Education requirement for nurse practitioner

MAISY, RN-ER, BSN, RN · Apr 5, 2009

Getting a doctorate to assist a physician? That's just precious.:chuckle
Needless to say, I'm not a big advocate of NPs or CRNAs. I feel they use nursing only to crossover into medicine. And while they still believe they are nurses, and while the nursing profession holds them up as shining examples of how "we are just as good as doctors!" I have yet to see any NP or CRNA doing nursing duties.
I believe as nurses get older and lose the energy or health required to do nursing (i.e., caring for patients at the bedside), they should prepare to move into nurse management, education, whatever. But we should never forget that nursing is the profession of taking care of people who can't care for themselves. Period. It's not rounding for a physician. It's not the diagnosis and treatment of illness, and it's not playing second fiddle to an anesthesiologist in the OR.
I know I'll catch some heat for this opinion, and I know that the vast majority of the nursing profession does not hold my opinion, but I'm a radical about the profession of nursing. It is the greatest possible profession, and it forges the greatest possible people on earth. Escaping it and then calling it "advanced practice" in my opinion is abominable. Healthcare must always have two entities, and never forget this: it must have the equivalent of an MD and an RN. Everyone else is an assistant to one or the other.
So, doctorate to be an assistant to a doctor. Yeah, I think that's a good idea. Why not?

NPs are not PAs. They work independently and I believe will fill the gap for primary care with a nursing approach to holistic patient care. Medicine does not follow the same path.

I currently work with an amazing NP who not only works independently but is quick, efficient, and portrays good nursing in that light. Never afraid of doing what needs to be done to and with a patient. Not too many docs doing that. Perhaps you haven't been around the right kind.

M

Polley93 · Apr 5, 2009

Just like in a perfect world the preferred education level for RNs is a BSN, a doctorate is a preferred educational level for an NP. Will this ever become solid? Im not sure, but the prescription writing capabilities for an NP may change to require a doctorate level of education for that priveledge. Time will tell.

Most RNs have an ADN. A percentage of those go on for a BSN, A very small marginal portion of those go onto a masters which is the educational level and ground floor level of advanced nursing practice, and then from those? A tiny percentage go on for a doctorate level of education which gives us our researchers and theory producers etc. The problem is, most nurses stop with the ADN and are in it for the job security and the wage. Where are the those of us who are in it due to the passion for people? This group seems to be becoming all but extinct. Sad...., very very sad.

js408 · Apr 5, 2009

I think you exaggerate a little bit. Sure there are tons of people who decide to go to nursing because of some myth about how nursing is easy or you'll always be able to find a job and never get laid off. I'm only pre-nursing but I would think nursing school and the first year of working as a nurse weeds out most of the people who are in it just for the money and alleged job security.

The problem is, most nurses stop with the ADN and are in it for the job security and the wage. Where are the those of us who are in it due to the passion for people? This group seems to be becoming all but extinct. Sad...., very very sad.

Flightline, BSN, RN · Apr 5, 2009

As far as the comment about retiring off to advance practice...wow.

I didn't really make myself clear on that because I was still aching from the laugh attack I had when I thought about nurses so desparate to get away from direct patient care that they would get a DNP to assist physicians. I don't think any nurse should become a NP or CRNA. I think nurses should be nurses, and PAs should be PAs. As one gets tired and less energetic (which we all do) they should consider nurse management, teaching, or some other less stressful area of nursing, always knowing that the full glory goes to the bedside nurse. I don't think any nurse, retired or otherwise should be an NP or CRNA.

NPs are not PAs. They work independently

No they don't. They work in collaboration with a physician. They have to. But even if they did work independently, my argument still stands that they are not performing as nurses but rather have crossed over into medicine.

and I believe will fill the gap for primary care with a nursing approach to holistic patient care.

Frankly, I've never gotten that whole "holistic" bit. I know NPs. I know what they do. They diagnose and perscribe tx. That's medicine. They don't "care" for patients. (Well, of course, they do when they finish school, realize the nursing shortage is a God-given gift to bedside staff nurses only, and thus can't can't get a job as a nurse practitioner. Then they do work at the bedside grumbling all the time about how they are better than "just a nurse.")

I currently work with an amazing NP who not only works independently but is quick, efficient, and portrays good nursing in that light.

Excuse me: what are you talking about? Are you saying this NP takes a patient load, brings them water, makes sure they are sat up to eat, feeds them, bathes them, administers their medications, assesses them (well she probably does that), walks them in the hall, monitors them, and only them, for 8-12 hours, etc?

