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RN to Medschool 1,118 Views

Joined: Jul 8, '08; Posts: 33 (15% Liked) ; Likes: 11

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  • 2
    Faith213 and SKM-NURSIEPOOH like this.

    Quote from TheCommuter
    It's true that society places substantially more value on you, the physician.

    For example, physicians who verbally abuse nurses repeatedly get away with it, because they are the 'Money Makers' for hospital systems. Nurses who verbally abuse physicians will be shown the door if too many complaints are made. The nurse is considered an expense on the hospital's account, along with the courtesy soap and bedpan.

    In addition, the patient who becomes silent and respectful when the physician enters the room is the same patient who berates the nursing staff 24 hours per day. Sorry, but society will always bestow more respect upon you, and it is probably deserved due to your substantial level of educational attainment and importance to humankind.
    So if a nurse fails to record vital signs, Blood sugars, follow medicine orders, perform standard tests ordered IE: EKG on a 40 year old before surgery, a Doctor should not confront the Nurse because this in not respectful? Please, the nurse has now placed the patient in potential harm have they not? The Nurse has not done their job! ANd this is about 90% of what I have witnessed as confrontation in 20 years of nursing.
    10% of the uncalled for stuff, Please get a grip.

    I expect better from Nurses, I expect better from myself, Nurses should make sure the orders are carried out that have been signed off and resigned off as checked, that is the biggest problem.
    If an order could not be carried out then a reason must be charted. Most times it was not.

  • 6

    Quote from CRNA2007
    Let's look at some of history's greatest change agents

    Stalin
    Mussolini
    Hitler
    Robert Mugabe
    Pol Pot
    Fidel Castro
    How can you in compare Doctors to these monsters? OMG

    This has to be the worse post I have ever seen.

    I'm a Nurse and went to medical school to practice medicine, not for the money, for my Patients, I will lobby for change also, I'm not a monster?

    So if you ever get cancer or some other disease and the only one to save your life is a Doctor, what will you do? DIE because of this general belief? WOW

  • 0

    Its really difficult if not impossible to make money in primary care. In a shortage market specialty care can offer more money.
    Exactly and that’s why groups have so many us running around seeing patients for them. Cost benefit ratio: More seen more money in the bank.

    Advancement of nursing education + sicker population + shortage of providers + delegation of authority = Certain providers are losing ground (i.e. money, prestige)

    Nurses have been diagnosing, ordering test, intervening well before any of us even existed. Still happens now, tomorrow and the next. Hospital nurses, office nurses doing what needs to be don. Doctors have not only delegated this authority but they have given it away. [
    1st off, the concept of having a PA or NP working in primary care with the physician is a sound one if set up right, the physician should be seeing the same patients on a rotation basis. It is not meant and in some states by law, that the PA or NP are the only care givers. Again that this goes on does not mean it is the right thing to do, in some cases it is breaking the law, in states where the law is broken it does not matter if you think it is a bad law, adhering to a law is the civic duty, if you disagree with a state law you lobby for change, open defiance by breaking it is criminal and is prosecuted.

    2nd Physicians did not give away anything, its lay people who have been influenced and confused, many lay people think Nurses are "Junior Doctors" after 20 years as an RN this concept was told to me 100's of times, Law makers are not in medicine, they are lay people.

    As far as ordering tests, sure did that as a Nurse, but do nurses always know why they order a test? I have already caught mistakes in test ordering in CLinicals.

    3rd Diagnosis? What percentage of them are right? That would be the real figure to know, ( probably will not be studied though) One thing to point out its hard to write a diagnosis of something you have no knowledge of, a disease process you have never heard of, limited class time and study time of PA and NP can lead to wrong diagnosis at times, it happens to Physicians with more class and study time, how does less class and study time on Medicine equate to being expert at Diagnosis? The longer residency of MD/DO helps too, residency is learning time, PA's and NP's have an extremely short Clinical time (MD and DO have both Clinicals for 2 years plus any residency so at least 5 years on the wards) PA and NP have only about a year, how does a year become better then 5 years?

