Is anybody else tired of the nurse practitioner craze?

czyja, MSN, RN · Sep 17, 2011

@czyja - you are correct about school for APNs being (like the RN education model), a starting point. I've been out of school for over 5 years now and I'm still learning. School is the starting point for entry level. Just as an RN new grad is entry level, so is newly educated APN entry level.

Right. The same way medical school is the starting point for physicians and surgeons. There is a good reason why July is a dreaded month for staff nurses! Nobody expects an R1 to work without a close level of support. We should not expect the same of NPs.

FCMike11, BSN · Nov 17, 2011

You cant compare the two, or even say RN is the starting point for NPs (ive known many nps who just went straight through from rn-np never getting any clinical exp).

Really where nps are stepping on toes is the huge push for independent rights

WillRegNurse · Dec 9, 2011

Will's feelings are not original. They were first voiced by Martha Rogers herself. I don't agree with her either, but Will should give credit where credit is due.
Will is free to see whomever he chooses as his care provider, and I support his choice. If he is uncomfortable with an APN, I do not think he should see one and I sincerely hope the option to see a primary care physician continues to be available to him and everyone who prefers one. However, there is no disputing that for a great many, a primary care physician is not available for any number of reasons and for those people, APNs and PAs are not "second best," they are their lifeline.

I'm not intimately familiar with Martha Rogers' views on nurses transitioning into medicine, but if she and I are of one stance on this, then she sounds like an intriguing individual whose views might be worth researching.

The role of "filling in" for the role that the unavailable, thinly stretched primary care physician is transitioning out of seems flawed. While filling a social need is an admirable role, I believe that the "second string" reputation of NPs that it perpetuates only hurts the profession. It makes them seem less like independent practitioners, not more so.

In my carefully considered opinion, the future of nursing lies in bedside care, case management, consulting with social services, end of life issues, ethical decisions. I would sooner see financing for more medical school seats in order to increase our pool of physicians, so that nurses can unify and focus efforts into causes which are (in my estimation) more worthwhile than opening more NP schools.

MyUserName,RN · Dec 9, 2011

people are commending nps without any actual reasoning here, it seems. i think this is due to loyalty to the profession rather than actual logic. you guys are just giving anecdotal "crappola" testimony rather than showing any data that warrants the notion that fnp's provide equal to or better care than medical doctors. that just does not fly in an academic setting.
i remember one time i was seen by an np at my university infirmary, she just immediately had the md see me after suggesting some weird diagnosis, which was contradicted by the md's true diagnosis minutes later. then the np said "yes, i agree. that's what i thought too."
if people want to give an actual reason for why visiting an np trumps an md, i'm all ears. if people instead just want to toot their own horns, then i won't be as receptive to that. that kind of ignorant chest-beating is not intelligent.
my family practice md would have an appointment ready for me within a week. if fnps are there just to shorten appointment times, or to "fill a gap," then i think they need to reconsider their role badly! the fnps that i have seen seem more interested in "proving themselves" rather than following up on care.

it's interesting to note that you are requesting something that you aren't giving. in both your posts all i've seen is your opinion that you don't see the use in midlevels and you've given your anecdotal "crappola" testimony as to why you have that opinion, yet you want the replies to contain some sort of scientific data as to why you are wrong? here's your "evidence" as to why np's are "useless"

"i don't know about all of you, but if i had a medical issue, i wouldn't bother seeing an np. i'd go straight to an md. the idea of an np seems folly to me. either you are a nurse or you aren't one. or, either you practice medicine or you don't. a nurse practicing some form of low-level to mid-level medicine seems absurd. "

notice the "i" and "seems" language? you think it seems absurd....yeah, real evidence there.

"if nps had limitless prescription power, and could be trained for some surgeries, we'd be looking at something real. but the np's that i have seen "practicing" at my hospital just seem to be adjunct to the mds who see their patients."

once again, they seem to you to be useless....