Nursing is nursing. Medicine is medicine. And the two don't mix.

Never afraid of doing what needs to be done to and with a patient. Not too many docs doing that. Perhaps you haven't been around the right kind.

Docs aren't supposed to do that! Doctors are applied scientists. The greatest offense I ever took was when a resident brought my patient a cup of ice water. If I had caught it in time, I would have prevented it, somehow, I gaurantee you. If he wanted to be a nurse, then he should have gone to nursing school.

It's not low to be a nurse. It's the greatest possible profession. If one can't handle it, then they should go on to become a doctor and help patients that way.

Just my thinking. I don't want to personally offend anyone. OK?

js408 · Apr 5, 2009

* I am not a nurse, I'm a student in pre-nursing. *

NP's are not physician assistants. PA's are physician's assistance. This probably varies by state, but in California, an NP works independently and can diagnose and prescribe just like a physician. I used to go to Kaiser and when I made an appointment, I was seen by an NP who diagnosed and prescribed without any physician supervision or approval. My wife has also been seen by many NP's at the Palo Alto Medical Foundation and the NP's were never supervised by a doctor.

I understand that you take a strict view of the difference between nursing and medicine. I accept your opinion and respect it, but I don't agree with it. * I am not a nurse * so perhaps my opinion doesn't count (yet) but from where I sit, I don't see any reason why there can't be crossover between nursing and medicine.

Even with NP's and CRNA's, nurses can still be nurses. NP and CRNA make up a small small minority of nurses. The fact that NP's and CRNA's exist doesn't mean that RN's have no place anymore. I don't understand your reasoning for why a nurse should not be an NP or CRNA if they choose to. I don't see how it damages the profession of nursing for there to be crossover.

I didn't really make myself clear on that because I was still aching from the laugh attack I had when I thought about nurses so desparate to get away from direct patient care that they would get a DNP to assist physicians. I don't think any nurse should become a NP or CRNA. I think nurses should be nurses, and PAs should be PAs. As one gets tired and less energetic (which we all do) they should consider nurse management, teaching, or some other less stressful area of nursing, always knowing that the full glory goes to the bedside nurse. I don't think any nurse, retired or otherwise should be an NP or CRNA.
No they don't. They work in collaboration with a physician. They have to. But even if they did work independently, my argument still stands that they are not performing as nurses but rather have crossed over into medicine.
Frankly, I've never gotten that whole "holistic" bit. I know NPs. I know what they do. They diagnose and perscribe tx. That's medicine. They don't "care" for patients. (Well, of course, they do when they finish school, realize the nursing shortage is a God-given gift to bedside staff nurses only, and thus can't can't get a job as a nurse practitioner. Then they do work at the bedside grumbling all the time about how they are better than "just a nurse.")
Excuse me: what are you talking about? Are you saying this NP takes a patient load, brings them water, makes sure they are sat up to eat, feeds them, bathes them, administers their medications, assesses them (well she probably does that), walks them in the hall, monitors them, and only them, for 8-12 hours, etc?
Nursing is nursing. Medicine is medicine. And the two don't mix.
Docs aren't supposed to do that! Doctors are applied scientists. The greatest offense I ever took was when a resident brought my patient a cup of ice water. If I had caught it in time, I would have prevented it, somehow, I gaurantee you. If he wanted to be a nurse, then he should have gone to nursing school.
It's not low to be a nurse. It's the greatest possible profession. If one can't handle it, then they should go on to become a doctor and help patients that way.
Just my thinking. I don't want to personally offend anyone. OK?

Flightline, BSN, RN · Apr 5, 2009

The problem is, most nurses stop with the ADN and are in it for the job security and the wage. Where are the those of us who are in it due to the passion for people? This group seems to be becoming all but extinct. Sad...., very very sad.

There's nothing about nursing that requires a bachelors degree. Obviously there isn't or we wouldn't have had nurses from diploma schools forever and now ADNs. As for a passion for people, more education is probably worse in that regard.

Polley93 · Apr 5, 2009

I wish I was exaggerating, truly. But in my experience in just about every stage of nursing, in mulitiple states and various specialties I see this becoming more and more of the norm and not the exception.

