Is anybody else tired of the nurse practitioner craze?

[WillRegNurse]

Hi all. I am a new graduate RN who is enjoying his first job as a med-surg nurse. I don't know about everyone else, but I am so tired of the nurse practitioner craze that seems to be overtaking the newest wave of graduate RNs. Half the people I know at my new job are part-timers in grad school for a master's degree as a family nurse practitioner or a psychiatric nurse practitioner. Good on them, but does anyone else think the idea of a mid-level practitioner has been taken a bit too far?

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.

The position also seems discredited by the variance in the scope of practice among different states and the fact that NPs can never do surgery. 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. 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. I don't see NP's as the future of nursing -- AT ALL. 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?" Of course I never say that. But that's what is in my mind. I see no point in them.

I see pure bedside nursing as our future. Nursing education. Stuff more involved in social services.

I think NPs are suffering from an identity crisis. Let me know your thoughts too.

[fromtheseaRN, BSN, RN]

k, i'll stop saying "treat the disease not the person", and now say "let's stop feeding the troll."

[WillRegNurse]

Last physical I had was with an NP.

Now that's a physical exam baby. Never had such an involved H to H. We talked about me cutting back on the coffee (how to do it) and trying to destress. We talked about ways to strengthen my off and on owie medial L knee... she noticed I slightly favored in ROM. She gave me job hunting advice. Got a flu shot and TB test from her. She didn't have to leave and send another person in to do that.

The time before that, I went to a internist, and got a quick listen to H and L and a blood draw and that was it.

My last physical exam was with an NP for employee health at my new job. I have never seen so rushed an exam in my life. Definitely gave the "I've done this already 10x today" impression.

Have any other anecdotal evidence which does not impress? Because I sure do, and it's all real.

[ERRNinMI]

Can't say I agree either, we use NP's in the ED where I work, and they are a Godsend. They see and diagnose patients, prescribe, and do the same as a doctor. A doctor never sees the patient the NP sees unless it is something crazy, but there is always a doctor working over the NP if that makes sense. They even can do minor procedures like suturing. I think NP's are valuable, but I do believe there may be an over-saturation in the future. I just started grad school part time, been a nurse for 2 years, and I am going the education route, simply because I have no interest in being an NP or CRNA.

[lckrn2pa]

oh, and to give you some data on a pt I saw in clinic the other day. Follow up on PSA level with hx prostate ca, gleason 6, 1/10 biopsy. He was seen by the MD 3mo ago and his note was 4 lines long. My H&P on him was full ROS, PE I covered HEENT to get my CN's, neck and nodes, back, post/ant thorax/lungs, CV, GI/GU and extremities and a DRE since I could not find in notes of one in almost a year. Prostate CA is slow grow with direct extension mets but hematogenous spread can occur once out of capsule.

Do I think I gave him better care than the doc, nope, not at all but the next person that see's him will have a clear picture of what I covered when I saw him. I went a little farther than are general rule of system above and system below complaint but that is the beauty of being a provider, you can do whatever exam you feel is warranted.

[ERRNinMI]

Ok, lets look at this from another angle. By your logic, Midlevel's can not give a level of care equal to a MD/DO. So get rid of midlevels. Now, same argument, CNA's, MA's, LPN's can not give the same level of care as an RN so why not get rid of them as well. Since an RN can do the job they do but they can't do the job of the RN then I guess they serve no role, going by your logic.

Same as saying get rid of the nurses, because really, doctors can do it all!!!!!

As nurses, we would not be able to survive without ancillary help, although I find many of the techs I work with lazy and having to be told what to do, but it makes up for it when you have a tech working with you that's on it, and actually does their job!!

[Katie5]

Do I think I gave him better care than the doc, nope, not at all but the next person that see's him will have a clear picture of what I covered when I saw him. I went a little farther than are general rule of system above and system below complaint but that is the beauty of being a provider, you can do whatever exam you feel is warranted.

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

[Katie5]

My last physical exam was with an NP for employee health at my new job. I have never seen so rushed an exam in my life. Definitely gave the "I've done this already 10x today" impression.

Have any other anecdotal evidence which does not impress? Because I sure do, and it's all real.

I went to a store the other day and got such shoddy service, I almost swore never to go back.

Then I went just the other day and would elated at the impressive service.

So what's the point? Don't generalize because you had ONE bad experience.

[netglow, ASN, RN]

Op, you need to deal with the fact that you will need to follow the orders of NPs PAs as well as MDs. I think, you are unhappy that you are second fiddle in your own mind. This will never change for you. But you will drive yourself crazy and begin screwing up your own career if you don't understand how to build relationships with midlevel providers. Believe me, as soon as you try to discredit the entire profession by suggestion at work, you will be thought a fool by the MDs as well.

[lckrn2pa]

one thing your totally missing is your only looking at this from an inpt setting. Are there only patients in the hospital? I've got a buddy that is a PA in central Cali and he is the only provider in his clinic. His supervising MD is in another clinic 50 miles away. If he were not there then that clinic would not be open and those 30 or so pts he sees everyday would not get the care they need.

Here's some numbers for you:

as of aug 2011

• 6,429 Primary Care HPSAs with 66.7 million people living in them. It would take 17,762 practitioners to meet their need for primary care providers (a population to practitioner ratio of 2,000:1).
  

This number is only going to get worse with the decline of MD's entering primary care. Each year residency slots in primary care go unfilled.

[CCL RN, RN]

k, i'll stop saying "treat the disease not the person", and now say "let's stop feeding the troll."

Page 3 before someone finally called the OP out on what he really is?

It will be a great day when nobody feeds trolls, let them starve.

[nurseryRN14]

I think that nobody is perfect, but NP and MD's need to list to what the pt is saying. A NP saw my niece about 5 years ago. She was crying and her throat was hurting. I think that my sister had taken her to her a couple of days before and brought her back. The NP tried to tell my sister she was fine. My sister told her that her daughter doesnt usually cry for any reason continuosly. She asked for a second opinion and her daughter was reevaluated. The MD sent her got an xray for Ct of her throat. She was sent to Duke immediatly, her throat was closing. If she would have said ok, I think you're right. My niece might not be here today. My neice spent almost 2 months in Duke Hosp with an abscess on her esophagus that kept growing back, she almost died. I just think that no one is perfect, but everyone need to take their job seriously if you're going to be a medical provider. Do it cause you love the job. Don't do it just for the money.

[lckrn2pa]

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

Not gloating at all, I did the exam I felt was needed on the patient. Giving a reference to this case in this discussion is to provide the less educated OP with the "Data" he so desperately needs. Go back and read the post again, never mentioned test, only mentioned the PE I did based on the risk to the patient and propensity of prostate CA to mets to back, ribs and long bones. Also add to the possiblity of hematogenous spread of the disease. I was not looking for spotted zebra's I knew what I was looking for and did the appropriate exams.