I have been following your discussions here on the recent media coverage of the primary gap, and NPs place in it. I posted this on another forum that I moderate, and felt it was only fair to give you all a chance to chime in. I hope it doesn't come across as an attack, but rather a clinician of a different stripe with some real questions about how we market ourselves. The text below is addressed to PAs, so read in that context:
I have been reading the coverage of the recent articles from CNN and Time that we discuss here, in particular the responses on allnurses.
Of course I have to provide my PA disclaimer.....I work with NPs.....about a dozen of them at my institution. I have never had a negative experience with any of them, and have no need to write a "hit piece". We confer, they give medical feedback, I give surgical, etc....collegial and pleasant.
That being said, I have read over and over again about the presumed advantage NPs provide over docs (this is in their words) becuase they offer a "nursing perspective", "treat the patient, not the disease", "look at the patient as a whole", "offer prevention as well as treatment", etc.....
I really don't see this as NP bashing, but I see these comments as somewhat elitist....or at least "leading the argument". The NPs I work with practice the same medicine (!) as the rest of us, PAs, MDs, etc. Their preop cardiac workups look just like any other. And they're good. A clinic NP treating OM...are they really offering that much of an edge over a non-NP due to their nursing background? What does the nursing backgroud teach about listening, empathy, and thinking about interdependent body systems that our medical model education does not?
This all seems like a phoney selling point that is SO subjective that there is no way to argue it, putting NPs in a position which is easy to defend and impossible to refute.
Thoughts?
Do you feel like you treat your patients any less holistically b/c you were trained in the medical model?
Ha, I guess you'd have to take my word for it but I'm certainly not anti nurse.
I'm a member at American College of Clincians and think that there is more to gain from collaboration than division; it's the distinction being drawn, that NPs offer superior care by virtue of a nursing model, compared to MDs/PAs, that pushes us away from any potential collaboration as nonphysician providers. As I'm sure you can imagine, as a PA (or doc, but I hesitate to speak for them), it is frustrating to hear en entire group of clinicians say that PAs are lesser providers, have poor bedside manner, or at worst indicate that we don't look at patients in totality.
Take my questions as genuine curiosity about why NPs feel they way they do about their practice model and 1 how many of them believe in it and 2) how many see it as theory without real application.
I've seen a lot of comments on my forum- FROM NPs and RNs- reinforcing the latter.
(I moderate at the PA Forum. I appreciate your troll radar, trust me.)
The February 2000 JAMA included an article that compared patient satisfaction between Medical Doctors and Nurse Practitioners. The conclusion showed that Nurse Practitioners were given a satisfaction rate of 89% over 11% for Medical Doctors. The number one reason that patients stated why they preferred Nurse Practitioners was the good communication of the Nurse Practitioners and the perception that the patients were being listened to. The most stated reason for the difference was that more Nurse Practitioners appear to listen to what the patients had to say and not just hear what they said. Communication was the line of demarcation.
Nurse practitioners have existed in North America for many years
An increasing number of such nurses are being employed in the United Kingdom in general practice, emergency departments, and other primary care settings
Reviews suggest that nurse practitioners are equivalent to doctors on most variables studied, but the relevance of this in the context of the NHS is unclear
What this study adds
Patients are more satisfied with care from a nurse practitioner than from a doctor, with no difference in health outcomes
Nurse practitioners provide longer consultations and carry out more investigations than doctors
Most recent research has related to patients requesting same day appointments for minor illness, which is only a limited part of a doctor's role
studies demonstrating equivalent or superior nurse practitioner patient outcomes and high np patient satisfaction
aigner, m.j., drew, s. & phipps, j. (2004). a comparative study of nursing home resident outcomes between care provided by nurse practitioner/physicians versus physicians only.
j am med dir assoc
, 5 (1), 16-23
anderson, d. m. and m. b. hampton (1999). "physician assistants and nurse practitioners: rural-urban settings and reimbursement for services."
j rural health
15(2): 252-63.
avorn, j., everett, d. e., & baker, m. w. (1991). the neglected medical history and therapeutic choices for abdominal pain. a nationwide study of 799 physicians and nurses.
archives of internal medicine
, 151 (4), 694-698.
barrow, cr. & graber, rb. (2000). nurse practitioner care versus physician care: an analysis of recent outcomes research.
advance for nurse practitioners
, 17-18.
barton, a.j., baramee, j., sowers, d., & robertson, k.j. (2003). articulating the value-added dimension of np care.
the nurse practitioner
, 28 (12), 34-40.
brooten, d., youngblut, jm., kutcher, j., & bobo, c. (2004). quality and the nursing workforce: apns, patient outcomes and health care costs.
nursing outlook
, 52 (1), 45-52.
brown, s. a. & grimes, d. e. (1995). a meta-analysis of nurse practitioners and nurse midwives in primary care.