MAISY, RN-ER, BSN, RN · Apr 5, 2009

I didn't really make myself clear on that because I was still aching from the laugh attack I had when I thought about nurses so desparate to get away from direct patient care that they would get a DNP to assist physicians. I don't think any nurse should become a NP or CRNA. I think nurses should be nurses, and PAs should be PAs. As one gets tired and less energetic (which we all do) they should consider nurse management, teaching, or some other less stressful area of nursing, always knowing that the full glory goes to the bedside nurse. I don't think any nurse, retired or otherwise should be an NP or CRNA.
No they don't. They work in collaboration with a physician. They have to. But even if they did work independently, my argument still stands that they are not performing as nurses but rather have crossed over into medicine.
Frankly, I've never gotten that whole "holistic" bit. I know NPs. I know what they do. They diagnose and perscribe tx. That's medicine. They don't "care" for patients. (Well, of course, they do when they finish school, realize the nursing shortage is a God-given gift to bedside staff nurses only, and thus can't can't get a job as a nurse practitioner. Then they do work at the bedside grumbling all the time about how they are better than "just a nurse.")
Excuse me: what are you talking about? Are you saying this NP takes a patient load, brings them water, makes sure they are sat up to eat, feeds them, bathes them, administers their medications, assesses them (well she probably does that), walks them in the hall, monitors them, and only them, for 8-12 hours, etc?
Nursing is nursing. Medicine is medicine. And the two don't mix.
Docs aren't supposed to do that! Doctors are applied scientists. The greatest offense I ever took was when a resident brought my patient a cup of ice water. If I had caught it in time, I would have prevented it, somehow, I gaurantee you. If he wanted to be a nurse, then he should have gone to nursing school.
It's not low to be a nurse. It's the greatest possible profession. If one can't handle it, then they should go on to become a doctor and help patients that way.
Just my thinking. I don't want to personally offend anyone. OK?

WOW! Well we all understand your opinion, feel better?

I am sure there are as many alternative opinions as there are colors in a crayon box. However, nursing is many things; but all of them involve the patient. If I choose to be a NP, I will be doing so as a NURSE! The medical model and the nursing model are very different and if you read the literature-patients have greater satisfaction with NPs than PMDs. There is a reason for that-nurses behave differently and approach problems differently.

In NJ NPs are affiliated with but DO NOT PRESENT OR ASK A PHYSICIAN ABOUT THEIR CURRENT PATIENTS-that is what PAs must do. NPs prescribe and treat, but also educate and do the best assessments I have ever seen. Our NP does many things as her expertise is Emergency Medicine and she is also family trained. As for expectations, I expect anyone taking an oath to care for their patients to provide a sip of water, put in an NG tube or help sit someone up. This includes doctors...residents.... and whoever is there at the time of the request. We are all expected to care for our patients, answer that call bell and make it happen. OR NPs can work for a corporation such as minute clinic or CVS and work within a limited scope of illnesses (like a PMD) or as in an ER fast track area with NO PHYSICIAN LIASON! Again, the scope and requirement of the job depends on circumstances.

I guess some people like a box. I don't believe in limitations or lists. The best people to perform a function should perform it. I'll do what I want, and encourage anyone to follow their dreams. IF that is as an NP, a bedside nurse, a manager, or an educator....so be it!

M

hypocaffeinemia, BSN, RN · Apr 5, 2009

. I don't think any nurse should become a NP or CRNA.

You realize, don't you, that nurses have been providing anesthesia since the beginning of the modern era of medicine, right? It isn't like this is some non-traditional role encroachment by nurses.

Excuse me: what are you talking about? Are you saying this NP takes a patient load, brings them water, makes sure they are sat up to eat, feeds them, bathes them, administers their medications, assesses them (well she probably does that), walks them in the hall, monitors them, and only them, for 8-12 hours, etc?

If you narrowly define nursing's scope to the above, you've eliminated a significant percentage of all nurses, not just the "advance practice" ones.

Nursing is nursing. Medicine is medicine. And the two don't mix.

Yes they do. There's significant overlap in many areas of healthcare. The same exact task can be nursing or medicine or x or y or z depending on the license of the person performing it.

For instance:

Medication order clarification: Nursing or Pharmacy?

Range of Motion Exercise: Nursing or Physical Therapy?

Dysphagia Screening: Nursing or Speech Therapy?

Diet managment: Nursing, Medicine, or Dietitian?

Discharge Coordination: Nursing or Social Works?

ACLS code-running: Nursing or Medicine?

Prescribing antibiotics: Medicine, Dentistry, Podiatry, Clinical Pharmacy, or Advanced Practice Nursing?

That's just some very few examples of overlapping roles.

