Explaining the NP role to pts and everybody else

[npstudent22]

Hello everyone!

For practicing NP's or NP students how do you explain the NP role to your family members, friends, and most importantly to patients when asked "What is a Nurse Practitioner"? So many people are not aware of what the role is and what we do in comparison to the bedside nurse or physician. They understand the word nurse or doctor but get confused as to what an APRN is. I get asked so many times, "So you're like a doctor?". People really just don't get it.

Is there a quick, simple, and easy way to explain this to individuals who do not have medical knowledge very much like the majority of our patients? I've had very long lectures in my coursework on the role and what we do etc. but have not been taught on how to easily explain this to patients in a way they can understand and in a way that doesn't take 20 minutes. I struggle to answer the question every time specifically for the acute care setting only. I am not talking about primary care. Help!! Thanks

[Jules A, MSN]

Physicians always bring up the clinical hours, forgetting that NPs function as a RN BEFORE receiving their NP. The total amount of clinical hours spent with patients is well into the thousands by the time the NP BEGINS their training.

Unfortunately this is not true any longer. It is my understanding this is how the NP concept came about back in the day but now anyone with the money to pay tuition can apply to most any of the direct entry NP programs and graduate without ever working as a nurse. Seems crazy to me.

[nursetim, NP]

I start with where their understanding is? PAs are pretty much universally know, at least that is my experience so far. Then I tell them we are like PAs only in a few states we can practice w/o an MD and we don't do a surgical rotation, generally speaking.

Then when they ask me when I'm going to go to med school I say, "why would I want to do that? I'm doctor lite, half the glory (less than half the pay( I never tell them the pay part) and none of the guilt."

[Riburn3, BSN, MSN, APRN, NP]

I have often thought it would be appropriate to fully explain the difference between education and training between physicians and nurse practitioners. Then patients and the general public understand the education and training the NP has received versus a physician, and can make an informed choice as to who they receive care from. In my opinion it really is untrue to address the difference between nurse practitioners and physicians to patients as "in the primary care setting we all function exactly the same", and "I am able to provide care to you just like a physician does as I am a nurse with advanced license and training", since you are not a physician, have not received a physician's education and training, and do not provide care at the level of a physician.

The last time I checked the number of clinical hours required for nurse practitioner training at the master's degree level, the maximum number of clinical hours I found at reputable universities was around 600-800 hours, although I understand there is some variation. This is a tiny fraction of the clinical hours a physician receives. Physicians spend typically four years in medical school where their training follows the medical model, after having already obtained a bachelor's degree, usually in a science, and then spend several more years in internships, residencies, and often fellowships. Entry for Nurse Practitioner programs varies: one must have RN licensure, but not all programs require a BSN for entry; the program is then typically three years for a master's degree and around 600-800 clinical hours.

Ouch, this is pretty ignorant.

It doesn't take into account that most APRN's have years and thousands of hours as caregivers.

It also doesn't factor in like Boston said, that time and again research has shown that an NP's have similar outcomes to a physician.

All your post really does for me is highlight that physicians spend way more time and money to get the same end result as an NP. The fact that over 80% of physicians are going into specialties emphasizes this even more. Why spend way more for an education as a physician if an NP is going to be doing the exact same thing for less?

It's like having two options to get from Los Angeles to San Francisco. You can go straight north on I-5 and be there in a few hours, or you can take I-10 to Florida, drive up to New York, then take I-80 all the way back across country to San Francisco, taking a week. In the end you get to the exact same destination. One is just much more efficient and cost effective.

[BostonFNP, APRN]

It's like having two options to get from Los Angeles to San Francisco. You can go straight north on I-5 and be there in a few hours, or you can take I-10 to Florida, drive up to New York, then take I-80 all the way back across country to San Francisco, taking a week. In the end you get to the exact same destination. One is just much more efficient and cost effective.

You do get a lot of experience seeing different parts of the country on that tour, which has some value if not cost-effective value.

I don't think we should discount the breadth of experience physicians have, I am very thankful to work with some excellent ones. I also work with some excellent NPs with >20 years experience who are every bit as good. I just feel in the primary care environment it's not cost-effective for the outcomes produced.

[Riburn3, BSN, MSN, APRN, NP]

You do get a lot of experience seeing different parts of the country on that tour, which has some value if not cost-effective value.

I don't think we should discount the breadth of experience physicians have, I am very thankful to work with some excellent ones. I also work with some excellent NPs with >20 years experience who are every bit as good. I just feel in the primary care environment it's not cost-effective for the outcomes produced.

I agree with you completely. I work for a physician and defer to him regularly. He has been my mentor throughout this journey and am thankful for him.

My comments apply strictly to primary care, and I agree, even with more education, the environment for primary care isn't cost effective for physicians. They absolutely have more knowledge and education than we as NP's do, but that doesn't translate into better patient care at the primary level as you pointed out earlier. Again, that's why almost every physician is going into a specialty. Primary care doesn't pay physician's as well to begin with, the outcomes aren't different to NP's, and for the cost it's more worthwhile to go into a specialty where compensation will be significantly more.