nursing research
, 44 (6), 332-339.
clintron, g., bigas, c., linares, e., aranda, j. m., hernandez, e. (1983). nurse practitioner role in a chronic congestive heart failure clinic: in-hospital time, costs, and patient satisfaction.
heart & lung: the journal of critical care
, 12 (3), 237-240.
congressional budget office (1979). physician extenders: their current and future role in medical care delivery. washington, d. c.: u.s. government printing office.
cooper, ra. (2001). health care workforce for the twenty-first century: the impact of nonphysician clinicians.
annual rev med
, 52, 51-61.
cooper, m. a., lindsay, g. m., kinn, s., swann, i. j. (2002). evaluating emergency nurse practitioner services: a randomized controlled trial.
journal of advanced nursing
, 40 (6).
donald, f. c. & mccurdy, c. (2002). review: nurse practitioner primary care improves patient satisfaction and quality of care with no difference in health outcomes.
evidence-based nursing
. 5 (4), 121.
edmunds, m. (1978). evaluation of nurse practitioner effectiveness: an overview of the literature.
evaluation and the health professions
, 1, 69 - 82.
ettner, s. l., kotlerman, j., abdelmonem, a., vazirani, s., hays, r. d., shapiro, m., cowan, m. (2006). an alternative approach to reducing the costs of patient care? a controlled trial of the multi-disciplinary doctor-nurse practitioner (mdnp) model.
medical decision making
, 26, 9-17.
feldman, m., ventura, m., & crosby, f. (1987). studies of nurse practitioner effectiveness.
nursing research
, 36(5), 303 ð 308.
grumbach, l., hart, l. g., mertz, e., coffman, j., palazzo, l. (2003). who is caring for the underserved? a comparison of primary care physician and nonphysician clinicians in california and washington.
annals of family medicine
, 1, 97-104.
hooker, r. s., cipher, d. j., & skescenski, e. (2005). patient satisfaction with physician assistant, nurse practitioner, and physician care. a national survey of medicare beneficiaries.
jcom
, 12 (2), 88-92.
hooker, r.s. & mccaig, l.f. (2001). use of physician assistants and nurse practitioners
in primary care, 1995-1999.
health affairs
, 20(4), 231-238.
horrocks, s., anderson, e., salisbury, c. (2002). systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors.
bmj
, 324, 819-823.
kinnersley, p., anderson, e., parry, k., clement, j., archard, l., turton, p., stainthorpe, a., et al. (2000). randomized controlled trial of nurse practitioner vs general practitioner care for patients requesting "same day" consultations in primary care.
bmj
, 320, 1043-1048.
kleinpell, r. & gawlinski, a. (2005). assessing outcomes in advanced practice nursing practice.
aacn clinical issues
, 16 (1), 43-57.
knudtson, n. (2000). patient satisfaction with nurse practitioner service in a rural setting.
journal of the american academy of nurse practitioners
, 12 (10), 405-412.
larkin, h. (2003). the case for nurse practitioners.
hospitals and health networks
, august 2003, 54-59.
lambing, a.y., adams, d.l., fox, d.h. & divine, g. (2004). nurse practitioners and physicians' care activities and clinical outcomes with an inpatient geriatric population.
journal of the american academy of nurse practitioners
, 16 (8), 343-352.
larochelle, d. (1987). research studies on nurse practitioners in ambulatory health care: a review 1980 ð 1985.
journal of ambulatory care management
, 10(3), 65 ð 75.
larrabee, j. h., ferri, j. a., & hartig, m. t. (1997). patient satisfaction with nurse practitioner care.
journal of nursing care quality
, 11 (5), 9-14.
laurent, m., reeves, d., hermes, r., braspenning, j., grol, r., sibbald, b. (2006). substitution of doctors by nurses in primary care.
cochrane database of systemic reviews
, issue 1.
lenz, e. r., mundinger, m. o., kane, r. l., hopkins, s. c., & lin, s. x. (2004). primary care outcomes in patients treated by nurse practitioners or physicians: two year follow-up.
medical care research and review
, 61 (3), 332-351.
lin, s. x., hooker, r. s., lens, e. r., hopkins, s. c. (2002). nurse practitioners and physician assistants in hospital outpatient departments, 1997-1999.
nursing economics
, 20 (4), 174-179.
litaker, d., mion,l., planavsky, l., kippes, c., mehta, n. & frolkis, j. (2003) physician-nurse practitioner teams in chronic disease management: the impact on costs, clinical effectiveness, and patients' perception of care.
journal of interprofessional care
, 17 (3), 223-237.
mezey, m. burger, s.g., bloom, h.g., bonner, a., bourbonniere, m., bowers, b. burl, j.b., capezuti, e., carter, d., dimant, j., jerro, s.a., reinhard, s.c., & termaat, m. (2005) experts recommend strategies for strengthening the use of advanced practice nurses in nursing homes.
