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.

[samirish]

I really love mid level practitioners inclucing NP's. I don't think they are "absurd" at all. Our family goes to a PA. We used to go to a MD but my husband decided he just didn't feel as comfortable with him as he does our PA. The MD at our family practice is a little too "clinical" and brusk while our PA is very non threatening and easy to talk to. An example that happened a couple of years ago involved my husband seeing the MD. The doctor told him he needed to lose 100lbs. When my husband asked him if he had any tips on weight loss the doctor said "Yea, stop eating so much". Well obviously my husband left feeling embarrassed and like he had asked a stupid question. On the other hand, he sees the PA and she praises him for the little bit of weight he's lost and encourages him to keep going and lose more. She has broken his weight loss up into small manageable goals, and so far its working pretty good. I've had an issue with alcohol in the past and while I am completely honest with our PA when she asks how I'm doing. I wouldn't be so open pertaining to that subject with the MD. I would feel like he is "judging" me or something, where I dont feel that way at all with the PA.

So overall I would have to say we have had very good experiences (except for one instance)with mid level practitioners and I hope. I would live to see NP able to enlarge their scope of practice one day.

[SeeTheMoon]

Don't agree. NP's have a place and some of them fill it very well. Is there a time and place for a MD and a specialist? Absolutely. But I agree with another poster, so many MD's are unwilling to go into primary care, and NP's are greatly needed to fill that void. Plus they take a more holistic view (obviously) than PA's would. To me it's almost like getting the best of both worlds (nursing and medicine) in one package. :)

[littleneoRN]

NPs have an ESSENTIAL role in my unit. They don't have as much autonomy as other settings, but we would not be able to function without them. They round on stable patients. They place lines, intubate, do LPs, etc. They manage patients on transport. All for a heck of a lot less money than the additional physicans that would be necessary if we didn't have them. Families know and love them. If you don't like the role, don't be one. But you sure as sugar better respect their position in your facility and follow their orders. If you truly just felt that the role didn't have legitimacy, I don't know why you'd be so fired up about it....since it has nothing to do with you. So do you want to fess up a real reason why this bothers you?

[eagle78]

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 have some cheese to go with that whine...

[nohika]

so many MD's are unwilling to go into primary care, and NP's are greatly needed to fill that void.

I think it's less that they're unwilling, but that more and more medical students are entering residencies with over 150k in loans. I've seen several cases of 250k or even 300k. With that much debt, primary care looks far less feasible than the specialties that make more.

[BuckyBadgerRN, ASN, RN]

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.

I thought you were looking for people's opinions on NP's, who mentioned "academic setting"? And they HAVE given you actual reasons WHY they prefer to see an NP over an MD: shorter wait time for an appt, the feeling of not being on the patient assembly line, the compassion they feel from a NP and more. Are you reading the responses?

I agree with the posters who pointed out your new grad status and the lack of understanding you seem to have about mid-level providers.....

[kakamegamama]

Well, hmm...interesting discussion. As a NP student, it's nice to know there are those who think NP's aren't worth much, such as the OP. Can better arm oneself when one is aware of who the attitudinal folks are. And, who the supportive folks are too. What it boils down to is what is best for the patient...bottom line. Sheesh...sounds like the OP has a chip on the old shoulder.

[BuckyBadgerRN, ASN, RN]

In the end, it's the appendectomy that saves the patient with appendicitis. Not the NP's "holistic" spew.

No disrespect to the NPs out there, or their training, but I see the bedside nurses as more important to the patient's care than the NP's visits that usually just reinforce the MD's diagnosis and plan of care. I truly see bedside RNs as more integral to the healthcare team and more vital to the patient's wellbeing than anything an NP could ever do (write limited, crappy scripts).

"Treat the disease not the person" is a silly little overused catchphrase. Please don't repeat it in this thread. This is not an alternative medicine thread. Do you have any evidence that shows that an NP's "attitude" is better than an MD's? Is there a poll? May I see it? Well..?

Whoa. I clearly see now where YOU place yourself in the medical hiearchy....

[ZippyGBR, BSN, RN]

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.

a significant proportion of the NPs i nthe Uk are in emergency /urgent / out of hours primary care and function extremely well in these roles especially if they are independent prescribers , we've also goT or have had NPs in various specialities - Cardiac NPs were all the favour when thrombolysis was trendy now we've gone for primary PCI it's less so becasue by the time you've done the ECG and spoken to someone within the setting the patient is in you may as well be ringing the cath lab - hyper acute Stroke service NPs are the next big thing as rapid CT and thrombolysis of eligible strokes is the 'big thing ' at the moment.

you don't need to be an NP to suture, lots of ED nurses in the UK do wound closure before they are NPs but then again in well supported and switched on EDs 'ordinary' RNs are doing quite a lot of assessment heavy roles as it is as IR(ME)R referrers for plain films, direct to speciality referrals , selective immobilisation etc are the norm ...

[tyvin, BSN, RN]

As RNs we should be supporting NPs and all they do. I would rather see an NP then a PA that's for sure. With the future health care changes on the rise it's going to be NP and PAs doing most of the work so please give me an NP.

Oh and no I'm not tired of what you call a craze, which BTW has been going on for some time now. Perhaps you should search deeper for the reason NPs hit a nerve with you.

[Lunah, MSN, RN]

I've worked with some fabulous mid-level providers in various ERs that could run circles around MDs. And yes, as with everything, there were a few clunkers as well ... you know, the ones that make you groan out loud when you see their names on the schedule. But generally speaking, I have a lot of respect for the NPs that I know both personally and with whom I've worked. They are some sharp folks. Sorry I don't have anything non-anecdotal for you, just my personal experience. It's no accident that I chose an NP for my primary care manager, either. :)

[lckrn2pa]

As RNs we should be supporting NPs and all they do. I would rather see an NP then a PA that's for sure. With the future health care changes on the rise it's going to be NP and PAs doing most of the work so please give me an NP.

Oh and no I'm not tired of what you call a craze, which BTW has been going on for some time now. Perhaps you should search deeper for the reason NPs hit a nerve with you.

Hmm, interesting comment, please elaborate your reasoning for one over the other. I've worked with both over the years and found them equally competent. Just curious as to why people believe one to be better than the other. I've never seen it nor do I believe as a PA that I will be better than a NP, I'll see them as a colleague.