  • 0

    Quote from pinoyNP
    Again, we can argue about which professionals lack what courses and how long the training is for this field and that field. But is there proof that there is a difference in the product of training between a primary care physician, a primary care PA, and a primary care NP? It is easy to assume that a clone of a medical school program will produce a competent clinician in primary care if you apply the standards of medical school education. But isn't advanced practice nursing with its current model of education producing just as competent a clinician in primary care? Prove to me that this is incorrect and not with anecdotal evidence and unconfirmed data.
    You are missing the point, you cannot expect someone not trained as a Physician to replace a Physician. You are arguing that Nursing is training better Primary care providers, How? What is the evidence of this?

    How can Nurses train such providers without medical focus?

    What you are posting is worrisome and problematic IMHO.

    Why do I have to prove that Doctors are trained to practice medicine best? I think it is the NP's that need to prove they can practice just as well.

    That is what I'm asking.






    There are currently less than a quarter of all states that allow no physician involvement in NP practice and even less if you factor in prescriptive authority. If that is your definition of autonomy then, you are right. But my idea of the word "autonomy" is not exactly the same. Are family practice physicians truly autonomous? I think not. There are a multitude of disorders and conditions that a family practice physician could not manage on their own, hence, they need to refer their patients to specialists. Some even ask colleagues who are primary care physicians themselves for their opinion. Heck, I don't even think any physician is really independent.
    Name the states please till then this is anecdotal, name the states I will happily look into the laws and rules and see if that is true then. I would like to know. The study with charts I saw said it was only about 4.

    Primary Care NP's, even in those states that require some form of physician involvement, are the sole health care provider in a given rural clinic in some instances.
    what states? Georgia has NP's in rural settings but they must have physician involvement.
    The collaborating physician may be miles away only available by phone.
    So? Fax machines and email, phone calls, that Physician can still change the plan of care. So this is not pure autonomy. That is my point and by the way I agree with this level, still a high level but with a check and balance. Why would you appose that?
    Does the physician get to see the NP's patients? Not unless the NP thinks they need to be seen by a physician.
    This is not correct if there is collaboration, if the Physician who is collaborating wants to see the patient how can this be refused? Why would you? as far as I know it is not lawful.
    This happens in some states and is completely acceptable as the NP is not breaking any practice act or federal law in this case.
    I'm confused? a Physician requests to see a patient and the NP can refuse? this is normal practice?

    Now I know that there are certain states out there where this scenario would never happen because of restrictive practice acts for NP's but in this particular case I described, I WOULD call that autonomous practice.
    sure if this is the case but I doubt it is as clear cut as you post here. I have serious questions as above.

    As a physician I would never "Keep my patient" to myself, I would refer and confer with colleges, its scary to see a proposal that a NP may not to be "Autonomous" Taking care of patients is not a way to do this.

    Please explain because I think I may have misunderstood the intent here. from what I see you want me to believe these NP's are now alone and not part of the "Team" RURAL practice is different then you think, I'm in the middle of the deep south, times have changed.

    Please explain.

  • 0

    I have to go for while, please keep posting, I have no problem with you disagreeing with me, in fact I expect some to, I wish I had all the info in front of me, I have to study for clinicals tomorrow (IM) some review.

    Maybe in time I will understand this better and in time you will understand what I and others fear.

    Thanks to those of you willing to discuss this.

  • 0

    Quote from ibnathan
    I would like to see advanced nursing education changed. The first year would be devoted to clinical sciences such as bio, genetics, gross anatomy, and pharm. During the later part of first year start going through the ten systems and clinical application. Then the last 2 years full time clinical residency. Or instead of requiring a BSN make the requirement a BS in biology or biochemistry. I agree nursing does need to have more science in it's curriculum.
    I 100% agree with this, I think when in Nursing school the nursing theory and even (Gulp) nursing care plans were needed since I was studying nursing. But some more disease oriented study would have been a good thing.

    I also think Nurses should be allowed to do more disease process teaching in the Hospital, not diagnosing but teaching abut progression and possible options of care. This is done to some extent in the Teaching Hospitals but not in the small community hospitals as much. It needs to be universal.

    Off topic but one thing I want to say, I ask the floor nurses for opinion and collaboration, and read the nurses notes.

