In Support of Independent NP Practice

[Corey Narry, MSN, RN, NP]

Resources from Bridging the Provider Gap:

From the National Governors Association: http://www.nga.org/cms/home/news-room/news-releases/page_2012/col2-content/nurse-practitioners-have-potenti.html

- looks like state governors are in favor of practice independence for NP's

AANP Map of Practice Environments Across States, 2013

Citizens Advocacy Center: Reforming Scope of Practice, A White Paper

[subee, MSN, CRNA]

The governors just want to keep their Medicaid costs as low as possible. Little do they know the poor quality of many of our NP programs with their incredibly low standards (such as no previous experience). And online programs? - puhleez. As more MD's refuse to accept Medicare, the Medicaid clinics will swell. If nurses want to practice INDEPENDENTLY, they better insist on raising their entrance requirements and clinical requirements. I go to an FNP now because I'm healthy and the MD in the practice won't see me. She never had nursing experience. Fortunately for me, there's not much for her to do except renew my prescriptions. I've been lucky in health.

[Corey Narry, MSN, RN, NP]

I know that this is just your opinion but for the benefit of having an intelligent, balanced, and productive discussion on the subject, I would appreciate factual data supporting the dangers of granting NP's the right to practice primary care to the full extent of their training. Specifically, enumerate any encountered documented actual harm done by NP's in states where these individuals practice primary care independent of any physician supervision. Without that convincing data, I'm going to stick to my belief that your post is merely a subjective opinion of your perceived weakness of direct entry NP programs and online nurse practitioner education which has been discussed ad nauseam in other threads on the APRN forum.

[PMFB-RN, RN]

Great! I am all for it. How can I help?

[Corey Narry, MSN, RN, NP]

The way our country is set-up, changes occur within states to change legislation. Look for what your state NP groups are doing in terms of lobbying and watch out for bills that push back and restrict practice.

[Susie2310]

According to the terms of service I may respectfully disagree with other views put forward on this thread. Someone made the point on another thread that they believe medical school is the place for those who want to practice serious medicine. I agree completely. There is a big difference in the education and training a medical doctor receives versus the training a nurse practitioner or physician assistant receives. The former qualifies the person to practice medicine. My family members with multiple complex medical conditions need the expertise of a physician, and receive their medical care from internists and other physician specialists. I am not going to debate that medical doctors are much more highly trained in medicine than nurse practitioners and physician assistants because it is a foregone conclusion.

I too can tell of my family's personal experience with urgent care received by a non-physician, which resulted in my family member's delay in being diagnosed with sepsis and resulted in a delay in beginning treatment. I will not allow a non-physician to treat my family members again. This other poster mentioned that when your family member's life/health is at stake you want the most qualified person to be treating them, i.e., a physician. I will settle for no less than a physician for my family, for myself, and I wish the same for all the people of the US. I live in a state that does not have independent NP practice, and I wish for it to remain that way. As a nurse I support the physicians all over the country who are doing their best to push back against independent NP practice.

[BostonFNP, APRN]

According to the terms of service I may respectfully disagree with other views put forward on this thread. Someone made the point on another thread that they believe medical school is the place for those who want to practice serious medicine. I agree completely. There is a big difference in the education and training a medical doctor receives versus the training a nurse practitioner or physician assistant receives. The former qualifies the person to practice medicine. My family members with multiple complex medical conditions need the expertise of a physician, and receive their medical care from internists and other physician specialists. I am not going to debate that medical doctors are much more highly trained in medicine than nurse practitioners and physician assistants because it is a foregone conclusion.

I too can tell of my family's personal experience with urgent care received by a non-physician, which resulted in my family member's delay in being diagnosed with sepsis and resulted in a delay in beginning treatment. I will not allow a non-physician to treat my family members again. This other poster mentioned that when your family member's life/health is at stake you want the most qualified person to be treating them, i.e., a physician. I will settle for no less than a physician for my family, for myself, and I wish the same for all the people of the US. I live in a state that does not have independent NP practice, and I wish for it to remain that way. As a nurse I support the physicians all over the country who are doing their best to push back against independent NP practice.

You can disagree, refuse to see anyone but a MD for you and your family, and be an active advocate against NP practice based on your "experiences".

In the end, policy will be made on hard data of satisfaction, cost, and outcomes. If you are such a vehement advocate against NP autonomy, haven't you dug up some data to support your position?

[BostonFNP, APRN]

poor quality of many of our NP programs with their incredibly low standards (such as no previous experience). And online programs? .

The literature has confirmed that prior experience and online format have no significant effects on NP practice. What are your sources?

[SycamoreGuy]

Susie,

Your experiance with non-physician providers is completely anecdotal and has nothing to do with NPs ability to work independently within their scope of practice. Since we are sharing experiences let me share my wife's. She saw a family practice MD, an MD with "extra training" in dermatology, and a FNP at a dermatology clinic, in that order. She ended up having a simple fungal rash made worse by the MD with "extra training" prescribing a steroidal cream. It was the NP that finally got the Dx right.

[zenman]

According to the terms of service I may respectfully disagree with other views put forward on this thread. Someone made the point on another thread that they believe medical school is the place for those who want to practice serious medicine.

But I don't want to practice SERIOUS medicine...so boring.

I too can tell of my family's personal experience with urgent care received by a non-physician, which resulted in my family member's delay in being diagnosed with sepsis and resulted in a delay in beginning treatment. I will not allow a non-physician to treat my family members again.

Both my parents had complex comorbid conditions. Both loved their PAs and NPs more than their physicians. Dad's still trucking but mom passed on. I also went to an Urgent care after two visits to a physician for a rash. The NP gave me a new cream and knocked it out, yea!

[BostonFNP, APRN]

But I don't want to practice SERIOUS medicine...so boring.

Both my parents had complex comorbid conditions. Both loved their PAs and NPs more than their physicians. Dad's still trucking but mom passed on. I also went to an Urgent care after two visits to a physician for a rash. The NP gave me a new cream and knocked it out, yea!

I manage most of our patient panel that is complexly ill because I am afforded more time than my collaborating MD. I do not manage them in isolation, nor do I manage any patients in isolation, we have a collaborative office and we are very good at gatekeeping care with specialists. I have an excellent relationship with my collaborating doc and we consult each other multiple times per day.

Many patients that do not want to see me for their regular visits often end up seeing me for a sick visit and end up wanting to stay with me for future visits (though we always try and alternate).

[PMFB-RN, RN]

I too can tell of my family's personal experience with urgent care received by a non-physician, which resulted in my family member's delay in being diagnosed with sepsis and resulted in a delay in beginning treatment. I will not allow a non-physician to treat my family members again.

*** Since we are telling stories...........

I believe my wife's life was saved by an NP. After 4 visits to our family doctor (no visit lasted longer than 5 min) who told her that her symptoms were in her head she made an appointment with a different health system. She asked to see a women's health provider and they set up an appointment with an NP. The NP spent almost an hour talking with and examing her. She ordered labs and when the results came back immediatly sent us to an oncologist who told us my wife had ovarian cancer. She had surgery the next day and the oncologists said over and over that if it haden't been caught when it was the outcome would have been very different.