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Make Advanced Practice Nurses Independent

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Make no mistake, doctors oppose our independence because they are afraid of losing MONEY. We've all seen where a physician controlled health care system has gotten us - it's time for a change!

Physicians love NPs when we're working for THEM and making THEM money. God forbid when the NPs compete directly with the physicians. If doctors are so good at what they do, they shouldn't have to worry about competition.

Theoretically I know NPs can make the difference. I have been treated by an NP and request that my preemie son see an NP at his peds office- she is great. My main concern has come my first semester at NP school which is online and basically I am being given random assignments and taught NOTHING! To boot, I contacted a friend in CNS track at a VERY REPUTABLE school where they offer online as well and she said the same thing. She was just as bothered by it as I was. She said she is over it and ready to graduate. Again, I know NP's can do the job, I have witnessed that, its just that with the demand for convenience it seems that online professors forget to actually TEACH. The irony is that the criticism that comes from attending the UOP was much greater than my current school and the Univ of Phoenix actually TAUGHT me and interacted with students daily! I am afraid for my profession if our schools don't realize they may be lacking right now. I have been sitting here a week trying to decided if I want to write someone of authority on this matter. I mean, I want to take care of patients for crying out loud! I want to be confident that I can perform the duties of my job when it's all said and done.

FLoat RN

Specializes in Telemetry.

The fact of the matter nurses are already more directly involved in pt healthcare than many physicians. How many times have you called a physician with results and they asked you what do you want to do about it? So you just tell him or her what you think and they just say yes to your orders. Nurses need more authority. However, I believe nursing school needs to be more difficult and more involved with pathophysiology, diagnosis, pharmacology and treatments. I plan on going to NP school fall 2011. I looked over the courses and I could tell it was just a bunch of fluff. NP school should resemble PA school. PA school is more like medical school.

pedspnp

Specializes in General. Has 17 years experience.

The fact of the matter nurses are already more directly involved in pt healthcare than many physicians. How many times have you called a physician with results and they asked you what do you want to do about it? So you just tell him or her what you think and they just say yes to your orders. Nurses need more authority. However, I believe nursing school needs to be more difficult and more involved with pathophysiology, diagnosis, pharmacology and treatments. I plan on going to NP school fall 2011. I looked over the courses and I could tell it was just a bunch of fluff. NP school should resemble PA school. PA school is more like medical school.

The 17 years that I was a floor nurse have I have neber called and had a MD, PA or NP ask me what I wanted to do about about lab results. That is plain simple license jeopardy for them,a nd should be brought to someones attention, also I would not want to be the nurse who went ahead and wrote an order for what they thought should be done. In the end who is going to fry, not the MD not the PA not the NP but you.

The only time I was asked that type of question was when I was a NP student and the preceptor asked what I wanted to do with xyz results and let me tell you I had better had a good rationale for what I would do. I get the feeling that you think nurses should be able to diagnose. Nurses can not and should not be diagnosing a medical condition or so forth..diagnose they can make nursing diagnosis and develop a plan of care. A bachelors in nursing as in with any degree prepares you to practice at entry level. If you think NP school is a bunch of fluff why are you applying, why not PA school

FLoat RN

Specializes in Telemetry.

Let me correct my statement I should have have said something along the lines of a pt complaint. I wasn't referring to lab results or vital signs. For example, i had a pt that was complaining of pain. I noticed that the nurse from the prior shifts were administering two tabs of Darvocet N-100, which contains 1300 mg of tylenol! By the time I had her she had over 3200 my of tylenol in less than 24hrs (This pt had a history of hepatitis). I called the Dr. and reported this. He just said give her what pain medication she is not allergic to. This example is not that rare. I'm sorry if I offended you that was not my intention. I was replying to the entry before mine. I don't think floor nurses should diagnose pt symptoms or lab results. However, I was always under the impression that NP do. I am agreeing with the article that more authority should be given to NP. The original article states ,"For years advanced practice nurses — as well as a host of other caregivers such

as chiropractors and physical therapists —have butted heads with doctors over

"scope of practice" considerations. Doctors maintain that even with an advanced

degree, these nurses do not have the same education that physicians get in

medical school and residency programs and that patient safety could be

compromised. They are also wary that their practices could see significant

patient losses if the nurses were allowed to practice more independently."

Edited by FLoat RN

No healthcare provider is truly independent. Everyone defers to someone else at some point.