    One attending I was with read the nurses notes and told me most doctors do not, I agreed and said they are not doing what they should.

  • 0

    Quote from pinoyNP

    That's your opinion. If it looks like medical school, then shouldn't we be calling it medical school then and not a NP program?
    I do not think so, PA programs are more like medical school why cannot DNP be such if they expect this autonomy? I think its a fair question.

    Autonomous practice in primary care already began before the DNP was even made public. And what makes you think NP's do not need CME's or read journals because we do? The next time you attend a medical conference, look around you because you may be sitting next to a NP.
    Not true/pure Autonomy in most states ( like a Physician has) I want to clarify this



    Show me the studies and the figures to support this claim and how NP's contributed to these unsafe procedures and treatments.
    I do not know of any good ones, at least I have not seen them, I'm asking you the NP's for them. I will try to dig up the one I did see, it was based on Patient satisfaction surveys so only annecdotal

  • 1
    oldiebutgoodie likes this.

    Quote from tammy79, rn
    as i understand the debate rages on over the equivalency between physicians and np's, especially in the sense that soon we will all possess clinical doctorates-physician and apn alike. many have stated that physicians and np's are not "equivalent." although i believe that most are stating this in the context of comparing medical school training and np training, i am starting to get a sense, however, that this is transcending into a different area--that is from a training point of view to a product/professional standpoint. this concerns me.

    to that end, i think we can all agree that medical school is not the same as np school, just like md school is not the same as podiatry or optometry school. from a license structure, md's and anp's are quite different. apn's are no more licensed to practice medicine than physicians are licensed to practice nursing. the danger lies, i feel, when we start on a path describing discrepancies and disparities in the form of inequalities in the form of equivalencies between the two separate disciplines from a training and licensure standpoint to that of a profession and product.

    the oxford english dictionary, the gold standard for defining and initiating concept analysis provides the following definition for "equivalent":

    1. of persons or things: equal in power, rank, authority, or excellence.
    with the contemporary power structure there is much evidence to support the notion that physicians have superior power, rank and authority in comparison to np's (for now) in the health care industry. this is evidenced by the medical communities power in attempting to suppress nursings utility of clinical doctorate titles in the health care setting, while at the same time, supporting the use of other clinical-based" doctor" titles for other disciplines, such as dentistry and podiatry. this clearly sets the tone, as just one example, especially if supported by apn's that physicians truly do have more power, or i should say the power apn's allow them to have.

    i'm curious, though with regards to "excellence" in the definition. how many np's out there feel that the excellence they demonstrate through caring, practice and leadership are less than that of a physician?

    2. equal in value, significance, or meaning.
    how many np's out there feel that their value, significance or meaning to themselves, clients, the profession or intuitions are less than the physician?

    3. that is virtually the same thing; having the same effect.
    for those np's who consider themselves as practicing medicine: is the medicine you practice of any lesser quality than the medicine practiced by the physician? if not, does adhering to the same standard of care yield the same results--that is provide the same effect? for those who consider their apn practice as nursing and only nursing--that is functions of advanced nursing overlap with other disciplines (e.g. medicine) are the outcomes of your clients inferior to that of the outcomes effected by the physician?

    4. having the same relative position or function
    think about the term, concept and practice of "primary health care." how many np's feel they cannot perform primary care functions to the same standard and yield equivalent outcomes for their clients as the physician? do you take care of clients knowing they would have received better care and consequently a better outcome if they would have been seen by the physician?

    5. something equal in value or worth.
    how many np's out there feel they have less value or worth than that of a physician?


    to sum it up, when apn's state that md's and np's are "not equivalent" i am hopeful this is only in the context of training and licensure and not practice, outcome or product-based.

    in this context for anyone to claim that apn's and md's are not equivalent, they would have to subscribe to the following system of beliefs:
    1) apn's do not demonstrate the same excellence in care and practice as the physician,
    2) apn's are insignificant; of lesser value and ultimately mean less to themselves, their clients, their profession and the institutions in which they are employed.
    3) clients have less than a positive outcome when treated by apn's as compared to those who are treated by physicians.
    4) apn's provide primary health care services to clients in an inferior manner as compared to the physician.
    5) apn's have lesser of a value than physicians.

