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Sugah Britches 2,879 Views

Joined: May 9, '06; Posts: 83 (13% Liked) ; Likes: 19

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  • Aug 9 '10

    DRFP,

    First, good luck on your new career path. As a fellow nurse and a practicing nurse practitioner, I am particularly proud of nurses who venture into other fields of study and career paths specifically those who later on become physicians, lawyers, and other types of professionals. I hope you do not forget your nursing background as I feel that this will benefit you immensely in your future practice as a physician.

    I also understand that you are very passionate about making everyone in this forum realize that a nurse practitioner's training at the DNP level is not the same as that of a physician with a MD or DO degree. That is a fact nurse practitioners like me totally agree with. Regardless of what you've heard or read in the news or any form of media, and regardless of whatever anyone says in this forum, nurse pracitioners are NOT out to replace physicians. Even with the DNP, no reputable nurse practitioner organization or training program endorses this notion.

    I invite you to read the American Association of Colleges of Nursing's FAQ's on the DNP and focus your attention to questions number 21 and 22 (http://www.aacn.nche.edu/DNP/DNPFAQ.htm). Do not hesitate to ask any practicing NP's opinion on matters pertaining to our practice. As I respect your choice to become a physician, I ask that you also do the same for the NP's and would be NP's who frequent this forum. Flaming words and insults are not necessary as we exchange opinions.

  • Aug 9 '10

    No, I have not heard of an NP to MD program. And why would we want that? We need to remember nursing is not the same as medicine. Nursing is not only a science, but an Art. The care of the patient as a whole being is unique to our profession. Our advocacy is crucial to their wellness. I encourage you to embrace nursing for the powerful changes we make in the lives of all who receive our care.

    A DNP program is a nursing clinical focus. A PhD is geared towards scholarship, research, teaching, writing....etc.
    A nursing school can not give out the degree of "doctor of medicine" only "doctor of nursing practice" and "doctor of philosophy in nursing science"

    Nurses make up the largest healthcare profession, we must stay united and embrace what we do as vital to society. We are just as vital as a medical doctor in the care of patients. I would suggest you sit down and think about what we really do and come up with your own definition of nursing. There are many.

    I know so many who revel in the "glamor" that they perceive of medical doctors. My partner is a doctor, and he continues to find people’s perception of doctors as "hilarious." He works very hard treating and diagnosing patients and then leaves the rest to nurses and other professionals. We are a team with a unified goal.

    A wise nurse once told our class many years ago, “people come to the hospital for nurses, people can see a doctor in their office or an urgent care.”

    But in the end, if you'd rather be a doctor, go for it! Don't try to take a short cut! I don't want a doctor, nor a nurse, whose degree came too quickly.


    Jacques, R.N., NP student
    Washington, D.C.

  • Jul 17 '10

    Quote from anpfnpgnp
    one of the doctors who spoke before the legislature stated that np's were a "threat to the safety of the citizens of texas!" he also stated that they had made a mistake in the past by allowing us too much independence. he said, "we've let the cows out of the barn and now it's time to bring them back in!"

    (sounds of repeated projectile vomiting...)

    what an idiot.

  • Jul 4 '10

    Quote from straba
    Most NP's, particularly in inpatient settings, practice medicine (under the guise of "advanced practice nursing). I'm sorry , but simply calling the sun the moon, does not make it so. Just my .02
    Here I thought I had been practicing health care for the past 30 years

  • Jul 4 '10

    Quote from jjjoy
    My understanding is that as one looks back in history, "nursing" has generally been tending to the ill and infirm - the type of work often undertaken by family members, traditionally, female family members. Families of means might hire people into their home to help care for their infirm, and community institutions for the infirm would need workers. That has all been considered nursing traditionally. Those caring for infants and small children have also traditionally received the title of nurse. The role itself was one that theoretically anyone could minimally provide to their loved ones. Religious calling or financial desperation were what generally led people into working as a nurse; generally they were women with few alternatives for providing for themselves. After all, women weren't supposed to have to support themselves. Men were supposed to do that while the women took care of domestic issues.

    On the other hand, doctoring developed more as trade - specific skills to be honed and practiced for a price. Doctors were men, the same men who were expected to provide for their wives and families. There was much more incentive and resources for them to build it up as a reputable profession. In the 1800's it seems, both nursing and doctoring solidified into more distinctive professional roles, with nursing generally being low-paid, low-skilled care for the infirm and doctoring generally being well-paid services to those who could afford it and requiring much more education and training than nursing. Though there were some women of means who chose to work as nurses for charitable reasons. Some of these nurses took their goodwill directly to the heart of poor communities, encouraging hygiene and child health and starting the tradition of public health nursing. There were also the nurses who worked directly as doctor's assistants, with the doctor training them up as much or as little as suited their own needs. These nurses migh be trained to administer anesthesia agents, for example.