I am finishing up my ADN now, already having my BS and my paramedic. Nursing is a different ballgame from medicine obviously. I learned more in my paramedic course about medicine and pathophysiology and pharmacology than I did in nursing. If nurses want more "freedom" the educational requirements need revamped. More hard science and the like. In addition, I would like to go on to NP school but am so nervous about not receiving enough medical training. I prefer the PA/medical model but it will be easier to go NP if I am already an RN.

I am all for expanding the role of nurses, NPs, and PAs. I think the medical education system is in need of an overhaul. Sorry, just rambling.

Dr. Tammy, FNP/GNP-C

Specializes in ER; CCT.

Make no mistake, doctors oppose our independence because they are afraid of losing MONEY. We've all seen where a physician controlled health care system has gotten us - it's time for a change!.

Not all doctors oppose NP independence. In my graduating DNP cohort, as an example there are around 40 doctors (100%) in that class who all support NP independence and are chomping at the bit to act as transformational agents in the process of eliminating barriers to nursing practice as well as patients access to care. Next year, there will thousands of us...in five years, tens of thousands of doctors who will support NP independence and who will not stop until patients across the US have this artificial barrier to access removed.

The argument from organized medicine in that NP's can only deliver safe care if charts are signed by physicians a few days later and are available by phone (which constitutes supervision in many states) is rapidly dissolving. With the number of DNP programs and working DNP's being produced, organized medicine needs to come up with a different argument for maintaining a strangle hold on our practice while decreasing patients access to safe and affordable care.

Dr. T

Not all doctors oppose NP independence. In my graduating DNP cohort, as an example there are around 40 doctors (100%) in that class who all support NP independence and are chomping at the bit to act as transformational agents in the process of eliminating barriers to nursing practice as well as patients access to care. Next year, there will thousands of us...in five years, tens of thousands of doctors who will support NP independence and who will not stop until patients across the US have this artificial barrier to access removed.

The argument from organized medicine in that NP's can only deliver safe care if charts are signed by physicians a few days later and are available by phone (which constitutes supervision in many states) is rapidly dissolving. With the number of DNP programs and working DNP's being produced, organized medicine needs to come up with a different argument for maintaining a strangle hold on our practice while decreasing patients access to safe and affordable care.

Dr. T

Nurse Tammy,

The music department in my school graduates a bunch of "doctors" every year as well. But if these trumpet, trombone, and violin doctors come into my hospital or clinic and refer to themselves as "Doctor" they will be laughed at. So will any of your 48 cohorts who try to pull the "Call me Doctor" card. I know that's not a nice thing to say, and I apologize if it hurt your feelings, but that doesn't mean it's not true.

Medical Doctors have earned the privileges and responsibilities for independent practice because they have 4-10 years of graduate and post-graduate education and, on average, 10,000 hours of clinical medical practice. If the Nursing Doctorates raise the bar to that level, then more people would push for giving them independent practice rights. But, currently, the average NP/DNP program only consists of 2 years of graduate education and about 500 hours of clinical medical practice.

Big difference.

Some here blame physicians for the "poor state" of America's healthcare system, but they are wrong. It is not the big, nasty, overpaid, overeducated, and just plain mean physicians who have caused the problem. It is the "I want healthcare for free" patients, the "give them free healthcare" politicians, and the "you can sue them (so I can get my commission)" lawyers who have screwed our healthcare system up soooo bad.

PAs and NPs have vitally important roles in the future of America's healthcare, but they should work under the supervision of a trained (real) Doctor - - simply because that Doctor has spent many, many, many more years and hours studying and practicing medicine than we have.

Nurse Tammy,

The music department in my school graduates a bunch of "doctors" every year as well. But if these trumpet, trombone, and violin doctors come into my hospital or clinic and refer to themselves as "Doctor" they will be laughed at. So will any of your 48 cohorts who try to pull the "Call me Doctor" card. I know that's not a nice thing to say, and I apologize if it hurt your feelings, but that doesn't mean it's not true.

Medical Doctors have earned the privileges and responsibilities for independent practice because they have 4-10 years of graduate and post-graduate education and, on average, 10,000 hours of clinical medical practice. If the Nursing Doctorates raise the bar to that level, then more people would push for giving them independent practice rights. But, currently, the average NP/DNP program only consists of 2 years of graduate education and about 500 hours of clinical medical practice.

Big difference.

Some here blame physicians for the "poor state" of America's healthcare system, but they are wrong. It is not the big, nasty, overpaid, overeducated, and just plain mean physicians who have caused the problem. It is the "I want healthcare for free" patients, the "give them free healthcare" politicians, and the "you can sue them (so I can get my commission)" lawyers who have screwed our healthcare system up soooo bad.