journal of the american geriatric society
. 53 (10), 1790-1797.
moody, n.b., smith, p.l., & glenn, l.l. (1999). client characteristics and practice
patterns of nurse practitioners and physicians.
the nurse practitioner
, 24(3), 94-103.
mundinger, m. o., kane, r. l., lenz, e. r., totten, a. m., tsai, w. y., cleary, p. d., friedewald, w. t., siu, a. l., & shelanski, m. l. (2000). primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial.
jama
, 283, (1), 59-68.
office of technology assessment (1986). nurse practitioners, physician assistants, and certified nurse midwives: a policy analysis. washington d. c.: us government printing office.
prescott, p. a. & driscoll, l. (1980). evaluating nurse practitioner performance.
the nurse practitioner
, 1 (1), 28-32.
rhee, k. j., & dermeyer, a. l. (1995). patient satisfaction with a nurse practitioner in a university emergency service.
annals of emergency medicine
, 26 (2), 130-132.
roblin, d. w., becker, r., adams, e. k., howard, d. h., & roberts, m. h. (2004). patient satisfaction with primary care: does type of practitioner matter?
medical care
, 42 (6), 579-590.
rudy, e.b., davidson, l.j., daly, b., clochesy, j.m., sereika, s., baldisseri, m., hravnak, m., ross, t. & ryan, c. (1998). care activities and outcomes of patients cared for by acute care nurse practitioners, physician assistants, and resident physicians: a comparison.
american journal of critical care
, 7 (4), 267-281.
sacket, d. l., spitzer, w. o., gent, m., roberts, m. (1974). the burlington randomized trial of the nurse practitioner: health outcomes of patients.
annals of internal medicine
, 80 (2), 137-142.
safriet, b. j. (1992). health care dollars and regulatory sense: the role of advanced practice nursing.
yale journal on regulation
, 9 (2).
seale, c., anderson, e. & kinnersley, p. (2005). comparison of gp and nurse practitioner consultations: an observational study.
british journal of general practice
, 55, 938-943.
seale, c., anderson, e., & kinnersley, p. (2006). treatment advice in primary care: a comparative study of nurse practitioners and general practitioners.
journal of advanced nursing
, 54 (5), 534-541.
sekscenski, e. s., s. sansom, et al. (1994). "state practice environments and the supply of physician assistants, nurse practitioners, and certified nurse-midwives."
n engl j med
331(19): 1266-71.
spitzer, w. o., sackett, d. l., sibley, j. c., roberts, m., gent, m., kergin, d. j., hacket, b. d., & olynich, a. (1974). the burlington randomized trial of the nurse practitioner.
nejm
, 290 (3), 252-256.
sox, h.c. (1979). quality of patient care by nurse practitioners and physician assistants': a ten year perspective.
annals of internal medicine
, 91, 459-468.
sullivan-marx, e. m., m. b. happ, et al. (2000). "nurse practitioner services: content and relative work value."
nursing outlook
, 48 (6), 269-75.
sullivan-marx, e. m. and g. maislin (2000). "comparison of nurse practitioner and family physician relative work values."
journal of nursing scholarship
, 32 (1), 71-6.
venning, p., durie, a., roland m., roberts, c. & leese b. (2000). randomised controlled trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care.
bmj
, 320, 1048-1053.
wardrope, j. & rothwell, s. (2000). primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial.
j accid emerg med
, 17 (4), 290-291.
woods, l. (2006). evaluating the clinical effectiveness of neonatal nurse practitioners: an exploratory study.
I also believe we have more in common than not, and serve similar interests. We would gain far more in collaboration than as individual groups. It is undeniable however, that we (NPs, PAs, and MD/DOs) feel threatened by the other groups for whatever reason. There are differences but they are minor in my opinion.
studies demonstrating equivalent or superior nurse practitioner patient outcomes and high np patient satisfaction
aigner, m.j., drew, s. & phipps, j. (2004). a comparative study of nursing home resident outcomes between care provided by nurse practitioner/physicians versus physicians only.
j am med dir assoc
, 5 (1), 16-23
anderson, d. m. and m. b. hampton (1999). “physician assistants and nurse practitioners: rural-urban settings and reimbursement for services.”
j rural health
15(2): 252-63.
avorn, j., everett, d. e., & baker, m. w. (1991). the neglected medical history and therapeutic choices for abdominal pain. a nationwide study of 799 physicians and nurses.
archives of internal medicine
, 151 (4), 694-698.
barrow, cr. & graber, rb. (2000). nurse practitioner care versus physician care: an analysis of recent outcomes research.
advance for nurse practitioners
, 17-18.
barton, a.j., baramee, j., sowers, d., & robertson, k.j. (2003). articulating the value-added dimension of np care.
the nurse practitioner
, 28 (12), 34-40.