    i hope, in this context, that i will not be the only one on this board who believes apn's are equivalent to physicians.
    i do not know you started a new thread to discuss virtually the same issue?

    i do not think that np's pa's and or dnp's do not have value,

    i do think that they are not equivalent to md and do's

    i think that np's, pa's and dnp's do and should have a level of autonomy just not complete.

    residents who are doctors do not have 100% autonomy, not until they are finished and in private practice, and even then they are held to the standard of care.

    i think the nursing philosophy has great worth, these are people we care for not diseases,

    i think the nursing take on team is good too (just that the md or the do is the team captain)

    we need pa's and np's and dnp's

    my take is not as replacements of physicians but to work with physicians

  • 0

    AN yet a new thread pops up, for those of you who say NP's are not being equated to MD/DO's

    To sum it up, when APN's state that MD's and NP's are "not equivalent" I am hopeful this is only in the context of training and licensure and not practice, outcome or product-based.

    In this context for anyone to claim that APN's and MD's are not equivalent, they would have to subscribe to the following system of beliefs:
    1) APN's do not demonstrate the same excellence in care and practice as the physician,
    2) APN's are insignificant; of lesser value and ultimately mean less to themselves, their clients, their profession and the institutions in which they are employed.
    3) Clients have less than a positive outcome when treated by APN's as compared to those who are treated by physicians.
    4) APN's provide primary health care services to clients in an inferior manner as compared to the physician.
    5) APN's have lesser of a value than physicians.

    I hope, in this context, that I will not be the only one on this board who believes APN's are equivalent to physicians.
    https://allnurses.com/forums/f34/np-...ml#post2957696

    Please stop posting I have a chip on my shoulder for addressing this.

  • 0

    Quote from pinoyNP
    I think that you should probably research the studies on nurse practitioner care outcomes before you post your opinions. Many regular members here have posted links to them and I know that they are not perfect studies. In fact, there will never be a perfect study because no study involving human subjects can allow a strict manipulation of variables for ethical reasons. Like you said "we are talking about life and death here".

    But one thing nurses in general are aware of is the fact that health care can be a matter of life and death. Nurse practitioners no matter how independent they are in their practice, will know when things are beyond their knowledge and expertise. We did not earn the reputation of being the most trusted profession in the US for years on end for nothing. I am not a primary care NP and I am not independent in my practice either. My NP specialization deals with clinically complex critically-ill adult patients. Nothing less than an interdisciplinary team of collaborating professionals will suffice in my setting.

    I invite you to take the time to talk to primary care NP's who have successfully practiced with little physician involvement and then let me know if there is anything they do that is unsafe and beyond what is expected in a primary care environment.
    I have seen the research and it was based on satisfaction surveys. Wheres the Outcomes? that is what I'm talking about. It needs to be done in rural areas not in ares where the NP is backed up by MD and DO's

    You earned the reputation because many MD and DO's have bad bedside manners, I have been there and seen it this past year, the loved doctors are the ones who take the extra time ( a few minutes most times) like I have learned as a Nurse to do. So I understand this,

    You are talking about two different things though, the difference between perception and real life statistics in the treatment, cure and management of diseases, At the moment NP's cannot practice outside the NP cert, meaning if it is Peds then they cannot practice on Adults ( true in my state but I think this is true other states) A IM in Peds can see adults and Kids if they want there are no limitations, an Licensed MD is a Licensed MD (DO)

    Public perception can be skewed

    facts about outcomes should not be.

    As far as unsafe, if the states laws say collaboration or oversight and this is not happing then its breaking the law and deemed out of the practice limitations and seen as unsafe.

    Some of you are the NP's show me the studies or links so I can see what you are claiming.

    in time I'll dig up the stuff I have read too.

    We should work together not call me names and act unprofessional because I went to medical school. What happened to team work?

