highest of the mid levels? We have come a long ways but the road is still long and unfinished. So does anyone expect our placement in the medical delivery world to improve in the next 5, 10, 15, 20+ years.
I really don't care my license states: Advanced Practice - NP (not that I am a family nurse practitioner this sort of perturbs me more than an insurance company called me a mid-level).
I see my group of patients some stay with me some want to go to the doctor some don't want to see the doctor they want to see me.. Isn't that what it supposed to be patients rights, patient choice? Does healthcare have to be an run by like and oligarchy?
core0
1,831 Posts
First off I'm a guest here, you're a guest here, this is a nursing board where nurses discuss issues. This thread is about "Do you think NP's are midlevels" and had some interesting discussion until the annual July SDN invasion (although I'm as guilty as anyone as diverting it).
As far as what you said:
What I said:
So lets see. Your comment as you have posted was incorrect. In the State of Georgia (and most other states) you can practice medicine with only an intern year. Now you can try to later add qualifiers that Carribean grads cannot practice in Georgia etc, but thats not what you said. There are other states beside Georgia and IMGs can practice in some of them without three years of residency. BTW every single one of the IM residencies in the great state of Georgia continues to be three years long despite what you "heard".
As far as the rest:
I bolded some stuff to help you "remember".
David Carpenter, PA-C