Make Advanced Practice Nurses Independent

Dr. Tammy, FNP/GNP-C · Oct 30, 2010

ironic you allude to doctors as being the ones who are arrogant. now which group is it that is taking a short cut around tens of thousands of hours of clinical training, scores of hours of hard sciences and years of residency and then calls themselves equivalent? explain to me which group is arrogant- the people taking the short cuts or the ones calling them out on it.
personally i think that nps should have closer supervision. i agree chart reviews days later does next to nothing; regulations should be tighter such that an np should have to present to an attending after each case just we had to do in during resident clinic.

just curious, are you starting to see the positive and linear relationship between the rhetoric you espouse and the continual and progressive advancement of independent np practice in states across the us or do you just like being on the losing side of arguments, progress and action?

at any rate, this should make you feel better:

1965: np profession born - 0 states with independent np practice

2010: 29 states with independent np practice; 6 other states actively moving towards np independence.

2002: 70 students enrolled in 2 dnp programs

2009: 5,165 enrolled dnp students (10% of the current np population present in the us) in 119 dnp programs - 161 more dnp programs being added shortly

i'm not sure what any of this means but my education and training in those fluff dnp courses tells me its not favorable to you. anyway, keep up the good work as you have no idea how much you are aiding in progressing np's to independent practice. who knows? maybe one day you might be in our hall of fame or at the very least working for one of our dnp members.

dr. tammy

wowza · Oct 30, 2010

Again, just because a politician gave you permission to have independent practice does not mean you have the skills or knowledge to do so. You are confusing the two.

Whenever I bring up the chasm in knowledge between a real doctor and a nurse practitioner you like to side step the issue by bringing up the fact that politicians saw fit to expand practice rights. That has more to do with the nursing lobby than if you are fit to be an independent practitioner. Again, good for you that nurses have more rights- bad for the patients when you miss a diagnosis because of inexperience and lack of knowledge. The eyes cannot see what the brain does not know. That is why extensive training is necessary.

Until NP education comes in line with the rigor and length of medical training, NPs will always be second rate. So call yourself doctor if you want; the real doctors will just chuckle behind your back and hope you don't kill someone with your lack of training and knowledge.

pedspnp · Oct 30, 2010

DR does not = Md thanks, I know my limitations wish that other could too

Dr. Tammy, FNP/GNP-C · Oct 30, 2010

Again, just because a politician gave you permission to have independent practice does not mean you have the skills or knowledge to do so. You are confusing the two.
Whenever I bring up the chasm in knowledge between a real doctor and a nurse practitioner you like to side step the issue by bringing up the fact that politicians saw fit to expand practice rights. That has more to do with the nursing lobby than if you are fit to be an independent practitioner. Again, good for you that nurses have more rights- bad for the patients when you miss a diagnosis because of inexperience and lack of knowledge. The eyes cannot see what the brain does not know. That is why extensive training is necessary.
Until NP education comes in line with the rigor and length of medical training, NPs will always be second rate. So call yourself doctor if you want; the real doctors will just chuckle behind your back and hope you don't kill someone with your lack of training and knowledge.

The only chasm here is between your lack of credentials, knowledge, training and education in the nursing world and what you purport to know about the nursing profession and nursing practice.

It's very curious--you seem to think you know much about nursing and nursing practice yet you hold absolutely no nursing credentials and besides spouting off on this nursing board, have absolutely no standing within nursing, with nursing practice and have absolutely no say as to where nursing practice is heading.

Maybe you might want to start sharing your thoughts of superiority with other practice-based doctors in how MD's are the only real doctors worthy of the doctor title. Perhaps visiting and sharing your thoughts on sites with the PharmD's, DPM's, DDS's, PschD's and OD's might be in order. You can then compare and contrast their education with yours and then inform them they are not worthy of the title doctor. I am sure they would welcome your comments in this area. I have recently started networking with optometrists, as an example, in advancing nursing practice, and apparently, they have had the same experiences in their profession with some other "real doctors" just like you who have nothing but wonderful things to say about the optometry profession.

If that doesn't float your boat, here's something novel--why not address issues and problems in your own profession --the profession of medicine--with other "real doctors"? Why not start by reading one of my favorite books, "Death by Medicine" by your kind of doctors---Martin Feldman, MD; Debora Rasio, MD; and Carolyn Dean, MD, ND which clearly illustrates the destructive forces of those who hold the medical doctor credentials and how they facilitate the croaking people process under their care. After reading this book you might even wonder as I did,--"What carries a higher mortality rate--cancer or being treated by a physician?"

If that doesn't keep you busy, how about addressing why physicians, as the captain of the ship, have completely failed in keeping our country healthy, failed to provide equitable medical resource distribution to vulnerable populations at risk and why our medical system has fallen from a priemier system to that of bandaide-based system comparable to systems in developing countries. Please do let me know if you need citations here--hard to believe, but I have a bit of knowledge on this one from those DNP fluff courses.

As far as chuckling, the only laughter I hear is that from NP's as they gain independent practice in state after state after state. (Kerplunck!) whoops, there goes another state with independent NP practice!

Dr. Tammy

Trauma Columnist · Oct 30, 2010

I'm well aware that this is a hot topic and I appreciate that its going so well. Please continue to keep it civil and debate the topic, not the poster.

Thank you.

wowza · Oct 30, 2010

1) The only chasm here is between your lack of credentials, knowledge, training and education in the nursing world and what you purport to know about the nursing profession and nursing practice.
2) Maybe you might want to start sharing your thoughts of superiority with other practice-based doctors in how MD's are the only real doctors worthy of the doctor title. Perhaps visiting and sharing your thoughts on sites with the PharmD's, DPM's, DDS's, PschD's and OD's might be in order.