"the patients don't take the nps seriously for just that reason. they seem roleless. i feel like the hospital hires them just as tokens."

oh really? patients don't take nps seriously? well, i've seen plenty of posts on here from other nurses who actually see np's instead of md's who take them quite seriously. i also have talked to patients who aren't nurses who very much appreciate the np's or pa's that they see at the office. but that is just anectdotal evidence i guess because it relies on the patients "opinion" and not scientific data...but that's all you are offering as well. have you asked your patients if they take the np's seriously or are you just assuming that's how they feel just because that's how you feel? it's obvious you think your opinion is so great that it must equal scientific data and is obviously above all others opinions to any matter. :uhoh3: once again, notice your "seem roleless" and "i feel like" terms....oh and i don't know of any hospital that would blow money on anyone they felt were just "tokens". hospitals like money and they like to keep it. so that statement is just absurd. once again, you "feel like" that's what the hospital is doing, but have you asked the hospital administrators why they hire np's? no. this is just your opinion.

"there is this one lady nurse practitioner at my hospital who goes into the patients' room and says "hi, my name is kristen and i'm the nurse practitioner," and begins some interview while i as the bedside nurse think to myself "you know that patient doesn't care right? you know they will just forget about you once they are seen by the actual md?"

you stated it. you as the bedside nurse think to yourself. did you ask the patient what they thought? you are thinking to yourself that the patient doesn't care what they say. once again, you assuming that because you think it, it must be fact!

"i think nps are suffering from an identity crisis. let me know your thoughts too."

you think....okay fine. you asked for others thoughts....they gave you their opinions, then you dismissed all of them because they aren't based on "scientific data" and are just their opinions. well, that's all you've given as well....but that may be hard to grasp from somebody who thinks their opinions are equal to fact. :cool:

MyUserName,RN · Dec 9, 2011

NPs, are essential, but funny enough,some RNs totally disregard or are critical of NPs. Very ironical.

I'm starting to think it may all boil down to jealousy.

poopprincess · Dec 9, 2011

I have a family member who prefers the NP to the MD. I think they def serve a purpose in healthcare. As long as they are experienced I think they are great. The only thing I disagree with on the "NP craze" are the programs that allow nurses to go straight in without any bedside experience. I think that nurses having goals to further their education is a wonderful thing, as long as they understand what they are getting themselves into and they see it as a true calling. Sure, you can get some sorry NP's, but you can also get some sorry MD's too.

TECHTORNHOPEFULLY · Jan 2, 2012

I am in total agreement. One nurse on my unit decided to go for FNP and everyone in the unit decided to get on the bandwagon. So all of them, may 6, went part time or PRN. And of course they have the nerve to complain about their schedules. :confused: I am all for advancing your education, but PRN are gap fillers. Stop complaining.

kanzi monkey · Jan 2, 2012

I have not read the rest of this thread, and I KNOW I am taking the bait--but hey. Katie5, I feel like I have read your posts in the past and you seem like a pretty reasonable person. Even though I am currently under the impression that this thread is in fact, troll-sponsored, I feel like something is askew here, so I will respond.

What lckrn2pa described was a head-to-toe exam. It is not costly other than time. And it is an expected part of any diagnostic exam. It is quite possible that the doctor who previously saw the patient actually did part (or all) of this evaluation, then just wrote a stinky note. Or, the doc didn't. Who knows? But if the patient is going to be the recipient of any FURTHER evaluation or work-up, a proper note indicating that the patient has been adequately evaluated is, well, important. So, the only "gloating" would be to say "yay NPs for holding to standard documentation practices! Hooray!". (we don't all the time, by the way. And I'm sure I have room for improvement in this area myself). But the evaluation of the patient and the documentation that follows (and is then shared with later providers) is so frigging important and I spend so much of my life wishing that we did better in this regard...(tangent and deterioration of grammar on-coming...)

To be brief, you responded directly to the the the comment: "that is the beauty of being a provider, you can do whatever exam you feel is warranted."

