Full Practice Authority

Oldmahubbard · Sep 12, 2019

Great question. In many states, APRN's are relatively independent, within their scope of practice, usually after some defined period of experience.

It doesn't mean APRN's can do anything physicians can do. My state is relatively independent, ie, no specific physician is required to monitor me, but the state requires me to maintain a relationship with a hospital, which I find rather hilarious.

There are still a couple of pieces of paperwork that I cannot sign, for no good reason.

As Medicare providers, by definition, NP's are expected to collaborate with other clinicians. Opticians, podiatrists, all included, we are there.

The rules and regs surrounding APRN practice vary so greatly by state, it precludes any explanation here.

Many restrict the prescription of controlled substances. So far, this has not seemed to have much benefit.

Perhaps the best answer to your question would be personal observation of NP's in practice.

NP's are known for their bedside manner, and their patient outcomes.

Of course, there are many things that physicians are qualified to do, that we are not. As a Psych NP, I don't do ECT.

One thing that did not have any effect whatsoever on outcomes, was the previous laws of my state. Where the MD had to review the NP's records every 3 months for a half hour.

Our Governor, Andrew Cuomo, made the comment that this was a financial arrangement, and not a clinical arrangement.

It was discontinued on January1, 2015.

Thank you Mr Cuomo

babyNP., APRN · Sep 13, 2019

In regards to neglect or malpractice, it's my understanding that NPs are held to a similar level as physicians. It's not like if a NP screws up a medication prescribed to a patient that harms the patient- that they are held to less of standard as if the physician made the same error.

rkealy, BSN · Sep 13, 2019

So nurses that are practitioners, practice both nursing and medicine without supervision. what is the logic behind having different standards of practice levels. I mean why is it that doctors are held to a different level of education to practice medicine a nurse practitioners are not held to the same standard. But yet we are fighting for this independence without oversight without any real restrictions other than your own morals on how to practice. I have some difficulty squaring that as a public safety issue. Especially with so many diploma mills turning out NPs without standardization of education or standardization of experience requirements.

Hoosier_RN, MSN · Sep 13, 2019

52 minutes ago, rkealy said:
Especially with so many diploma mills turning out NPs without standardizati5on of education or standardization of experience requirements.

While that statement may be true as a stand alone statement, remember that NPs must go take boards and certifications, and pass, beyond the RN boards. They don't just finish class, graduate, and turn out and practice. Sadly, some of those diploma mill graduates find out too late that they didn't get the education that they needed to pass or get credentialing...There have been a couple on here that I vaguely remember

Oldmahubbard · Sep 14, 2019

The PMHNP boards are a total joke, as I have said here before. Most RN's could pass it with a couple of hours of study.

Penguins10, MSN, RN, NP · Sep 15, 2019

Had similar questions as a new grad, now think FPA makes sense. The NP model has been around since the 1960s and tested extensively. I have not seen a study showing NP care is unsafe (happy to see if someone has one), if someone disagrees then do the research and show it.

How does someone reading my progress notes days or weeks after I see a patient provide “supervision”? If I’m such a threat to public health how can you rely on my version of a patient encounter to evaluate my care? As a professional I need to know when to ask for help whether I’m working as an RN, an RN with NP license, PT, MD, JD....

Current supervision requirements are almost always a facade and essentially about asserting physician control as a professional guild.

I am happy to critique NP education, but I don’t think requiring nominal physician supervision helps patients, nurses, or physicians.

Oldmahubbard · Sep 15, 2019

Absolutely. The nominal physician collaboration previously required in my state did nothing at all to protect the public. A chart review months after the fact? And the patient was never seen by the MD? What does that do?

I suppose it might be possible to identify the grossly incompetent in this manner, but it seems to be a political farce. And all about lining the MD's pocket

MikeFNPC, MSN · Sep 15, 2019

I work with an MD who doesn't follow guidelines, leading to frequent adverse reactions, poor outcomes, and even hospitalizations. If it weren't for my nursing background (all nurses are type A it seams, lol) and my preponderance to follow national guidelines, I'd get pushed around to treat patients like the MD does.

Yes, it matters what education you get before treating patients. But as the adage goes, they still call the last graduate in medical school doctor.

Anyone who practices medicine has to know they're own limitations and when to refer. And, that is a personal matter. We don't need a medical degree to treat a sore throat, but we do need to know when that sore throat needs to go to ENT because it could be cancer (as what happened to one of my patients).

Full practice authority is where this country is heading, we get to participate in what that looks like.

Trauma Columnist · Sep 15, 2019

On 9/13/2019 at 1:50 PM, babyNP. said:
In regards to neglect or malpractice, it's my understanding that NPs are held to a similar level as physicians. It's not like if a NP screws up a medication prescribed to a patient that harms the patient- that they are held to less of standard as if the physician made the same error.

I can certainly attest to this. I made a prescribing error when I first became an APRN and yes, I was held to the standard of being completely knowledgeable about the med. The MD was not involved.

popopopo · Sep 15, 2019

This has been discussed many times over the years. Common points for FPA seems to be

1. primary care is "easy"

2. already doing it d/t poor physician supervision

3. physician "shortage"

4. outcomes are the "same"

5. medschool knowledge superfluous and not practical

^I put quotes above because those topics are debated in a whole other issue. Proponent against FPA seems to be centered around the discussion of diploma mills and quality of training of nps overall. A few nps here will chime in about how rigorous their training is despite being online, working ft, yada yada... or how their physician is inept and the np saves the day.

I don't know OP, seen it all, don't know which side I'm on, but I've said that in the past it would be great if we can invite some physician friends over to calmly discuss the issue on the forums. I know student doctor.net knows about us and we know about them.

Oldmahubbard · Sep 15, 2019

At the same time the quality of NP education is declining, which I think is indisputable, FPA is increasing. I fear a perfect storm, but I hope to be at least semi-retired by then.