How is the NP role different from MD

SN2bExpAt · Mar 14, 2008

What if NP's trained by reading textbooks only and never saw patients while in school? How competent do you think that NP would be? Not very. Would a car mechanic be any good at fixing your car if he only read textbooks? I don't think so either.
You can't learn this stuff by reading a textbook only. You need hands-on learning. You read, a preceptor points it out to you in a live patient, you see for yourself, then you read some more. Physicians do much more of this stuff and see weirder things because their training is so much longer. Their differential is much longer.
Why don't you try to learn how to play a musical instrument by reading about it only and then pick up the instrument for the first time in front of Carnegie Hall.

BINGO!!!

I was fortunate enough to witness an autopsy in my medicine clinical rotation. The pathologist was excellent about teaching my group as she cut and dissected each organ. The patient was a 285 lb female 25 year old heavy smoker who died of a pulmonary artery clot. And when I say clot, I mean this thing was the width of a child's finger and at least 15 cm long. If she had cut into her leg, I am sure there would have been more. I never would have imagined clots being that big considering all my nursing A&P comes out of a textbook and little else. I also got to see what a uterus looks like in a non-pregnant woman (size of a walnut), the circle of willis, substantia nigra, the enormity of the human liver, and much more that will stick in my brain for years to come. I learned more about putting it all together and "critical thinking" in that 1 1/2 hours than I have in weeks of medicine/nursing theory classes.

I dunno, maybe I am just jaded from all the holier than EVERYONE ELSE, INCLUDING DOCTORS attitude the majority of my nursing faculty seems to share. My medicine prof described iatrogenic as caused by doctors. If you look it up, iatrogenic means secondary problems caused by health care workers. This could mean an incompetent physiotherapist to a nurse giving the wrong medication, as well as doctors.

What I am saying is if this Dr Mundinger-esque attitude is prevalent in nursing grad schools, then I want no part of it. I was once of the attitude that 500-700 hours of clinical experience was no biggie, I can gain the rest experientially as I go along. But it seems as though egotistically charged nurses (with ZERO foundation, btw) could be a part of that experience and quite frankly, I have had more than enough verbal abuse from nursing instructors who think they are as smart as doctors because they are hoping the students won't clue in to their SEVERE A&P, immunology, pathology, organic and biochemistry, knowledge deficits. My medicine instructor is so rigid in her rightness that she will make up answers before she admits to making a mistake (and we have caught her plenty of times).

Would I be comfortable letting a seasoned NP Dx pneumonia? Sure. She/He has years of experience in a collaborative care setting.

If you are asking me to choose between a newly minted IM MD/DO grad and a newly minted ACNP grad, I'll take the grad with 10,000+ clinical hours under their belts, tyvm. I don't **** around when it comes to my health care provision.

NeuroNP · Mar 14, 2008

I learned more about putting it all together and "critical thinking" in that 1 1/2 hours than I have in weeks of medicine/nursing theory classes.
I dunno, maybe I am just jaded from all the holier than EVERYONE ELSE, INCLUDING DOCTORS attitude the majority of my nursing faculty seems to share.
...I was once of the attitude that 500-700 hours of clinical experience was no biggie, I can gain the rest experientially as I go along.

I think you've hit the nail on the head...I'm lucky enough to have a background in Biology and Chemistry and I took Anatomy and Physiology as separate classes at the graduate level before deciding to go to nursing school. I think I have a MUCH better grasp of it than most of my classmates.

I am hoping to do an externship this summer that in 10 weeks will provide me with more than 7 times the amount of clinical teaching hours (not just shadowing, but working) than my entire two year nursing program!

But it seems as though egotistically charged nurses (with ZERO foundation, btw) could be a part of that experience and quite frankly, I have had more than enough verbal abuse from nursing instructors who think they are as smart as doctors because they are hoping the students won't clue in to their SEVERE A&P, immunology, pathology, organic and biochemistry, knowledge deficits. My medicine instructor is so rigid in her rightness that she will make up answers before she admits to making a mistake (and we have caught her plenty of times).

A few weeks ago in Pharmacology (which is taught by nursing instructors, NOT pharmacologists or pharmacists:rolleyes:), the teacher was talking about respiratory medicines and made an obvious mistake on her slides. She had a slide that listed short-acting medicines and another listing long-acting medicines. The problem was, it was the same list. Someone pointed it out and she went into a 30 minute discussion of how she was right. She claimed that the Albuterol on the short-acting list and the Albuterol on the long-acting list were DIFFERENT drugs!! They were only SLIGHTLY different chemically so they called them the same thing, but actually had different actions and effects. Now, I've got a background in Chem and OChem and even took a class on drug design, so I knew this was total BS, but the majority of the class just accepted it. I even looked in the text she referenced and IT has the lists correct. This was simply a case of a teacher not having the first clue what she's talking about and not wanting to admit it! I've stopped going to any class where she is lecturing...

Nursing school has given me a lot more respect for the GOOD nurses I've worked with - because I see they got that way IN SPITE of nursing school, not because of it - and a lot less respect for nursing as a profession. All I know to do is to keep studying and trying to learn and become one of those good nurses and eventually a good NP.

This has also made me certain that NPs should not have independant practice. I'm sure there are lots out there who could do it fine, but I don't think that it's true across the board. BTW, a lot of my instructors are NPs! (The one who totally made up her own rules of Chemistry and Pharmacology isn't, but she is working on a MSN)

Bryan

jjjoy, LPN · Mar 14, 2008

Nursing school has given me a lot more respect for the GOOD nurses I've worked with - because I see they got that way IN SPITE of nursing school, not because of it

I hadn't thought of it that way, but you make a point. That's not to say that there aren't exceptional programs out there, but from my experience and from what I read here, I think there's plenty of room for improvement in nursing education.

amzyRN · Mar 14, 2008

As I'm now in nursing school, I see it's short comings. There seem to be a lot of emphasis on care plans, nursing diagnoses, and not enough biological science or even psychology for that matter. And from what I've done in clinical so far is primarily pass medication, which isn't holistic. I'd love to actually see some of the nursing theory in clinical.

My goal is to become an NP. I have an extensive science background, including med school prerequisites. I really love the science aspect and wish that nursing schools wouldn't be afraid of taking it to a higher level. What would happen if the science requirements for med school and nursing school were the same or similar, but nursing school would go into more depth with the social, spiritual, psychological aspects of healing? In my program, an Accelerated BSN, many students have science backgrounds with pre med prerequisites completed and one of my class mates even did the MCAT with a good score. We could be learning things that are more interesting and challenging, versus tricky, like deciphering NCLEX questions.

I just hope that when I go on to a masters program the it will go into more depth with the biology of healing and also will truly delve into holistic aspects of healing. And I hope that the roles of NP and MD are similar, though the former has a smaller scope of expertise, but expertise nonetheless. And I hope that the roles are different in that the NP truly uses a holistic approach to practice.