    In the 1900's there was the medical technology explosion. This is when hospitals as we know them today developed, with doctors admitting and directing medical care and nurses providing the day-to-day care. Physicians were predominantly well-educated men with financial resources. They were able to effectively band together to carve out their profession. Nurses were mostly women who either quit once they married or were of limited educational and financial background who had to work full-time AND take care of their families. No wonder they didn't have the same kind of influence as physicians.

    So there continued to be quite a gap between nursing and doctoring even as functionally, they became more interdependent on each other and as both became dependent upon the quickly advancing medical technology.

    Nursing also professionally separated itself from medicine. I realize the pressures to do so since medicine didn't want anyone encroaching on their domain anyway. But I'm not convinced that nursing as a whole was best served by the direction nursing as a profession took in attempting to define itself as an independent practice when the majority of those practicing nursing (eg, in hospitals) DO depend upon a doctors' practice for their livelihood. I can see, though, that nursing as a profession had incentive to specifically excuse itself from diagnosing and treating in order to be free from the direct oversight of the powerful medical lobby. Unfortunately, that leaves the role of the NP and some other advanced practice nurses difficult to define as "nursing" and to defend as not requiring the oversight of the medical community.

    Financial pressures, though, are powerful and I think that's how NPs got a foothold and kept that foothold in the protected realm of medicine. However, with the expansion of PA programs and overall ramp up for more mid-level providers, it will be interesting to see how this continues to play out in the future.
    Hmmm good discussion I love veiw points of others.. Oh my goodness that must mean I am not a doctor :chuckle



    How many doctors could survive in the practice they know now w/o nurses and vice versa? Maybe it can be said that nursing had to evolve so we could better advocate for the patients we serve?

    There is a lot that the medical community whines about in public when in fact a large part of that medical community has been doing just the opposite. I have see doctors delegate /relegate there duties to RNs and at times LPNs. Just to list a few: standing orders, signed prescription pads, tests/procedures ordered, H&Ps and D/C summaries, permits.

    The overall outcome may not be what any of us want. It's really going to boil down to "financial pressures" which means what the patient wants. But I doubt the feature of health care will be delivered as a monopoly.


    Probable Future:
    1) Technology is going to keep advancing enabling the sicker and sicker to live longer. We see this now.
    2) The hospital population and general population are going to be sicker than we can even imagine especially with the baby boomers peaking. We can't meet the demand we have now.
    3) Health care as we know it know is going to crash. There is no way the general population can support itself with all these financial pressures (Gas, food or medicine, etc).

    Look at hosptials now ventilators on floor patients, cardiac monitoring and drips on floor patients, etc.. etc,,, All these used to be ICU type things
    We have a whole group of doctors that are called hospitalist but they have evolved to not staying in the hospital.
    The hospitals that doctors and nurses have come to depend on to survive are struggling to survive and so far for the most part the medical community has not come to there rescue. So the nature of the beast needs a solution and why not nurses..

    The days of the caveman came to an end and the horse was replaced by the car...
    Maybe no replacement but team work will keep us all employed???

  • Jul 2 '10

    Quote from wowza
    I am kinda equivocal about that one. I don't really care one way or another. Psych is really in its own realm of "medicine" and I am still not so sure I would include it under the title of "medicine." It has diverged so much that it kinda surprises me that you need an MD/DO for psych except for in patient/med-psych
    Gee, so not only is anyone not a physician not allowed to be referred to as "Doctor," despite holding a doctoral degree, in clinical settings, but psychiatrists aren't really practicing medicine?? That would be big news to all the psychiatrists I know, esp. since all they do, all day every day (even in outpatient settings), is diagnose people and prescribe meds (after graduating from medical school and completing a residency). How would you define that, if not practicing "medicine"??

    Quote from zenman
    Actually, I was talking about physical medicine & rehab, but there are psychologists running around in psych units also.
    Yes. I've worked in psych nursing for 25 years now, and I've known quite a few clinical psychologists working in clinical psych settings. Every one has referred to her/himself (and everyone else has referred to them, at least in front of clients and families) as "Dr. XYZ" -- I've never encoutered clients having any difficulty keeping track of who was who, and I've never heard anyone, including physicians, suggest that that was inappropriate in any way.

  • Jun 30 '10

    Quote from wowza
    I think those collaborative agreements where 5 or 10% of charts are reviewed are worthless. Reviewing a chart is kinda worthless in and of itself. Most charts say very little and without eye-balling the patient when you have issues, what's the point?
    I completely agree with you, but would submit that the existence of these "collaborative agreement" requirements with such limited requirements about supervision is basically a covert acknowledgement of the ability of NPs in those states to practice independently -- the "collaborative agreement" is just the final "fig leaf" covering up the reality of, essentially, independent practice. I would guess that many of those states will eventually do away with the "collaborative agreement" requirement and just allow independent practice, which seems to be the general trend nationally.

