Full Practice Authority

Published

I am not sure on what side of the fence I stand on as of yet. I am having difficulty squaring the different level of standards for an APN to practice medicine vs a physician. Can somebody explain this to me?

Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
On 9/16/2019 at 3:06 AM, frozenmedic said:

Source-married to an MD, been together through his medical school/residency and my nursing school.

Similar — my husband graduates from an MD program in 8 months, and we have been married since he was working on undergrad; I had already been an RN for five years when we met. Watching him go through the MCAT study, application process, interviewing, and acceptance was bad enough! Now we're looking at residency applications and interviews, it feels like the beginning all over again, hahaha. Seeing his journey through med school really made me not want to pursue NP in its current state of education requirements. I find it disheartening when non-physicians claim that their education and training is the same as an MD's. It simply isn't. That doesn't make it bad! Everyone can make a contribution to patient care.

@traumaRUs, I really appreciate your viewpoint on what FPA means. I just hope less experienced APRNs will embrace your philosophy too!

4
Up Vote Up Vote ×
Specializes in Nephrology, Cardiology, ER, ICU.
36 minutes ago, Pixie.RN said:

Similar — my husband graduates from an MD program in 8 months, and we have been married since he was working on undergrad; I had already been an RN for five years when we met. Watching him go through the MCAT study, application process, interviewing, and acceptance was bad enough! Now we're looking at residency applications and interviews, it feels like the beginning all over again, hahaha. Seeing his journey through med school really made me not want to pursue NP in its current state of education requirements. I find it disheartening when non-physicians claim that their education and training is the same as an MD's. It simply isn't. That doesn't make it bad! Everyone can make a contribution to patient care.

@traumaRUs, I really appreciate your viewpoint on what FPA means. I just hope less experienced APRNs will embrace your philosophy too!

Thanks for your kind words. As Clint Eastwood says, "a man's got to know his limitations."

3
Up Vote Up Vote ×
Specializes in CCRN BSN Student FNP.
35 minutes ago, traumaRUs said:

Thanks for your kind words. As Clint Eastwood says, "a man's got to know his limitations."

And that's what I am talking about. So many don't know what they don't know. Which brings me back to the different levels of treatment for practicing medicine. NPs have a significantly lower bar for minimum competency for medical practice. They just do. NPs should not advertise themselves as separate but equal....we just aren't. You might not, she/he might not, but academia and the powers that be do, or at the very least don't appear to try very hard to correct misplaced assumptions.

Up Vote Up Vote ×
Specializes in Nephrology, Cardiology, ER, ICU.
42 minutes ago, rkealy said:

And that's what I am talking about. So many don't know what they don't know. Which brings me back to the different levels of treatment for practicing medicine. NPs have a significantly lower bar for minimum competency for medical practice. They just do. NPs should not advertise themselves as separate but equal....we just aren't. You might not, she/he might not, but academia and the powers that be do, or at the very least don't appear to try very hard to correct misplaced assumptions.

Hmmm...I never represent myself nor do I allow my pts to think I'm the MD. I work with several pts who are vets (as am I) and they call me "doc" but they are very aware I'm not the physician.

APRNs who put themselves out there as equal to MDs IMHO are the ones that are dangerous - not knowing your limitations can harm pts.

That said, APRNs certainly have a role to fulfill and it is very rewarding and lucrative. Healthcare is a team sport - we all are cogs in the big wheel of patient care.

4
Up Vote Up Vote ×
On 9/16/2019 at 6:27 AM, rkealy said:

... all these filler classes about leadership, healthsystems, informatics and health policy leadership is a bunch of bunk. Its like the nursing academia are trying to turn NPs into the koolaid man crashing through the door yelling "I am a case-manager! A policy leader! I am a practitioner! I am EVERYTHING TO EVERYONE! and you.......you are a puny physician!"

This. So much this. I want to post it in every breakroom and have it printed on cards for when I have to sigh at my coworkers with 3 months of experience who are already in DNP programs. I have never seen a better and more hilarious summation of the problems with DNP curriculum and the navel-gazing nursing academics who created it.

FWIW: Physicians are studying this stuff too...the difference is "Clinical Informatics" is a dedicated TWO YEAR fellowship after medical residency. But sure, let's toss that into a DNP program and call it covered too.

3
Up Vote Up Vote ×
Specializes in Psychiatric and Mental Health NP (PMHNP).

I'm not sure why we are even debating this. The trend is to grant FPA to NPs and it is not going to suddenly halt or reverse. Like it or not, over 100 studies have shown quality of care provided by NPs to be the same as MDs and patient satisfaction tends to be higher with NPs. How many studies have to be done to satisfy the doubters?