  • 0

    Quote from djc1981
    yes, no one here is arguing the equivalency of the dnp to a physician. the op seems to have a huge chip on his/her shoulder -- bordering on being a big ole' troll. any more passive agressiveness should lead to banning the hairy thing under the bridge.
    this has been brought up in a "passive aggressive way" by people here on the site, when openly comparing md and do training to dnp and statements like md = doctorate and dnp= doctorate
    as for the time it takes to do the programs... a dnp and md *are* the same amount of time (a doctoral degree is a doctoral degree is a doctoral degree)
    i have read these articles, you tell me what is the real intent? i feel it is to replace md and do's in primary care and so do many other people.

    the american association of colleges of nursing (aacn) is calling for the requirement of doctorate in nursing for advanced practice nurses, such as nurse practitioners, nurse midwives, clinical nurse specialists, and nurse anesthetists. this new degree will be called a doctor of nursing practice and, if the aacn has its way, will become the entry level for advanced nursing practice.

    http://www.aacn.nche.edu/media/news.../dnprelease.htm
    you think i have a "chip" because i question the dnp degree and the intentions of the nurse educators to make this a replacement to family practicioners, i have read the articles, i have a right as a nurse to be here and comment my take on this and question it. this is a real issue not made up by me. and at the moment i do not think dnp's should replace md and do's as primary care givers, so i want to disscuss this.

    i believe calling me a troll is unprofessional. what are you afraid of?

  • 0

    Prior to the advent of the DNP, NP's have already been training at the master's degree level and were already providing safe, cost-effective, and quality care to all types of patients. Primary care NP's have been able to practice with little physician involvement in rural and underserved areas of the country. There is approximately 1% of NP's who are independent but this number is likely inaccurate.
    Not all master's prepared Nurses are NP's, this is part of the problem, if the admission critea was for NP's only then the DNP would be accepted a little better by Physicians

    Part of the Problem I have is this:

    The courses I have looked at are nursing oriented when if you expect to be primary care givers it should look like medical school

    to be 100% autonomous then DNP should look like Medical school
    2 years Basic Science and then at least 2 years residency to equal 4 years for this.

    You are asking for autonomous practice for the DNP so you should accept that more time and study will be involved, time in the field cannot replace study and class time, if it could then there would be no reason for CME's or journals.

    Nursing experience can help in a lot of ways but it does not replace medical experience, I now see that myself.

    Autonomous means no Physician oversight what so ever, 1% is correct.

    The fact there is currently NP's working in real life in areas of the country where Physicians are not doing a proper over sight does mean this is right and safe, there have been 100's of proactices, procedures and treatments over the last 100 years that were found to be unsafe with time.

    Tylenol is one of the most dangerous drugs on the market, why is it still out there? What is practiced does not make it the right thing to do.

  • 0

    To answer an earlier Question IM residency:

    The IM residency that includes other specialties it is 4 years then

    SO CORE0 was right on this in the sense that IM itself is 3 years but an extra year for focus can be added. This is considered a 4 year IM residency not a IM residency and a fellowship to make that clear

  • 0

    Quote from pinoyNP
    Long before the DNP became public, nurse practitioners have been providing primary care to many patients. The nurse practice acts of each state have provisions that allow this to happen. Physician involvement varies but that does not in any way discredit the fact that NP's have been providing primary care.
    I feel there are two points, sure there have been states where NP's have a lot of autonomy, but where are the studies that show Care for patients has exceeded care by a Doctor? Patients satisfaction surveys are not even close to the right kind of study, we are talking about life and death here.

    I want to see that the NP's are catching Diseases and properly treating and referring people, by themselves.

    The Model I think is best is the Collaboration model, this is where a MD or DO is consulted on the cases, not all the routine but all the unusual and complicated. Why are so many Nurses and NP's against simple collaboration? Are not to work together? NP's are not licensed to practice Medicine.

  • 0

    Quote from core0
    I'll man up here. I apologize for my unprofessional comments. Blame it on a job where a bad week means people die.

    David Carpenter, PA-C
    OK I did get "Sassy" myself. I really did not mean to create an online fight, SO I apologize too

    heated debate sure pass the popcorn.

    As far as this debate I will come back and check but I posted what I wanted.

    I think this does need to be discussed, Maybe you can change my mind?


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