brooten, d., youngblut, jm., kutcher, j., & bobo, c. (2004). quality and the nursing workforce: apns, patient outcomes and health care costs.
nursing outlook
, 52 (1), 45-52.
brown, s. a. & grimes, d. e. (1995). a meta-analysis of nurse practitioners and nurse midwives in primary care.
nursing research
, 44 (6), 332-339.
clintron, g., bigas, c., linares, e., aranda, j. m., hernandez, e. (1983). nurse practitioner role in a chronic congestive heart failure clinic: in-hospital time, costs, and patient satisfaction.
heart & lung: the journal of critical care
, 12 (3), 237-240.
congressional budget office (1979). physician extenders: their current and future role in medical care delivery. washington, d. c.: u.s. government printing office.
cooper, ra. (2001). health care workforce for the twenty-first century: the impact of nonphysician clinicians.
annual rev med
, 52, 51-61.
cooper, m. a., lindsay, g. m., kinn, s., swann, i. j. (2002). evaluating emergency nurse practitioner services: a randomized controlled trial.
journal of advanced nursing
, 40 (6).
donald, f. c. & mccurdy, c. (2002). review: nurse practitioner primary care improves patient satisfaction and quality of care with no difference in health outcomes.
evidence-based nursing
. 5 (4), 121.
edmunds, m. (1978). evaluation of nurse practitioner effectiveness: an overview of the literature.
evaluation and the health professions
, 1, 69 - 82.
ettner, s. l., kotlerman, j., abdelmonem, a., vazirani, s., hays, r. d., shapiro, m., cowan, m. (2006). an alternative approach to reducing the costs of patient care? a controlled trial of the multi-disciplinary doctor-nurse practitioner (mdnp) model.
medical decision making
, 26, 9-17.
feldman, m., ventura, m., & crosby, f. (1987). studies of nurse practitioner effectiveness.
nursing research
, 36(5), 303 ð 308.
grumbach, l., hart, l. g., mertz, e., coffman, j., palazzo, l. (2003). who is caring for the underserved? a comparison of primary care physician and nonphysician clinicians in california and washington.
annals of family medicine
, 1, 97-104.
hooker, r. s., cipher, d. j., & skescenski, e. (2005). patient satisfaction with physician assistant, nurse practitioner, and physician care. a national survey of medicare beneficiaries.
jcom
, 12 (2), 88-92.
hooker, r.s. & mccaig, l.f. (2001). use of physician assistants and nurse practitioners
in primary care, 1995-1999.
health affairs
, 20(4), 231-238.
horrocks, s., anderson, e., salisbury, c. (2002). systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors.
bmj
, 324, 819-823.
kinnersley, p., anderson, e., parry, k., clement, j., archard, l., turton, p., stainthorpe, a., et al. (2000). randomized controlled trial of nurse practitioner vs general practitioner care for patients requesting “same day” consultations in primary care.
bmj
, 320, 1043-1048.
kleinpell, r. & gawlinski, a. (2005). assessing outcomes in advanced practice nursing practice.
aacn clinical issues
, 16 (1), 43-57.
knudtson, n. (2000). patient satisfaction with nurse practitioner service in a rural setting.
journal of the american academy of nurse practitioners
, 12 (10), 405-412.
larkin, h. (2003). the case for nurse practitioners.
hospitals and health networks
, august 2003, 54-59.
lambing, a.y., adams, d.l., fox, d.h. & divine, g. (2004). nurse practitioners and physicians’ care activities and clinical outcomes with an inpatient geriatric population.
journal of the american academy of nurse practitioners
, 16 (8), 343-352.
larochelle, d. (1987). research studies on nurse practitioners in ambulatory health care: a review 1980 ð 1985.
journal of ambulatory care management
, 10(3), 65 ð 75.
larrabee, j. h., ferri, j. a., & hartig, m. t. (1997). patient satisfaction with nurse practitioner care.
journal of nursing care quality
, 11 (5), 9-14.
laurent, m., reeves, d., hermes, r., braspenning, j., grol, r., sibbald, b. (2006). substitution of doctors by nurses in primary care.
cochrane database of systemic reviews
, issue 1.
lenz, e. r., mundinger, m. o., kane, r. l., hopkins, s. c., & lin, s. x. (2004). primary care outcomes in patients treated by nurse practitioners or physicians: two year follow-up.
medical care research and review
, 61 (3), 332-351.
lin, s. x., hooker, r. s., lens, e. r., hopkins, s. c. (2002). nurse practitioners and physician assistants in hospital outpatient departments, 1997-1999.
nursing economics
, 20 (4), 174-179.
litaker, d., mion,l., planavsky, l., kippes, c., mehta, n. & frolkis, j. (2003) physician-nurse practitioner teams in chronic disease management: the impact on costs, clinical effectiveness, and patients’ perception of care.