PAs and NPs have vitally important roles in the future of America's healthcare, but they should work under the supervision of a trained (real) Doctor - - simply because that Doctor has spent many, many, many more years and hours studying and practicing medicine than we have.

Ha. Touche.

You took the words out of my mouth.

- (real) Doctor Wowza

Dr. Tammy, FNP/GNP-C

Specializes in ER; CCT.

Ha. Touche.

You took the words out of my mouth.

Wonza,

Glad to see that your keeping up the anti nursing sentiment. Sorry, its been a while, but I've been quite busy building coalitions to advance nursing's position in my state and developing tools from those "fluff" DNP courses to make it happen. Since the last time I responded to your anti-nursing rhetoric and nurse bashing comments on this site we now have five more states with independent NP privileges. Without your thoughts, and sharing those thoughts with numerous individuals and organizations, I don't think I could have persuaded my colleagues as effectively as I had to take real action. Keep up the good work.

Dr. T

Ha. Touche.

You took the words out of my mouth.

Wonza,

Glad to see that your keeping up the anti nursing sentiment. Sorry, its been a while, but I've been quite busy building coalitions to advance nursing's position in my state and developing tools from those "fluff" DNP courses to make it happen. Since the last time I responded to your anti-nursing rhetoric and nurse bashing comments on this site we now have five more states with independent NP privileges. Without your thoughts, and sharing those thoughts with numerous individuals and organizations, I don't think I could have persuaded my colleagues as effectively as I had to take real action. Keep up the good work.

Dr. T

Mrs T,

Instead of building coalitions to advance what nurses are legally allowed to do, how about you spend some of that time improving nursing education so that DNPs graduate with more than 800 clinical hours.

Somehow you think that because the nursing lobby has pushed for expanded practice rights, that makes it ok for a poorly trained practitioner to practice independently. Just because a politician ok'ed it doesn't mean it is ok. If you knew how little you actually know when compared to an attending, you would be too ashamed to call yourself doctor.

pedspnp

Specializes in General. Has 17 years experience.

Mrs T,

Instead of building coalitions to advance what nurses are legally allowed to do, how about you spend some of that time improving nursing education so that DNPs graduate with more than 800 clinical hours.

Somehow you think that because the nursing lobby has pushed for expanded practice rights, that makes it ok for a poorly trained practitioner to practice independently. Just because a politician ok'ed it doesn't mean it is ok. If you knew how little you actually know when compared to an attending, you would be too ashamed to call yourself doctor.

I was under the mistaken impression that the DNP offered more of the hard sciences so far all I have seen is Financial Management and Budget Planning, Qauntiative Methods to evaluate health care, more leadership courses etc in any DNP program I have looked into. This looks more business driven than any thing.Still DR does not = MD

Edited by pedspnp
need to add

I was under the mistaken impression that the DNP offered more of the hard sciences so far all I have seen is Financial Management and Budget Planning, Qauntiative Methods to evaluate health care, more leadership courses etc in any DNP program I have looked into. This looks more business driven than any thing

but how can you practice medicine with only business driven skills like you mentioned? let alone independent? you mentioned yourself that there isn't even close to enough diagnostic/pathophys/pharm/"hard sciences" in your "fake-doctor" curriculum.

Can MBA's be doctors now? How about MPH's ? Let me know, I'd sure be willing to apply.

Dr. Tammy, FNP/GNP-C

Specializes in ER; CCT.

Mrs T,

If you knew how little you actually know when compared to an attending, you would be too ashamed to call yourself doctor.

Thanks much, but with over two decades in health care, I'm pretty confortable with what I know, and humbled by what I don't know. Moreover, I don't call myself "doctor"...others do. Welcome to the need deal and thanks for your support.

Dr. T

Thanks much, but with over two decades in health care, I'm pretty confortable with what I know, and humbled by what I don't know. Moreover, I don't call myself "doctor"...others do. Welcome to the need deal and thanks for your support.

Dr. T

you just called yourself doctor.

FAIL.

Dr. Tammy, FNP/GNP-C

Specializes in ER; CCT.

I was under the mistaken impression that the DNP offered more of the hard sciences so far all I have seen is Financial Management and Budget Planning, Qauntiative Methods to evaluate health care, more leadership courses etc in any DNP program I have looked into. This looks more business driven than any thing.Still DR does not = MD

After you complete a DNP program, do let us know if you feel the same way.

Dr. Tammy, FNP/GNP-C

Specializes in ER; CCT.

you just called yourself doctor.

FAIL.

That's what we call a "signature." Do let me know if you need more help in identifying message elements.

Dr. T

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