  • Jun 29 '10

    There is one simple answer to this question F-E-A-R...
    I am a student, getting my BSN-DNP. I have been hit with all sorts of negativity....not only from physicians, but also from nurses...MSNs especially. I think it is crazy. Why would more education be a bad thing? I don't get the hostility. Now, I'm going to guess that some DNPs get a God complex...but my guess is that they had this before....probably when they were a nurse's aide.

    I want to scream when I hear "airy fairy", or "fluff" classes. Come sit in class with me...I GUARANTEE you will change your mind. The rigor is equivalent to the PhD program, and in fact some of the classes are the same.

    Now, to address the "why"...people do not understand the DNP. This is not a program meant to create mini physicians. This is a program meant to create NURSING LEADERS, and bring the evidence that the PhD's obtain to the bedside, and identify new area that need to be examined. DNPs will partner with PhDs in doing research, each playing a different role in the process. The classes are not all clinical classes, because the program is not designed for that. I think the best way to describe it is to compare the BSN prgrams to the ADN...we all thought these "non clinical" classes were stupid. But they produced nurses that could critically think.

    I don't know what all the hullabaloo is all about. More education = better nurse. Everyone freaked out when the NP program went from a certificate program to a masters, and said it would "never happen", and "no one would do it." etc. Well...guess what? It did happen, and nurses still went into the masters program.

    I think physicians think that nurses just want to be called "Dr"...perhaps that may be some people's motiviation, but I don't go into a room as a staff nurse and introduce myself as "Amy, a bachelor's prepared nurse"....I introduce myself as "Amy, your nurse for the next 12 hours". ANY profession will have some "hot dog, know it all, deputy dog"...It's not fair to to assume that all DNPs will be that way.

  • Jun 23 '10

    Wowza.
    It is obvious that you are informed with only half the story. If you are truly interested in the truth, I ask you to read my response, take a breath and think about it, not just fire off an angry response.

    How many patients have I admitted: NONE, and if you read my original post you will see that I never stated that I had, that is not my job. How many brain surgeries have you performed, NASA launches? It doesn't mean that you’re not competent at what you do, it's just not in your job description.

    Yes, I can read an EKG, can you read X-rays/MRI? Yes I can perform a pelvic exam (depends on state) but I certainly would never because I leave that to those who are experts in the area. I also draw and interpret labs, perform examinations (real honest to goodness physical exams with a stethoscope and everything…..sarcasm intended) and refer out when appropriate (hmmm doesn’t that sound like your garden variety GP).

    Would I tell an MD that I am a physician, NO because in order for that to come up in conversation it would have to be in an argumentative setting; I work hand in hand with the MD not in an adversarial way. Many MD's refer their patients to my office. I have several surgeons, GPs, specialists, dentists and over 30 nurses as my patients. So unlike you who obviously believes that there is some great war, we work together, everyone knows their role, everyone respects each other’s opinion.

    I am an honest person and never attacked in my original post, nor did I downgrade anyone; in fact, I believe that I praised nurses. This makes me ponder your hostility. I also must protest that you called me a liar when you’ve never met me; when I say hundreds, I mean hundreds.

    I will agree that many chiropractors, although trained, do not practice as physicians because they do have tunnel vision and only see what they want to see without looking at the big picture. I however am not one of them and do assess all aspects of my patients as it pertains to their history, symptomology, and objective finding (orthopedic and neurological exams); I know many MDs with tunnel vision myself and I’m certain if you are honest, you do too.
    Why did I bump a 3 year old thread? I was doing some research for one of my Nurse Practitioners and was looking for a nursing perspective…does that sound like someone who is one sided to you.
    Look, I’m not going to go back and forth with you as obviously you have your mind set, but I will tell you that I own several very reputable medical facilities and I have an objective vantage from both sides. It’s not about drawing a line in the sand with me, it’s about the truth. My job is to be the front line, if it’s a musculoskeletal condition, I’ll treat it, if it’s a condition that warrants referral, I refer. The only difference is the scope of our modalities and each has his/her place. I’ve unfortunately found cancer on several patients when their medical doctors had not bothered to investigate radiologically and had been treated with NSAIDS for months and in one case almost a year; I can’t believe that whatever your prejudices may be that your don’t believe that is a medical diagnosis and not simply a chiropractic one.
    I wish you luck

  • Jun 15 '10

    what "A high school student could study and pass that FNP exam...it's that easy! " I think that is enough to infuriate any FNP who worked their butts off through school. So much for advancing the NP profession. I dont know of any high school graduate who would know that asthmatics should not take ace inhibitors or what is the first line treatment for HTN.