journal of interprofessional care
, 17 (3), 223-237.
mezey, m. burger, s.g., bloom, h.g., bonner, a., bourbonniere, m., bowers, b. burl, j.b., capezuti, e., carter, d., dimant, j., jerro, s.a., reinhard, s.c., & termaat, m. (2005) experts recommend strategies for strengthening the use of advanced practice nurses in nursing homes.
journal of the american geriatric society
. 53 (10), 1790-1797.
moody, n.b., smith, p.l., & glenn, l.l. (1999). client characteristics and practice
patterns of nurse practitioners and physicians.
the nurse practitioner
, 24(3), 94-103.
mundinger, m. o., kane, r. l., lenz, e. r., totten, a. m., tsai, w. y., cleary, p. d., friedewald, w. t., siu, a. l., & shelanski, m. l. (2000). primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial.
jama
, 283, (1), 59-68.
office of technology assessment (1986). nurse practitioners, physician assistants, and certified nurse midwives: a policy analysis. washington d. c.: us government printing office.
prescott, p. a. & driscoll, l. (1980). evaluating nurse practitioner performance.
the nurse practitioner
, 1 (1), 28-32.
rhee, k. j., & dermeyer, a. l. (1995). patient satisfaction with a nurse practitioner in a university emergency service.
annals of emergency medicine
, 26 (2), 130-132.
roblin, d. w., becker, r., adams, e. k., howard, d. h., & roberts, m. h. (2004). patient satisfaction with primary care: does type of practitioner matter?
medical care
, 42 (6), 579-590.
rudy, e.b., davidson, l.j., daly, b., clochesy, j.m., sereika, s., baldisseri, m., hravnak, m., ross, t. & ryan, c. (1998). care activities and outcomes of patients cared for by acute care nurse practitioners, physician assistants, and resident physicians: a comparison.
american journal of critical care
, 7 (4), 267-281.
sacket, d. l., spitzer, w. o., gent, m., roberts, m. (1974). the burlington randomized trial of the nurse practitioner: health outcomes of patients.
annals of internal medicine
, 80 (2), 137-142.
safriet, b. j. (1992). health care dollars and regulatory sense: the role of advanced practice nursing.
yale journal on regulation
, 9 (2).
seale, c., anderson, e. & kinnersley, p. (2005). comparison of gp and nurse practitioner consultations: an observational study.
british journal of general practice
, 55, 938-943.
seale, c., anderson, e., & kinnersley, p. (2006). treatment advice in primary care: a comparative study of nurse practitioners and general practitioners.
journal of advanced nursing
, 54 (5), 534-541.
sekscenski, e. s., s. sansom, et al. (1994). “state practice environments and the supply of physician assistants, nurse practitioners, and certified nurse-midwives.”
n engl j med
331(19): 1266-71.
spitzer, w. o., sackett, d. l., sibley, j. c., roberts, m., gent, m., kergin, d. j., hacket, b. d., & olynich, a. (1974). the burlington randomized trial of the nurse practitioner.
nejm
, 290 (3), 252-256.
sox, h.c. (1979). quality of patient care by nurse practitioners and physician assistants’: a ten year perspective.
annals of internal medicine
, 91, 459-468.
sullivan-marx, e. m., m. b. happ, et al. (2000). “nurse practitioner services: content and relative work value.”
nursing outlook
, 48 (6), 269-75.
sullivan-marx, e. m. and g. maislin (2000). “comparison of nurse practitioner and family physician relative work values.”
journal of nursing scholarship
, 32 (1), 71-6.
venning, p., durie, a., roland m., roberts, c. & leese b. (2000). randomised controlled trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care.
bmj
, 320, 1048-1053.
wardrope, j. & rothwell, s. (2000). primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial.
j accid emerg med
, 17 (4), 290-291.
woods, l. (2006). evaluating the clinical effectiveness of neonatal nurse practitioners: an exploratory study.
journal of clinical nursing
, 15, 35-44.
the defense rests its case...
your case is very short cited and scientifically biased. perhaps you should read the studies that you copy and paste....then perhaps you would understand how your "case" supports the medical model.
the changing demands of today's complex health care environment, outlined in recent reports from the institute of medicine, require that nurses serving in specialty positions have the highest level of scientific knowledge and practice expertise possible. nurses are constantly working with individuals who have a high level of preparation in their respective fields - physicians, pharmacists, and other health providers. the effectiveness of nurses is directly related to the amount and type of education they receive, and recent research has established a clear link between higher levels of nursing education and better patient outcomes.
is the nursing organization admitting that np education is inadequate, that programs lack standardization, and np outcomes aren't as good as those trained in the medical model. what's interesting is that the dnp education is still less academic and clinical training than a pa program at any level and that isn't taking into consideration all the time np's spend on nursing theory.....what's even more concerning is that the dnp can be done once again online...and part-time....set up your own clinical.