3) If that doesn't keep you busy, how about addressing why physicians, as the captain of the ship, have completely failed in keeping our country healthy, failed to provide equitable medical resource distribution to vulnerable populations at risk and why our medical system has fallen from a priemier system to that of bandaide

4) As far as chuckling, the only laughter I hear is that from NP's as they gain independent practice in state after state after state. (Kerplunck!) whoops, there goes another state with independent NP practice!
Dr. Tammy

1) You can label it whatever you want- whether nursing or medicine, but diagnosing and treating whether a nurse practitioner or an MD is the same job. You can call it "nursing practice" if you want to but it is the same job. Thus, the fact that I don't have a nursing degree is completely irrelevant. I have standing to comment.

2) Now as to dentists, podiatrists and pharmacists- each of these is the absolute expert in their domain. MDs do not have the extensive training dentists have for dealing with mouth pathology, the extensive training podiatrist have for foot pathology or the training in drug kinetics and interactions that pharacists have for drugs. So within those domains, they are the experts and I cede to their authority. Thus dentists are the doctors of the mouth, podiatrists the doctors of the foot and pharmacists the doctor of drugs. DNP's are the doctors of what exactly?

An NPs domain is the exact same as an MDs, so they are NOT the masters of their domain. In fact, they claim to do the same job as MDs yet have a fraction of the knowledge and training. Here is the major difference between you and a dentist/podiatrist/pharmacist- they have the highest level of training possible in their field. NPs aren't even close; instead NPs have 800 clinical hours and more nursing leadership credits than pathophysiology credits. That is why there has been such an increase in autonomy of NPs; the students have been taught to advance their degree instead of how to better take care of patients (more pharm, more path, more phys etc).

3) So you really think it is doctors who are the ones who control how resources are distributed in our health care system? I wish we had that much power. Perhaps you should direct your anger at the bureaucrats in DC and those who run the insurance companies because we doctors would love to be able to treat everyone and have the power to do so. (Good try at mud slinging)

4) Until NP education comes in line with the rigor and length of medical training, NPs will always be second rate. So, chuckle all you want. You are putting yourself and your profession above your patients and that is a pity for them.

Dr. Tammy, FNP/GNP-C · Oct 30, 2010

A good read is "The Social Transformation of American Medicine--The rise of a sovereign profession and the making of a vast industry" by Paul Starr. In his book, Starr identifies the disgusting and repugnant actions and paths taken by physicians over the last 150 years in which the third rate profession of medicine assended to a central political and economic power at the expense of patients, families, communities and the general status of health in the US.

Dr. Tammy

allnurses Guide · Oct 31, 2010

"Until NP education comes in line with the rigor and length of medical training, NPs will always be second rate."

Second rate??? I take great offense at that. I don't claim to be an MD or have the same knowledge base, but NPs aren't second rate. That totally goes against the trend we are seeing in my practice where patients are asking to switch their PCP from an MD to a NP in ever increasing numbers. And please don't tell me that the patients don't have the ability to make intelligent choices about their care-they do, and they like the care they get from NPs. Doesn't sound second rate to me......

wowza · Oct 31, 2010

A good read is "The Social Transformation of American Medicine--The rise of a sovereign profession and the making of a vast industry" by Paul Starr. In his book, Starr identifies the disgusting and repugnant actions and paths taken by physicians over the last 150 years in which the third rate profession of medicine assended to a central political and economic power at the expense of patients, families, communities and the general status of health in the US.
After this read, perhaps you can then inform us who the true prostitutes are.
Dr. Tammy

I'll give it a read.

Again, this doesn't negate any of the other arguments put forth in this thread- a nice diversion but I'd love a response from some of the other arguments put forth.

AbeFrohman, BSN, RN · Oct 31, 2010

The fact is wowza, they are getting these rights because there are studies showing their efficacy. while nursing has a powerful lobby, the medical lobbies would be plenty strongto shut down any opposition if they had some evidence. Maybe they'll have some soon with the study that the AAFP is putting on, but until you have sound statistical evidence it's a no win game.

I'm not for NPs being independent as it is in most places (I prefer the Maine model where they have to spend so much time in supervised practice first), but it's going to happen as a natural evolution whether you or I like it or not. Just look at what happened with DOs, slowly as they ratcheted up there requirements. They eventually got the same universal scope of practice as MDs. Now nurses may never have the same educational level as doctors, but I don't think they are looking for universal scope of practice. Just looking for independent practice in the area they've been trained in. So in that respect it could very well happen.

Editorial Team / Admin · Oct 31, 2010

Truly unprofessional actions on the part of the non-nurses, who are OUR guests, and who WE graciously allow to post at allnurses.com. This will not be tolerated.

Thread closed for further review.

Action will be taken.

Trauma Columnist · Oct 31, 2010

I try for several reasons not to engage in these discussions. However, I find I can't stop myself this time:

Not all APNs WANT independent practice.

There: I've said it. I just have no problems whatsoever with any of the 14 MDs I work with: they all respect my opinions and they are all excellent teachers. Do they trust my judgement? Yes, you bet. However, I know my limitations and ask for help when I need it. If I have a question, I ask it.

Independent practice isn't going to enhance anything I do now: I provide excellent mid-level care. Note: I said mid-level which means not at the level of a physician.

However, I do have to say that my pts see a physician once a month and the rest of the time, they see me. I care for hemodialysis pts. My pts are complex and many of their own primary care physicians call me to check drug dosing and ask for assistance in handling their other medical problems.