Independent practice for APRN's, unfair to MD's.

Jules A, MSN · Feb 20, 2017

"Physicians and the general public do not have a full concept of the education and training of nurse practitioners," said Linda McIntosh who works as an APRN in a clinic in Searcy.

And if they actually did have the full concept including our minimal admission requirements, no requirement for RN experience, minimal clinical hours, brand new NPs precepting and the overload of nursing theory courses does she think that would help or hurt the cause? :uhoh3:

allnurses Guide · Feb 20, 2017

Independent practice for APRN's, unfair to MD's. Not only that but, " it could take patients away from them (MD's) and impact their bottom lines. These are the kind of comments when there is no real evidence.
Bills allowing APRNs more independence fail in health committee | KATV

What the article is speaking to is anti-competition and is illegal in almost every instance.

There is no evidence to suggest that APRNs are unsafe or provide lower quality of care compared to their physician counterparts.

MikeFNPC, MSN · Feb 21, 2017

That's my point. We finally have in print the best argument to keep APRN's in delegation agreements, it just isn't fair to the doctors. What a sophomoric point to make. Not to mention, where does the patient fit into the argument?

Riburn3, BSN, MSN, APRN, NP · Feb 21, 2017

And if they actually did have the full concept including our minimal admission requirements, no requirement for RN experience, minimal clinical hours, brand new NPs precepting and the overload of nursing theory courses does she think that would help or hurt the cause?

My problem with your mentality is that you consistently offer no clinical proof that our quality is lacking. I agree with you on this site 99% of the time, but in this regard I struggle to understand why a smart individual works in anecdotes to belittle your very profession. Do you think the majority of NP's working out there have no RN experience and went to schools with low admission standards? I'm upset schools like this exist myself, but I don't think NP's like this are anywhere close to the majority.

If we were really so unsafe and dangerous, states that have had independent practice for some time now would be seeing a significant drop in their quality and outcomes. The opposite has happened with more people having access to healthcare.

If we were so unsafe, states would be rolling back our independence, but in reality, more and more states are becoming independent practice.

If we were so unsafe, medical lobbying groups would be able to put up better arguments other than "we have more education" or dumb articles like this one where they argue that we might hurt physicians bottom lines.

If we were so unsafe, there would be a mountain of research proving it, when the reality is there have been hundreds of articles to the opposite effect.

When the VA announced that they wanted all their NP's to be able to practice without physician supervision, this is all the American Medical Association could muster:

The American Medical Association (AMA) is disappointed by the Department of Veterans Affairs' (VA) unprecedented proposal to allow advanced practice nurses (APRN) within the VA to practice independently of a physician's clinical oversight, regardless of individual state law. With over 10,000 hours of education and training, physicians bring tremendous value to the health care team. All patients deserve access to physician expertise, whether for primary care, chronic health management, anesthesia, or pain medicine.

Not once do they mention any reasoning suggesting we are inferior, only that they have more education so that's why the VA shouldn't allow us to be independent practitioners. This is an organization that has spent hundreds of millions of dollars in lobbying, and this was all they could come up with.

I'm sorry, I just don't understand why some nurses in our own profession love to bring each other down when all the evidence points to us doing a solid job in the healthcare system. Doing so in a more cost effective manner and without us spending ages in school.

Jules A, MSN · Feb 21, 2017

My problem with your mentality is that you consistently offer no clinical proof that our quality is lacking. I agree with you on this site 99% of the time, but in this regard I struggle to understand why a smart individual works in anecdotes to belittle your very profession. Do you think the majority of NP's working out there have no RN experience and went to schools with low admission standards? I'm upset schools like this exist myself, but I don't think NP's like this are anywhere close to the majority.
If we were really so unsafe and dangerous, states that have had independent practice for some time now would be seeing a significant drop in their quality and outcomes. The opposite has happened with more people having access to healthcare.
If we were so unsafe, states would be rolling back our independence, but in reality, more and more states are becoming independent practice.
If we were so unsafe, medical lobbying groups would be able to put up better arguments other than "we have more education" or dumb articles like this one where they argue that we might hurt physicians bottom lines.
If we were so unsafe, there would be a mountain of research proving it, when the reality is there have been hundreds of articles to the opposite effect.
When the VA announced that they wanted all their NP's to be able to practice without physician supervision, this is all the American Medical Association could muster:
The American Medical Association (AMA) is disappointed by the Department of Veterans Affairs' (VA) unprecedented proposal to allow advanced practice nurses (APRN) within the VA to practice independently of a physician's clinical oversight, regardless of individual state law. With over 10,000 hours of education and training, physicians bring tremendous value to the health care team. All patients deserve access to physician expertise, whether for primary care, chronic health management, anesthesia, or pain medicine.

Not once do they mention any reasoning suggesting we are inferior, only that they have more education so that's why the VA shouldn't allow us to be independent practitioners. This is an organization that has spent hundreds of millions of dollars in lobbying, and this was all they could come up with.
I'm sorry, I just don't understand why some nurses in our own profession love to bring each other down when all the evidence points to us doing a solid job in the healthcare system. Doing so in a more cost effective manner and without us spending ages in school.