i think it's clear.....the motivation of the nursing world is complete autonomy. they aren't happy as mid level providers. they see opportunity in the primary care specialties. it's a step by step process politically. it may work..... can you blame them. the nursing organizations work for their people. they know that with time, the public will accept them as dr's alongside do's and md's.
they also know that there is strength in numbers. they make their degrees accessible (online, distance learning, part-time, less rigorous training and education) affordable (nurses have been very effective in employer paid education). soon there will dnp's everywhere......all without generalist training academically or clinically (exactly how can you specialize without generalist training?.....the educational model doesn't make sense). it's perfect timing with america on the cusp of healthcare reform.
they know what they're doing! they are experts at this game.
if they had high standards, long clinical training requirements, generalist training/education, full-time resident classroom requirements....the dnp would fail. they would have to reform everything they do from clinical instructors and faculty to curriculum. then it would simply be pa education.
they have a formula where they can compete with less and succeed.
it's a basic business model. they have a mission with goals. their decisions are predicated on the mission. they no reason to readjust their mission.
the nursing mantra continues.
who cares i guess. it only bothers me because the real nurses, bedside nurses, don't seem to be much of the focus for the nursing organization. they are what bring respect to the nursing profession. they are the bread and butter of healthcare. the rn is equally important as the md. the np is not, imho
dnp curriculum:
course of study
the 38-credit dnp program includes 18 credits of required dnp core, 12 credits of elective in the student's focus specialty area, and 8 credits for the required capstone project.
the dnp begins in the fall only.
first semester
nr 210.803 nursing inquiry for evidence based practice 3
nr 210.802 advanced nursing health policy 3
nr 210.801 analytic approaches for outcomes management: individuals & populations 3
nr 210.896 capstone project i 1
second semester
nr 210.804 organizational and systems leadership for quality care 3
nr 210.805 translating evidence to practice 3
nr 210.806 health economics and finance 3
nr 210.897 capstone project ii 1
third semester
nr 210.898 capstone project iii 3
electives 6 *
= doctor
this looks more like a curriculum for social workers
if you read the studies that you copied and pasted you would learn that they seem to be equally effective in treating ear infections and uti's. they don't see the complex patients....and don't have the same success rates...they refer and they lack the ability to identify the zebra's. the limitations of these studies are way too obvious. it's not good research when an investigator has the answer they want and then formulates the study to achieve the answer. the better, more scientific and medical way of learning is testing your hypothesis or curiosity with a study design that gives you an answer.
go ahead and compare md/do vs. np
fnp referrals to the er
referrals
rx
complexity of patient
weirdness of practitioner
unfortunately for me, i've lived a sickly life. every time i've had consultation with an np....they've made a mistake and/or referral that didn't need to happen.... that had to be corrected by an md....and quite often a pa.....and some are just downright strange.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
If I might offer a comment from the perspective of "just a nurse"....
Hold out your right hand, spread the fingers and call it "MD"....hold out your left hand, spread the fingers and call it "NP" (or PA)...now fit those fingers together so that the spaces between are pretty much filled by the fingers of the other hand. THAT is sort of how medicine and nursing fit....the fingers represent the more or less common/similar areas of education, knowledge, and practice, we overlap in our care with varying degrees of ability often dictated by our professional experience and who we are as people...the rest of the hand is what makes us different in our education, knowledge, and practice. OF COURSE there will be a difference in the delivery of care...each of these providers was trained in a different fashion...each of these providers has different scopes of practice. That is a good thing...the divergent background, training, and focus enriches and improves the healthcare experience for most patients by creating a more flexible, available, and cost effective model.
We are spending more than any other civalized country on healthcare and we are not as healthy - Other countries are just beginning to look at midlevel providers.....In the US they have been around since the 60's.
Midlevels are 15-20% cheaper reimbursement wise....but that doesn't mean their cheaper! If they are indeed referring more and requiring more visits to achieve favorable outcomes....it's not cheaper...or if they miss a DX....ect.
NP's currently offer nothing to enhance healthcare that RN's don't already do..... it's the bedside nurses that add to the dynamics of healthcare....NP's are trying to practice medicine. I haven't seen a reasonable arguement to that yet. Why the lobbying efforts to be "INDEPENDENT". That isn't exactly a team approach.
If advance practice nurses stuck to bedside nursing....that would improve care. Work to improve bedside nursing....it needs help in the USA. Aside from the practice of defensive medicine by PA's/MD/DO, their doing good work.
We are spending more than any other civalized country on healthcare and we are not as healthy - Other countries are just beginning to look at midlevel providers.....In the US they have been around since the 60's.
Midlevels are 15-20% cheaper reimbursement wise....but that doesn't mean their cheaper! If they are indeed referring more and requiring more visits to achieve favorable outcomes....it's not cheaper...or if they miss a DX....ect.