  • Jun 15 '10

    As usual , I agree completely with llg. Irrespective of the modality (B&M or online), there are good and bad programs out there, and it is the responsibility of the prospective student (IMHO) to do the necessary research to make sure you're getting into a good program. How often do we see threads started on this site about "what is the quickest/easiest/cheapest NP program (or any other graduate level/advanced practice option)?" ALL THE TIME. Well, there are plenty of schools out there willing to meet those individuals' needs ...

  • Jun 15 '10

    In day to day life ,"Your Highness" is my preferred, but rarely used, title. As an NP, I introduce myself as XYZ, an FNP. Many times, I give a short tutorial on what actually an NP is and does. Many people don't really know why NP's are so wonderful. Besides, the public really doesn't know the difference in job description between any healthcare professional wearing scrub clothing and personally I feel nursing does itself a disservice by further fragmenting its various degrees and professional certifications-no wonder people are confused. Oops Im going off on a rant, sorry.

  • Jun 2 '10

    Quote from RNTwin

    lets be serious do you really think we need florence N. theory to tell us that we need to keep the environment clean to promote healing/well being
    All professions are theory driven. Trade schools aren't. So you need some theoretical framework to operate from.

    so i need 3 semesters of research class to tell me that a RCT is superior to a quasi...
    I think you had more research classes than I did. I don't know what the "appropriate" amount of research classes would be. Depends on content, I guess. But in the health fields you better keep up with research weekly. And you better know how flawed many studies are.


    never knew that patients were non-complaint, i thought people always took their meds as prescribed and never put anything into their bodies that could harm them or participated in risky behaviors
    Know it and being able to do anything about it are two different things. I hear physicians complain all the time about non-compliant patients. All that means to me is that you are lacking in the ability to change your patient's behavior. They came to you for help and you failed.



    {quote]can you point me to that model so i can change my way of thinking...

    Cognitive Behavior Therapy. It can also help you with your

    bottom line is that we need more "core" classes, i gurantee if you ask any physician on what NPs lack and they will tell you patho/physio/pharm/assessment skills they won't ever mention theory/health promotions/research/adv pract role/information systems
    I agree we need more core courses but don't go so far as to throw out what might be needed. Physicians are trained in really hard science. I personally don't like such a reductionistic approach but to each his own. I prefer to look into the other end of the microscope.

    When I was a young pup in a Level I I loved all that technical and procedure stuff. That got boring after awhile. Now I get my giggles by having nothing on me and using just my brain to help someone else. I have a physician preceptor and a couple weeks ago he told me medicine just "sucks your soul out."

    Another doctor's daughter was shadowing me and others trying to decide whether to get a Ph.D. in psychology, or go to medical school or go to NP school. Both my preceptor and her dad told her to go to NP school!

  • Jun 2 '10

    I took advanced pathophysiology, pharmacology, suturing, casting, reading XR in my MSN/NP coursework. I work in Consultation Liaison Psychiatry and I can say with certainty that my ability to write well enhances my credibility with those requesting the consultations. While I don'tplan to do independent research, it behooves all of us to be able to read and interpret research. I don't want to trust the media to interpret findings for me. My ability to care for patients and to continue my own learning requires that I be able to read research studies and apply findings to my practice.

    That said, I do wish that furthering my education in advanced practice nursing did not mean MORE theory and research work. Most of my continuing education involves courses designed for Physicians, NP's and PA's alike.

    Whether you want to be a PA, NP, or physician, you should be able to read, write, and interpret others' work. Of course, I still believe in a liberal arts education as a basis for further study.

    Nursing Education is NOT as well standardized as PA education. You need to study the different programs and select that which offers you the best opportunity to meet your goals.

  • May 27 '10

    I find that all the frustration we have about all the "fluff" courses we have to take in our respective NP programs boils down to the fact that our Nurse Practitioner Educational Leaders continue to ignore the problem of lack of standardization in our curricula and not having a true system of accreditation for all NP programs. Instead, we got sidetracked with this DNP business that just added more confusion to the mix. I personally did not mind the "fluff" courses as they do give our training the unique nursing identity that is actually part of our title (that is, if anyone has forgotten that we are called Nurse Practitioners). However, I also believe that a more substantial clinical training that is consistent regardless of what particular institution students are attending is a must for our profession to continue to assert our credibility as providers.

    If you look at specific NP programs across the US, you will find that some programs have more basic medical science content and more robust clinical courses than others though the programs all lead to the same NP track. Also notice that our regulatory boards continue to ask programs to come up with the bare minimum of clinical hours and didactic content and some programs do follow these bare minimums in their curricular content while other institutions who have more of a reputation to protect go over and beyond the basic requirements in the curriculum. We have made enough noise about the inadequacy of some NP programs that the AMA has cited this in their recent release about the need for continuation of close NP-physician supervision. It's time that NONPF and certification boards listen by being proactive and stop being defensive when our training is attacked by other professions.


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