Docs aren't supposed to do that! Doctors are applied scientists. The greatest offense I ever took was when a resident brought my patient a cup of ice water. If I had caught it in time, I would have prevented it, somehow, I gaurantee you. If he wanted to be a nurse, then he should have gone to nursing school.

This is insidiously ridiculous: Bringing a patient water is a common courtesy most humans are capable of, not something restricted to the domain of nursing. Implying otherwise is insulting to both the profession of nursing and to the humanity of everyone else.

Polley93 · Apr 5, 2009

Amen Sistah!! We all have our passions and gifts and each of us definitely has our opinions. And what is this about "nursing is nursing and medicine is medicine and the two dont' mix". Are you kidding me?

NPs give some of the best care Ive seen and I for one, cannot wait to join forces and become one. They can diagnose and prescribe, educate but also give the care we have all become so well versed in.

Flightline, BSN, RN · Apr 6, 2009

* I am not a nurse, I'm a student in pre-nursing. *
I understand that you take a strict view of the difference between nursing and medicine. I accept your opinion and respect it, but I don't agree with it. * I am not a nurse * so perhaps my opinion doesn't count (yet) but from where I sit, I don't see any reason why there can't be crossover between nursing and medicine.

Because you are not a nurse yet, your opinion matters a great deal more than you may think. If nursing has no glory in the eyes of future nurses, then the profession is doomed. And there can be no glory when the center of nursing glory is shifted away from the bedside staff nurse.

Nursing, even now, is struggling, maybe harder than ever, to define itself as a profession among the accepted professions. It fails if it tries to be "just as good as a doctor." Because it will never be "just as good as a doctor." For one, it's not medicine--it's caring. We provide professional "care" for people who for whatever reason and in whatever way cannot "care" for themselves. That is our profession. So, the center of glory must be with the bedside nurse. If we call NPs "advanced practice" then we inadvertently play catch up to doctors.

We are nurses! Our degrees are the ADN/Diploma, BSN, MSN, Ph.D. and maybe some of the newer ones I'm not too familiar with and like most new doctorate programs are probably just wannabes for a Ph.D. We have been around longer than MDs. We are the original healthcare providers.

The fact is MDs are useless without us, and they are threatened by us. They are threatened because in the arena of patient care, when they come to the floor, they know they don't have it within them to "care" for people. They knew it all along, and so they became doctors. Anyone who's ever worked a shift as a nurse or a CNA, and really gave a damn about the work they were doing, knows how much strength it takes to care for a patient. Doctors don't have it within them to do that, and yet such a person who can care for another person is indispensible in our world.

Doctors are the highest profession; no one disputes that. Every parent wants a doctor in the family. Society holds them up as all-important, and they are given great pay for the extremely hard academic road they have to travel to get to that professional level. But nursing is the greatest profession, and everyone knows it, including doctors. We do what they are afraid of doing. We do what they have climbed a massive wall to avoid doing. They are high, but we are great--never forget that.

Jesus didn't say, "I was sick and you diagnosed and treated me." Jesus said, "I was sick, and you cared for me." At the last supper, Jesus didn't say, "Work really hard, Peter, so you can get to the top of the pile and be considered by everyone to be the highest." He got into the equivalent of scrubs, and washed the disciples feet, and said to Peter: "If you don't let me do this, you have no part in me."

To be low enough in self to care for others is to be the greatest in God's eyes. Nurses and CNAs know this. MDs know this. Patient's families know this. Everyone knows this. We pick up our cross daily for others and hang on it. Every nurse knows what I mean.

So, pre-nursing student, J.S., your opinion matters. What you think of nursing matters. Will you come to the bedside, like Mother Teresa, and do what so few people in the world can bring themselves to do? Can you lower yourself enough to care for another human being who cannot care for himself? Or will you see what's required at the bedside, shrink from it, and be tempted by the lie that says, "If you become a NP, you can be just as good as a doctor, and never have to answer a call light again. You'll be better than a nurse."

What if Jesus had listened to our old friend and taken "all the kingdoms of the world." Given what he was, he would have been the highest ruler to have ever lived. Rejecting that temptation made him the greatest person that ever lived. Given what you are, and what's inside you, will you choose high or great?

If you can't be great and you have to be elevated, then by God, go to medical school, be an MD, then you can come and write our orders--write my orders--and tell yourself that in those orders you have proved once and for all that you are better than "just a nurse." You can agree with Peter when he said, "My Lord, you will never wash my feet!" Just remember the Lord's reply to that.

hypocaffeinemia, BSN, RN · Apr 7, 2009

Poe's law?