NP's currently offer nothing to enhance healthcare that RN's don't already do..... it's the bedside nurses that add to the dynamics of healthcare....NP's are trying to practice medicine. I haven't seen a reasonable arguement to that yet. Why the lobbying efforts to be "INDEPENDENT". That isn't exactly a team approach.
If advance practice nurses stuck to bedside nursing....that would improve care. Work to improve bedside nursing....it needs help in the USA. Aside from the practice of defensive medicine by PA's/MD/DO, their doing good work.
Really? They're doing good work? Tell that to the first year resident who misinterpreted a heart rate strip as a-fib when it was multiple PVCs and then got mad when ME, the nursing student and other nurses interpreted it correctly. And he was a graduate from the BEST med school in the US.
But yes, ALL MDs are soooooo much better than NPs. :chuckle
Midlevels are 15-20% cheaper reimbursement wise....but that doesn't mean their cheaper! If they are indeed referring more and requiring more visits to achieve favorable outcomes....it's not cheaper...or if they miss a DX....ect.
It absolutely means they are cheaper!!! Less reimbursement is by insurance and Medicare is less cost!! Same care given by MD is reimbursed 15-20% MORE!!! Your argument for NPs requiring more referrals and more visits to achieve favorable outcomes is just plain wrong!!! Show me the studies!! I've included mine---reflecting same or better outcomes and high patient satisfaction. There have been dozens of studies--way too many to be simply disregarded as biased.
NP's currently offer nothing to enhance healthcare that RN's don't already do..... it's the bedside nurses that add to the dynamics of healthcare....NP's are trying to practice medicine. I haven't seen a reasonable arguement to that yet. Why the lobbying efforts to be "INDEPENDENT". That isn't exactly a team approach.
If advance practice nurses stuck to bedside nursing....that would improve care. Work to improve bedside nursing....it needs help in the USA. Aside from the practice of defensive medicine by PA's/MD/DO, their doing good work.
Here is where you step off into nonsense. Got a issue with NPs? So be it. Go see your doctor. Thankfully, you represent the ignorant minority. NPs and PAs have been around for 40+ years and will not be going away. They fulfill a need and deliver quality care.
most have been performed by mundenger, lenz, lambing, ect - the nursing organization
these are anti-physician people who create their studies to get the answers they want.
they don't want to do the high powered randomized controlled studies comparing referral rates, patient visits and medical error - so they cherry pick what and how they study.
when the patient is difficult...the doctor takes over or is consulted.
i don't completely disagree that outcomes of routine primary care are similar b/t physician, pa and seasoned nurse practitioners. they should be. i do disagree when the complexity of the patient increases.
there are studies that compare pa's and md's that show similar results. however, the pa organization recognizes the difference in training and education between pa and md/do. they know their limits and complete autonomy as an organization is something they don't want.
conclusion: an np can treat uti's as effectively as an md/do provider......
so couldn't an rn or a pharmacist......
it's my understanding that mundinger has been asked if she would have an interest in performing a comparison study b/t md and np family medicine providers in the treatment of musculoskeletal health, dx, and tx.
np's are clueless in this area and it's also my understanding that mundinger admits this off the record. my background is pt and atc. i get unnecessary referrals from np's all the time because they just don't understand the nms system. i don't get them from pa's or md/do - they know what to refer and often times dx it before i see the patient. np's write shoulder pain....eval and treat. it's also my understanding that 15-20% of all primary care visits are musculoskeletal related. i can't tell you how many times i get inappropriate referrals from np's.
my favorite this week: referred as "moderate ankle sprain" patient presented + otowa signs....np never ordered radiograph....so had to back track...called referring np and requested radiograph. np ordered films, but failed to order stress view after i told her i thought it was necessary.....didn't seem to know what it was. so had to go over np's head and call md in the same practice who ordered the stress view....and then we were able to get the patient the appropriate referral to the podiatrist. i've never had an md or pa make this mistake. if the np had appropriate training they would have known from the red flags during the physical evaluation that this wasn't a simple ankle sprain and referred to the podiatrist to begin with who would have ordered the workup they wanted.
this is what it amounted to....an unnecessary visit to pt....multiple trips to the hospital for the patient for films and delayed care......surgery needed!
do you think that np's have adequate training in the neuro-muscularskeletal system when compared to md's and pa's?
i know a good many pa's that are not happy with the mid-level moniker...
i know a good many pa's and nps that are perfectly happy with the mid-level moniker.
i know a good many nps that would voice they are practicing advanced nursing within a medical model.
