FNP care compared to MD

Jules A, MSN · Jul 31, 2016

My question is does FNP knowledge prepare you to take on this role? I never found the nursing education to be mentally stimulating and I know medical school is quiet rigorous and teaches the thinking process that is necessary to take on this role. I'm not trying to put down our profession, I am just worried and misunderstood as to how our education allows us to practice independently in some states.

I feel the same way which is why I believe it is so important we have our nursing experience in a similar specialty to at least provide a bit of a background and MD preceptors. There are plenty of nursing research articles that support positive NP outcomes but personally I think many have holes especially when so many include patient satisfaction. The truth is patients love NPs because so many spend far too much time doing things that aren't provider level and in my experience some of the most incompetent NPs and MDs are also the most beloved by their patients because they are either very nice or prescribe whatever the patient requests. What about the outcomes in primary care? How many primary care presentations aren't in need of medical care and will resolve with no intervention? What about some of the routine blunders such as prescribing antibiotics for ear infections that aren't ear infections and get included in these studies? A year later the patient will be alive and well if in fact they were treated inappropriately and didn't have an ear infection does that mean they received competent care?

allnurses Guide · Aug 2, 2016

What does the published data say? All the rest is opinion.

IcanHealYou · Aug 2, 2016

What does the published data say? All the rest is opinion.

I haven't read the data myself to be honest. However from what I've read (on forums) and heard. NP can deliver great care if not better than some physicians.

Again I havent read it myself but I think these studies may also have something to do with patient satisfaction and not really quantifying the competency of care. You can have an NP that prescribes Abx for a common viral infection. The patient will be happy and the end result will still be the same for the patient but with the risk of developing future abx resistance. Just an example, I'm sure most NPs would not be doing this.

I haven't worked a day as an NP nor have I had any clinicals yet. So I am just speaking from what I know thus far.

Purrsx2 · Aug 2, 2016

Two of my preceptors were MDs and I have seen Abx prescribed right and left for just about everything... whether it was needed or not (even to a healthy 19 y.o. with runny nose, fever of 99.9 x 1 day and no other signs/symptoms).

Adherence to the recommended treatment guidelines and EBP does not depend on the length of education.

RockMay · Aug 3, 2016

MD/DO>PA>>>>>>>>>>>>>NP

Trauma Columnist · Aug 4, 2016

Healthcare is a team sport. MD and NP are not players on opposite teams - we are not adversaries. I was called on Tuesday night to see an MDs pts Wednesday as he had a conflict in his schedule. I assure you if he felt I would provide substandard care, he wouldn't have asked me to cover his pts.

As to whether right out of the gate we are as competent and prepared as a newly minted MD....hmmmm....depends on many factors. I know that now after 10 years experience I'm a lot more competent and confident then I was as a new grad. I am well-respected among my peers and my MD colleagues. I provide good care, I ask questions when I need to, I look things up when I need to, I cont my informal education by reading journals and EBP.

I think its okay to be a little scared and humble at the beginning - for both NP and MD.

Malenurse1235954 · Aug 4, 2016

There are so many studies looking at this, have you done a lit search? I assume you have access since you are a student

Malenurse1235954 · Aug 4, 2016

Many NP vs MD arguments fail to point out how poor MDs do during residency. Everyone messes up especially as they begin their career. Looking at the classes for my first year of DNP studies, it looks like complete fluff. I'm not surprised you feel this way.

How far are you in?

Also, many people say medical school is rigorous. Not all four years are the same intensity. Look at their studies, its 2 years of hard stuff then they start clinicals. It does make sence to frontload info so you can practice your skills with a "full deck" rather than waste the first year with fluff and then start clinicals as you are learning material. Imo, this is the biggest advantage med school has over NP school. Then the sheer quanity of practice hours, but then its not apples to apples with how specialised NPs are.

If by the end of school you want more practice, dont forget NP residencies are available for FNP, ACNP, and PMHNP. Perhaps more but those are I have looked for personally

Jules A, MSN · Aug 5, 2016

Many NP vs MD arguments fail to point out how poor MDs do during residency. Everyone messes up especially as they begin their career.
If by the end of school you want more practice, dont forget NP residencies are available for FNP, ACNP, and PMHNP. Perhaps more but those are I have looked for personally

While I agree with you about the learning curve for all professions please remember that MDs during their residencies/fellowships are still in school and not functioning as independent practitioners like NPs are expected to do when they graduate.

Excellent point about fellowships or residencies. I'm hoping and suspect that as the large number of NPs continue to graduate that fellowships will become mandatory. In the past our brief education was justified because of our many years of RN experience which thanks to the greedy schools is no longer the case in many instances-retain those students at all costs because if they go out and gain experience they might not come back to school or might spend their money at another school.

How can anyone feel it is acceptable to hand someone full prescribing rights with only 1 or possibly 2 pharmacology courses?

allnurses Guide · Aug 5, 2016

While I agree with you about the learning curve for all professions please remember that MDs during their residencies/fellowships are still in school and not functioning as independent practitioners like NPs are expected to do when they graduate.

Medical residents often practice as independently (if not more) than NPs working in collaborative practice states. In some ways, collaborative practice acts as a residency of sorts for novice NPs.

Jules A, MSN · Aug 5, 2016

Medical residents often practice as independently (if not more) than NPs working in collaborative practice states. In some ways, collaborative practice acts as a residency of sorts for novice NPs.

Interesting point for states with a collaborative requirement and I guess depending on the Doc there might be some helpful oversight. How was your collaborating experience?

My collaborating physician had no involvement in my practice. He wasn't at my worksites, wasn't privy to my documentation or prescribing. Seriously I was shown the bathroom, given an office and prescription pad. In my state now NPs have independent practice rights so new NPs only need to list a mentor with the BON, no other stipulations requiring any type of supervision.