It is no secret that I believe our profession which was light to begin with absolutely will start showing the signs of poor care and a lack of knowledge. What is very interesting lately is that a few old timers here with what appears to be impressive backgrounds used to disagree with me on this topic and yet now it seems more and more they are also frustrated with our profession's low expectations. As far as I know it has only been a few years that the admission standards have dropped so significantly, schools are crawling out of the woodwork and the lack of RN experience has become common place so there is no data yet.

Worth noting I don't think I have harped on the point that inexperienced or incompetent NPs are actually dangerous just not likely to be good. That doesn't mean the brand new NP with no RN experience making $90,000 a year, my biggest complaint of this entire scenario, prescribing antibiotics to every kid who comes in because the parents are pushing for it is a dangerous NP, just a lousy one. And that some NPs have the gall to assert they are not mid-levels and are equal to physicians is appalling.

Riburn3, BSN, MSN, APRN, NP · Feb 22, 2017

It is no secret that I believe our profession which was light to begin with absolutely will start showing the signs of poor care and a lack of knowledge. What is very interesting lately is that a few old timers here with what appears to be impressive backgrounds used to disagree with me on this topic and yet now it seems more and more they are also frustrated with our profession's low expectations. As far as I know it has only been a few years that the admission standards have dropped so significantly, schools are crawling out of the woodwork and the lack of RN experience has become common place so there is no data yet.
Worth noting I don't think I have harped on the point that inexperienced or incompetent NPs are actually dangerous just not likely to be good. That doesn't mean the brand new NP with no RN experience making $90,000 a year, my biggest complaint of this entire scenario, prescribing antibiotics to every kid who comes in because the parents are pushing for it is a dangerous NP, just a lousy one. And that some NPs have the gall to assert they are not mid-levels and are equal to physicians is appalling.

Time will tell, and I agree with you that something should be done about the standards of some of the schools out there that have low admission standards. I know where I live in Texas, some for profits don't have recognition by our state board, and I imagine many other states are the same. To me that will be what kills the take all comers model, when more and more states stop recognizing degrees from those institutions. That said, I doubt direct entry students, for profit students, or nurses with no experience make up a significant chunk of new NP grads out there, so I don't think a large quality dip will occur as a whole.

I also don't think you will find many asserting that NP's are equal to physician's in terms of education and knowledge. That is folly. The larger argument predominantly comes from the scope of primary care, where numerous studies comparing the disciplines find similar outcomes/quality. This is largely where the push for independence comes from. We have a profession (NP's) where over 80% of us work in primary care versus another profession (physicians) where fewer and fewer providers are choosing to enter into primary care at less than 15% of new docs. Combine that with the growing demand for primary care and you see where NP's draw their argument. It's not to say that we are equal, but more to say we can perform a similar role, safely, effectively, and often at a lower cost.

Jules A, MSN · Feb 22, 2017

I know where I live in Texas, some for profits don't have recognition by our state board, and I imagine many other states are the same. To me that will be what kills the take all comers model, when more and more states stop recognizing degrees from those institutions. That said, I doubt direct entry students, for profit students, or nurses with no experience make up a significant chunk of new NP grads out there, so I don't think a large quality dip will occur as a whole.
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Sigh, I need to move to Texas! Check this out. There is a long list approved by the CCNE. In Maryland yowza 27 pages of approved NP programs for the state. DC lists the board certifications it accepts. No clue about the last source but it lists 85 accredited online NP programs. Imagine if each of the 85 online schools only graduate 50 students a year = 4,250 in a year = 42,500 in 10 years and that is only from the list of online schools, not all schools. All other things aside I'm not sure any industry could contain quality with this kind of growth.

http://directory.ccnecommunity.org/reports/rptAccreditedPrograms_New.asp?sort=institution

http://mbon.maryland.gov/Documents/approved-np-programs.pdf

https://doh.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/12%20APRN%20New%20License%20Instructions.pdf

Accredited Online Nurse Practitioner Programs

OllieW, DNP, PhD, NP · Feb 23, 2017

my biggest complaint of this entire scenario, prescribing antibiotics to every kid who comes in because the parents are pushing for it is a dangerous NP, just a lousy one. And that some NPs have the gall to assert they are not mid-levels and are equal to physicians is appalling.

Many years ago as a travel nurse in a backwoods hospital in the midwest, I was receiving report from a brand new nurse in a sad step-down unit. She was reporting on a patient who was actively screaming in his room and the reporting RN stated he has 1mg ativan Qq4 hrs PRN. I asked, "are you giving him a full dose?". She looked at me as if I had just taken a dump right in front of her and said, "you mean a NURSING dose? I would NEVER do that!!!" I will never forget her look of indignation over the mere thought of giving a touch more than was prescribed for a patient who would clearly benefit from it.

Flash forward to me as a newbie NP and the MD suggest I prescribe antibiotics for a patient with now clinical indications other than they were a PIA and asking for them. I struck that same indignant look and my physician said, "whatever" and walked away. It took me a while to remember back to that nurse with her 6 months experience as if she knew the world. Not saying that it is right to prescribe abx all willy nilly but sometime you do prescribe when all else fails. 98% of the time I say no, but there are those times I just give in.

Also, I do agree NPs and PAs are not equal to the MD. I cringe when I hear others make that claim.