"i ask b/c plenty of nps i have spoken to have said they feel the "nursing, not medicine" concept is bogus (their sentiment, not mine). so when a np treats bronchitis, or does a preop cardiac eval, how are they not practicing medicine"? i know from years of observation/practice my delivery of care and teaching and explaining is different than most of my fellow providers (pa's, md's and do's)... i also know from years of observation/practice my delivery of care and teaching and explaining is not always different from that of my fellow providers (pa's, md's and do's)... i also know my medical background is more varied than a lot of those around me. patient care delivery is shaped by the person delivering the care and their education (we could add personality, financial motive, religion, ethnicity, sex, etc., etc..).. i myself like: nursing in medicine...
"first year resident who misinterpreted a heart rate strip as a-fib when it was multiple pvcs and then got mad when me, the nursing student and other nurses interpreted it correctly"..... this happens in hospitals across the states (probably from country to country).... this is where collaboration is supposed to come into effect but often times does not.... this is where pride (or god complex) often times puts the patient on the back seat
nps by not sticking to bedside nursing are helping to improve nursing research, patient safety/care. this might run against those who think that the medical model is all there should be. this may run against those who think nurses should have remained the handmaidens of healthcare... there are a lot of sour nurses, pas, mds etc., out there i have ran into more than a few. i have also ran into a larger portion who believe in working hard, collaborating and helping the patient and their family...
"midlevels are 15-20% cheaper reimbursement wise....but that doesn't mean their cheaper! if they are indeed referring more and requiring more visits to achieve favorable outcomes....it's not cheaper...or if they miss a dx....ect". will the person or persons on this site who has never made a mistake please id yourself. will the person or persons who can handle all aspects of healthcare please id yourself. i work in family practice heck yes i refer. so do the doctors and pas i work with. i work in the hospital and the term refer is used sometimes but oftentimes it's the term consultation that is most used.
"i'm a member at american college of clincians and think that there is more to gain from collaboration than division; it's the distinction being drawn, that nps offer superior care by virtue of a nursing model, compared to mds/pas, that pushes us away from any potential collaboration as nonphysician providers. as i'm sure you can imagine, as a pa (or doc, but i hesitate to speak for them), it is frustrating to hear en entire group of clinicians say that pas are lesser providers, have poor bedside manner, or at worst indicate that we don't look at patients in totality". so does american college of clinicians not view the distinction that is being drawn that pa's (md's) offer superior care by virtue of the medical model than that of combining the nursing and medical model that we nps use?
"is the nursing organization admitting that np education is inadequate, that programs lack standardization, and np outcomes aren't as good as those trained in the medical model. what's interesting is that the dnp education is still less academic and clinical training than a pa program at any level and that isn't taking into consideration all the time np's spend on nursing theory.....what's even more concerning is that the dnp can be done once again online...and part-time....set up your own clinical". wow read the postings across this site.. we all (for the most part) say it could/should be done better.. all parts of all the schools could be better. if all was right all the programs across the board would be 100% the same without need for change/improvement. name any of the schools that have not changed anything over the last 5-10-15 years. research continues to build new knowledge necessitating change and will continue to do so.
"my favorite this week: referred as "moderate ankle sprain" patient presented + otowa signs....np never ordered radiograph....so had to back track...called referring np and requested radiograph. np ordered films, but failed to order stress view after i told her i thought it was necessary.....didn't seem to know what it was".
hey that's weird last week i saw a patient. md thought sprain/strain since some swelling and patient could walk on it... the patient was given an ace wrap. next day my exam (by me little old np) yes the patient could walk on it.. swelling for sure... prior to x-ray: rice instructions... splint / ace wrap applied with instructions.. crutches with instructions and use observed. x-rays confirmed fracture at the base of the fibula. difference in care? difference in providers? you did what you should have done to help the patient and guess what so did i.... anyone who has practiced for any length of time has stories they could tell....
this type of discussion will continue for years to come. who knows with two groups of mid-levels and so many different flavors of doctors and so many different groups wanting some type of prescriptive authority one would probably be wrong to think another type of provider is not on the horizon.
the market will also drive change in practice / education and if not heeded extinction for the parties that don't adapt.
TakeBack
203 Posts
Ha, I guess you'd have to take my word for it but I'm certainly not anti nurse.
I'm a member at American College of Clincians and think that there is more to gain from collaboration than division; it's the distinction being drawn, that NPs offer superior care by virtue of a nursing model, compared to MDs/PAs, that pushes us away from any potential collaboration as nonphysician providers. As I'm sure you can imagine, as a PA (or doc, but I hesitate to speak for them), it is frustrating to hear en entire group of clinicians say that PAs are lesser providers, have poor bedside manner, or at worst indicate that we don't look at patients in totality.
Take my questions as genuine curiosity about why NPs feel they way they do about their practice model and 1 how many of them believe in it and 2) how many see it as theory without real application.
I've seen a lot of comments on my forum- FROM NPs and RNs- reinforcing the latter.
(I moderate at the PA Forum. I appreciate your troll radar, trust me.)
:chuckle