In addition, given that almost 1/2 of states and the Veterans Administration have FPA for NPs, is there any evidence that quality of care has suffered in those jurisdictions? NO.

Most NPs work in primary care. The chances of someone dying in primary care are quite low, a lot lower than in the inpatient setting. NPs are quite sufficient to treat most primary care problems. Anything really complicated should be referred to a specialist anyway.

I favor FPA. Not for a brand new grad NP, but after a certain number of years of experience, say 2 to 5. I would support granting expedited independence to NPs working in areas with a severe shortage of providers, such as rural areas. This can be easily calculated using the HPSA score.

There is NO evidence that MD oversight of NPs improves quality outcomes. NONE. It is just a way for MDs to line their pockets.

Any NPs who don't want FPA can move to a state with restricted practice.

Here is one problem I have seen repeatedly with MDs in primary care: they don't want to admit they don't know how to help a patient. Some MDs will keep trying different crap and the patient gets no help, sometimes for several months. Patient comes to see me and I refer to specialist - specialist solves problem immediately.

In addition, all MDs are not created equal. There are plenty of crappy ones out there.

I'd rather see a competent NP than an incompetent MD.

Up Vote Up Vote ×
Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
1 minute ago, FullGlass said:

I favor FPA. Not for a brand new grad NP, but after a certain number of years of experience, say 2 to 5.

Unfortunately it's all or nothing, right?

1
Up Vote Up Vote ×
Specializes in Psychiatric and Mental Health NP (PMHNP).
2 hours ago, Pixie.RN said:

Unfortunately it's all or nothing, right?

Why would it be all or nothing? FPA is granted at the state level and so the state can determine the requirements. Based on responses from other posters, some states have experience requirements for FPA.

1
Up Vote Up Vote ×
Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
43 minutes ago, FullGlass said:

Why would it be all or nothing? FPA is granted at the state level and so the state can determine the requirements. Based on responses from other posters, some states have experience requirements for FPA.

That was why I asked — I didn't know. Thanks for the info.

1
Up Vote Up Vote ×
3 hours ago, Pixie.RN said:

Unfortunately it's all or nothing, right?

No. My state requires about 2 years of experience

2
Up Vote Up Vote ×
Specializes in Nephrology, Cardiology, ER, ICU.
On 9/24/2019 at 2:35 PM, Pixie.RN said:

Unfortunately it's all or nothing, right?

Our FPA in IL states you have to have 4000 hours of practice prior to being granted an APRN-FPA license.

1
Up Vote Up Vote ×
Quote

And that's what I am talking about. So many don't know what they don't know. Which brings me back to the different levels of treatment for practicing medicine. NPs have a significantly lower bar for minimum competency for medical practice. They just do. NPs should not advertise themselves as separate but equal....we just aren't. You might not, she/he might not, but academia and the powers that be do, or at the very least don't appear to try very hard to correct misplaced assumptions.

Very true. And yet, multiple studies show that NPs provide quality primary care. Why is that? It’s an interesting question.

I used to work bedside in a unit with lots of NPs. In that setting, roles were sharply demarcated, with MDs directing the care and NPs doing so-called “scut work” like writing routine prescriptions and simpler procedures. I would not want to be under the care of an NP in a cardiac unit. But a primary care office is not a cardiac unit. Perhaps MDs are working below their potential in the primary care role?

The system itself may be to blame. MDs who choose a primary care track go through lots of training, including rotations in the hospital and learning surgeries. But in primary care, where you have to see a new patient every 15 minutes, how can they utilize that knowledge? I think that is why, at least in my experience, primary care NPs and MDs provide almost identical care. We all work under the same constraints, with the same goals, and we all refer on to specialists at about the same point.

Add to this that education can take you only so far. For most people, a few years in the field whittles your knowledge base down to the specifics of your population. An MD may have more schooling, but much of that recedes with time and experience. We are all left with the same patients and the same standards.

I have big concerns about low standards for NP schools at present, but I don’t think that’s something that we can depend on physicians to correct. If oversight needs to happen, I don’t see why another NP with a certain amount of experience can’t be the one to oversee new grads and pick out the ones that are incompetent. In any event, I think that NPs should have the option of becoming independent after a certain number of years of practice without incident.

2
Up Vote Up Vote ×
+ Join the Discussion