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Is anybody else tired of the nurse practitioner craze?

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by WillRegNurse WillRegNurse (Member)

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traumaRUs has 27 years experience as a MSN, APRN, CNS and specializes in Nephrology, Cardiology, ER, ICU.

165 Articles; 21,045 Posts; 192,904 Profile Views

@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.

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Jules A is a MSN and specializes in Family Nurse Practitioner.

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NP education is the starting point for NP practice- nobody I know preteded to be an expert straight out of school. The first few years of practice are a learning period under the close supervison of an expereinced NP or MD. .

Very good point and I hope it works out in practice so NPs with limited nursing experience are mentored upon graduation.

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czyja is a MSN, RN and specializes in Critical Care, Progressive Care.

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@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.

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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

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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.

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164 Posts; 5,203 Profile Views

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." :rolleyes:

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:

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164 Posts; 5,203 Profile Views

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.

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135 Posts; 4,515 Profile Views

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.

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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.

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kanzi monkey has 5 years experience.

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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...

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horrorxgirl has 8 years experience and specializes in LTC, peds, rehab, psych.

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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.

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kanzi monkey has 5 years experience.

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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.

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