I have all the respect in the world for physicians, but when it comes to explaining my role in a primary care environment to that of a physician, the differences from a patient and practice perspective are almost non-existent.

[Corey Narry, MSN, RN, NP]

I have often thought it would be appropriate to fully explain the difference between education and training between physicians and nurse practitioners. Then patients and the general public understand the education and training the NP has received versus a physician, and can make an informed choice as to who they receive care from. In my opinion it really is untrue to address the difference between nurse practitioners and physicians to patients as "in the primary care setting we all function exactly the same", and "I am able to provide care to you just like a physician does as I am a nurse with advanced license and training", since you are not a physician, have not received a physician's education and training, and do not provide care at the level of a physician.

The last time I checked the number of clinical hours required for nurse practitioner training at the master's degree level, the maximum number of clinical hours I found at reputable universities was around 600-800 hours, although I understand there is some variation. This is a tiny fraction of the clinical hours a physician receives. Physicians spend typically four years in medical school where their training follows the medical model, after having already obtained a bachelor's degree, usually in a science, and then spend several more years in internships, residencies, and often fellowships. Entry for Nurse Practitioner programs varies: one must have RN licensure, but not all programs require a BSN for entry; the program is then typically three years for a master's degree and around 600-800 clinical hours.

I don't see the need to one-up one another (Physician vs NP) in the setting I work at. After all we're a collaborative practice with physicians of various levels of expertise with some who are still in training working alongside us NP's with various years of experience and skill. We all represent our institution so the reality is, the patient gets all of us (NP and MD) or they take their business somewhere else.

And just to paint the opposite scenario to you. Let's say I'm about to insert a temporary hemodialysis catheter using a large French triple lumen Trialysis brand central venous catheter. Should I ask the patient and his family this question?

"I'm a Nurse Practitioner with 10 years of experience in the critical care setting. I have 4 years of BSN and 2 years of MSN. I have placed over 500 of these lines since I started working in the ICU.

I am working with Dr. ___. He had 4 years of medical school, 4 years of residency, and a year of his fellowship was spent in the ICU. He has not placed these types of lines in 10 years. Which one of us do you want to do the procedure?"

[treejay]

Physicians always bring up the clinical hours, forgetting that NPs function as a RN BEFORE receiving their NP. The total amount of clinical hours spent with patients is well into the thousands by the time the NP BEGINS their training. Most MDs haven't touched a patient except as a volunteer until they are in med school. And, if you still believe the NP FUNCTIONS differently in the PCP role, explain how? Boston FNP's explanation was actually spot on.

This simply isn't true anymore. It used to be, but with the proliferation of many direct entry programs, it is no longer the case.

[treejay]

Ouch, this is pretty ignorant.

It doesn't take into account that most APRN's have years and thousands of hours as caregivers.

I see this posted time and time again... And I will say it again. It isn't true anymore. The large number of direct entry NP programs have made this blanket statement not truthful. It is true for a substantial number of NPs. But most definitely not all. It's important to be accurate and not misleading.

[Jules A, MSN]

I see this posted time and time again... And I will say it again. It isn't true anymore. The large number of direct entry NP programs have made this blanket statement not truthful. It is true for a substantial number of NPs. But most definitely not all. It's important to be accurate and not misleading.

I believe in the next decade the years of RN experience in new grad NPs will be significantly lower. It truly worries me both from the patient care aspect as well as our professional reputation.

[Riburn3, BSN, MSN, APRN, NP]

How many direct entry programs are there versus traditional? There are none in my part of the country and just about every school in my region requires experience before attending. Doing a basicGoogle search, I would wager direct entry programs are less than 5-10% of all NP programs put there.

[Jules A, MSN]

How many direct entry programs are there versus traditional? There are none in my part of the country and just about every school in my region requires experience before attending. Doing a basicGoogle search, I would wager direct entry programs are less than 5-10% of all NP programs put there.

Old stats but this many graduates imo is significant. And I also have no use for the rationale that these direct entry MSNs have any business teaching without nursing experience. I had a couple of courses taught by intelligent instructors who had not a clue about the inner workings of health care and it was frustrating when I felt I was more knowledgeable about things especially prescribing issues than the freaking instructor.

• In accelerated master's nursing programs, 6,168 students were enrolled and 2,086 students graduated in 2012. By comparison, in 2011, there were 5,980 students enrolled and 1,796 graduates from these programs.
  
• Given their experience and level of educational achievement, many graduates of accelerated master's programs are being encouraged to pursue roles as nurse educators to help stem the growing shortage of nurse faculty.
  
• American Association of Colleges of Nursing | Accelerated Nursing Programs
  

[Neuro Guy NP, DNP, PhD, APRN]

This simply isn't true anymore. It used to be, but with the proliferation of many direct entry programs, it is no longer the case.

~Eye roll ~