To be a good NP (or any provider) you have to be good at determining what exam is warranted. And that is what school and training is for. We (MLPs and doctors) don't always make the best choices in hindsight. However, thanks to the training, most of us are capable of making pretty good choices. (note the difference between "gloating" and "being capable of making a pretty good choice").

In Lck's case, I wouldn't even call a documented physical assessment a "standard of care". It's a PRACTICE standard to do an adequate clinical exam on a patient. Good (and cost-efficient) care can follow...

horrorxgirl · Jan 2, 2012

I totally disagree with you. In fact, my Dad sees a physician who also utilizes an NP. My Dad and his wife prefer the NP because she is better than the doctor. Recently, my dad became very ill, began throwing up everyday, lost 15 lbs in a month. He was sent to several specialists who all pretty much told him that the problem was anxiety. Well it didn't improve, and my stepmom finally just called their NP and told her she was at her wits end with this illness that no one was diagnosing or treating. NP asks, "well what does the bloodwork say?" My stepmom replies, "Um...nobody did any bloodwork." NP has my dad come in the office, does the bloodwork, and also feels his abdomen and finds his liver enlarged. Liver enzymes come back very high. Sonogram is ordered that shows is gallbladder is pretty much full of sludge. Emergency cholecystectomy done, and now everything is normal now.... because of the NP.

How could a more educated nurse that is filling a very important void in healthcare be a bad thing? This makes no sense to me whatsoever.

kanzi monkey · Jan 2, 2012

Maybe if your bedside nursing was better the NP wouldn't have to waste their time by coming into the room to reinforce the MD's plan of care.

I love the nurses I work with for the most part. But sometimes this is totally true.

Beyond the clinical and diagnostic stuff..

I support (and occasionally direct) a solid nursing care plan. And I act as a liaison between the attending and the patient. And sometimes I also act as a liaison between the attending and the nursing staff.

As a hospital based NP I am a PMM. (Professional Middle Man). I accept this role in all of its glory and humility. I definitely don't disagree with a healthy interrogation of the NP role in all of its multiplicities. There are plenty of things wrong with the profession. But whether NPs or PAs serve a necessary role--if one took the time to look at the research (which most of us, besides perhaps the OP, have at least encountered), is not really a question. I know that my role in my job (whether I'm good at it or not) is indispensable (and since I have not been fired, I feel assured that I'm at least adequate). I do feel, sometimes, that the reason I'm indispensable is because of the nuances of attending-nursing-patient relationships and the inevitable communication challenges. This is not my favorite part of my job.

But doesn't everybody look at what they've accomplished at the end of a day--for me that being negotiating with consults, nurses, patients, families, and finding attendings, or calling family members or kennel's where patient's dogs are staying, or retrieving a wheel-chair from a parking-lot across the street and then transporting my patient to the OR because the floor was too busy and the transport service not responsive, or trouble-shooting a VAC on a huge perineal wound on a patient who is not even on my list but I know their resident is in the OR, or writing long, heart-felt letters to insurance providers about why my patient needs the 7,000 dollar/wk antibiotic, or represent my attending in a family meeting where a patient is going down-hill or a family member has been threatening staff, and think--at some point-- "seriously, was this what I was trained for?" or "how in he!! is this my job?" For what it's worth, the demand is there. Filling gaps where doctors, nurses, social workers, PT, and ancillary staff can't is a large part of what I do, though not what I was specifically trained to do, nor what I was hired for. But because I have the ability to fill these gaps, in addition to providing medical care (or finding a specialist or doctor quickly when needed) my role is generally pretty indispensable.

kanzi monkey · Jan 2, 2012

I hope you know the patient gets stuck with the bill and for an uninsured patient even worse.So unless you ABSOLUTELY have no idea,sticking to the NECCESSARY Tests would be economical. Disregard if you were not referring to tests.
Again, I'm not sure you should gloat about it, I would expect an over and beyond attempt at least- human beings have one life.Just saying.:heartbeat

(Sorry to repeat my response here, but I just realized I hadn't quoted this older post, thus leaving no context. Sorry about that. Mods, if there is a better way to edit a post, please let me know. Been a long new year :jester: )

I have not read the rest of this thread, and I KNOW I am taking the bait--but hey. Katie5, I feel like I have read your posts in the past and you seem like a pretty reasonable person. Even though I am currently under the impression that this thread is in fact, troll-sponsored, I feel like something is askew here, so I will respond.

What lckrn2pa described was a head-to-toe exam. It is not costly other than time. And it is an expected part of any diagnostic exam. It is quite possible that the doctor who previously saw the patient actually did part (or all) of this evaluation, then just wrote a stinky note. Or, the doc didn't. Who knows? But if the patient is going to be the recipient of any FURTHER evaluation or work-up, a proper note indicating that the patient has been adequately evaluated is, well, important. So, the only "gloating" would be to say "yay NPs for holding to standard documentation practices! Hooray!". (we don't all the time, by the way. And I'm sure I have room for improvement in this area myself). But the evaluation of the patient and the documentation that follows (and is then shared with later providers) is so frigging important and I spend so much of my life wishing that we did better in this regard...(tangent and deterioration of grammar on-coming...)

To be brief, you responded directly to the the the comment: "that is the beauty of being a provider, you can do whatever exam you feel is warranted."

To be a good NP (or any provider) you have to be good at determining what exam is warranted. And that is what school and training is for. We (MLPs and doctors) don't always make the best choices in hindsight. However, thanks to the training, most of us are capable of making pretty good choices. (note the difference between "gloating" and "being capable of making a pretty good choice").

In Lck's case, I wouldn't even call a documented physical assessment a "standard of care". It's a PRACTICE standard to do an adequate clinical exam on a patient. Good (and cost-efficient) care can follow...

Ruby Vee, BSN · Jan 4, 2012

as rns, we should be supporting what's best for the patient -- whether that be nurse practitioner or physicians's assistant -- or the physician herself. i've been working with all three since the early 1980s . . . . back when nurse practitioners and physicians' assistants were fairly rare.

years ago, nurse practitioner programs required that anyone applying have at least five years of experience at the bedside. the way the programs were structured, there was far less clinical time than in a physician's assistant program or in medical school, so it was to the future np's advantage to have enough clinical time before starting the program. the nps i worked with in those days were awesome! they knew what was going on with the patients; they were thorough in their exams and their histories and they listened. they listened to their patients, and they listened to the nurse spending 12 hours with the in-patient at the bedside. i would have used an np as my primary care provider, and i vastly preferred to deal with nps at the bedside.

over the years, the trend has been for less and less actual bedside experience before heading off to np school, and now it seems that folks head directly from bsn graduation ceremonies to graduate school with nary a job in the meantime. consequently, the quality of nps coming out of their programs is trending distinctly downward. the quality of pas, however, has stayed the same . . . .

now i'm forced to work with nurse practitioners who couldn't make it at the bedside and whose solution for that was to become nps. i'm working with nps who didn't even try to make it at the bedside because they have so little respect for what bedside nurses do. i'm working with nps who cannot recognize atrial fibrillation without a 12 lead ecg they require the physician's help in interpreting and who wouldn't recognize a paced rhythm until you turn the pacer off. all of that could be ok . . . ignorance is fixable. arrogance, however, ensures that ignorance won't be fixable. if you already think you know everything, why would you listen to me when i'm trying to tell you that those cute little blips on your monitor are pacing spikes?

and now, some of the worse nps have caught on that they should have had some clinical experience -- or maybe that us seasoned nurses are more likely to listen to and respect the opinions of those nps who do have bedside experience -- and they're trying to micromanage our bedside care to prove that they know what they're doing. only they don't know what they're doing. worse, many of our new grads respect initials after the name far more than they respect experience, and they actually do some of the witless things suggested by the nps in question. on their way to graduate school, of course.

i love working with our pas and with the few nps who have had some bedside experience, but those nps without make it all miserable.